Navegando por Palavras-chave "Posttraumatic stress disorder"
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- ItemAcesso aberto (Open Access)Avaliação da Terapia Interpessoal de grupo em pacientes com Transtorno do Estresse Pós-Traumático vítimas de violência urbana(Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Braga, Rosaly Ferreira [UNIFESP]; Mello, Marcelo Feijó de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Posttraumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the “gold standard” therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT-G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. Methods: Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, previously approved by the UNIFESP Ethics Review Board, they received a semistructured diagnostic interview (SCID-I), administered by a trained mental health worker, to confirm the presence of a-PTSD diagnosis according DSM-IV criteria. Other instruments were administered, and patients completed out selfreport instruments at baseline, and endpoint to evaluate clinical outcomes.Results: Thirty-three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. Conclusions: IPT-G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials.
- ItemSomente MetadadadosCandidate-Gene Approach in Posttraumatic Stress Disorder After Urban Violence: Association Analysis of the Genes Encoding Serotonin Transporter, Dopamine Transporter, and BDNF(Humana Press Inc, 2011-05-01) Marques Valente, Nina Leao [UNIFESP]; Vallada, Homero; Cordeiro, Quirino; Miguita, Karen; Bressan, Rodrigo Affonseca [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Mari, Jair Jesus [UNIFESP]; Mello, Marcelo Feijo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Kings Coll London; Adolfo Lutz InstPosttraumatic stress disorder (PTSD) is a prevalent, disabling anxiety disorder marked by behavioral and physiologic alterations which commonly follows a chronic course. Exposure to a traumatic event constitutes a necessary, but not sufficient, factor. There is evidence from twin studies supporting a significant genetic predisposition to PTSD. However, the precise genetic loci still remain unclear. the objective of the present study was to identify, in a case-control study, whether the brain-derived neurotrophic factor (BDNF) val66met polymorphism (rs6265), the dopamine transporter (DAT1) three prime untranslated region (3'UTR) variable number of tandem repeats (VNTR), and the serotonin transporter (5-HTTPRL) short/long variants are associated with the development of PTSD in a group of victims of urban violence. All polymorphisms were genotyped in 65 PTSD patients as well as in 34 victims of violence without PTSD and in a community control group (n = 335). We did not find a statistical significant difference between the BDNF val66met and 5-HTTPRL polymorphism and the traumatic phenotype. However, a statistical association was found between DAT1 3'UTR VNTR nine repeats and PTSD (OR = 1.82; 95% CI, 1.20-2.76). This preliminary result confirms previous reports supporting a susceptibility role for allele 9 and PTSD.
- ItemSomente MetadadadosA Double-Blind Randomized Controlled Trial To Study the Efficacy of Topiramate in a Civilian Sample of PTSD(Wiley-Blackwell, 2011-01-01) Yeh, Mary S. L. [UNIFESP]; Mari, Jair Jesus [UNIFESP]; Pupo Costa, Mariana Caddrobi [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Mello, Marcelo Feijo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ LondonObjective: To evaluate the efficacy and tolerability of topiramate in patients with post-traumatic stress disorder (PTSD). Method: We conducted a 12-week double-blind, randomized, placebo-controlled study comparing topiramate to placebo. Men and women aged 18-62 years with diagnosis of PTSD according to DSM-IV were recruited from the outpatient clinic of the violence program of Federal University of São Paulo Hospital (Prove-UNIFESP), São Paulo City, between April 2006 and December 2009. Subjects were assessed for the Clinician-Administered Posttraumatic Stress Scale (CAPS), Clinical Global Impression, and Beck Depression Inventory (BDI). After 1-week period of washout, 35 patients were randomized to either group. the primary outcome measure was the CAPS total score changes from baseline to the endpoint. Results: 82.35% of patients in the topiramate group exhibited improvements in PTSD symptoms. the efficacy analysis demonstrated that patients in the topiramate group exhibited significant improvements in reexperiencing symptoms: flashbacks, intrusive memories, and nightmares of the trauma (CAPS-B; P = 0.04) and in avoidance/numbing symptoms associated with the trauma, social isolation, and emotional numbing (CAPS-C; P = 0.0001). Furthermore, the experimental group demonstrated a significant difference in decrease in CAPS total score (topiramate -57.78; placebo -32.41; P = 0.0076). Mean topiramate dose was 102.94 mg/d. Topiramate was generally well tolerated. Conclusion: Topiramate was effective in improving reexperiencing and avoidance/numbing symptom clusters in patients with PTSD. This study supports the use of anti-convulsants for the improvement of symptoms of PTSD.
