Martha Moreira Cavalcante Castro

Validade da escala hospitalar de ansiedade e depressão em pacientes com dor crônica

JUSTIFICATIVA E OBJETIVOS: Diversos estudos sugerem forte associacao entre a ansiedade e a depressao com dor cronica, o que pode ser evidenciado pela utilizacao de escalas padronizadas para a deteccao desses sintomas. O objetivo deste estudo foi estimar a sensibilidade e a especificidade da Escala Hospitalar de Ansiedade e Depressao (HAD), em pacientes portadores de sindromes dolorosas cronicas acompanhados no Centro de Dor do Hospital Universitario Professor Edgard Santos. METODO: Foi realizado um estudo descritivo transversal em pacientes que procuraram o Centro de Dor entre marco de 2002 e julho de 2003, que constou de entrevistas utilizando a Escala HAD e o M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTADOS: Foram avaliados 91 pacientes. A utilizacao da HAD evidenciou que 61 pacientes (67%) apresentaram ansiedade e 42 pacientes (46,2%) apresentaram depressao. Os resultados da HAD mostraram que dos pacientes deprimidos, 38 (90,5%) eram tambem ansiosos; enquanto dos ansiosos, 38 (62,3%) tambem estavam deprimidos, sendo esta uma associacao considerada como significativa pela analise estatistica (p < 0,001). O M.I.N.I. PLUS revelou 40,7% de transtorno do humor atual e 47,3% de transtorno de ansiedade. Quanto a sensibilidade e a especificidade da HAD foram encontrados os seguintes resultados: sensibilidade 73,3% para depressao e 91,7% para ansiedade. Especificidade 67,2% para depressao e 41,8% para ansiedade. CONCLUSOES: A escala HAD mostrou boa sensibilidade para avaliar sintomas de ansiedade e depressao, porem nao evidenciou boa especificidade para diagnosticos de depressao e ansiedade.BACKGROUND AND OBJECTIVES Several studies suggest a strong association between anxiety and depression with chronic pain. That can be demonstrated using standard scales to detect these symptoms. The objective of this study was to determine sensibility and specificity of the Hospital Anxiety and Depression Scale (HAD) in patients with chronic pain syndromes followed at the Pain Center of the Hospital Universitário Professor Edgard Santos. METHODS A transversal, descriptive study was conducted with patients who sought to the Pain Center between March 2002 and July 2003. It was composed of interviews using the HAD Scale and the M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTS Ninety-one patients were evaluated. The HAD demonstrated that 61 patients (67%) presented anxiety, while 42 patients (46.2%) presented depression. HAD results showed that among patients with depression, 38 (90.5%) also had anxiety; while among those with anxiety, 38 (62.3%) also had depression. Statistical analysis showed that this association was statistically significant (p < 0.001). M.I.N.I. PLUS revealed an incidence of 40.7% in current mood changes and 47.3% of anxiety. As for HADs sensibility and specificity, we found the following results: sensibility of 73.3% for depression and 91.7% for anxiety, and a specificity of 67.2% for depression and 41.8% for anxiety. CONCLUSIONS The HAD scale showed good sensibility to evaluate anxiety and depression symptoms, but did not demonstrate good specificity for the diagnosis of depression and anxiety.

Sleep patterns and symptoms of anxiety and depression in patients with chronic pain

BACKGROUND Sleep disturbances and symptoms of anxiety and depression have been shown to be involved in the genesis and perpetuation of chronic pain. OBJECTIVE To evaluate sleep patterns and the prevalence of symptoms of anxiety and depression in patients with chronic pain. METHOD Four hundred consecutive patients referred to a chronic pain outpatient clinic were investigated using patient charts, the numerical Visual Analogue Scale for the evaluation of pain, the Hospital Anxiety and Depression scale and the Mini-Sleep Questionnaire. RESULTS The mean age of patients was 45.6+/-11.4 years. The most frequent medical diagnosis was myofascial pain followed by neuropathic pain. The prevalence of symptoms of anxiety was 72.8%, depression 93% and altered sleep patterns 93%. CONCLUSION This study revealed a high prevalence of symptoms of depression and anxiety and alterations in sleep patterns in patients with chronic pain, justifying investigation into these disturbances in this group of patients.

Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia

What is known and Background:  Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial‐based thought record (TBTR), which targets the restructuring of patients’ core beliefs.

Comorbidade de sintomas ansiosos e depressivos em pacientes com dor crônica e o impacto sobre a qualidade de vida

