Estudo Comparado entre Alcoólicos e Não Alcoólicos: sintomas psicopatológicos: amostra brasileira

Os sintomas psicológicos nos indivíduos consumidores de álcool é o tema investigado neste trabalho, que se dedicou a analisar as diferenças entre grupos de indivíduos alcoólicos e não alcoólicos homens e mulheres. A oportunidade desta investigação se originou no trabalho de psicologia clínica com pacientes alcoólicos e, principalmente, frente às carências bibliográficas no mercado sobre o assunto. O presente trabalho, buscou, portanto, investigar-se, a partir das hipóteses, a intensidade de problemas psicológicos e sintomas psicopatológicos em sujeitos alcoólicos de ambos os sexos. Para tal, foram realizadas entrevistas orientadas para a aplicação do instrumento. O instrumento utilizado na pesquisa foi o SCL 90-R (Symptom Check List 90 - Revised) (DEROGATIS, 1983) que se propõe a medir a intensidade dos sintomas, especificamente em casos de alcoolismo, sendo este instrumento validado no Brasil (LALONI, 2001). Os sintomas psicológicos avaliados foram: Psicose, Relações Interpessoais, Ansiedade, Ideação Paranóide, Hostilidade, Depressão, Fobia e Obsessivo Compulsivo. A população investigada abrangeu pessoas não consumidoras de álcool da comunidade e pessoas alcoólicas pertencentes aos AA (Alcoólicos Anônimos). Os dois grupos pertencem à Região Metropolitana de Porto Alegre no Estado do Rio Grande do Sul, Brasil. A comparação foi abrangente em relação aos aspectos de gênero, pois além de comparar o grupo de alcoólicos e não alcoólicos verificou as relações de gênero, analisando as diferenças entre o grupo de homens e mulheres alcoólicos e não alcoólicos. Os resultados encontrados demonstram que os alcoólicos são mais sintomáticos que os não alcoólicos e as mulheres apresentam-se em relação aos sintomas avaliados com médias mais altas que os homens. Os alcoólicos homens e mulheres não diferem de forma estatisticamente significativa em seus sintomas psicológicos. Da mesma forma homens e mulheres não alcoólicos não diferem em seus sintomas psicológicos. / The subject of this research concerns about psychological symptoms on alcohol consuming individuals, analyzing the differences between groups of alcoholic and non alcoholic individuals, men and women. This investigation arose from the psychological clinic work with alcoholic patients in face of the lack of literature about this subject. Based on the hypothesis we investigated the intensity of psychological problems and psychopathological symptoms in alcoholic individuals of both sexes. We also evaluated the presence and intensity of psychological problems and psychopathological symptoms in non alcoholic individuals of both sexes. For this research we performed interviews oriented to the application of the instrument. The instrument employed in the research was SCL 90-R (Symptom Check List 90 - Revised) (DEROGATIS, 1983) which measures the intensity of the symptoms. The instrument was validated in Brazil (LALONI, 2001) and is specific to evaluate symptoms in case of alcoholism. The psychological symptoms we evaluated were: Psychosis, Interpersonal Relations, Anxiety, Paranoid Ideation, Hostility, Depression, Phobia, and Obsessive Compulsive. The population investigated is formed by non alcohol consuming people and alcoholics belonging to the Anonymous Alcoholics (AA). Both groups are from the Metropolitan Region of Porto Alegre in the southern sate of Rio Grande do Sul, Brazil. The comparison was comprehensive regarding the aspects of gender, since besides comparing the group of alcoholics and non alcoholics, it compared alcoholic men and women among themselves, and non alcoholic men and women as well. The results that were found demonstrate that alcoholics are more symptomatic than non alcoholics and women, regarding the evaluated symptoms, present themselves with higher averages than men. Alcoholic men and women do not expressively differ in their psychological symptoms, as non alcoholic men and women do not expressively differ in their psychological symptoms as well.

