Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). In a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. In both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. The intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.

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Background: We carried out a qualitative synthesis of international literature to provide insight into the patient’s experience as a means to help clinicians recognize symptoms of anorexia nervosa. Method: International publications from 1990 to 2005 were searched for relevant qualitative investigations, and meta-ethnography was employed to identify common themes across studies. Databases included were PubMed, ISI, PsycINFO, EMBASE, LILACS and SciELO. Results: 24 studies were included from a total of 3,415 papers. The second-order interpretation process using reciprocal translation allowed the identification of two concepts: (1) symptom identification (disease representation, self-concept, development of anorexia) and (2) disease interpretation (positive aspects, negative aspects, areas of life affected). Third-order constructs emerged revealing the disease as connected with identity and control. Conclusion: Knowledge of patients’ efforts to interpret the illness as a part of their own identity and sense of control have a key role in physician understanding of the disorder by allowing physicians to bring structure to the patients’ lives generally and to their help-seeking behavior specifically. The study has some limitations. Most of the results come from B-grade studies (as classified by the Critical Appraisal Skills Programme) that used qualitative methodology, implying the need for caution in data interpretation. Moreover, study populations were almost exclusively female, and no comparison was attempted concerning the severity of the condition between studies.

A validity study of the Brazilian version of the 15-item Short Psychiatric Evaluation Schedule (SPES), included in the mental health assessment of Older Americans Resources and Services (OARS), designed to detect psychiatric disorders in the elderly, against the "caseness" criterion suggested by Cooper and Schwarz was carried out with a community sample, as part of a survey to study health and living conditions of the elderly in a large urban center of a developing country, São Paulo, Brazil. The screening questionnaire was completed by 292 subjects, and 91 were selected for the psychiatric interview. The validity coefficients were as follows: sensitivity 61%, specificity 89%, positive predictive value 66%, negative predictive value 87% and misclassification rate 18%. A discriminant analysis using a stepwise procedure was then applied to select the best item discriminators of the screening questionnaire. The best set of discrimination comprised six items leading to the following validity coefficients: sensitivity 82%, specificity 77%, positive predictive value 58%, negative predictive value 92% and misclassification rate 21%. The possible factors related to false positive and false negative responses on the screening are discussed.