- ItemAcesso aberto (Open Access)Ensaio clínico randomizado controlado comparativo com mulheres com diagnóstico de Transtorno de Estresse Pós-traumático após abuso sexual entre terapia interpessoal e sertralina(Universidade Federal de São Paulo, 2024-08-09) Proença, Cecília Roberti [UNIFESP]; Mello, Andrea Feijó de [UNIFESP]; Mello, Marcelo Feijá de [UNIFESP]; http://lattes.cnpq.br/9828693113292175; http://lattes.cnpq.br/5024373026936383; http://lattes.cnpq.br/9912936685632887Introdução: A violência sexual é um dos eventos traumáticos que mais frequentemente desencadeia o transtorno de estresse pós-traumático (TEPT), condição clínica que pode se tornar crônica e debilitante se não for tratada precocemente e de forma efetiva. Embora a maioria das diretrizes recomende inibidores seletivos de recaptação de serotonina e psicoterapias focadas no trauma como opções de tratamento, nem todos os pacientes respondem a essas abordagens, além de muitos não tolerarem a exposição às memórias traumáticas. Já existem estudos na literatura que evidenciam a eficácia de terapias não focadas no trauma, como a terapia interpessoal (TIP), que explora as consequências interpessoais do trauma, em vez de confrontar o trauma em si. Objetivo: O presente estudo visa comparar a eficácia da terapia interpessoal adaptada para o TEPT (TIP-TEPT) com a sertralina em mulheres que sofreram violência sexual recente, por meio de um ensaio clínico. Visa também explorar as trajetórias de resposta terapêutica em busca de fatores preditores, principalmente o abuso sexual infantil. Método: Este estudo consistiu em um ensaio clínico randomizado e controlado com duração de 14 semanas, envolvendo mulheres diagnosticadas com TEPT decorrente de violência sexual sofrida até seis meses antes da inclusão. As participantes foram randomizadas para receber um dos dois tratamentos, sertralina ou TIP-TEPT. Após o período de intervenção, as participantes foram acompanhadas até completar um ano da inclusão. Foram aplicados instrumentos de avaliação para mensurar os sintomas de TEPT, ansiedade e depressão. A Escala de TEPT Administrada por Clínicos-5 (CAPS-5) foi a principal medida de desfecho. Além disso, a análise de trajetória de classe latente foi utilizada para avaliar preditores de resposta ao tratamento ao final do ensaio clínico e após um ano de acompanhamento. Resultados: Foram incluídas 74 mulheres, 35 no braço sertralina e 39 no braço TIP. Ambos os tratamentos reduziram significativamente os sintomas de TEPT, ansiedade e depressão, sem diferenças nos resultados entre os grupos. A média da CAPS-5 diminuiu de 42,5 (DP = 9,4) para 27,1 (DP = 15,9) com a sertralina e de 42,6 (DP = 9,1) para 29,1 (DP = 15,5) com a TIP-TEPT. A taxa de abandono do ensaio clínico foi alta, 37,8%, sem diferença significativa entre os grupos (p = 0,40). O modelo não condicional de duas classes, resposta e não resposta, foi o modelo que melhor explicou as trajetórias das pacientes ao longo do estudo. O abuso sexual na infância foi avaliado como fator preditor, sendo associado negativamente à resposta terapêutica. Conclusões: Este ensaio mostrou melhora significativa dos sintomas de TEPT, independente da variável tempo, em ambos os braços do estudo, sem diferenças entre a TIP-TEPT e o tratamento com sertralina, sugerindo que psicoterapias não baseadas em exposição podem beneficiar pacientes com TEPT. A identificação do abuso sexual na infância como fator preditor de resposta terapêutica, independente da abordagem terapêutica, é um alerta para os clínicos avaliarem os pacientes de forma individualizada, personalizando o tratamento a ser oferecido.
