Navegando por Palavras-chave "Comorbidity"

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    Adolescents with chronic migraine commonly exhibit depressive symptoms
    (Springer, 2013-03-01) Arita, Juliana Harumi [UNIFESP]; Lin, Jaime [UNIFESP]; Pinho, Ricardo Silva [UNIFESP]; Cianciarullo Minett, Thais Soares; Souza Vitalle, Maria Sylvia de [UNIFESP]; Fisberg, Mauro [UNIFESP]; Prieto Peres, Mario Fernando [UNIFESP]; Pereira Vilanova, Luiz Celso [UNIFESP]; Masruha, Marcelo Rodrigues [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Cambridge; Hosp Israelita Albert Einstein
    Psychiatric comorbidity in patients with headache contributes to poorer prognosis, chronification of disease, poor response to treatment, increased cost of treatment, and decreased quality of life. the purpose of the present study was to evaluate the depressive symptoms in adolescents with chronic and episodic migraines and healthy adolescents. the study was performed between November 2010 and November 2011. All patients completed a detailed headache questionnaire comprising of demographical and clinical data and were instructed to fill out a headache diary over a 2-month period. the subjects ranged in age from 13 to 19 years. To evaluate depression symptoms, all of the subjects were asked to fill out the Beck Depression Inventory (BDI). A total of 137 participants were evaluated; 44 had episodic migraine (EM), 46 had chronic migraine (CM) and 47 were control subjects. Patients with a history of chronic migraine had significantly higher scores on the BDI than the other participants. Patients with chronic migraine had BDI scores that were 8.8 points higher than controls [95 % CI (beta) = 5.0, 12.6] and 5.8 points higher than patients with EM [95 % CI (beta) = 2.2, 9.4]. the main finding of this study was that chronic migraine is strongly associated with depression symptoms, regardless of demographic data. Comorbid depression may increase the total burden of migraine and diagnosis and treatment of depression in adolescents with migraine is likely to result in a better prognosis.
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    Alcohol use disorders in patients with obsessive-compulsive disorder: the importance of appropriate dual-diagnosis
    (Elsevier B.V., 2009-02-01) Gentil, Andre F.; Mathis, Maria Alice de; Torresan, Ricardo C.; Diniz, Juliana B.; Alvarengat, Pedro; Rosario, Maria Conceicao do [UNIFESP]; Cordioli, Aristides V.; Torres, Albina R.; Miguel, Euripedes C.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do Sul
    Objective: To evaluate the prevalence and clinical associated factors of alcohol use disorders (AUD) comorbidity in a large clinical sample of patients with obsessive-compulsive disorder (OCD).Methods: A cross-sectional study including 630 DSM-IV OCD patients from seven Brazilian university services, comparing patients with and without AUD comorbidity. the instruments of assessment used were a demographic and clinical questionnaire including evaluation of suicidal thoughts and acts and psychiatric treatment, the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I), the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Beck Depression and Anxiety Inventories and the Clinical Global Impression Scale. Current or past alcohol and other psychoactive substances use, abuse and dependence were assessed using the SCID-I (section E) and corroborated by medical and familial history questionnaires.Results: Forty-seven patients (7.5%) presented AUD comorbidity. Compared to OCD patients without this comorbidity they were more likely to be men, to have received previous psychiatric treatment, to present: lifetime suicidal thoughts and attempts and to have higher scores in the hoarding dimension. They also presented higher comorbidity with generalized anxiety and somatization disorders, and compulsive sexual behavior. Substance use was related to the appearance of the first O.C. symptoms and symptom amelioration.Conclusions: Although uncommon among OCD treatment seeking samples, AUD comorbidity has specific clinical features, such as increased risk for suicidality, which deserve special attention from mental health professionals. Future studies focused on the development of specific interventions for these patients are warranted. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
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    Association among physical, psychiatric and socioeconomic conditions and WHOQOL-Bref scores
    (Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2011-04-01) Blay, Sergio Luis [UNIFESP]; Marchesoni, Marina Sthal Merlin; Universidade Federal de São Paulo (UNIFESP); Centro Universitário Hermínio Ometto
    The aim of this study is to investigate the impact of psychiatric morbidity, depression, cognitive deficit, number of self-reported illnesses and socio-demographic variables on the WHOQOL-Bref domain scores. WHOQOL-Bref domain scores are substantially affected by psychiatric morbidity and income. Depression, the number of self-reported illnesses and the female gender also explain the variability of other domains to a lesser extent.