Deteção da simulação em indivíduos com e sem diagnóstico de depressão

A simulação consiste na produção voluntária de sintomas físicos e psicológicos para obter compensações externas. O presente estudo tem como objetivo avaliar a eficácia de um conjunto de instrumentos utilizados na identificação de situações de simulação, bem como averiguar se esses instrumentos são sensíveis a sintomas psicopatológicos. Deste modo, espera-se que os resultados obtidos pelos grupos com depressão e sem depressão honestos difiram significativamente dos resultados obtidos pelo grupo sem depressão simulador. Para tal, foi recolhida uma amostra de 59 sujeitos, todos do sexo feminino, divididos por três grupos: com diagnóstico de depressão (n=19), sem diagnóstico de depressão simuladores (n=20) e sem diagnóstico de depressão honestos (n=20). O protocolo de avaliação incluiu o Test of Memory Malingering (TOMM: Tombaugh, 1996), o Structured Inventory Malingered Symptomatology (SIMS: Widows & Smith), os subtestes de Memória de Dígitos e dos Cubos da WAIS-III, (Wechsler, 1997) e a Figura Complexa de Rey (FCR: Rey, 1988). Os resultados não sugerem diferenças significativas no primeiro e segundo ensaios de aprendizagem do TOMM entre os grupos em estudo. No ensaio de retenção, o grupo sem diagnóstico de depressão simulador difere significativamente do grupo sem diagnóstico de depressão honesto. No SIMS, apenas a subescala Psicose (P) difere significativamente entre os grupos com diagnóstico de depressão e sem diagnóstico de depressão simulador. As subescalas Défices Neurológicos (NI), Perturbações Afetivas (AF), P e Perturbações Mnésicas (AM), com exceção da escala Capacidade Intelectual Reduzida (LI) diferem significativamente entre os grupos com diagnóstico de depressão e sem diagnóstico de depressão honesto e entre este e o grupo sem diagnóstico de depressão simulador. No subteste de Memória de Dígitos verifica-se diferenças significativas entre os grupos sem diagnóstico de depressão simulador e honesto. No subteste dos Cubos não foram encontradas diferenças significativas entre os grupos estudados e na cópia da FCR foram encontradas diferenças significativas entre os grupos com diagnóstico de depressão e sem diagnóstico de depressão simulador. Este estudo contribui para o enriquecimento da literatura nacional e internacional, uma vez que inclui um grupo clínico e alguns instrumentos que não são habitualmente utilizados numa avaliação de simulação. Para além disso, estes resultados têm implicações no contexto clínico e forense, no sentido preventivo e de conhecimento da doença mental.

Identifying Risk Factors for Postpartum Mood Episodes in Bipolar Disorder – A UK Prospective Study

Background and Aims: Women with bipolar disorder are vulnerable to episodes postpartum, but risk factors are poorly understood. We are exploring risk factors for postpartum mood episodes in women with bipolar disorder using a prospective longitudinal design. Methods: Pregnant women with lifetime DSM-IV bipolar disorder are being recruited into the Bipolar Disorder Research Network (www.BDRN.org). Baseline assessments during late pregnancy include lifetime psychopathology and potential risk factors for perinatal episodes such as medication use, sleep, obstetric factors, and psychosocial factors. Blood samples are taken for genetic analysis. Perinatal psychopathology is assessed via follow-up interview at 12-weeks postpartum. Interview data are supplemented by clinician questionnaires and case-note review. Potential risk factors will be compared between women who experience perinatal episodes and those who remain well. Results: 80 participants have been recruited to date. 32/61 (52%) women had a perinatal recurrence by follow-up. 16 (26%) had onset in pregnancy. 21 (34%) had postpartum onset, 19 (90%) within 6-weeks of delivery: 11 (18%) postpartum psychosis, 5 (8%) postpartum hypomania, 5 (8%) postpartum depression. Postpartum relapse was more frequent in women with bipolar-I than bipolar-II disorder (45% vs 17%). 62% women with postpartum relapse took prophylactic medication peripartum and almost all received care from secondary psychiatric services (95%). Conclusions: Rate of postpartum relapse is high, despite most women receiving specialist care and medication perinatally. A larger sample size will allow us to examine potential risk factors for postpartum episodes, which will assist in providing accurate and personalised advice to women with bipolar disorder who are considering pregnancy.