- ItemAcesso aberto (Open Access)A estrutura e o metabolismo cerebral de crianças e adolescentes de 7 a 12 anos vítimas de violência(Universidade Federal de São Paulo (UNIFESP), 2017-03-23) Milani, Ana Carolina Coelho [UNIFESP]; Jackowski, Andrea Parolin [UNIFESP]; Mello, Marcelo Feijó de [UNIFESP]; http://lattes.cnpq.br/9828693113292175; http://lattes.cnpq.br/7508415549513991; http://lattes.cnpq.br/6702640941720501; Universidade Federal de São Paulo (UNIFESP)Child maltreatment is a global problem with serious consequences throughout life. Child abuse victims experience many, often multiple, adverse experiences that may result in behavioral changes and psychopathologies such as posttraumatic stress disorder. The main objective of the thesis is to evaluate the impact of traumatic experiences on children between 7 and 12 years of age, victims of violence (with or without psychiatric diagnosis - PTSD or PTSS), on the structure and brain metabolism using magnetic resonance imaging in a prospective study. As a methodology, the study was performed longitudinally (one year follow-up) in children aged 7 to 12 years, victims of violence (with PTSD or PTSS), and compared them with controls exposed to violence (but without psychopathology) and with healthy controls in relation to brain structure and metabolism (in the region of the anterior cingulate gyrus) through magnetic resonance imaging. The results suggest that although structural abnormalities were not observed in patients diagnosed with PTSS / PTSS, metabolic changes (NAA / Cr ratio) were already present, which might reflect that structural magnetic resonance imaging may not be sensitive enough to Detect subtle or shorttime changes, unlike spectroscopy. New longitudinal studies with larger populations and for a longer time are necessary to elucidate the psychobiological consequences of traumas in childhood and adolescence.
- ItemSomente MetadadadosHigher striatal dopamine transporter density in PTSD: an in vivo SPECT study with [Tc-99m]TRODAT-1(Springer, 2012-11-01) Hoexter, Marcelo Q. [UNIFESP]; Fadel, Gustavo [UNIFESP]; Felicio, Andre C. [UNIFESP]; Calzavara, Mariana B. [UNIFESP]; Batista, Ilza R. [UNIFESP]; Reis, Marilia A. [UNIFESP]; Shih, Ming C. [UNIFESP]; Pitman, Roger K.; Andreoli, Sergio B. [UNIFESP]; Mello, Marcelo F. [UNIFESP]; Mari, Jair J. [UNIFESP]; Bressan, Rodrigo A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Israelita Albert Einstein; Harvard UnivSome evidence suggests a hyperdopaminergic state in posttraumatic stress disorder (PTSD). the 9-repetition allele (9R) located in the 3' untranslated region of the dopamine transporter (DAT) gene (SLC6A3) is more frequent among PTSD patients. in vivo molecular imaging studies have shown that healthy 9R carriers have increased striatal DAT binding. However, no prior study evaluated in vivo striatal DAT density in PTSD.The objective of this study was to evaluate in vivo striatal DAT density in PTSD.Twenty-one PTSD subjects and 21 control subjects, who were traumatized but asymptomatic, closely matched comparison subjects evaluated with the Clinician-Administered PTSD Scale underwent a single-photon emission computed tomography scan with [(TC)-T-99m]-TRODAT-1. DAT binding potential (DAT-BP) was calculated using the striatum as the region of the interest and the occipital cortex as a reference region.PTSD patients had greater bilateral striatal DAT-BP (mean +/- SD; left, 1.80 +/- 0.42; right, 1.78 +/- 0.40) than traumatized control subjects (left, 1.62 +/- 0.32; right, 1.61 +/- 0.31; p = 0.039 for the left striatum and p = 0.032 for the right striatum).These results provide the first in vivo evidence for increased DAT density in PTSD. Increases in DAT density may reflect higher dopamine turnover in PTSD, which could contribute to the perpetuation and potentiation of exaggerated fear responses to a given event associated with the traumatic experience. Situations that resemble the traumatic event turn to be interpreted as highly salient (driving attention, arousal, and motivation) in detriment of other daily situations.
