Fernando Kratz Gazalle

Sintomas depressivos e fatores associados em população idosa no Sul do Brasil

OBJECTIVE To determine the frequency of some depressive symptoms in the elderly, to build up a score of depressive symptoms and to evaluate the association between depressive symptoms and demographic, socioeconomic and behavioral variables. METHODS A population-based cross-sectional study was conducted in individuals aged 60 and more living in the urban city area of Pelotas, Brazil. The sample was selected in multiple stages based on the citys census tracts. It was used a questionnaire comprising eight question commonly included in depression evaluation instruments and specific to the elderly. Analyses were carried out using multiple linear regressions following a hierarchical approach. RESULTS A total of 583 subjects were interviewed and non-response rate was 4.7%. Each participant had on the average score of depressive symptoms was 3.4 (SD 2.1)Lack of willingness to carry out daily activities was the most frequent symptom (73.9%) reported. In the adjusted analysis according to the conceptual framework, the following groups had statistically higher averages (p<0.05) of depressive symptoms: older women, individuals with less schooling, unemployed, smokers, and those whose family member or significant other died in the past year. CONCLUSIONS It was found both high rates of isolated symptoms and high average of depressive symptoms in the study sample, highlighting the importance of studying specific symptoms of the elderly, which are different from those found in young adults.

Anxiety comorbidity and quality of life in bipolar disorder patients

Objective: To assess the impact of anxiety comorbidity on the quality of life of patients with bipolar disorder (BD). Methods: We undertook a cross-Sectional survey of 162 BD outpatients interviewed with the Structured Clinical Interview for DSM-IV. The primary outcome measure was quality of life, assessed with the 26-item WHO Quality of Life Instrument (WHOQOL-BREF). Results: Anxiety comorbidity in BD patients was associated with lower scores in all domains of quality of life. The impact of anxiety comorbidity on the psychological domain of the WHOQOL-BREF was kept, even when the current level of depression was added to the model as a confounding factor. Current anxiety comorbidity was also associated with lifetime alcohol abuse and dependence, rapid cycling, lifetime psychosis, number of suicide attempts, and a lower score in the Global Assessment of Functioning measure. Conclusion: Our findings suggest that anxiety comorbidity in BD patients is related to lower quality of life, particularly on the psychological domain. BD–anxiety comorbidity may be associated with such markers of illness severity as number of suicide attempts, rapid cycling, lifetime alcohol abuse, and psychosis. The recognition and treatment of anxiety comorbidity may help patients with BD to relieve their psychological pain and improve their overall quality of life.

Depressão na população idosa: os médicos estão investigando?

OBJECTIVES To evaluate whether doctors are investigating depression in the elderly. METHODS Cross-sectional population-based survey, including individuals aged 60 years or above, resident in the urban area of Pelotas, Brazil. The sample was selected using a multiple-stage protocol based on Brazilian census data. RESULTS We interviewed 583 subjects (losses and refusals: 4.7%). We found that 76.6% of the subjects were not asked if they were feeling sad or depressed in their previous medical consultation. Investigation of depression was significantly higher among women and among those with higher depression score. Among women, sadness or depression was investigated in 28.7% of the previous consultations, while among men, the equivalent percentage was 14.8% (PR=1.93; p<0.001). CONCLUSION Depression is not routinely investigated in clinical settings. Doctors should be alerted and trained on the monitoring of depression in this age group.

Manic symptoms and quality of life in bipolar disorder

This study evaluates the influence of manic symptoms on quality of life in a sample of adult bipolar disorder (BD) patients. This was a cross-sectional study including 125 BD outpatients from a university-based program. All patients were diagnosed using the Structured Clinical Interview for DSM-IV for BD. Manic symptoms and quality of life were assessed using the Young Mania Rating Scale (YMRS) and the World Health Organization Quality of Life Instrument-Short Version (WHOQOL-BREF), respectively. In the unadjusted analysis using linear regression, the score of manic symptoms was inversely associated with scores of quality of life within the social domain of the WHOQOL. In the adjusted analysis, the score of manic symptoms was inversely associated with the social, physical, and psychological domains of the WHOQOL. In a separate analysis at the YMRS items, items 4 (irritability) and 5 (sleep) were associated with lower quality of life.

Emotional memory in bipolar disorder

BACKGROUND Cognitive impairment has been well documented in bipolar disorder. However, specific aspects of cognition such as emotional memory have not been examined. AIMS To investigate episodic emotional memory in bipolar disorder, as indicated by performance on an amygdala-related cognitive task. METHOD Twenty euthymic patients with bipolar disorder and 20 matched controls were recruited. Participants were shown a slide show of an emotionally neutral story, or a closely matched emotionally arousing story. One week later, participants were assessed on a memory-recall test. RESULTS In contrast with the pattern observed in controls, patients with bipolar disorder had no enhancement of memory for the emotional content of the story (F=14.7, d.f.=1,36, P<0.001). The subjective perception of the emotional impact of the emotional condition was significantly different from that of the neutral condition in controls but not in people with bipolar disorder. CONCLUSIONS Our data suggest that the physiological pattern of enhanced memory retrieval for emotionally bound information is blunted in bipolar disorder.

