Lucas Francisco Botequio Mella

Depressive symptoms in rheumatoid arthritis

OBJETIVO: Determinar a prevalencia de sintomas depressivos e ansiosos na artrite reumatoide (doenca inflamatoria cronica) em comparacao com um grupo controle com osteoartrite (doenca cronico-degenerativa nao inflamatoria). Identificar variaveis sociodemograficas e clinicas associadas a sintomas depressivos nesses pacientes. METODO: Participaram do estudo 62 pacientes com artrite reumatoide e 60 pacientes com osteoartrite. Foram coletados dados sociodemograficos e clinicos e foram aplicadas as escalas Hospital Anxiety and Depression Scale e Disability Index of the Health Assessment Questionnaire. RESULTADOS: A prevalencia dos sintomas depressivos foi 53,2% na artrite reumatoide e 28,3% na osteoartrite (p = 0,005). A prevalencia dos sintomas ansiosos foi 48,4% na artrite reumatoide e 50,0% na osteoartrite (p = 0,859). Os valores medios (desvio padrao) de Disability Index of the Health Assessment Questionnaire foram 1,4 (0,8) na artrite reumatoide e 1,4 (0,6) na osteoartrite (p = 0,864). Pacientes com artrite reumatoide e sintomas depressivos apresentaram menor nivel educacional e maiores niveis de atividade da doenca e incapacidade funcional. CONCLUSAO: Embora ambas as doencas reumatologicas sejam similares em termos de dor e incapacidade funcional, uma prevalencia significativamente maior de sintomas depressivos na artrite reumatoide foi encontrada. Essa diferenca poderia ser explicada por meio da hipotese de um mecanismo neuroimunobiologico relacionado as citocinas nas doencas inflamatorias, o qual vem sendo considerado candidato para o desenvolvimento de sintomas depressivos.OBJECTIVE To determine the prevalence of depressive and anxiety symptoms in patients with rheumatoid arthritis (a chronic inflammatory disease) in comparison to a control group with osteoarthritis (a chronic non-inflammatory degenerative disease) and to identify the sociodemographic and clinical variables associated with depressive symptoms in these patients. METHOD Sixty-two rheumatoid arthritis patients and 60 osteoarthritis patients participated in the study. Sociodemographic and clinical data were collected and the Hospital Anxiety and Depression Scale and the Disability Index of the Health Assessment Questionnaire were applied. RESULTS The prevalence of depressive symptoms was of 53.2% in rheumatoid arthritis and 28.3% in osteoarthritis (p = 0.005). The prevalence of anxiety symptoms was of 48.4% in rheumatoid arthritis and 50.0% in osteoarthritis (p = 0.859). The mean (and standard deviation) scores in the Disability Index of the Health Assessment Questionnaire were 1.4 (0.8) in rheumatoid arthritis and 1.4 (0.6) in osteoarthritis (p = 0.864). Rheumatoid arthritis patients with depressive symptoms had lower education and higher disease activity and functional disability. CONCLUSION Although these two rheumatic diseases are similar in terms of the pain and functional disability that they cause, a significantly higher prevalence of depressive symptoms was found in rheumatoid arthritis patients. This difference might be explained by the hypothesis of a neuroimmunobiological mechanism related to cytokines in inflammatory diseases, which has been considered as a candidate to the development of depressive symptoms.

