Gláucia Rosana Guerra Benute

Cognitive deficits in patients with mild to moderate traumatic brain injury

UNLABELLED Traumatic brain injury (TBI) is one of the most frequent causes of brain damage. Cognitive deficits reported in the literature after moderate to severe TBI include memory, language, executive functions, attention and information processing speed impairments. However, systematic studies on patients with mild TBI are scarce although neuropsychological changes are present. OBJECTIVE To investigate the cognitive functioning of patients with mild to moderate TBI. METHOD We evaluated 12 patients with mild to moderate TBI using a comprehensive protocol (PN01) of neuropsychological tests. RESULTS There were significant deficits of episodic memory including immediate and delayed verbal memory recall, verbal recognition, immediate and delayed visual memory recall, naming, verbal fluency and information processing speed. CONCLUSION These results emphasize the importance of comprehensive neuropsychological assessments even in cases of mild TBI in order to identify impaired and preserved functions providing adequate managing including rehabilitation programs for each case.

Women's opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital

OBJECTIVE to describe womens feelings about mode of birth. DESIGN exploratory descriptive design. Semi-structured interviews were conducted using a questionnaire that had been developed previously (categorical data and open- and closed-ended questions). Qualitative analysis of the results was performed through a context analysis technique. SETTING the largest public university hospital in Brazil. PARTICIPANTS 48 women in their third trimester of pregnancy. FINDINGS most women expressed a preference for vaginal birth, as they perceived that they would have a faster recovery. Women who expressed a preference for caesarean section did so because of lack of pain during the birth and the need for tubal sterilisation. The majority of women considered it important to have experience with a mode of birth in order to choose a preference. Complications associated with maternal illness were very influential in the decision-making process. KEY CONCLUSIONS these results provide a useful first step towards the identification of aspects of womens feelings about modes of birth. Most women expressed a preference for vaginal birth. Further exploration of womens feelings regarding parturition and the decision-making process is required.

Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes

BACKGROUND: Approximately one‐fifth of women present depression during pregnancy and puerperium, and almost 13% of pregnant women experience a major depressive disorder. OBJECTIVE: The aim of this study was to identify risk factors for depression among pregnant women with a medical disorder and to evaluate the influence of depression on perinatal outcomes. METHODS: Three hundred and twenty‐six pregnant women with a medical disorder were interviewed. A semistructured interview was conducted for each participant using a questionnaire that had been developed previously. Major depression was diagnosed using the Portuguese version of the Primary Care Evaluation of Mental Disorders (PRIME‐MD). The medical records of the participants were thoroughly reviewed to evaluate the perinatal results. RESULTS: Major depressive disorder was diagnosed in 29 cases (9.0%). The prevalence of major depression was as follows: 7.1% for preeclampsia or chronic hypertension, 12.1% for cardiac disorder, 7.1% for diabetes mellitus, 6.3% for maternal anemia, 8.3% for collagenosis and 12.5% for a high risk of premature delivery. An univariate analysis showed a significant positive correlation between an average household income below minimum wage and a PRIME‐MD diagnosis of major depression. A multiple regression analysis identified unplanned pregnancy as an independent predictor of major depression (86.2% in the group with a diagnosis of major depression by PRIME‐MD vs. 68.4% in the group without major depression). A comparison between women who presented major depression and those who did not revealed no significant differences in the perinatal results (i.e., preterm delivery, birth weight and low Apgar scores). CONCLUSION: In the present study, unplanned pregnancy in women with a medical disorder was identified as a risk factor for major depression during gestation. Major depression during pregnancy in women with a medical disorder should be routinely investigated using specific methods.