- ItemAcesso aberto (Open Access)Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing(Frontiers Research Foundation, 2014-06-10) Raboni, Mara Regina [UNIFESP]; Alonso, Fabiana Fernanda Dias; Tufik, Sergio [UNIFESP]; Suchecki, Deborah [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Assoc Fundo Incent PesquisaPosttraumatic stress disorder (PTSD) patients exhibit depressive and anxiety symptoms, in addition to nightmares, which interfere with sleep continuity. Pharmacologic treatment of these sleep problems improves PTSD symptoms, but very few studies have used psychotherapeutic interventions to treat PTSD and examined their effects on sleep quality. Therefore, in the present study, we sought to investigate the effects of Eye Movement Desensitization Reprocessing therapy on indices of mood, anxiety, subjective, and objective sleep. the sample was composed of 11 healthy controls and 13 PTSD patients that were victims of assault and/or kidnapping. All participants were assessed before, and 1 day after, the end of treatment for depressive and anxiety profile, general well-being and subjective sleep by filling out specific questionnaires. in addition, objective sleep patterns were evaluated by polysomnographic recording. Healthy volunteers were submitted to the therapy for three weekly sessions, whereas PTSD patients underwent five sessions, on average. Before treatment, PTSD patients exhibited high levels of anxiety and depression, poor quality of life and poor sleep, assessed both subjectively and objectively; the latter was reflected by increased time of waking after sleep onset. After completion of treatment, patients exhibited improvement in depression and anxiety symptoms, and in quality of life; with indices that were no longer different from control volunteers. Moreover, these patients showed more consolidated sleep, with reduction of time spent awake after sleep onset. in conclusion, Eye Movement Desensitization and Reprocessing was an effective treatment of PTSD patients and improved the associated sleep and psychological symptoms.
- ItemSomente MetadadadosIs tonic immobility the core sign among conventional peritraumatic signs and symptoms listed for PTSD?(Elsevier B.V., 2009-05-01) Rocha-Rego, Vanessa; Fiszman, Adriana; Portugal, Liana Catarina; Pereira, Mirtes Garcia; Oliveira, Leticia de; Mendlowicz, Mauro V.; Marques-Portella, Carla; Berger, William; Freire Coutinho, Evandro Silva; Mari, Jair J. [UNIFESP]; Figueira, Ivan; Volchan, Eliane; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal Fluminense (UFF); Fiocruz MS; Universidade Federal de São Paulo (UNIFESP)Background: Previous Studies suggested the importance of peritraumatic reactions as predictors of PSTD symptoms severity. Despite mounting evidence that tonic immobility occurs under intense life threats its role as predictor of PTSD severity remains by and large understudied. the objective of this study was to investigate the role of peritraumatic reactions (tonic immobility, panic and dissociation) as predictors of PTSD symptoms severity.Methods: Participants were 32 victims of urban violence with PTSD diagnosed through the SCID-I. in order to evaluate PTSD symptoms at baseline, we used the Post-Traumatic Stress Disorder Checklist - Civilian Version. To assess peritraumatic reactions we employed the Physical Reactions Scale, the Peritraumatic Dissociative Experiences Questionnaire and Tonic Immobility questions. As confounding variables, we considered negative affect (measured by the Positive and Negative Affect Schedule Trait Version), sex and time elapsed since trauma.Results: Tonic immobility was the only predictor of PTSD symptoms severity that kept the statistical significance after controlling for potential confounders.Limitations: This study was based on a relatively small sample recruited in a tertiary clinic, a fact that may limit the generalizability of its findings. the retrospective design may have predisposed to recall bias.Conclusions: Our study provides good reason to conduct more research on tonic immobility in PTSD with other samples and with different time frames in an attempt to replicate these stimulating results. (C) 2008 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosReduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample(Elsevier B.V., 2011-12-01) Baldacara, Leonardo [UNIFESP]; Jackowski, Andrea Parolin [UNIFESP]; Schoedl, Aline [UNIFESP]; Pupo, Mariana [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Mello, Marcelo Feijó de [UNIFESP]; Lacerda, Acioly Luiz Tavares de [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); UFTBackground: Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. in this context, the current study evaluated whether cerebellar volume is associated with PTSD.Methods: Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of 530 Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis.Results: PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. in PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01).Conclusion: the cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development. (C) 2011 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosReduction of anterior cingulate in adults with urban violence- related PTSD(Elsevier B.V., 2014-10-15) Baldacara, Leonardo [UNIFESP]; Zugman, Andre [UNIFESP]; Araujo, Celia [UNIFESP]; Cogo-Moreira, Hugo [UNIFESP]; Tavares Lacerda, Acioly Luiz [UNIFESP]; Schoedl, Aline [UNIFESP]; Pupo, Mariana [UNIFESP]; Mello, Marcelo Feijo [UNIFESP]; Andreoli, Sergio B. [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Jackowski, Andrea Parolin [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed TocantinsBackground: To evaluate differences in limbic structure volume of subjects exposed to urban violence during adulthood, between those who developed posttraumatic stress disorder (with PTSD) and resilient matched controls (without PTSD).Methods: Limbic volumetric measures of 32 subjects with PTSD and 32 subjects without PTSD who underwent brain MRI were analyzed in an epidemiological study in the city of São Paulo. the hippocampus, amygdala, cingulate, and parahipocampal gyri volumes were estimated using FreeSurfer software. We also investigated the association between limbic volumetric measurements, symptom's severity, and early life stress history (measure by Early Trauma Inventory - ETI).Results: Subjects with PTSD presented reduced volume of the right rostral part of the anterior cingulate, compared to subjects without PTSD, after controlling for iraracranial volume, Eft and depressive symptoms. Subjects with PTSD presented larger bilateral hippocampus and right amygdala, but secondary to the higher EU in PTSD group there was a positive correlation between with bilateral hippocampus, bilateral amygclala, and left parahippocampus.Limitations.: First, the cross-sectional study design precludes causal interpretation of limbic structure reduction in PTSD, consequence of PTSD, or other life events. Finally, since the sample size was not sufficiently large, we could not observe whether or not limbic structure volume could be related to the type of trauma.Conclusions: the present study provides evidence of a reduced anterior cingulate volume in subjects with PTSD than in resilient subjects exposed to urban violence. Enlargement of hippocampus and amygdala volume was observed in subjects with PTSD, however secondary to early trauma experience. (C) 2014 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Transtorno de estresse pós-traumático em pacientes de unidade de terapia intensiva(Associação de Medicina Intensiva Brasileira - AMIB, 2010-03-01) Caiuby, Andrea Vannini Santesso [UNIFESP]; Andreoli, Paola Bruno De Araújo; Andreoli, Sergio Baxter [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert Einstein Prática Assistencial MultiprofissionalPost-traumatic stress disorder has been detected in patients after treatment in intensive care unit. The main goal of this study is to review the psychological aspects and therapeutic interventions on those patients after their treatment on intensive care unit. Thirty eight articles have been included. The prevalence of post-traumatic stress disorder has varied from 17% up to 30% and the incidence from 14% to 24%. The risk factors were: previous anxiety historic, depression or panic, having delusional traumatic memories (derived from psychic formations as dreams and delirium), belief effects, depressive behavior, stressing experiences and mechanical ventilation. High doses of opiates, symptoms caused by sedation or analgesia reduction and the use of lorazepam were related with the increase of delirium and delusional memory. The disorder sintomatology can be reduced with hydrocortisone administration, with daily sedation interruption. No other effectiveness psychological intervention study was found.