RESUMOO atendimento a pacientes que procuram serviços primários de saúde deveria compreender uma avaliação global, tanto física como psicológica. Diversos estudos internacionais sobre prevalência de transtornos mentais entre pacientes atendidos em serviços de saúde que prestam cuidados primá-rios (1) mostram que de 10 a 31% dos pacientes apresentam pelo menos um tipo de diagnóstico psiquiátrico (principalmente depressão e ansiedade). Além disso, sabe-se que as dificuldades nas interações sociais podem manifestar-se sob a forma de doenças psicossomáticas, problemas emocionais ou de relacionamento, de forma isolada ou em combinação (2, 3).O desenvolvimento de problemas psiquiátricos é influenciado pelas particularidades do indivíduo e de suas interações com a família, sendo que as dificuldades são maiores quando já há outros membros da família com doença psiquiátrica. O processo de adoecimento também é afetado pelas relações de vizinhança, de trabalho e pelas relações do indivíduo com instituições como a escola e os centros de saúde.Para muitos pacientes, o sucesso do tratamento depende do entendimento da dinâmica familiar e da função que a doença assume na família e na vida do próprio paciente. O envolvimento da família no tratamento de todas as manifestações de uma doença, sejam elas de caráter psiquiátrico ou não, freRev Panam Salud Publica/Pan Am J
The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.
In this prospective study, a sample of 86 postpartum women was compared with a sample of 75 women from a random period of 8 consecutive days out of puerperium. Symptoms were evaluated each day using the Blues Questionnaire. Postpartum women and women out of puerperium showed a different distribution of percentile scores on the scale on the third, fourth and fifth days. The postpartum symptom peak occurred on the fifth day. Symptoms more significantly associated with the third, fourth and fifth postpartum days were overemotionalism and oversensitivity. It is concluded that maternity blues in Brazilian women appear to be characterized by maternal mental state alterations occurring on the third, fourth and fifth days postpartum. MB seems to be better defined as an emotional oversensitivity syndrome of cross-cultural dimension than as depression.
Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.
A semi-structured interview for assessing the knowledge and attitude of health workers concerning mental health problems was applied in seven developing country areas within the context of a World Health Organization coordinated collaborative study. The results indicate a lack of basic mental health training associated with a failure to recognize mental health problems,
ANDREOLI, S.B. et al. Estrutura fatorial do questionário de morbidade psiquiátrica de adultos aplicado em amostras populacionais de cidades brasileiras. Rev. Saúde Pública, 28: 249 -60, 1994. A análise de componentes principais é uma técnica de estatística multivariada utilizada para examinar a interdependência entre variáveis. A sua principal característica é a capacidade de reduzir dados, e tem sido usada para o desenvolvimento de instrumentos de pesquisas psiquiátricas e na classificação dos transtornos psiquiátricos. Esta técnica foi utilizada para estudar a estrutura fatorial do Questionário de Morbidade Psiquiátrica do Adulto (QMPA). O questionário foi composto de 45 questões de resposta sim/não que identificam sintomas psiquiátricos, uso de serviço e de drogas psicotrópicas. O questionário foi aplicado em 6.470 indivíduos maiores de 15 anos, em amostras representativas da população de três cidades brasileiras (Brasília, São Paulo e Porto Alegre). O estudo teve como objetivo comparar a estrutura fatorial do questionário nas três regiões urbanas brasileiras. Sete fatores foram encontrados que explicam 42,7% da variância total da amostra. O fator l, Ansiedade/Somatização ("eigenvalue" (EV) = 3.812 e variância explicada (VÊ) = 10,9%); O fator 2, Irritabilidade/Depressão (EV = 2.412 e VE = 6,9%); O fator 3, Deficiência Mental (EV= 2.014 e VE = 5,8%); O fator 4, Alcoolismo (EV = 1.903 e VE = 5,4%); O fator 5, Exaltação do Humor (EV = 1.621 e VE = 4,6%); O fator 