Fábio Gomes de Matos e Souza

Quality of life and depression in women abused by their partners

OBJECTIVE To evaluate quality of life and depression among women who suffer domestic violence and to describe the socioeconomic profile of women who were abused by their partners and aspects of these abuses. METHODS The study sample comprised 100 women who were abused by their partners and filed a complaint at the Police Office for Women of the state of Ceara, Brazil. Three questionnaires were applied: one for collecting demographic and violence data; the second one (GHQ-28) one to evaluate general quality of life; and the third one (Beck) to quantify depression. RESULTS Abused women are young, married, Catholic, have children, low schooling and low family income. Alcohol use and jealousy were the main reported factors leading to partners abuse. Of all, 84% of women suffered physical attacks. It was observed that 72% had depression symptoms; 78% had anxiety symptoms and insomnia; 39% had already thought of killing themselves, and 24% started taking anxiety medications after been abused. CONCLUSIONS Data analysis suggests that domestic violence is associated with a negative perception by women of their mental heath.

Tratamento do transtorno bipolar: eutimia

Bipolar disorder is a complex disorder characterized by depression episodes, mania or hypomania and asymptomatic phases. The treatment aims at the control of acute episodes and prevention of new episodes. The pharmacological treatment was inaugurated with lithium. Until the moment, lithium remains as the treatment with more favorable evidences in the maintenance phase. Other treatments demonstrate efficacy in this phase, as valproate, carbamazepine and atypical antipsychotics. Of the atypical antipsychotics, the most studied in this phase of treatment is olanzapine. More prospective studies are necessary to confirm prophylactic action of new agents.

Prevalence of bipolar disorder in a HIV-infected outpatient population

This study assesses the prevalence of bipolar disorder (BD) among 196 HIV-infected adult outpatients attending in a specialized unit in Fortaleza, Brazil. Patients were interviewed with the Mood Disorder Questionnaire (MDQ), the Mini International Neuropsychiatric Interview (MINI), the Alcohol Use Disorders Identification Test (AUDIT), and a socio-demographic questionnaire based on WHOs behavioral surveillance surveys. Positive MDQ screening was found in 13.2% (N=26) and the BD diagnosis was confirmed in 8.1% (N=16) of the sample. There is an almost four times higher prevalence of BD among the HIV-infected patients of the sample (8.1%) than in the general population from the USA (2.1%). The prevalence of BD type I in the HIV patients was 5.6% (N=11) which is almost six times higher than the US general population (1%). The odds ratios of sexual behaviors and substance abuse variables correlated with BD were calculated. The variables associated with the diagnoses of BD were sex with commercial partners, sex outside the primary relationship, alcohol use disorders, and illicit drug abuse. The most common psychiatric comorbidity in the BD group was substance abuse (61.5%). A better understanding of psychiatric comorbidities and behavioral aspects of HIV-positive patients may help in improving long-term outcome of these patients.This study assesses the prevalence of bipolar disorder (BD) among 196 HIV-infected adult outpatients attending in a specialized unit in Fortaleza, Brazil. Patients were interviewed with the Mood Disorder Questionnaire (MDQ), the Mini International Neuropsychiatric Interview (MINI), the Alcohol Use Disorders Identification Test (AUDIT), and a socio-demographic questionnaire based on WHOs behavioral surveillance surveys. Positive MDQ screening was found in 13.2% (N=26) and the BD diagnosis was confirmed in 8.1% (N=16) of the sample. There is an almost four times higher prevalence of BD among the HIV-infected patients of the sample (8.1%) than in the general population from the USA (2.1%). The prevalence of BD type I in the HIV patients was 5.6% (N=11) which is almost six times higher than the US general population (1%). The odds ratios of sexual behaviors and substance abuse variables correlated with BD were calculated. The variables associated with the diagnoses of BD were sex with commercial partners, se...