CONTEXTO: Dor e uma experiencia emocional e sensorial desagradavel. Tanto a dor cronica como a depressao reduzem de forma significativa a qualidade de vida, alem de aumentar muito os custos dos cuidados com a saude. OBJETIVOS: Analisar a associacao entre sintomas depressivos e de ansiedade em relacao a dor cronica e investigar o impacto desses sintomas na saude e na qualidade de vida em individuos com dor cronica. METODOS: A dor foi avaliada por meio de uma Escala Analogica Visual (VAS). Os sintomas depressivos e a ansiedade foram avaliados pela Escala Hospitalar de Ansiedade e Depressao (HAD). A qualidade de vida foi avaliada por meio do SF-36. RESULTADOS: Quatrocentos pacientes foram estudados, com idade media de 45,6 ± 11,4 anos e 82,8% sao do sexo feminino. De acordo com a HAD, 70% tinham ansiedade e 60%, os sintomas de depressao. A SF-36 apresentou escores < 50% para todos os dominios. Os pacientes com dor intensa/ extrema apresentaram maior frequencia (70,4%) de ansiedade do que aqueles com dor selvagem/moderada (59,5%). Essa foi uma associacao estatisticamente significante (p = 0,027). No entanto, a frequencia de depressao nao atingiu significância estatistica quando ambos os grupos foram comparados (p = 0,109). CONCLUSAO: Os sintomas depressivos/ansiedade e dor, em conjunto, apresentaram piores desfechos clinicos de cada estado sozinho. E necessaria mais investigacao para determinar se o tratamento da dor ajuda os sintomas dos pacientes depressivos e se o alivio dos sintomas depressivos melhora a dor e sua morbidade.

Validity of the hospital anxiety and depression scale in patients with chronic pain

JUSTIFICATIVA E OBJETIVOS: Diversos estudos sugerem forte associacao entre a ansiedade e a depressao com dor cronica, o que pode ser evidenciado pela utilizacao de escalas padronizadas para a deteccao desses sintomas. O objetivo deste estudo foi estimar a sensibilidade e a especificidade da Escala Hospitalar de Ansiedade e Depressao (HAD), em pacientes portadores de sindromes dolorosas cronicas acompanhados no Centro de Dor do Hospital Universitario Professor Edgard Santos. METODO: Foi realizado um estudo descritivo transversal em pacientes que procuraram o Centro de Dor entre marco de 2002 e julho de 2003, que constou de entrevistas utilizando a Escala HAD e o M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTADOS: Foram avaliados 91 pacientes. A utilizacao da HAD evidenciou que 61 pacientes (67%) apresentaram ansiedade e 42 pacientes (46,2%) apresentaram depressao. Os resultados da HAD mostraram que dos pacientes deprimidos, 38 (90,5%) eram tambem ansiosos; enquanto dos ansiosos, 38 (62,3%) tambem estavam deprimidos, sendo esta uma associacao considerada como significativa pela analise estatistica (p < 0,001). O M.I.N.I. PLUS revelou 40,7% de transtorno do humor atual e 47,3% de transtorno de ansiedade. Quanto a sensibilidade e a especificidade da HAD foram encontrados os seguintes resultados: sensibilidade 73,3% para depressao e 91,7% para ansiedade. Especificidade 67,2% para depressao e 41,8% para ansiedade. CONCLUSOES: A escala HAD mostrou boa sensibilidade para avaliar sintomas de ansiedade e depressao, porem nao evidenciou boa especificidade para diagnosticos de depressao e ansiedade.BACKGROUND AND OBJECTIVES Several studies suggest a strong association between anxiety and depression with chronic pain. That can be demonstrated using standard scales to detect these symptoms. The objective of this study was to determine sensibility and specificity of the Hospital Anxiety and Depression Scale (HAD) in patients with chronic pain syndromes followed at the Pain Center of the Hospital Universitário Professor Edgard Santos. METHODS A transversal, descriptive study was conducted with patients who sought to the Pain Center between March 2002 and July 2003. It was composed of interviews using the HAD Scale and the M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTS Ninety-one patients were evaluated. The HAD demonstrated that 61 patients (67%) presented anxiety, while 42 patients (46.2%) presented depression. HAD results showed that among patients with depression, 38 (90.5%) also had anxiety; while among those with anxiety, 38 (62.3%) also had depression. Statistical analysis showed that this association was statistically significant (p < 0.001). M.I.N.I. PLUS revealed an incidence of 40.7% in current mood changes and 47.3% of anxiety. As for HADs sensibility and specificity, we found the following results: sensibility of 73.3% for depression and 91.7% for anxiety, and a specificity of 67.2% for depression and 41.8% for anxiety. CONCLUSIONS The HAD scale showed good sensibility to evaluate anxiety and depression symptoms, but did not demonstrate good specificity for the diagnosis of depression and anxiety.

Quality of Life and Functional Independence in Patients with Osteoarthritis of the Knee.

Purpose To verify the association between functional independence (FI) and quality of life (QOL) in patients with knee osteoarthritis. Materials and Methods A cross-sectional study composed of 93 patients with knee osteoarthritis was performed. Osteoarthritis was stratified according the classification of Ahlbach. For evaluation of the patients overall FI, the Barthel index was used. The patients QOL was measured by means of the Medical Outcomes Study 36–Item Short Form Health Survey (SF-36) questionnaire. Results The mean age of the patients was 60 years (range, 54.0 to 69.5 years) and only 32 patients (34.3%) were found to be independent. Dependent or independent individuals presented difference in all domains of the QOL including physical function (p=0.001), role-physical (p=0.005), bodily pain (p=0.001), general health (p=0.004), vitality (p=0.009), social function (p=0.010), role-emotional (p=0.002) and mental health (p=0.001). Correlation between FI and QOL was different for all domains of the SF-36. Correlation with FI was strongest for physical function (r=0.609, p<0.001), followed by the domains of bodily pain (r=0.410, p<0.001) and mental health (r=0.402, p<0.001). Conclusions Our data demonstrated a strong association of FI with QOL and positive correlations with all QOL domains, indicating the greater the FI is, the higher the QOL is.