The efficacy of antidepressants for generalized anxiety disorder: a systematic review and meta-analysis

OBJECTIVE To investigate the efficacy and acceptability of antidepressants in the treatment of generalized anxiety disorder. METHODS All randomized controlled trials assessing the use of antidepressants in generalized anxiety disorder up to may 2002 were included. Non randomized trials and those that included patients with both generalized anxiety disorder and another Axis I co-morbidity were excluded. Relative risks, weighted mean difference and number needed to treat were estimated. People who died or dropped out were regarded as having had no improvement. RESULTS Antidepressants (imipramine, venlafaxine and paroxetine) were found to be superior to placebo in treating generalized anxiety disorder. The calculated number needed to treat for antidepressants in generalized anxiety disorder was 5.15. Dropout rates did not differ between antidepressants and placebo. CONCLUSION The available evidence suggests that antidepressants would probably be a reasonable treatment for generalized anxiety disorder patients in the clinical context.OBJETIVOS: Investigar a eficacia e tolerabilidade dos antidepressivos no tratamento do Transtorno de ansiedade generalizada (TAG). METODOS: Todos os ensaios clinicos randomizados que investigavam o uso de antidepressivos para Transtorno de ansiedade generalizada ate maio de 2002 foram incluidos nesta revisao. Ensaios clinicos nao randomizados e aqueles que incluiram pacientes com Transtorno de ansiedade generalizada e outra comorbidade de Eixo I foram excluidos. Riscos relativos, diferencas de medias e numero necessario para tratar (NNT) foram estimados. Pessoas que morreram ou sairam dos estudos foram considerados como sem melhora. RESULTADOS: Antidepressivos (imipramina, venlafaxina e paroxetina) foram superiores ao placebo no tratamento do Transtorno de ansiedade generalizada. O numero necessario para tratar para os antidepressivos em Transtorno de ansiedade generalizada foi 5,15. Taxas de abandono nao diferiram entre antidepressivos e placebo. CONCLUSAO: A evidencia disponivel sugere que os antidepressivos sao um tratamento adequado para pacientes com Transtorno de ansiedade generalizada.

Prevalência e fatores associados a sintomas depressivos em adultos do sul do Brasil: estudo transversal de base populacional

To identify the prevalence of depressive symptoms and examine associated factors in a Southern Brazilian adult population, a cross-sectional population-based study was carried out, including 972 subjects, men and women, aged 20 to 69 years, living in the urban area of Pelotas, Rio Grande do Sul. The sampling strategy relied on the census tracts of the city as primary sampling units and households as the secondary units. The questionnaire included socio-demographic, behavioral and nutritional variables. The prevalence of sadness, anxiety, loss of energy, lack of will to do things, thinking about the past, and wishing to stay at home were 29.4%, 57.6%, 37.4%, 40.4%, 33.8%, and 54.3%, respectively. Female gender, older ages, smokers and obese individuals showed association with depressive symptoms. Population-based studies using longitudinal designs may help to clarify the relationship between biopsychosocial variables and depressive symptoms.

Polypharmacy and suicide attempts in bipolar disorder

OBJECTIVE The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

Diagnóstico precoce do Transtorno Bipolar

Sr. Editor,Um problema grave na psiquiatria e a demora no diagnosti-co correto e o consequente tratamento adequado das patolo-gias. Talvez o problema mais grave seja em relacao ao Trans-torno Bipolar (TB). Muitas vezes, os pacientes sao erronea-mente diagnosticados e tratados como esquizofrenicos, devi-do aos episodios psicoticos; em outras, nas formas mais levesdo transtorno, como deprimidos, devido ao nao reconheci-mento de alguns sintomas, como irritabilidade, impulsividadee hiperatividade.

Validation of the Portuguese version of the Lithium Attitudes Questionnaire (LAQ) in bipolar patients treated with lithium: cross-over study

BackgroundPoor adherence to lithium is very common in bipolar patients and it is a frequent cause of recurrence during prophylactic treatment. Several reports suggest that attitudes of bipolar patients interfere with adherence to lithium. The Lithium Attitudes Questionnaire (LAQ) is a brief questionnaire developed as a means of identifying and grouping the problems patients commonly have with taking lithium regularly. The original version is validated in patients, but a validated version in Portuguese is not yet available.MethodsOne-hundred six patients with bipolar disorder (DSM-IV criteria) criteria under lithium treatment for at least one month were assessed using LAQ. LAQ is a brief questionnaire administered under interview conditions, which includes 19 items rating attitudes towards prophylactic lithium treatment. We analysed the internal consistency, concurrent validity, sensitivity and specificity of the Portuguese version of LAQ.ResultsThe internal consistency, evaluated by Cronbachs alpha was 0.78. The mean total LAQ score was 4.1. Concurrent validity was confirmed by a negative correlation between plasma lithium concentration and total LAQ score (r = -0,198; p = 0.048). We analysed the scales discriminative capacity revealing a sensitivity of 69% and a specificity of 71% in the identification of negative attitudes of bipolar patients.ConclusionThe psychometric assessment of the Portuguese version of LAQ showed good internal consistency, sensitivity and specificity. The results were similar to the original version in relation to attitudes of bipolar patients towards lithium therapy.