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    Avaliação da classificação de risco em um serviço de emergência da Bahia
    (Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Jesus, Ana Paula Santos De [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Universidade Federal de São Paulo
    Objectives: To associate the risk classification categories with demographic profile, clinical aspects, comorbidities, times of care and patient outcomes in the emergency department, to assess the Manchester Screening System. Methods: Cross-sectional, analytical study. Patients aged 18 years or older were included in relation to the urgency of care under the Manchester Protocol in an emergency department. For statistical processing and analysis, the Statistical Package for Social Science (SPSS), version 23 was used. Descriptive analysis was performed using the calculations of mean, standard deviation, median, minimum and maximum. For categorical variables, frequency and percentage were calculated. Chi-square test, Student's t test, analysis of variance and generalized linear model were used, with a significance level of 5%. Comorbid load was calculated using the Charlson comorbidity index. Results: Data from 3,624 medical records were analyzed. Age ranged from 18 to 114 years, with a mean of 48.4 ± 18.7 years. There was a predominance of females (51.8%), brown skin (94.4%; n = 2,751), those from the household (88.1%), those classified in the yellow risk category (31.5%) and those with outcome of hospital discharge (42.9%). White individuals were older, and men had a higher percentage of red risk when compared to women (p = 0.0018). Patients classified in the high priority categories (red and orange) had a higher frequency of comorbidities, altered vital signs, cardiac complaints, external causes, two or more tests performed and death. The average waiting time to start the risk classification and the duration of the classification were longer than recommended, except the red category. The average waiting time for medical care in the red and orange categories was significantly longer than estimated. The death outcome was associated with the red category, which had shorter average waiting times for care and reduced stay in the emergency department. The average score on the age-adjusted comorbidity index was higher in patients in the red and white categories, with vascular and endocrine complaints, and those who underwent cranial tomography, with a high risk of mortality (p <0.0001). Hospital admission, transfer and death were associated with higher mean comorbidity scores (p <0.0001). Conclusion: The use of the Manchester Triage System was essential to prioritize severe cases, adequate use of diagnostic resources and the identification of a higher risk for hospitalization and death. There was a difference between the average waiting time for medical care and that recommended by the protocol. Despite the prioritization of urgent cases, improvements must be implemented to organize the flow of care, aiming at reducing waiting times, especially in high priority categories. The evaluation of comorbid load can be used to establish the clinical priority, defined by the Manchester Protocol, when it is desired to identify patients with the highest chances of progressing to death.
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    Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study
    (Cambridge Univ Press, 2012-06-01) Alvarenga, Pedro Gomes de; Mathis, Maria Alice de; Dominguez Alves, Anna Claudia; Rosario, Maria Conceicao do [UNIFESP]; Fossaluza, Victor; Hounie, Ana Gabriela; Miguel, Euripedes Constantino; Torres, Albina Rodrigues; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Objective. To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample.Method. A cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders.Results. the sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). the general lifetime prevalence of TD was 29.0% (n=236), with 8.9% (n=72) presenting Tourette syndrome, 17.3% (n=5141) chronic motor tic disorder, and 2.8% (n=523) chronic vocal tic disorder. the mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD1TD group. Compared to OCD patients without comorbid TD, those with TD (OCD1TD group, n=236) were more likely to be males (49.2% vs. 38.5%, p<005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the aggressive, sexual/religious, and hoarding symptom dimensions were more severe in the OCD+TD group.Conclusion. Tic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.
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    Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates
    (Associação Brasileira de Divulgação Científica, 2010-05-01) Andrade, Laura Helena; Benseñor, Isabela Martins; Viana, Maria Carmem; Andreoni, Solange [UNIFESP]; Wang, Y.-p.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20% of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.