Validez de la escala hospitalaria de ansiedad y depresión en pacientes con dolor crónico

JUSTIFICATIVA E OBJETIVOS: Diversos estudos sugerem forte associacao entre a ansiedade e a depressao com dor cronica, o que pode ser evidenciado pela utilizacao de escalas padronizadas para a deteccao desses sintomas. O objetivo deste estudo foi estimar a sensibilidade e a especificidade da Escala Hospitalar de Ansiedade e Depressao (HAD), em pacientes portadores de sindromes dolorosas cronicas acompanhados no Centro de Dor do Hospital Universitario Professor Edgard Santos. METODO: Foi realizado um estudo descritivo transversal em pacientes que procuraram o Centro de Dor entre marco de 2002 e julho de 2003, que constou de entrevistas utilizando a Escala HAD e o M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTADOS: Foram avaliados 91 pacientes. A utilizacao da HAD evidenciou que 61 pacientes (67%) apresentaram ansiedade e 42 pacientes (46,2%) apresentaram depressao. Os resultados da HAD mostraram que dos pacientes deprimidos, 38 (90,5%) eram tambem ansiosos; enquanto dos ansiosos, 38 (62,3%) tambem estavam deprimidos, sendo esta uma associacao considerada como significativa pela analise estatistica (p < 0,001). O M.I.N.I. PLUS revelou 40,7% de transtorno do humor atual e 47,3% de transtorno de ansiedade. Quanto a sensibilidade e a especificidade da HAD foram encontrados os seguintes resultados: sensibilidade 73,3% para depressao e 91,7% para ansiedade. Especificidade 67,2% para depressao e 41,8% para ansiedade. CONCLUSOES: A escala HAD mostrou boa sensibilidade para avaliar sintomas de ansiedade e depressao, porem nao evidenciou boa especificidade para diagnosticos de depressao e ansiedade.BACKGROUND AND OBJECTIVES Several studies suggest a strong association between anxiety and depression with chronic pain. That can be demonstrated using standard scales to detect these symptoms. The objective of this study was to determine sensibility and specificity of the Hospital Anxiety and Depression Scale (HAD) in patients with chronic pain syndromes followed at the Pain Center of the Hospital Universitário Professor Edgard Santos. METHODS A transversal, descriptive study was conducted with patients who sought to the Pain Center between March 2002 and July 2003. It was composed of interviews using the HAD Scale and the M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTS Ninety-one patients were evaluated. The HAD demonstrated that 61 patients (67%) presented anxiety, while 42 patients (46.2%) presented depression. HAD results showed that among patients with depression, 38 (90.5%) also had anxiety; while among those with anxiety, 38 (62.3%) also had depression. Statistical analysis showed that this association was statistically significant (p < 0.001). M.I.N.I. PLUS revealed an incidence of 40.7% in current mood changes and 47.3% of anxiety. As for HADs sensibility and specificity, we found the following results: sensibility of 73.3% for depression and 91.7% for anxiety, and a specificity of 67.2% for depression and 41.8% for anxiety. CONCLUSIONS The HAD scale showed good sensibility to evaluate anxiety and depression symptoms, but did not demonstrate good specificity for the diagnosis of depression and anxiety.

Uso de terapêutica com ácidos graxos ômega-3 em pacientes com dor crônica e sintomas ansiosos e depressivos

JUSTIFICATIVA E OBJETIVOS: Desordens ansiosas e depressivas muitas vezes ocorrem simultaneamente com condicoes dolorosas cronicas e sao associadas a uma gama de desfechos negativos. Apesar desta associacao, tanto a dor quanto essas desordens sao frequentemente tratadas de forma inadequada, causando incapacidade laboral, reducao da saude, da qualidade de vida e aumento dos custos com a saude. Foi realizada uma revisao das acoes terapeuticas dos acidos graxos omega-3 (w-3) no tratamento de pacientes com dor cronica que apresentam sintomas ansiosos e depressivos. CONTEUDO: Estudos vem demonstrando que sintomas ansiosos e depressivos contribuem para exacerbar o quadro algico e que a presenca de dor cronica contribui para o surgimento destes transtornos. E possivel que o emprego de substâncias capazes de reduzir os sintomas algicos possa aliviar os sintomas ansiosos e depressivos. O acido graxo (w-3) pode atuar na neuroprotecao e estabilizacao do humor, e na reducao do estado inflamatorio, comum na dor cronica. Ensaios clinicos evidenciaram a eficacia do acido graxo em pacientes com sintomas ansiosos e depressivos, e com dor cronica. CONCLUSAO: A suplementacao com acidos graxos w-3 em pacientes com dor cronica que apresentam sintomas ansiosos e depressivos pode ser uma estrategia efetiva tanto para a melhoria destes sintomas quanto do quadro algico.