Autistic and Schizotypal Traits and Global Functioning in Bipolar Disorder

Background and Aims To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar disorder (BD), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD. Methods Autistic and positive schizotypal traits were assessed in 797 individuals with BD recruited by the Bipolar Disorder Research Network (BDRN), using the Autism-Spectrum Quotient and Kings Schizotypy Questionnaire (KSQ), respectively. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits. Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results 47.2% (CI = 43.7–50.7%) showed clinically significant levels of autistic traits. Mean of sample on the KSQ-Positive scale was 11.98 (95% CI: 11.33–12.62). In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning than the low autistic, low positive schizotypal group (mean difference = 3.72, p = 0.004). High levels of co-occurring traits were associated with better global functioning in both mood states in individuals with a history of psychosis (GASM: p < 0.001; GASD: p = 0.055). Conclusions Expression of autistic and schizotypal traits in adults with BD is prevalent, and may be important to predict course of illness, prognosis, and in devising individualised therapies. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

Lo que sé de los hombrecillos de Juan José Millás: la ficción psicótica de la sociedad perfecta.

This short essay deals with literary representations of identity and of social reality, especially in relation to the novelistic works published by the Spanish writer Juan José Millás. The article is divided into three parts. The first section is dedicated to a general overview of the new perspectives brought by the contemporary ‘linguistic turn’ in culture, which is currently considered as the product of different discourses and not as an ontological datum. The postmodern condition, on the other hand, is described as the age in which it has become radically difficult to rely on such ideas as “nation” and “people” for the construction of personal identity. The second part of the article identifies Millás’ poetics as an excellent example of describing the neurotic symptoms produced by the urban way of life in Western communities. Millás recognizes the separateness between language and material reality as the origin of the subject's isolation, especially in contemporary life. Finally, the third part handles with Lo que sé de los hombrecillos, the last novel by Millás, in which we witness a significant switch from neurosis to psychosis in the mind of the protagonist who offers us a distorted realisation of his idea of community and plenitude.

Identifying health inequalities in individuals with major mental illness (MMI) using routine data