Abortamento espontâneo e provocado: ansiedade, depressão e culpa

BACKGROUND: Pregnancy has a symbolic meaning for each woman. It varies according to personality structure and is related to womens previous life experiences. OBJECTIVES: the aim was to characterize the women that suffered abortion, asking about anxiety and depression, looking for guilty feelings after abortion, and to compare results between women who suffered spontaneous abortion and those who had intentional abortion. METHODS: fifty women with spontaneous and fifty with induced abortion were interviewed 30 days after the procedure. A semistructured questionnaire with open and closed-end questions and Hospital Anxiety and Depression Scale were administered. RESULTS: woman who induced abortion revealed to be more anxious (mean 11) and depressed (mean 8.3) than woman with spontaneous abortion (means 8.7 and 6.1 respectively, p<0.05). CONCLUSIONS: women who presented induced abortion were more anxious and depressed, as shown by later life events, full of problematic feelings and the need fort sychological support.

Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation

OBJECTIVE this study investigated the feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. The aim of this study was to present the decision making process of women that chose for pregnancy termination and to present selected speeches of women about their feelings. DESIGN open psychological interviews conducted by a psychologist immediately after the diagnosis of fetal malformation by ultrasound. Analysis of the results was performed through a content analysis technique. SETTING the study was carried out at a public university hospital in Brazil. PARTICIPANTS 249 pregnant women who had received the diagnosis of a severe lethal fetal malformation. FINDINGS fetal anencephaly was the most frequent anomaly detected in 135 cases (54.3%). Termination of pregnancy was decided by 172 (69.1%) patients and legally authorised by the judiciary (66%). The reason for asking for termination was to reduce suffering in all of them. In the 77 women who chose not to terminate pregnancy (30.9%), the reasons were related to feelings of guilt (74%). KEY CONCLUSIONS the results support the importance of psychological counselling for couples when lethal fetal malformation is diagnosed. The act of reviewing moral and cultural values and elements of the unconscious provides assurance in the decision-making process and mitigates the risk of emotional trauma and guilt that can continue long after the pregnancy is terminated.

Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test

Objective The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C. Methods We recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C. Results Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference. Conclusion Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

Cognitive impairments in patients with low grade gliomas and high grade gliomas

OBJECTIVE The relationship between brain tumors and cognitive deficits is well established in the literature. However, studies investigating the cognitive status in low and high-grade gliomas patients are scarce, particularly in patients with average or lower educational level. This study aimed at investigating the cognitive functioning in a sample of patients with low and high-grade gliomas before surgical intervention. METHOD The low-grade (G1, n=19) and high-grade glioma (G2, n=8) patients underwent a detailed neuropsychological assessment of memory, executive functions, visuo-perceptive and visuo-spatial abilities, intellectual level and language. RESULTS There was a significant impairment on verbal and visual episodic memory, executive functions including mental flexibility, nominal and categorical verbal fluency and speed of information processing in G2. G1 showed only specific deficits on verbal and visual memory recall, mental flexibility and processing speed. CONCLUSION These findings demonstrated different levels of impairments in the executive and memory domains in patients with low and high grade gliomas.

Risk of suicide in high risk pregnancy: an exploratory study

OBJECTIVE To identify the risk of suicidal behavior in high-risk pregnant women at a public hospital in São Paulo. METHODS We conducted a semi-structured interview with each of the participants (n = 268) through a previously prepared questionnaire. Risk of suicidal behavior was assessed by the Portuguese version of PRIME-MD. RESULTS The mean age of patients was 29 years (SD = 0.507) and gestation period was 30 weeks (SD = 0.556). Of the total sample, specific risk of suicide was found in 5% (n = 14). Of these, 85% have a stable relationship (married or cohabitating), the pregnancy was planned in 50% of cases, and 71% have no religion or professional activities. The correlation of risk of suicide with data from marital status, planned birth, age, education, professional practice, risk of prematurity, and religion showed that having a religion is statistically significant (p = 0.012). There were no positive associations for any of the other selected variables when compared with the risk of suicide. By correlating the risk of suicide with other characteristic symptoms of major depression, there was statistical significance in the sample with regard to insomnia or hypersomnia (p = 0.003), fatigue or loss of energy (p = 0.001), decreased or increased appetite (p = 0.005), less interest in daily activities (p = 0.000), depressed mood (p = 0.000), feelings of worthlessness or guilt (p = 0.000), decreased concentration (p = 0.002), and agitation or psychomotor retardation (p = 0.002). CONCLUSION We found that religion can be a protective factor against suicidal behavior. Besides providing a social support network needed by women during pregnancy, religion supports belief in life after death and in a loving God, giving purpose to life and self esteem and providing models for coping with crises. The results show the importance of prevention and early diagnosis of suicidal behavior, since suicide is an attempt to move from one sphere to another by force, seeking to solve what seems impossible.