Brazilian Portuguese validation of Mood Disorder Questionnaire

BACKGROUND The Mood Disorder Questionnaire (MDQ) is a screening instrument for bipolar spectrum disorders already validated in many languages. METHODS Patients from 2 psychiatric outpatient facilities were diagnosed with bipolar disorder (BD) type I and II and major depression according to the mood module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), Axis I Disorders--Clinician Version. In addition, a control group of healthy subjects was selected. The diagnostic interviews were used as the gold standard against which to investigate the performance of the MDQ. The MDQ was administered to 153 subjects, distributed among 4 groups. We analyzed the test reliability and discriminative capacity of the MDQ for the detection of patients with BD. RESULTS Based on the SCID, Axis I Disorders--Clinician Version, 52 subjects (33.3%) presented a bipolar spectrum disorder (type I, II, or not otherwise specified), 48 (32.4%) were diagnosed as having unipolar depressive disorder, whereas 54 (35.3%) were unaffected by any type of psychiatric disorder (had no psychiatric disorder according to SCID results). The sensitivity for bipolar disorder was 0.72 (bipolar I disorder, 0.81; bipolar II disorder, 0.58; and bipolar disorder not otherwise specified, 0.69), with specificity of 0.95. The Brazilian Portuguese MDQ demonstrated adequate internal consistency (Cronbach α = .87). LIMITATIONS Recruiting patients attending tertiary services may inflate the performance of the MDQ. CONCLUSIONS The performance of the Brazilian Portuguese MDQ is comparable with other language validations. In a psychiatric outpatient sample, the Brazilian Portuguese MDQ proves to be a feasible and reliable screening instrument.

Intraocular pressure in schizophrenic patients treated with psychiatric medications

PURPOSE In order to assess the occurrence of adverse ocular effects of antipsychotic drugs, we sought to evaluate intraocular pressure of schizophrenic patients treated with psychiatric medications. METHODS Twenty-eight outpatients with DSM-IV diagnosis of schizophrenia who met both the inclusion and exclusion criteria were submitted to an ophthalmic evaluation for ocular abnormalities which included intraocular pressure measurement with Goldmann applanation tonometry. RESULTS Raised intraocular pressure was found in three patients (11%). Abnormality in cup-disc ratio was seen in only one patient with cup-disc ratio asymmetry of 0.4. All these four patients were taking only ziprasidone. CONCLUSIONS Patients using ziprasidone were found to have abnormalities in both intraocular pressure and cup-disc ratio.

Is bipolar disorder a risk factor for HIV infection

HIV/AIDS is an extremely important public health challenge. Bipolar disorder spectrum has a significant prevalence, reported to be around 2.6%. This study analyses the relationship between sexual behaviors among MDQ positive and MDQ negative patients and its influence in HIV infection, and the impact of HIV diagnosis in both groups. Two hundred outpatients from a specialized clinic for HIV-care located in Walter Cantídios University Hospital in Fortaleza, Brazil answered to a demographic questionnaire, the Mood Disorder Questionnaire (MDQ) and a sexual behavior questionnaire based on WHOs Behavioral Surveillance Surveys (BSS). Fifteen percent (N=30) of all HIV positive patients were MDQ+. The MDQ+ group was more likely to: be or have been married, have offspring, have sex with commercial and non-regular partners, have infrequent condom use with non-regular partners and of not have used condom in their first sex. Despite more sexual practices among MDQ+ patients before HIV diagnosis, these patients had a more significant reduction of all behaviors after HIV diagnosis than the MDQ- group.

Hyperthyroid rage: when bipolar disorder hides the real disorder.

Long-term lithium therapy has been associated with euthyroid goiter, hypothyroidism, and less commonly, hyperthyroidism. We report a case of a 19-year-old male patient with schizoaffective disorder who was hospitalized after trying to suffocate his mother. Severe psychomotor agitation persisted despite the high dose of antipsychotics. Initial laboratory tests showed elevated creatine kinase and free thyroxine. Lithium was replaced by sodium valproate, and new laboratory tests were obtained. After lithium discontinuation, the patient had a rapid improvement in agitation and tremors. Antithyroid drugs were not necessary, suggesting the diagnosis of lithium-associated thyrotoxicosis that progressed to spontaneous remission. There are only 2 other reports of lithium-associated thyrotoxicosis successfully treated with lithium withdrawal. Even patients on long-term use of lithium are not free from having acute thyroid dysfunction and may present with treatment-resistant symptoms.

Tratamento farmacológico do transtorno de personalidade limítrofe: revisão crítica da literatura e desenvolvimento de algoritmos

