Morbidade psiquiátrica em pacientes com coréia de Sydenham: um estudo descritivo
Data
2000
Autores
Zappitelli, Marcelo Cardoso 
Orientadores
Porto, Jose Alberto Del
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A literatura tem demonstrado variada morbidade psiquiátrica em crianças e adolescentes com coréia de Sydenham, apontando para uma maior freqüência tanto de transtorno obsessivo-compulsivo e tiques como de quadros de ansiedade, depressão e hiperatividade com déficit de atenção. A presente pesquisa vem contribuir para o maior conhecimento desta morbidade psiquiátrica associada à coréia reumática em jovens do nosso meio. Objetivos: Avaliar a sintomatologia psiquiátrica em um grupo de crianças e adolescentes com coréia de Sydenham, identificando os transtornos psiquiátricos e os problemas de saúde mental presentes, verificando se tal sintomatologia remitia com a melhora do quadro coreico. Verificar possíveis alterações em exames de ressonância magnética de crânio e cintilografia cerebral. Verificar a influência de fatores estressores sobre a saúde mental de crianças e adolescentes com coréia de Sydenham. Método: Desenho do estudo: série de casos. A amostra constituiu-se por todos os pacientes com coréia de Sydenham aguda atendidos no ambulatório de Reumatologia Pediátrica e Alergia do Departamento de Pediatria da Universidade Federal de São Paulo, Escola Paulista de Medicina, durante um ano (N=12). Os participantes foram submetidos a uma avaliação psiquiátrica, incluindo entrevistas com os pacientes e seus responsáveis, além da aplicação de instrumentos padronizados (Kiddie-Sads-Present Episode, Child Behavior Checklist, Leyton Obsessional Inventory Child Version). Problemas de saúde mental dos responsáveis foram identificados através do Self Reporting Questionnaire. Todos os pacientes foram acompanhados por um período aproximado de três meses. Resultados: Considerando-se os 12 pacientes da amostra estudada (11 meninas e um menino, com idades entre sete e 15 anos), observou-se a presença de transtorno de ansiedade de separação (33,3%) e episódio depressivo maior (8,3%) segundo critérios do DSM-IV. Os pacientes que não preencheram critérios diagnósticos apresentaram quadros subclínicos (ansiedade ou depressão) ou sintomas isolados variados. Quanto ao total de problemas de saúde mental detectados pelo CBCL, 41,7% dos casos apresentaram escores T total em nível clínico, 33,3% tiveram problemas de saúde mental do tipo ¿internalização¿ e 41,7% do tipo ¿externalização¿. Em relação às escalas individuais, problemas com a atenção foi a escala que se mostrou mais freqüente (25%). O seguimento dos pacientes demonstrou que a sintomatologia psiquiátrica melhorou com a remissão da coréia. Devido ao tamanho reduzido da amostra a associação entre problemas de saúde mental no responsável (41,7% da amostra) e morbidade psiquiátrica, não pode ser verificada. Conclusões: Crianças e adolescentes coreicos tendem a apresentar sintomatologia psiquiátrica concomitante à coréia de Sydenham. Transtorno de ansiedade de separação é um transtorno psiquiátrico próprio da infância que pode estar associado à coréia de Sydenham aguda. Crianças e adolescentes coreicos tendem a apresentar problemas de saúde mental dos tipos “externalização” e “internalização” concomitantes à coréia de Sydenham. Problemas com a atenção podem estar associados à coréia de Sydenham aguda. Alterações nos gânglios da base e de perfusão em lobo temporal podem estar associadas à coréia de Sydenham. A morbidade psiquiátrica que acompanha o quadro coreico, tende a desaparecer com a remissão da coréia. A possível influência de fatores estressores sobre a saúde mental de crianças e adolescentes com coréia de Sydenham aguda não parece ser independente do próprio quadro coreico, pois os problemas de saúde mental não persistem após a remissão da coréia.