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    Co-occurrence patterns of anxiety, depression and alcohol use disorders
    (Dr Dietrich Steinkopff Verlag, 2007-10-01) Almeida-Filho, Naomar; Lessa, Ines; Magalhaes, Lucelia; Araujo, Maria Jenny; Jesus Mari, Estela Aquino Jair de; Palacio Reitoria Univ Fed Bahia; Universidade Federal da Bahia (UFBA); Universidade Federal de São Paulo (UNIFESP)
    Co-occurrence of anxiety and depressive symptoms with alcohol consumption/abuse was analyzed in a sample of 2,302 adults in Bahia, Brazil. A cross-sectional household survey collected self-reported information on social and personal health, as well as individual psychological status, with standardized techniques and trained examiners. Twelve-month prevalence was 15% for anxiety, 12% for depressive disorders and 7% for alcohol abuse/dependence. Symptom co-occurrence was more frequent for depression (94% of cases co-occurring with other diagnoses), followed by anxiety disorders (82%), and alcoholism (only 20%). There was a 74% proportion of anxiety symptoms among depressed, and a 61% proportion of depressed among anxiety sufferers. the combination of depression plus anxiety was the most prevalent in both gender groups, ranging from 17% for women to 5% for men. Comorbid combinations of alcoholism yielded low prevalences, the smallest (around 1%) being the triple combo alcoholism+anxiety+depression. Gender ratios increased substantially in the absence of comorbidity, reaching peaks in depression (F:M ratio = 13.8) and alcoholism (M:F ratio = 11.8). Set component analyses indicate strong overlapping of anxiety and depression and complementarity between depression and alcoholism, modulated by gender (women depressed, men alcoholic).
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    Comorbidade: uso de álcool e outros transtornos psiquiátricos
    (Associação Brasileira de Psiquiatria - ABP, 2004-05-01) Alves, Hamer [UNIFESP]; Kessler, Felix; Ratto, Lilian Ribeiro Caldas; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio Grande do Sul Departamento de Psiquiatria; Santa Casa Faculdade de Ciências Médicas Departamento de Psiquiatria e Psicologia Médica
    Alcohol related disorders often coexist with other psychiatric disorders and its incidence is increasing in last decades. Studies show that patients with comorbidity, specially those with severe psychiatric disorders, have higher rates of suicide, relapse, money spent in treatment, homeless and they use more medical service. Their evaluation must be meticulous because the differencial diagnosis become complicated without a long period of alcohol withdrawal. These patients have a worse prognostic and their treatment is more difficult. Most of studies in this area have indicated that the integration of psychosocial and pharmacological techniques is more effective. The long term treatment must focus in the reduction of symptoms, improvement of social and familiar funcioning, coping skills and relapse prevention.
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    Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: results from a large multicentre clinical sample
    (Elsevier Science Bv, 2016) Torres, Albina Rodrigues; Fontenelle, Leonardo Franklin da Costa; Shavitt, Roseli Gedanke; Ferrão, Ygor Arzeno; Rosario, Maria Conceicao do [UNIFESP]; Storch, Eric A.; Miguel, Euripedes Constantino
    Background: Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders. Methods: Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression. Results: The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking
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    Correlates of substance use during adolescent pregnancy in São Paulo, Brazil
    (Associação Brasileira de Psiquiatria - ABP, 2010-03-01) Bessa, Marco Antonio [UNIFESP]; Mitsuhiro, Sandro Sendin [UNIFESP]; Chalem, Elisa [UNIFESP]; Barros, Marina Carvalho de Moraes [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Mário de Moraes Altenfelder Silva Maternity Hospital
    OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.
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    A cross-sectional study to assess the prevalence of DSM-5 specific learning disorders in representative school samples from the second to sixth grade in Brazil
    (Springer, 2016) Fortes, Isabela S.; Paula, Cristiane S. [UNIFESP]; Oliveira, Melaine C.; Bordin, Isabel A. [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Rohde, Luis A.
