Estudo prospectivo de atenção e funções executivas em vítimas de violência urbana com transtorno do estresse pós-traumático
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Data
2016
Autores
Mozzambani, Adriana Cristine Fonseca [UNIFESP]
Orientadores
Mello, Marcelo Feijó de [UNIFESP]
Tipo
Tese de doutorado
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Resumo
Resumo: Evidências científicas mostraram correlações significativas entre os sintomas do transtorno de estresse pós-traumático e déficits no processamento cognitivo. Modelos explicativos usam dados de estudos neuropsicológicos que mostram perdas em áreas como memória, atenção, orientação espacial, regulação do comportamento emocional e funções executivas. Compreender como esses déficits correlacionam com sintomas do transtorno de estresse pós-traumático em estudos prospectivos podem fornecer argumentos para melhorar modelos explicativos de mecanismos patológicos desta doença. Objetivo: Avaliar prospectivamente adultos vítimas de violência urbana que sofrem do transtorno de estresse pós-traumático, considerando seu impacto na atenção, funções executivas e os fatores associados a estas Mudanças. Método: reaplicação de uma bateria de testes neuropsicológicos em uma coorte de quarenta e três pacientes com transtorno de estresse pós-traumático devido à violência urbana. Os pacientes participaram antes de um estudo caso-controle. Convidamos esses pacientes nesse estudo a partir de um estudo epidemiológico realizado na cidade de São Paulo. Na sua inclusão, esses pacientes foram avaliados e tratados no Programa de Cuidados e Tratamento da Violência da Universidade Federal de São Paulo. Eles foram submetidos a uma avaliação clínica e neuropsicológica que reavaliamos posteriormente. Os períodos de reavaliação variaram de um mínimo de três e máximo de seis anos após o tratamento. Também reaplicamos a Escala de Estresse Pós-Traumático Clínico - Administrada, e o inventário de Depressão de Beck. Administramos uma bateria de testes neuropsicológicos: Dígitos - ordem direta e inversa, Spatial Span - ordem direta e inversa, Stroop, e Wisconsin Card Sort Test.Resultados: Os pacientes apresentaram melhora clínica evidenciada por uma diminuição estatisticamente significativa nas escalas no follow-up. Em relação aos testes neuropsicológicos, foram encontradas diferenças significativas no follow-up, como um número reduzido de erros perseverativos no Wisconsin (p = 0,004) e um aumento no span do subteste dígitos ordem inversa (p = 0,007). Estas mudanças
estão diretamente associadas com o nível de escolaridade (p = 0,030), e sintomas do transtorno de estresse pós-traumático (p = 0,005). Os pacientes, em média, mostraram uma melhoria nos sintomas de estresse pós- traumático e depressão na xiii reavaliação. Conclusão: Os dados mostraram uma melhora no desempenho cognitivo das funções executivas, como memória operacional e flexibilidade cognitiva ao longo dos anos. Essas melhorias são significativas para os pacientes
com mais anos de escolaridade e para aqueles que se recuperaram clinicamente. Os dados sugerem que a gravidade da patologia do estresse pós-traumático afeta a flexibilidade cognitiva e, quanto maior a gravidade, maior o risco de erros perseverativos.