Background: A variety of psychiatric morbidity in children and adolescents with Sydenham’s chorea has been reported in the literature, which has highligthed the high frequency of obsessive-compulsive disorder, tics, anxiety, depression and attention deficit hyperactive disorder. The present study can contribute to the knowledge of the psychiatric morbidity associated to Sydenham’s chorea in Brazilian youngsters. Objectives: To evaluate psychiatric symptoms in a clinical sample of children and adolescents with Sydenham’s chorea, identifying psychiatric disorders and behaviour problems, and verifying whether these symptoms disappear with Sydenham’s chorea remission. To verify structural or functional alterations in imaging of brain. To verify the influence of stressors on the mental health of children with Sydenham’s chorea. Method: Study design: case series. Sample (N=12) included all patients with acute Sydenham’s chorea assisted at Paediatric Reumatology outpatient clinic from Universidade Federal de São Paulo- Escola Paulista de Medicina throughout a year. Data collection was based on psychiatric evaluation of the study subjects, including the use of standardized instruments (K-Sads-P, LOI-CV, CBCL). Mothers or substitutes were interviewed to complete the Self Reporting Questionnaire, a screening instrument to identify mental health problems in adults. Results: In our sample (11 girls and a boy aged 7–15 years) 33,3% met DSM-IV criteria for separation anxiety disorder and 8,3% for major depressive episode. Those who did not meet criteria for any disorder were not free from psychiatric symptomatology (subthreshold clinical features of anxiety and/or depression or varied isolated symptoms). According to CBCL, 41,7% of patients were identified as clinical cases (total behaviour problem T score above the cut-off), 33,3% had internalizing behaviour problems and 41,7% had externalizing behaviour problems. When considering CBCL individual scales the most frequent syndrome was attention problems (25%). The follow-up of patients pointed out the non endurance of psychopathology which disappeared with Sydenham's chorea remission. Owing to reduced sample size, the association of maternal mental health problems (41,7%) with child psychiatric morbidity could not be verified. Conclusions: Patients with acute Sydenham’s chorea have a great number of psychiatric symptoms. Deserves special attention the presence of separation anxiety disorder, externalizing and internalizing behaviour problems and attention problems. The psychiatric morbidity seems to be temporary with no persistence after remission of Sydenham’s chorea, nevertheless. Alterations in basal ganglia and underperfusion of the temporal areas of the brain can be associated to Sydenham’s chorea. The influence of stressors on child mental health does not appear to be independent of chorea itself, due to non persistence of mental health problems after chorea remission.
Background: A variety of psychiatric morbidity in children and adolescents with Sydenham’s chorea has been reported in the literature, which has highligthed the high frequency of obsessive-compulsive disorder, tics, anxiety, depression and attention deficit hyperactive disorder. The present study can contribute to the knowledge of the psychiatric morbidity associated to Sydenham’s chorea in Brazilian youngsters. Objectives: To evaluate psychiatric symptoms in a clinical sample of children and adolescents with Sydenham’s chorea, identifying psychiatric disorders and behaviour problems, and verifying whether these symptoms disappear with Sydenham’s chorea remission. To verify structural or functional alterations in imaging of brain. To verify the influence of stressors on the mental health of children with Sydenham’s chorea. Method: Study design: case series. Sample (N=12) included all patients with acute Sydenham’s chorea assisted at Paediatric Reumatology outpatient clinic from Universidade Federal de São Paulo- Escola Paulista de Medicina throughout a year. Data collection was based on psychiatric evaluation of the study subjects, including the use of standardized instruments (K-Sads-P, LOI-CV, CBCL). Mothers or substitutes were interviewed to complete the Self Reporting Questionnaire, a screening instrument to identify mental health problems in adults. Results: In our sample (11 girls and a boy aged 7–15 years) 33,3% met DSM-IV criteria for separation anxiety disorder and 8,3% for major depressive episode. Those who did not meet criteria for any disorder were not free from psychiatric symptomatology (subthreshold clinical features of anxiety and/or depression or varied isolated symptoms). According to CBCL, 41,7% of patients were identified as clinical cases (total behaviour problem T score above the cut-off), 33,3% had internalizing behaviour problems and 41,7% had externalizing behaviour problems. When considering CBCL individual scales the most frequent syndrome was attention problems (25%). The follow-up of patients pointed out the non endurance of psychopathology which disappeared with Sydenham's chorea remission. Owing to reduced sample size, the association of maternal mental health problems (41,7%) with child psychiatric morbidity could not be verified. Conclusions: Patients with acute Sydenham’s chorea have a great number of psychiatric symptoms. Deserves special attention the presence of separation anxiety disorder, externalizing and internalizing behaviour problems and attention problems. The psychiatric morbidity seems to be temporary with no persistence after remission of Sydenham’s chorea, nevertheless. Alterations in basal ganglia and underperfusion of the temporal areas of the brain can be associated to Sydenham’s chorea. The influence of stressors on child mental health does not appear to be independent of chorea itself, due to non persistence of mental health problems after chorea remission.
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Citação
São Paulo: [s.n.], 2000. 121 p.