6, Transtorno de Percepção (EV = 1.599 e VE = 4,6%) e o fator 7, Tratamento (EV = 1.592 e VE = 4,5%).O QMPA apresentou estruturas fatoriais semelhantes nas três cidades. Baseados nos achados, são feitas sugestões para que algumas questões sejam modificadas e para a exclusão de outras em uma futura versão do questionário.Descritores: Psiquiatria, métodos. Escalas de graduação psiquiátrica. Análise fatorial. IntroduçãoA natureza e a estrutura sintomatológica da morbidade psiquiátrica na comunidade têm sido crescentemente consideradas como importante tópico para pesquisas de cunho epidemiológico. Uma das estratégias dessa abordagem é aquela em que os dados são explorados em ordem para determinar a sua estrutura, requerendo a aplicação de técnicas de análise multivariada (Vázquez-Barquero e col. 22 , 1988). O uso da análise fatorial e da análise de componentes principais para examinar dados coletados na comunidade através de escalas de rastreamento como o "General Health Questionnarie" (GHQ) (Goldberg 9,10,11 , 1972(Goldberg 9,10,11 , , 1978(Goldberg 9,10,11 , , 1990
Dear Edi tor:Jer ome (1) dis cusses a re cent clini cal situa tion in volv ing a mother with depres sion who is cur rently re fus ing an tide pres sants for fear of harm ing her un born sec ond child. A re port that infants ex posed to fluoxet ine in the third tri mes ter had higher rates of pre ma ture de liv ery, res pi ra tory dif fi culty, jit teriness, cya no sis, and lower birth weight sup ports her con cern (2). Neu ro bio logical fea tures are sug gested by stud ies link ing sub clini cal im pair ment of lung air ways in panic dis or der, uter ine ir ri tabil ity in pre term la bour, and dys regu lation of mood (3,4). Simi larly, an other study in di cates that anxi ety dis or ders in fe male chil dren pre dict rela tively short stat ure in early adult hood due to in hi bition of growth hor mone by do pa mine ab nor mali ties lat er al ized to the right hemi sphere, for which the meta bolic rate is higher in girls and women (5).This hy pothe sis is sup ported by 2 reports. The first re port ob serves that se roto ner gic in hi bi tion of do pa mine in mice, caused by pre na tal ex po sure to a clinically rele vant dose of par oxet ine, may have height ened the per form ance on se lect anxi ety tests of in fant off spring, as evi denced by more sepa ra tion vo cali zation among both male and fe male pups (6). The sec ond re port con cludes that ciga rette smok ing in creases the risk of cer tain anxi ety dis or ders dur ing late ado les cence and early adult hood (7). These find ings prompt neu ro chemi cal and phar ma co thera peu tic in ves ti ga tion of the dys regu la tion of an cient neu romodu la tory sys tems in evolv ing brains (4). Ondansetron Rather Than Metoclopramide for Bupropion-Induced Nausea Dear Edi tor:Bupropion, once only an an ti de pres sant pre scribed by psy chia trists, is now routinely in di cated by any phy si cian to help pa tients stop smok ing (1). Al though usu ally well tol er ated, bupropion may cause nau sea (1,2), a side ef fect con sistent with do pa min er gic stimu la tion that might af fect treat ment ad her ence and effec tive ness. It might at first ap pear that this prob lem could be han dled eas ily by pre scrib ing the an tie metic me to clo pramide, a do pa mine D 2 an tago nist (3), or by re duc ing the dos age. This strat egy, how ever, could in the ory in ter fere with the ef fi cacy of bupropion, be cause its pro posed mecha nism of ac tion is precisely the en hance ment of do pa min er gic ac tiv ity (4).We re port the case of a 38-year-old woman who ex pe ri enced mod er ate nausea as she ini ti ated treat ment with 300 mg daily of bupropion (Zy ban), taken for de pres sion. This side ef fect was only par tially re lieved by the his ta mine H 1 an tago nist di men hy dri nate. It was, however, suc cess fully treated with the se rotonin 5-HT 3 an tago nist on dan setron (3) (8 mg orally as needed). Af ter 8 days of treat ment, the pa tient was able to dis continue this medi ca tion with out need ing to re duce the bupropion dos age. We therefore sug gest t...
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