Abstract and Summary of Thesis: Background: Individuals with Major Mental Illness (such as schizophrenia and bipolar disorder) experience increased rates of physical health comorbidity compared to the general population. They also experience inequalities in access to certain aspects of healthcare. This ultimately leads to premature mortality. Studies detailing patterns of physical health comorbidity are limited by their definitions of comorbidity, single disease approach to comorbidity and by the study of heterogeneous groups. To date the investigation of possible sources of healthcare inequalities experienced by individuals with Major Mental Illness (MMI) is relatively limited. Moreover studies detailing the extent of premature mortality experienced by individuals with MMI vary both in terms of the measure of premature mortality reported and age of the cohort investigated, limiting their generalisability to the wider population. Therefore local and national data can be used to describe patterns of physical health comorbidity, investigate possible reasons for health inequalities and describe mortality rates. These findings will extend existing work in this area. Aims and Objectives: To review the relevant literature regarding: patterns of physical health comorbidity, evidence for inequalities in physical healthcare and evidence for premature mortality for individuals with MMI. To examine the rates of physical health comorbidity in a large primary care database and to assess for evidence for inequalities in access to healthcare using both routine primary care prescribing data and incentivised national Quality and Outcome Framework (QOF) data. Finally to examine the rates of premature mortality in a local context with a particular focus on cause of death across the lifespan and effect of International Classification of Disease Version 10 (ICD 10) diagnosis and socioeconomic status on rates and cause of death. Methods: A narrative review of the literature surrounding patterns of physical health comorbidity, the evidence for inequalities in physical healthcare and premature mortality in MMI was undertaken. Rates of physical health comorbidity and multimorbidity in schizophrenia and bipolar disorder were examined using a large primary care dataset (Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICE)). Possible inequalities in access to healthcare were investigated by comparing patterns of prescribing in individuals with MMI and comorbid physical health conditions with prescribing rates in individuals with physical health conditions without MMI using SPICE data. Potential inequalities in access to health promotion advice (in the form of smoking cessation) and prescribing of Nicotine Replacement Therapy (NRT) were also investigated using SPICE data. Possible inequalities in access to incentivised primary healthcare were investigated using National Quality and Outcome Framework (QOF) data. Finally a pre-existing case register (Glasgow Psychosis Clinical Information System (PsyCIS)) was linked to Scottish Mortality data (available from the Scottish Government Website) to investigate rates and primary cause of death in individuals with MMI. Rate and primary cause of death were compared to the local population and impact of age, socioeconomic status and ICD 10 diagnosis (schizophrenia vs. bipolar disorder) were investigated. Results: Analysis of the SPICE data found that sixteen out of the thirty two common physical comorbidities assessed, occurred significantly more frequently in individuals with schizophrenia. In individuals with bipolar disorder fourteen occurred more frequently. The most prevalent chronic physical health conditions in individuals with schizophrenia and bipolar disorder were: viral hepatitis (Odds Ratios (OR) 3.99 95% Confidence Interval (CI) 2.82-5.64 and OR 5.90 95% CI 3.16-11.03 respectively), constipation (OR 3.24 95% CI 3.01-3.49 and OR 2.84 95% CI 2.47-3.26 respectively) and Parkinson’s disease (OR 3.07 95% CI 2.43-3.89 and OR 2.52 95% CI 1.60-3.97 respectively). Both groups had significantly increased rates of multimorbidity compared to controls: in the schizophrenia group OR for two comorbidities was 1.37 95% CI 1.29-1.45 and in the bipolar disorder group OR was 1.34 95% CI 1.20-1.49. In the studies investigating inequalities in access to healthcare there was evidence of: under-recording of cardiovascular-related conditions for example in individuals with schizophrenia: OR for Atrial Fibrillation (AF) was 0.62 95% CI 0.52 - 0.73, for hypertension 0.71 95% CI 0.67 - 0.76, for Coronary Heart Disease (CHD) 0.76 95% CI 0.69 - 0.83 and for peripheral vascular disease (PVD) 0.83 95% CI 0.72 - 0.97. Similarly in individuals with bipolar disorder OR for AF was 0.56 95% CI 0.41-0.78, for hypertension 0.69 95% CI 0.62 - 0.77 and for CHD 0.77 95% CI 0.66 - 0.91. There was also evidence of less intensive prescribing for individuals with schizophrenia and bipolar disorder who had comorbid hypertension and CHD compared to individuals with hypertension and CHD who did not have schizophrenia or bipolar disorder. Rate of prescribing of statins for individuals with schizophrenia and CHD occurred significantly less frequently than in individuals with CHD without MMI (OR 0.67 95% CI 0.56-0.80). Rates of prescribing of 2 or more anti-hypertensives were lower in individuals with CHD and schizophrenia and CHD and bipolar disorder compared to individuals with CHD without MMI (OR 0.66 95% CI 0.56-0.78 and OR 0.55 95% CI 0.46-0.67, respectively). Smoking was more common in individuals with MMI compared to individuals without MMI (OR 2.53 95% CI 2.44-2.63) and was particularly increased in men (OR 2.83 95% CI 2.68-2.98). Rates of ex-smoking and non-smoking were lower in individuals with MMI (OR 0.79 95% CI 0.75-0.83 and OR 0.50 95% CI 0.48-0.52 respectively). However recorded rates of smoking cessation advice in smokers with MMI were significantly lower than