Abstract: Scientific evidence showed significant correlations between symptoms of posttraumatic stress disorder and deficits in cognitive processing. Explanatory models use data from neuropsychological studies showing losses in areas such as memory, attention, spatial orientation, regulation of emotional behavior, and executive functions. Understanding how these deficits correlate with symptoms of posttraumatic stress disorder in prospective studies can provide arguments to improve explanatory models of pathological mechanisms of this disorder. Objective: To prospectively evaluate adult victims of urban violence suffering from posttraumatic stress disorder, considering its impact on attention, executive functions, and the factors associated with these changes. Method: Reapplication of a battery of neuropsychological tests on a cohort of 43 patients with posttraumatic stress disorder due to urban violence. The patients participated in a case-control study before. We invited these patients in that study from an epidemiological study conducted in the city of São Paulo. At their inclusion, these patients were evaluated and treated at Program of Care and Treatment of Violence at the Federal University of São Paulo. They underwent a clinical and neuropsychological assessment, and we reassessed them afterward. The periods of reassessment ranged from a minimum of three and maximum of six years after treatment. We also re-applied the Clinician Administered Posttraumatic Scales, and the Beck Depression Inventory scales. We administered a battery of neuropsychological tests: Digit Span (forward and backward), Spatial Span (forward and backward), Stroop, and Wisconsin Card Sort Test. Results: Patients showed a clinical improvement evidenced by a statistically significant decrease in Clinician Administered Posttraumatic Scales and the Beck Depression Inventory scales scores at follow-up. Regarding neuropsychological testing, significant differences were found at follow-ups such as a reduced number of perseverative errors in Wisconsin Card Sort Test (p=0.004) and an increase in the span of the backward digit subtest (p=0.007). These changes are directly associated with education level (p = 0.030), and posttraumatic stress disorder symptoms (p = 0.005). Patients on average showed an improvement in posttraumatic stress disorder and depression symptoms at re-evaluation. Conclusion: The data showed an improvement in cognitive performance of executive functions such as working xv memory and cognitive flexibility over the years. These enhancements are significant for better-educated patients, and for those that recovery clinically. The data suggests that the severity of posttraumatic stress disorder pathology affects cognitive flexibility, the greater the severity, bigger was the risk of making perseverative errors.
Abstract: Scientific evidence showed significant correlations between symptoms of posttraumatic stress disorder and deficits in cognitive processing. Explanatory models use data from neuropsychological studies showing losses in areas such as memory, attention, spatial orientation, regulation of emotional behavior, and executive functions. Understanding how these deficits correlate with symptoms of posttraumatic stress disorder in prospective studies can provide arguments to improve explanatory models of pathological mechanisms of this disorder. Objective: To prospectively evaluate adult victims of urban violence suffering from posttraumatic stress disorder, considering its impact on attention, executive functions, and the factors associated with these changes. Method: Reapplication of a battery of neuropsychological tests on a cohort of 43 patients with posttraumatic stress disorder due to urban violence. The patients participated in a case-control study before. We invited these patients in that study from an epidemiological study conducted in the city of São Paulo. At their inclusion, these patients were evaluated and treated at Program of Care and Treatment of Violence at the Federal University of São Paulo. They underwent a clinical and neuropsychological assessment, and we reassessed them afterward. The periods of reassessment ranged from a minimum of three and maximum of six years after treatment. We also re-applied the Clinician Administered Posttraumatic Scales, and the Beck Depression Inventory scales. We administered a battery of neuropsychological tests: Digit Span (forward and backward), Spatial Span (forward and backward), Stroop, and Wisconsin Card Sort Test. Results: Patients showed a clinical improvement evidenced by a statistically significant decrease in Clinician Administered Posttraumatic Scales and the Beck Depression Inventory scales scores at follow-up. Regarding neuropsychological testing, significant differences were found at follow-ups such as a reduced number of perseverative errors in Wisconsin Card Sort Test (p=0.004) and an increase in the span of the backward digit subtest (p=0.007). These changes are directly associated with education level (p = 0.030), and posttraumatic stress disorder symptoms (p = 0.005). Patients on average showed an improvement in posttraumatic stress disorder and depression symptoms at re-evaluation. Conclusion: The data showed an improvement in cognitive performance of executive functions such as working xv memory and cognitive flexibility over the years. These enhancements are significant for better-educated patients, and for those that recovery clinically. The data suggests that the severity of posttraumatic stress disorder pathology affects cognitive flexibility, the greater the severity, bigger was the risk of making perseverative errors.
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Citação
MOSSAMBANI, Adriana Cristine Fonseca. Estudo prospectivo de atenção e funções executivas em vítimas de violência urbana com transtorno do estresse pós-traumático. 2016. 112 f. Tese (Doutorado em Psiquiatria e psicologia médica) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2016.