Depressive symptoms in rheumatoid arthritis patients

OBJETIVO: Determinar a prevalencia de sintomas depressivos e ansiosos na artrite reumatoide (doenca inflamatoria cronica) em comparacao com um grupo controle com osteoartrite (doenca cronico-degenerativa nao inflamatoria). Identificar variaveis sociodemograficas e clinicas associadas a sintomas depressivos nesses pacientes. METODO: Participaram do estudo 62 pacientes com artrite reumatoide e 60 pacientes com osteoartrite. Foram coletados dados sociodemograficos e clinicos e foram aplicadas as escalas Hospital Anxiety and Depression Scale e Disability Index of the Health Assessment Questionnaire. RESULTADOS: A prevalencia dos sintomas depressivos foi 53,2% na artrite reumatoide e 28,3% na osteoartrite (p = 0,005). A prevalencia dos sintomas ansiosos foi 48,4% na artrite reumatoide e 50,0% na osteoartrite (p = 0,859). Os valores medios (desvio padrao) de Disability Index of the Health Assessment Questionnaire foram 1,4 (0,8) na artrite reumatoide e 1,4 (0,6) na osteoartrite (p = 0,864). Pacientes com artrite reumatoide e sintomas depressivos apresentaram menor nivel educacional e maiores niveis de atividade da doenca e incapacidade funcional. CONCLUSAO: Embora ambas as doencas reumatologicas sejam similares em termos de dor e incapacidade funcional, uma prevalencia significativamente maior de sintomas depressivos na artrite reumatoide foi encontrada. Essa diferenca poderia ser explicada por meio da hipotese de um mecanismo neuroimunobiologico relacionado as citocinas nas doencas inflamatorias, o qual vem sendo considerado candidato para o desenvolvimento de sintomas depressivos.OBJECTIVE To determine the prevalence of depressive and anxiety symptoms in patients with rheumatoid arthritis (a chronic inflammatory disease) in comparison to a control group with osteoarthritis (a chronic non-inflammatory degenerative disease) and to identify the sociodemographic and clinical variables associated with depressive symptoms in these patients. METHOD Sixty-two rheumatoid arthritis patients and 60 osteoarthritis patients participated in the study. Sociodemographic and clinical data were collected and the Hospital Anxiety and Depression Scale and the Disability Index of the Health Assessment Questionnaire were applied. RESULTS The prevalence of depressive symptoms was of 53.2% in rheumatoid arthritis and 28.3% in osteoarthritis (p = 0.005). The prevalence of anxiety symptoms was of 48.4% in rheumatoid arthritis and 50.0% in osteoarthritis (p = 0.859). The mean (and standard deviation) scores in the Disability Index of the Health Assessment Questionnaire were 1.4 (0.8) in rheumatoid arthritis and 1.4 (0.6) in osteoarthritis (p = 0.864). Rheumatoid arthritis patients with depressive symptoms had lower education and higher disease activity and functional disability. CONCLUSION Although these two rheumatic diseases are similar in terms of the pain and functional disability that they cause, a significantly higher prevalence of depressive symptoms was found in rheumatoid arthritis patients. This difference might be explained by the hypothesis of a neuroimmunobiological mechanism related to cytokines in inflammatory diseases, which has been considered as a candidate to the development of depressive symptoms.

Refinement of chromosome 3p22.3 region and identification of a susceptibility gene for bipolar affective disorder

Genome‐wide association studies and meta‐analysis, as well as our own previous family‐based association results, have pointed to chromosome (ch) 3p22.3 and 3p21.1 as candidate regions to contain a susceptibility gene for bipolar affective disorder (BPAD). In the present study, we further refined the region of interest on ch 3p22.3. We genotyped 94 SNPs within the candidate region in 74 families and performed family‐based association analysis using a transmission disequilibrium test. One single SNP (rs166508) was associated with the BPAD phenotype (P = 0.0187). This SNP is located within intron 15 of the integrin alpha 9 (ITGA9) gene. ITGA9 encodes the α9 subunit of the α9β1 integrin, a membrane glycoprotein receptor for neurotrophins, such as nerve growth factor (NGF) and brain‐derived neurotrophic factor (BDNF). Quantification of ITGA9 transcripts in the peripheral blood of patients with BPAD and controls showed an upregulation of ITGA9 (Kruskal–Wallis P = 0.0339) in patients with the disease‐associated genotype (rs166508*A/A), compared to those with rs166508*G/G and rs166508*G/A genotypes. Sequencing of the ITGA9 cDNA revealed a sequence variant (r.1689_1839del) in rs166508*A carriers, which leads to loss of the entire exon 16. In silico analysis revealed that the deleted region contains three putative microRNA binding sites, which may be involved in the negative regulation of ITGA9. In conclusion, our results confirm previous evidence pointing to a candidate region for BPAD on ch 3p.22.3. In addition, we suggest a molecular substrate that could explain the increase of ITGA9 mRNA levels in probands with BPAD, proposing a new mechanism that could be involved in the genetic susceptibility to the disease.