the recorded rates of smoking cessation advice in smokers with diabetes (88.7% vs. 98.0%, p<0.001), smokers with CHD (88.9% vs. 98.7%, p<0.001) and smokers with hypertension (88.3% vs. 98.5%, p<0.001) without MMI. The odds ratio of NRT prescription was also significantly lower in smokers with MMI without diabetes compared to smokers with diabetes without MMI (OR 0.75 95% CI 0.69-0.81). Similar findings were found for smokers with MMI without CHD compared to smokers with CHD without MMI (OR 0.34 95% CI 0.31-0.38) and smokers with MMI without hypertension compared to smokers with hypertension without MMI (OR 0.71 95% CI 0.66-0.76). At a national level, payment and population achievement rates for the recording of body mass index (BMI) in MMI was significantly lower than the payment and population achievement rates for BMI recording in diabetes throughout the whole of the UK combined: payment rate 92.7% (Inter Quartile Range (IQR) 89.3-95.8 vs. 95.5% IQR 93.3-97.2, p<0.001 and population achievement rate 84.0% IQR 76.3-90.0 vs. 92.5% IQR 89.7-94.9, p<0.001 and for each country individually: for example in Scotland payment rate was 94.0% IQR 91.4-97.2 vs. 96.3% IQR 94.3-97.8, p<0.001. Exception rate was significantly higher for the recording of BMI in MMI than the exception rate for BMI recording in diabetes for the UK combined: 7.4% IQR 3.3-15.9 vs. 2.3% IQR 0.9-4.7, p<0.001 and for each country individually. For example in Scotland exception rate in MMI was 11.8% IQR 5.4-19.3 compared to 3.5% IQR 1.9-6.1 in diabetes. Similar findings were found for Blood Pressure (BP) recording: across the whole of the UK payment and population achievement rates for BP recording in MMI were also significantly reduced compared to payment and population achievement rates for the recording of BP in chronic kidney disease (CKD): payment rate: 94.1% IQR 90.9-97.1 vs.97.8% IQR 96.3-98.9 and p<0.001 and population achievement rate 87.0% IQR 81.3-91.7 vs. 97.1% IQR 95.5-98.4, p<0.001. Exception rates again were significantly higher for the recording of BP in MMI compared to CKD (6.4% IQR 3.0-13.1 vs. 0.3% IQR 0.0-1.0, p<0.001). There was also evidence of differences in rates of recording of BMI and BP in MMI across the UK. BMI and BP recording in MMI were significantly lower in Scotland compared to England (BMI:-1.5% 99% CI -2.7 to -0.3%, p<0.001 and BP: -1.8% 99% CI -2.7 to -0.9%, p<0.001). While rates of BMI and BP recording in diabetes and CKD were similar in Scotland compared to England (BMI: -0.5 99% CI -1.0 to 0.05, p=0.004 and BP: 0.02 99% CI -0.2 to 0.3, p=0.797). Data from the PsyCIS cohort showed an increase in Standardised Mortality Ratios (SMR) across the lifespan for individuals with MMI compared to the local Glasgow and wider Scottish populations (Glasgow SMR 1.8 95% CI 1.6-2.0 and Scotland SMR 2.7 95% CI 2.4-3.1). Increasing socioeconomic deprivation was associated with an increased overall rate of death in MMI (350.3 deaths/10,000 population/5 years in the least deprived quintile compared to 794.6 deaths/10,000 population/5 years in the most deprived quintile). No significant difference in rate of death for individuals with schizophrenia compared with bipolar disorder was reported (6.3% vs. 4.9%, p=0.086), but primary cause of death varied: with higher rates of suicide in individuals with bipolar disorder (22.4% vs. 11.7%, p=0.04). Discussion: Local and national datasets can be used for epidemiological study to inform local practice and complement existing national and international studies. While the strengths of this thesis include the large data sets used and therefore their likely representativeness to the wider population, some limitations largely associated with using secondary data sources are acknowledged. While this thesis has confirmed evidence of increased physical health comorbidity and multimorbidity in individuals with MMI, it is likely that these findings represent a significant under reporting and likely under recognition of physical health comorbidity in this population. This is likely due to a combination of patient, health professional and healthcare system factors and requires further investigation. Moreover, evidence of inequality in access to healthcare in terms of: physical health promotion (namely smoking cessation advice), recording of physical health indices (BMI and BP), prescribing of medications for the treatment of physical illness and prescribing of NRT has been found at a national level. While significant premature mortality in individuals with MMI within a Scottish setting has been confirmed, more work is required to further detail and investigate the impact of socioeconomic deprivation on cause and rate of death in this population. It is clear that further education and training is required for all healthcare staff to improve the recognition, diagnosis and treatment of physical health problems in this population with the aim of addressing the significant premature mortality that is seen. Conclusions: Future work lies in the challenge of designing strategies to reduce health inequalities and narrow the gap in premature mortality reported in individuals with MMI. Models of care that allow a much more integrated approach to diagnosing, monitoring and treating both the physical and mental health of individuals with MMI, particularly in areas of social and economic deprivation may be helpful. Strategies to engage this “hard to reach” population also need to be developed. While greater integration of psychiatric services with primary care and with specialist medical services is clearly vital the evidence on how best to achieve this is limited. While the National Health Service (NHS) is currently undergoing major reform, attention needs to be paid to designing better ways to improve the current disconnect between primary and secondary care. This should then help to improve physical, psychological and social outcomes for individuals with MMI.