    Little is known about specific learning disorder (SLD) in low- and middle-income countries (LMICs), and even less from representative school samples in small size cities outside huge urban centers. Few studies addressed the new DSM-5 criteria for SLDs. We investigated the prevalence of DSM-5 SLDs, their comorbidities and correlates in school samples of students from the second to sixth grades living in median cities from four different geographic regions in Brazil. A national test for academic performance covering reading, writing and mathematical abilities was applied. Psychiatric diagnoses were assessed by the K-SADS-PL applied to the primary caregiver. A total of 1618 children and adolescents were included in the study. The following prevalence rates of SLDs were found: 7.6 % for global impairment, 5.4 % for writing, 6.0 % for arithmetic, and 7.5 % for reading impairment. Attention-deficit/hyperactivity disorder (ADHD) was the only comorbidity significantly associated with SLD with global impairment (p = 0.031). Anxiety disorders and ADHD were associated with SLD with arithmetic impairment. Significant differences were detected in prevalence rates among cities, and several socio-demographic correlates (age, gender, IQ, and socioeconomic status) were significantly associated with SLD with global impairment in our sample. Careful validation and normatization of instruments to assess academic performance is a major problem in LMICs. As expected, we found a significant heterogeneity in prevalence rates of SLD according to geographic regions considering that Brazil is a country with a robust diversity. SLD with global and arithmetic impairment was significantly associated with psychiatric comorbidities.
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    A cross-sectional study to assess the prevalence of DSM-5 specific learning disorders in representative school samples from the second to sixth grade in Brazil
    (Springer, 2016) Fortes, Isabela S.; Paula, Cristiane S. [UNIFESP]; Oliveira, Melaine C.; Bordin, Isabel A. [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Rohde, Luis A.
    Little is known about specific learning disorder (SLD) in low- and middle-income countries (LMICs), and even less from representative school samples in small size cities outside huge urban centers. Few studies addressed the new DSM-5 criteria for SLDs. We investigated the prevalence of DSM-5 SLDs, their comorbidities and correlates in school samples of students from the second to sixth grades living in median cities from four different geographic regions in Brazil. A national test for academic performance covering reading, writing and mathematical abilities was applied. Psychiatric diagnoses were assessed by the K-SADS-PL applied to the primary caregiver. A total of 1618 children and adolescents were included in the study. The following prevalence rates of SLDs were found: 7.6 % for global impairment, 5.4 % for writing, 6.0 % for arithmetic, and 7.5 % for reading impairment. Attention-deficit/hyperactivity disorder (ADHD) was the only comorbidity significantly associated with SLD with global impairment (p = 0.031). Anxiety disorders and ADHD were associated with SLD with arithmetic impairment. Significant differences were detected in prevalence rates among cities, and several socio-demographic correlates (age, gender, IQ, and socioeconomic status) were significantly associated with SLD with global impairment in our sample. Careful validation and normatization of instruments to assess academic performance is a major problem in LMICs. As expected, we found a significant heterogeneity in prevalence rates of SLD according to geographic regions considering that Brazil is a country with a robust diversity. SLD with global and arithmetic impairment was significantly associated with psychiatric comorbidities.
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    Curso clínico e prognóstico do transtorno obsessivo-compulsivo
    (Associação Brasileira de Psiquiatria - ABP, 2001-10-01) Miranda, Mary A [UNIFESP]; Bordin, Isabel Altenfelder Santos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The long-term course and prognosis of obsessive-compulsive disorder (OCD) is insufficiently known. To identify predictors of OCD course, follow-up studies of patients with OCD were reviewed and their findings summarized. According to these studies, the following variables were correlated with poor outcome: early onset, severity of OCD symptoms, chronic course, poor social functioning at baseline, lifetime history of comorbid psychiatric and personality disorders, presence of parental Axis I psychiatric diagnosis, and delayed response to serotonin reuptake inhibitors in the beginning of the treatment. Due to the availability of new treatments, most patients with OCD can expect significant improvement, but not complete remission of the disorder. The reviewed follow-up studies support previous reports on the chronicity of OCD.