INTRODUCAO: O transtorno de personalidade limitrofe (TPL) e uma sindrome psiquiatrica que causa significativa morbidade e mortalidade para pacientes internados e ambulatoriais tratados por profissionais de saude mental. Dada a sua alta prevalencia na populacao de pacientes psiquiatricos, esforcos sao necessarios para tratar esse grupo apropriadamente. OBJETIVO: O objetivo do presente artigo e revisar evidencias atuais acerca da efetividade das diversas abordagens farmacologicas empregadas como parte do plano de tratamento produzido para individuos que enfrentam essa doenca. METODOS: Para esse proposito, os autores revisaram o banco de dados MEDLINE em busca de ensaios clinicos publicados entre 1986 e 2003. Borderline personality disorder e clinical trials foram usados com descritores. RESULTADOS: Numerosos trabalhos foram encontrados, mas poucos estudos controlados estavam disponiveis. Notavel e o fato de que virtualmente todas as classes de psicofarmacos foram testadas nesse grupo de pacientes, comumente com desfechos modestos ou variaveis. Devido a limitacoes metodologicas na vasta maioria dos ensaios clinicos envolvendo drogas especificas nesse grupo de pacientes, foi dificil estimar o beneficio real dos varios agentes testados. A evidencia mais forte existe para os inibidores seletivos de serotonina, antipsicoticos e divalproato. DISCUSSAO: Claramente, mais ensaios clinicos bem delineados sao necessarios, mas os dados revisados sugerem que psicofarmacos sao efetivos para tratar sintomas-alvo nesses pacientes. Conclui-se que psicotropicos sao adjuntos uteis as abordagens psicoterapeuticas usualmente empregadas para tratar pacientes limitrofes.

Pharmacological treatment of borderline personality disorder: critical review of the literature and development of algorithms

INTRODUCAO: O transtorno de personalidade limitrofe (TPL) e uma sindrome psiquiatrica que causa significativa morbidade e mortalidade para pacientes internados e ambulatoriais tratados por profissionais de saude mental. Dada a sua alta prevalencia na populacao de pacientes psiquiatricos, esforcos sao necessarios para tratar esse grupo apropriadamente. OBJETIVO: O objetivo do presente artigo e revisar evidencias atuais acerca da efetividade das diversas abordagens farmacologicas empregadas como parte do plano de tratamento produzido para individuos que enfrentam essa doenca. METODOS: Para esse proposito, os autores revisaram o banco de dados MEDLINE em busca de ensaios clinicos publicados entre 1986 e 2003. Borderline personality disorder e clinical trials foram usados com descritores. RESULTADOS: Numerosos trabalhos foram encontrados, mas poucos estudos controlados estavam disponiveis. Notavel e o fato de que virtualmente todas as classes de psicofarmacos foram testadas nesse grupo de pacientes, comumente com desfechos modestos ou variaveis. Devido a limitacoes metodologicas na vasta maioria dos ensaios clinicos envolvendo drogas especificas nesse grupo de pacientes, foi dificil estimar o beneficio real dos varios agentes testados. A evidencia mais forte existe para os inibidores seletivos de serotonina, antipsicoticos e divalproato. DISCUSSAO: Claramente, mais ensaios clinicos bem delineados sao necessarios, mas os dados revisados sugerem que psicofarmacos sao efetivos para tratar sintomas-alvo nesses pacientes. Conclui-se que psicotropicos sao adjuntos uteis as abordagens psicoterapeuticas usualmente empregadas para tratar pacientes limitrofes.

Tratamiento farmacológico del trastorno de personalidad limítrofe: revisión crítica de la literatura y desarrollo de algoritmos

INTRODUCAO: O transtorno de personalidade limitrofe (TPL) e uma sindrome psiquiatrica que causa significativa morbidade e mortalidade para pacientes internados e ambulatoriais tratados por profissionais de saude mental. Dada a sua alta prevalencia na populacao de pacientes psiquiatricos, esforcos sao necessarios para tratar esse grupo apropriadamente. OBJETIVO: O objetivo do presente artigo e revisar evidencias atuais acerca da efetividade das diversas abordagens farmacologicas empregadas como parte do plano de tratamento produzido para individuos que enfrentam essa doenca. METODOS: Para esse proposito, os autores revisaram o banco de dados MEDLINE em busca de ensaios clinicos publicados entre 1986 e 2003. Borderline personality disorder e clinical trials foram usados com descritores. RESULTADOS: Numerosos trabalhos foram encontrados, mas poucos estudos controlados estavam disponiveis. Notavel e o fato de que virtualmente todas as classes de psicofarmacos foram testadas nesse grupo de pacientes, comumente com desfechos modestos ou variaveis. Devido a limitacoes metodologicas na vasta maioria dos ensaios clinicos envolvendo drogas especificas nesse grupo de pacientes, foi dificil estimar o beneficio real dos varios agentes testados. A evidencia mais forte existe para os inibidores seletivos de serotonina, antipsicoticos e divalproato. DISCUSSAO: Claramente, mais ensaios clinicos bem delineados sao necessarios, mas os dados revisados sugerem que psicofarmacos sao efetivos para tratar sintomas-alvo nesses pacientes. Conclui-se que psicotropicos sao adjuntos uteis as abordagens psicoterapeuticas usualmente empregadas para tratar pacientes limitrofes.