Sintomas depressivos em pacientes com artrite reumatoide

OBJETIVO: Determinar a prevalencia de sintomas depressivos e ansiosos na artrite reumatoide (doenca inflamatoria cronica) em comparacao com um grupo controle com osteoartrite (doenca cronico-degenerativa nao inflamatoria). Identificar variaveis sociodemograficas e clinicas associadas a sintomas depressivos nesses pacientes. METODO: Participaram do estudo 62 pacientes com artrite reumatoide e 60 pacientes com osteoartrite. Foram coletados dados sociodemograficos e clinicos e foram aplicadas as escalas Hospital Anxiety and Depression Scale e Disability Index of the Health Assessment Questionnaire. RESULTADOS: A prevalencia dos sintomas depressivos foi 53,2% na artrite reumatoide e 28,3% na osteoartrite (p = 0,005). A prevalencia dos sintomas ansiosos foi 48,4% na artrite reumatoide e 50,0% na osteoartrite (p = 0,859). Os valores medios (desvio padrao) de Disability Index of the Health Assessment Questionnaire foram 1,4 (0,8) na artrite reumatoide e 1,4 (0,6) na osteoartrite (p = 0,864). Pacientes com artrite reumatoide e sintomas depressivos apresentaram menor nivel educacional e maiores niveis de atividade da doenca e incapacidade funcional. CONCLUSAO: Embora ambas as doencas reumatologicas sejam similares em termos de dor e incapacidade funcional, uma prevalencia significativamente maior de sintomas depressivos na artrite reumatoide foi encontrada. Essa diferenca poderia ser explicada por meio da hipotese de um mecanismo neuroimunobiologico relacionado as citocinas nas doencas inflamatorias, o qual vem sendo considerado candidato para o desenvolvimento de sintomas depressivos.OBJECTIVE To determine the prevalence of depressive and anxiety symptoms in patients with rheumatoid arthritis (a chronic inflammatory disease) in comparison to a control group with osteoarthritis (a chronic non-inflammatory degenerative disease) and to identify the sociodemographic and clinical variables associated with depressive symptoms in these patients. METHOD Sixty-two rheumatoid arthritis patients and 60 osteoarthritis patients participated in the study. Sociodemographic and clinical data were collected and the Hospital Anxiety and Depression Scale and the Disability Index of the Health Assessment Questionnaire were applied. RESULTS The prevalence of depressive symptoms was of 53.2% in rheumatoid arthritis and 28.3% in osteoarthritis (p = 0.005). The prevalence of anxiety symptoms was of 48.4% in rheumatoid arthritis and 50.0% in osteoarthritis (p = 0.859). The mean (and standard deviation) scores in the Disability Index of the Health Assessment Questionnaire were 1.4 (0.8) in rheumatoid arthritis and 1.4 (0.6) in osteoarthritis (p = 0.864). Rheumatoid arthritis patients with depressive symptoms had lower education and higher disease activity and functional disability. CONCLUSION Although these two rheumatic diseases are similar in terms of the pain and functional disability that they cause, a significantly higher prevalence of depressive symptoms was found in rheumatoid arthritis patients. This difference might be explained by the hypothesis of a neuroimmunobiological mechanism related to cytokines in inflammatory diseases, which has been considered as a candidate to the development of depressive symptoms.

Insight na psicose: uma análise conceitual

INTRODUCTION: In the context of clinical psychiatry, insight is defined as a subcategory of self-awareness of patients, which is related to the recognition of the pathological manifestations that affect them and also the appreciation of the changes that these manifestations cause in their interaction with the outside world. OBJECTIVE: To examine the forms of presentation of insight in schizophrenia and other psychoses. METHODS: Conceptual analysis, with illustrative clinical vignettes, of the relation between insight and several symptomatologic dimensions of schizophrenia and related conditions, regarding clinical, neurocognitive, psychodynamic and transcultural aspects. RESULTS: From a conceptual point of view, the construct is shaped by the theoretical approach adopted; from a clinical point of view, its presentation in psychoses is the result of the interaction with different symptomatologic areas and subjective and cultural aspects of the patient. CONCLUSION: Psychopathology assessment of insight must consider the complexity of the phenomenon, the theoretical approach used, and the clinical purpose for which it is done.

P01-308 - The role of the consultation liaison psychiatry exemplified in a patient with an uncommon manifestation of behçet's syndrome

Objectives To exemplify the role and relationship of Consultation Liaison Psychiatry with other areas of knowledge involved in the health-disease process, intending to propose solutions, under a biopsychosocial perspective, to clinical (care delivery) or institutional (service-related) problems. Methods The review of a patient record who represents an instance of this need for integration of approaches is reported. Results The case of a patient who presented an unusual pathophysiological manifestation of Behcets Syndrome (pseudo tumor neurological inflammation) and also developed psychiatric manic symptoms after the pharmacological treatment with corticosteroids is described. Despite both the remission of mental and behavioral symptoms with psychopharmacological treatment of short duration, her clinical outcome made it necessary to reintroduce corticotherapy, with recrudescence of psychiatric manifestations and the need for maintenance treatment to assure its management. Conclusions Besides illustrating a rare clinical condition, the described report exemplifies the benefits of joint and planned actions between psychiatrists and other professionals involved in integral assistance to inpatients at hospital wards.