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    Depressive symptoms and alcohol correlates among Brazilians aged 14 years and older: a cross-sectional study
    (Biomed Central Ltd, 2014-07-15) Coelho, Cassiano L. S. [UNIFESP]; Laranjeira, Ronaldo R. [UNIFESP]; Santos, Jair L. F.; Pinsky, Ilana [UNIFESP]; Zaleski, Marcos; Caetano, Raul; Crippa, Jose Alexandre S.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade Federal de Santa Catarina (UFSC); Univ Texas Dallas; INCT Translat Med
    Background: the associations between depressive symptoms and alcohol-related disorders, drinking patterns and other characteristics of alcohol use are important public health issues worldwide. This study aims to study these associations in an upper middle-income country, Brazil, and search for related socio-demographic correlations in men and women.Methods: A cross-sectional study was conducted between November 2005 and April 2006. the sample of 3,007 participants, selected using a multistage probabilistic sampling method, represents the Brazilian population aged 14 and older. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and alcohol dependence was assessed using the Composite International Diagnostic Interview. Associations assessed using bi-variate analysis were tested using Rao-Scott measures. Gender specific multinomial logistic regression models were developed.Results: Among the participants with alcohol dependence, 46% had depressive symptoms (17.2% mild/moderate and 28.8% major/severe; p < 0.01); 35.8% (p = 0.08) of those with alcohol abuse and 23.9% (p < 0.01) of those with a binge-drinking pattern also had depressive symptoms. Alcohol abstainers and infrequent drinkers had the highest prevalence of major/severe depressive symptoms, whereas frequent heavy drinkers had the lowest prevalence of major/severe depressive symptoms. in women, alcohol dependence and the presence of one or more problems related to alcohol consumption were associated with higher risks of major/severe depressive symptoms. Among men, alcohol dependence and being = 45 years old were associated with higher risks of major/severe depressive symptoms.Conclusions: in Brazil, the prevalence of depressive symptoms is strongly related to alcohol dependence; the strongest association was between major/severe depressive symptoms and alcohol dependence in women. This survey supports the possible association of biopsychosocial distress, alcohol consumption and the prevalence of depressive symptoms in Brazil. Investing in education, social programs, and care for those with alcohol dependence and major/severe depressive symptoms, especially for such women, and the development of alcohol prevention policies may be components of a strategic plan to reduce the prevalence of depression and alcohol problems in Brazil. Such a plan may also promote the socio-economic development of Brazil and other middle-income countries.
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    Diretrizes da Associação Brasileira de Estudos do Álcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias
    (Associação Brasileira de Psiquiatria - ABP, 2006-06-01) Zaleski, Marcos [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Marques, Ana Cecília Petta Roselli [UNIFESP]; Ratto, Lílian; Romano, Marcos [UNIFESP]; Alves, Hamer Nastasy Palhares [UNIFESP]; Soares, Márcia Britto de Macedo; Abelardino, Valter; Kessler, Félix; Brasiliano, Sílvia; Nicastri, Sérgio; Hochgraf, Patrícia Brunferntrinker; Gigliotti, Analice de Paula; Lemos, Tadeu; Universidade Federal de Santa Catarina Núcleo de Psiquiatria; Instituto de Psiquiatria de Santa Catarina; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de São Paulo Unidade de Álcool e Drogas; Universidade de São Paulo (USP); Centro de Atendimento Médico e Social; Hospital de Clínicas de Porto Alegre; Hospital Israelita Albert Einstein; Santa Casa do Rio de Janeiro Setor de Dependência Química; Universidade Gama Filho
    Recently, several studies have focused on comorbity psychiatric disorders with alcohol and other substance dependence. The Brazilian Association of Studies on Alcohol and Other Drugs proposed the Brazilian Guidelines project. This study review diagnostic and therapeutic criteria to the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological, animal studies and other forms of research are reviewed. The main psychiatric comorbidities are studied based on guidelines adopted by other countries and the literature data resumed. Epidemiological aspects, diagnoses, integrated treatment and service organization, as well as specific psychotherapic and pharmacological treatment are discussed. The Brazilian Association of Studies on Alcohol and Other Drugs Guidelines reassures the importance of adequate diagnoses and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.