Interrupção da gestação após o diagnóstico de malformação fetal letal: aspectos emocionais

OBJETIVOS: descrever os processos emocionais vivenciados com a interrupcao da gestacao apos o diagnostico de malformacao fetal letal. METODOS: foram entrevistadas 35 gestantes cujo feto era portador de malformacao letal e que realizaram a interrupcao da gestacao apos solicitacao de autorizacao judicial. A malformacao fetal mais frequente foi a anencefalia (71,5%). As pacientes foram submetidas a entrevista psicologica aberta logo apos o diagnostico da malformacao fetal para que pudessem expressar os sentimentos desencadeados e para promover reflexao sobre a solicitacao da interrupcao da gravidez. O tempo medio de espera pelo deferimento do pedido judicial foi de 16,6 dias. As que solicitaram e tiveram o aborto realizado foram convidadas a retornar para a segunda entrevista psicologica 30 a 60 dias apos o procedimento, quando foi aplicado questionario semidirigido para identificar os aspectos emocionais vivenciados e descrever os sentimentos despertados. RESULTADOS: trinta e cinco pacientes foram entrevistadas apos o aborto. Quanto aos sentimentos vivenciados na decisao pela interrupcao, 60% relataram como negativos, 51,4% afirmaram que nao tiveram duvidas quanto a decisao tomada e 65,7% informaram que a propria opiniao foi a que mais pesou na decisao. A maioria das mulheres (89%) afirmou apresentar lembrancas do que viveram com certa frequencia, 91% afirmou que adotariam a mesma atitude em outra situacao semelhante e 60% diriam para interromper a gestacao caso alguem perguntasse seu conselho, numa mesma situacao. CONCLUSOES: as angustias vivenciadas demonstram que o processo de reflexao e de fundamental importância para decisao consciente e posterior satisfacao com a atitude tomada. O acompanhamento psicologico permite revisao dos valores morais e culturais para auxiliar a tomada de decisoes visando minimizar o sofrimento vivido.

Risco de suicídio em gestantes de alto risco: um estudo exploratório

OBJECTIVE: To identify the risk of suicidal behavior in high-risk pregnant women at a public hospital in Sao Paulo. METHODS: We conducted a semi-structured interview with each of the participants (n = 268) through a previously prepared questionnaire. Risk of suicidal behavior was assessed by the Portuguese version of PRIME-MD. RESULTS: The mean age of patients was 29 years (SD = 0.507) and gestation period was 30 weeks (SD = 0.556). Of the total sample, specific risk of suicide was found in 5% (n = 14). Of these, 85% have a stable relationship (married or cohabitating), the pregnancy was planned in 50% of cases, and 71% have no religion or professional activities. The correlation of risk of suicide with data from marital status, planned birth, age, education, professional practice, risk of prematurity, and religion showed that having a religion is statistically significant (p = 0.012). There were no positive associations for any of the other selected variables when compared with the risk of suicide. By correlating the risk of suicide with other characteristic symptoms of major depression, there was statistical significance in the sample with regard to insomnia or hypersomnia (p = 0.003), fatigue or loss of energy (p = 0.001), decreased or increased appetite (p = 0.005), less interest in daily activities (p = 0.000), depressed mood (p = 0.000), feelings of worthlessness or guilt (p = 0.000), decreased concentration (p = 0.002), and agitation or psychomotor retardation (p = 0.002). CONCLUSION: We found that religion can be a protective factor against suicidal behavior. Besides providing a social support network needed by women during pregnancy, religion supports belief in life after death and in a loving God, giving purpose to life and self esteem and providing models for coping with crises. The results show the importance of prevention and early diagnosis of suicidal behavior, since suicide is an attempt to move from one sphere to another by force, seeking to solve what seems impossible.