Fernanda Lucia Capitanio Baeza

Clinical differences between melancholic and nonmelancholic depression as defined by the CORE system

BACKGROUND The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles. METHODS A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables. RESULTS The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups. LIMITATIONS The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study. CONCLUSION Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects.

Translation and cross-cultural adaptation into Brazilian Portuguese of the Measure of Parental Style (MOPS) - a self-reported scale - according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations

OBJECTIVE To describe the translation and adaptation methodology for the Measure of Parental Style, a self-report instrument developed originally in English, following the International Society for Pharmacoeconomics and Outcomes Research guidelines, comparing this to other methodologies used for the same purposes. METHOD Translation and Cultural Adaptation group International Society for Pharmacoeconomics and Outcomes Research guidelines were followed (preparation, first forward translation, reconciliation, back translation, revision of back translation, harmonization, cognitive debriefing, revision of debriefing results, syntax and orthographic revision, final report). CONCLUSION A careful and qualified cross-cultural translation and adaptation of an instrument contribute for measuring what it is designed to measure across cultures. Presenting this process, besides its final product, provides the opportunity that this experience could be replicated for adaptation of other instruments.

Prevalence of psychotic symptoms in those with melancholic and nonmelancholic depression.

Abstract The best classification of depressive disorders is still to be established. A melancholic subtype has a lengthy history, and recent research demonstrates its relevance. This study compares the prevalence of psychotic symptoms in nonmelancholic and melancholic depression and assesses whether there is a dimensional pattern in the severity of symptoms among the subtypes. Patients with unipolar depression were assessed for melancholic status, psychotic symptoms, and severity of depression. The diagnosis of melancholia was made by both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), criteria and CORE measure. The DSM criteria assigned a much higher percentage of patients as melancholics (67.4%) than did the CORE (24.9%). Prevalence of psychosis was distinctly higher in the melancholics. Symptoms severity was higher among the melancholics when compared with the nonmelancholics. The presence of psychotic symptoms was not associated with an increase in the intensity of depressive symptoms. Psychotic symptoms are more frequently associated with the melancholic subtype of depression. This suggests clinical contiguity between the melancholic and psychotic subtypes and the clinical relevance of identifying melancholia.

Readmission in psychiatry inpatients within a year of discharge: The role of symptoms at discharge and post-discharge care in a Brazilian sample

INTRODUCTION Readmission into inpatient psychiatric beds is a useful outcome for patients, care providers, and policymakers. This study aims to investigate the role of level of symptoms at discharge and type of post-discharge care in determining readmissions after a year before a psychiatric admission. METHODS We performed a prospective and observational study in a general hospital psychiatric facility. Patients were assessed at admission, discharge, and one year after discharge. We used a multivariable logistic regression to determine predictors of readmission. RESULTS In total, 488 patients were included at admission, and 401 (82,17%) were accessed in the follow-up period. Psychiatric readmissions occurred in 29.17% of the followed patients. The number of previous admissions represents a 38% higher chance of being readmitted (OR 1.38; CI 1.16-1.60). For patients admitted in a depressive episode, not being in remission at discharge increases 140% the chance to be readmitted (OR 2.40; CI 1.14-5.07) as well as the follow-up at primary (OR 5.27; CI 1.06-26.15). For those with Schizophrenia and related disorders, higher scores in BPRS at discharge increases the chance to be readmitted (OR 1.28, CI 1.11-1.48). CONCLUSION Level of symptoms at discharge was related to higher chance to be readmitted in patients admitted in a depressive episode and those with schizophrenia and related disorders. Findings of the type of care raise the need for further investigation. Also, this finding confirms the importance of the history of previous admissions in predicting future admissions.

Predictors of length of stay in an acute psychiatric inpatient facility in a general hospital: a prospective study

Objective: There have been significant reductions in numbers of psychiatric beds and length of stay (LOS) worldwide, making LOS in psychiatric beds an interesting outcome. The objective of this study was to find factors measurable on admission that would predict LOS in the acute psychiatric setting. Methods: This was a prospective, observational study. Results: Overall, 385 subjects were included. The median LOS was 25 days. In the final model, six variables explained 14.6% of the variation in LOS: not having own income, psychiatric admissions in the preceding 2 years, high Clinical Global Impression and Brief Psychiatric Rating Scale scores, diagnosis of schizophrenia, and history of attempted suicide. All variables were associated with longer LOS, apart from history of attempted suicide. Conclusions: Identifying patients who will need to stay longer in psychiatric beds remains a challenge. Improving knowledge about determinants of LOS could lead to improvements in the quality of care in hospital psychiatry.

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Objective: To describe and evaluate the response and predictors of remission during inpatient treatment in a psychiatric unit in a general hospital based on symptomatology, functionality, and quality of life (QoL). Methods: Patients were admitted to a psychiatric unit in a tertiary general hospital in Brazil from June 2011 to December 2013 and included in the study if they met two of the severe mental illness (SMI) criteria: Global Assessment of Functioning (GAF) ≤ 50 and duration of service contact ≥ 2 years. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) Severity Scale , GAF, the World Health Organization Quality of Life Instrument – Abbreviated version (WHOQOL-Bref), and specific diagnostic scales. Results: A total of 239 patients were included. BPRS mean scores were 25.54±11.37 at admission and 10.96±8.11 at discharge (p < 0.001). Patients with manic episodes (odds ratio: 4.03; 95% confidence interval: 1.14-14.30; p = 0.03) were more likely to achieve remission (CGI ≤ 2 at discharge) than those with depressive episodes. Mean length of stay was 28.95±19.86 days. All QoL domains improved significantly in the whole sample. Conclusion: SMI patients had marked improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episodes had higher chance of remission according to the CGI.