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    Effects of heart failure on cerebral blood flow in copd: rest and exercise
    (Elsevier Science Bv, 2016) Oliveira, Mayron Faria [UNIFESP]; Alencar, Maria Clara [UNIFESP]; Arbex, Flavio [UNIFESP]; Souza, Aline [UNIFESP]; Sperandio, Priscila [UNIFESP]; Medina, Luiz [UNIFESP]; Medeiros, Wladimir Musetti [UNIFESP]; Hirai, Daniel Müller [UNIFESP]; O'Donnell, Denis E.; Neder, Jose Alberto [UNIFESP]
    Cerebral blood flow (CBF) and oxygenation (COx) are generally well-preserved in COPD. It is unknown whether prevalent cardiovascular co-morbidities, such as heart failure, may impair CBF and COx responses to exertion. Eighteen males with moderate-to-severe COPD (8 with and 10 without overlapping heart failure) underwent a progressive exercise test with pre-frontal CBF and COx measurements (indocyanine green and near-infrared spectroscopy). Mean arterial pressure and cardiac output were lower from rest to exercise in overlap. Only COPD patients demonstrated an increase in arterialized PCO2 towards the end of progressive exercise. CBF index was consistently higher and increased further by similar to 40% during exercise in COPD whereas a similar to 10% reduction was observed in overlap. COx was lower in overlap despite preserved arterial oxygenation. In conclusion, heart failure introduces pronounced negative effects on CBF and COx in COPD which may be associated with clinically relevant outcomes, including dyspnea, exercise intolerance, cerebrovascular disease and cognitive impairment. (C) 2015 Elsevier B.V. All rights reserved.
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    Elaboração E Eficácia De Um Protocolo De Intervenção Com Técnicas Alternativas No Tratamento De Sintomas De Depressão E Do Consumo Abusivo De Substâncias Psicoativas
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Batista, Leandro Cardozo [UNIFESP]; Tucci, Adriana Marcassa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Depression and drug use are public health problems and the main form of treatment in Western medicine is through pharmacotherapy that presents important adverse effects. There are alternative therapies to the pharmacological and psychotherapeutic treatments, such as: Mindfulness meditation, Reiki, Acupuncture and Auriculotherapy that may also be used for the treatment of symptoms of depression and psychoactive substance use. Objective: To elaborate and evaluate the effectiveness of a protocol based on alternative therapies to the pharmacological and psychotherapeutic treatments through Mindfulness meditation, Reiki, Acupuncture and Auriculotherapy in the treatment of symptoms of depression, as well as in psychoactive substances use. Method: This is an experimental, randomized controlled clinical study, of a quantitative nature. The techniques used in the protocol were Mindfulness, Reiki, Acupuncture and Auriculotherapy, which were applied during eight meetings. The study was carried out in one of the municipalities of Baixada Santista / SP. The sample consisted of 39 participants who responded to the criteria for depression through the Beck Inventory or a criteria of alcohol risk pattern, assessed by the Alcohol Use Disorders Identification Test, or a moderate other drugs problems, evaluated by the Drug Abuse Screening Test. Participants were divided into four groups: two experimental groups, depression or comorbid depression with substance use problem, and two control groups of the respective groups. Depression Anxiety and Stress Scale was also used to assess the symptoms of anxiety, stress, and depression in all participants. Results: Significant differences in symptoms of depression, anxiety and stress were detected in the two experimental groups when comparing the pre and post-intervention moments, while there was no change in the respective control groups. Among those with problems due to substance use, there was a significant difference between the experimental group and the control group regarding the pattern of alcohol consumption and other drugs problems when compared the pre and postintervention moments. Conclusion: The intervention protocol proposed in this study has been shown to be effective in reducing the symptoms of stress, anxiety and depression among people with depression, as well as in reducing these symptoms and alcohol or other drugs problems among those who uses psychoactive substances.
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    Estudo comparativo das diferentes versões de testes laboratoriais de triagem para doenças alérgicas em crianças e adolescentes brasileiros
    (Universidade Federal de São Paulo (UNIFESP), 2018-08-01) Pierotti, Felipe Faria [UNIFESP]; Sole, Dirceu [UNIFESP]; http://lattes.cnpq.br/8188258243306974; http://lattes.cnpq.br/1762529864832447; Universidade Federal de São Paulo (UNIFESP)
    Introduction: In the last decades, the prevalence of allergic diseases worldwide has increased. Although the clinical history is considered of great importance in the suspicion of an allergic disease, false-positive results can be observed when only anamnesis data are used. With this, measurable indicators used to examine any aspects of the disease become essential. Total immunoglobulin E dosage (TIgE) as well as panels that contain allergens prevalent in the population studied may serve as screening tests and facilitate a future diagnosis of an allergic disease. The objective of this study was to evaluate the positivity of the different versions of the screening tests for allergic diseases (PhadiatopEurope®, PhEU and PhadiatopInfant, PhInf) and TIgE values in patients with medical diagnosis of allergic disease and in children and adolescents without medical history of allergy. Methods: A cross-sectional study was carried out in 11 Brazilian Pediatric Allergy Centers whose patients were divided into groups according to the main disease. A control group composed of participants without allergic disease also integrated into the research. TIgE measurement and screening tests (Europe and Infant) were performed. Results: Serum total IgE concentration ranged from less than 2.0 kU/L to more than 5000 kU/L, with a median of 302 kU/L, and among allergy patients, values were significantly higher when compared to controls. In addition, the two screening tests performed in the same individuals showed an average agreement, according to the allergic disease evaluated, of 87.7%. Kappa index revealed substantial agreement (0.70). Conclusions:TIgE were significantly higher among "allergic" patients when compared to controls. The Infant test showed better performance in the identification of sensitized individuals, regardless of age. Screening tests do not diagnose allergic diseases. Once positive, referral to the specialist should be done.
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    Evolução da função renal de pacientes portadores do Vírus da Imunodeficiência Humana/ Síndrome da Imunodeficiência Adquirida
    (Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2009-01-01) Friedl, Daniane Bornea; Aprile, Daniele Cristina Bosco; Fino, Luana Camargo; Barbosa, Dulce Aparecida [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate the renal function in patients with Human Immunodeficiency Virus who were attending the Center for Infectious Diseases Control of the São Paulo Hospital of the Federal University of São Paulo. METHODS: This retrospective study consisted of the review of 200 randomly selected medical records. RESULTS: Patients were predominant white males with a mean age of 45 years. They had been diagnosed with the disease over 50 months ago, had from 0 to up 9 comorbidities, and a mean creatinine of .93mg/dl. The majority of patients were receiving antiviral medication. CONCLUSION: There was no significant alteration in renal function in the patients between the first and last visit.
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    Fatores associados ao uso excessivo de medicação sintomática em pacientes com enxaqueca crônica
    (Instituto Israelita de Ensino e Pesquisa Albert Einstein, 2012-09) Zukerman-Guendler, Vera [UNIFESP]; Mercante, Juliane Prieto Peres; Ribeiro, Reinaldo Teixeira [UNIFESP]; Zukerman, Eliova [UNIFESP]; Peres, Mario Fernando Prieto [UNIFESP]; Hospital Israelita Albert Einstein - HIAE; Universidade Federal de São Paulo - UNIFESP; Faculdade de Medicina do ABC - FMABC; Universidade de São Paulo - USP
    OBJETIVO: Avaliar a prevalência de transtornos psiquiátricos em pacientes com diagnóstico de enxaqueca crônica com e sem uso excessivo de medicação sintomática. MÉTODOS: Setenta e dois voluntários foram recrutados a partir de um Programa de Saúde da Família da comunidade de Paraisópolis, na cidade de São Paulo (SP). Esses pacientes foram submetidos a exames clínico e neurológico. As seguintes variáveis foram analisadas: idade, gênero, nível educacional, índice de massa corporal, tipo de uso excessivo de medicação, características da cefaleia, consumo de cafeína, presença de ansiedade e distúrbios de humor. RESULTADOS: Dos 72 pacientes, 50 (69%) tinham cefaleia crônica, com uso exagerado de medicação, e 22 (31%) tinham cefaleia crônica, sem uso excessivo de medicação. Os fatores idade, gênero, nível educacional, índice de massa corporal, tipo de uso excessivo de medicação, características da cefaleia e consumo de cafeína não mostraram diferença significante entre os grupos estudados. Os diagnósticos de ansiedade e de distúrbios de humor ao longo da vida foram mais comuns nos pacientes com uso excessivo de medicação (p=0,003 e p=0,045, respectivamente). CONCLUSÃO: Este estudo mostrou uma associação significativa entre cefaleia crônica e uso excessivo de medicação nos pacientes avaliados, quanto ao diagnóstico de transtornos de ansiedade e de humor ao longo da vida. Não foi encontrada nenhuma associação com outros distúrbios psiquiátricos pesquisados.