Neurobiology and clinical implications of lucid dreaming

Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.

El dolor en la enfermedad de Parkinson. Implicaciones autonómicas y afectivas

Introducción y objetivo: La enfermedad de Parkinson (EP) es una enfermedad neurodegenerativa, la segunda con mayor prevalencia, después de la enfermedad de Alzheimer (EA). La enfermedad presenta tanto síntomas motores como “no motores”, entre los que se encuentra disfunción autonómica, dolor, deterioro cognitivo, ansiedad, depresión, entre otros. El dolor en la EP, a pesar de su frecuencia, sigue siendo un síntoma infravalorado, infradiagnosticado e infratratado. Nuestro objetivo principal es evaluar la frecuencia y configuración del dolor en la EP y sus implicaciones afectivas y autonómicas. Pacientes, material y métodos: Estudio multicéntrico, transversal, de carácter retrospectivo y prospectivo. Se incluyeron 407 pacientes con enfermedad de Parkinson (EP) de los que un 70% estaban en una situación leve-moderada (estadios 2 o 3 de Hoehn y Yahr), con edad media de 65,01 años y 7,07 años de duración de la EP. Se administraron las escalas SCOPA-Motor, SCOPA-Autonómica, SCOPA-Cog, Parkinson’s Psychosis Rating Scale modificada, Hoehn & Yarh, las Escala Hospitalaria de Ansiedad y Depresión, Dolor (EVA frecuencia), EQ-5D y estudios neurofisiológicos específicos de Sistema Nervioso Autónomo (SNA). El análisis estadístico se ha realizado con el programa de cálculo estadístico SPSS versión 22. Resultados: En nuestro estudio encontramos una prevalencia del dolor elevada (72%) y los pacientes afirman mayoritariamente (79,2%) que su dolor tiene relación con la EP. La duración de la enfermedad se correlaciona con la intensidad y frecuencia del dolor (dolor intensidad: r: 0,138; p< 0,01; dolor frecuencia: r: 0,168; p< 0,01 ). A mayor evolución de la EP mayor es la percepción del dolor. El 60% de los pacientes de EP manifiestan sentir dolor cuando aparecen episodios de rigidez y tirantez en alguno de los miembros superiores o inferiores frente a un 40% que no. Curiosamente un número mayor (el 76% de los pacientes) siente dolor durante los episodios de discinesias frente a un 24% que no lo percibe. Sin embargo, en la EP el dolor se relaciona más con la situación afectiva que con la motora, como hemos podido demostrar la relación entre el Dolor Total y la HADS (Depresión) Total y la Escala Hoehn & Yahr. El coeficiente de contingencia es mayor en la depresión (C: 0,894; N=403) que en la situación motora (C: 0,637; N=401). El dolor evoluciona y se percibe de forma paralela a otros síntomas no motores (ánimo, nicturia, alteración del control vesical, estreñimiento, etc.) pero con lo que se relaciona más es con la situación afectiva del paciente parkinsoniano (ansiedad (r: 0,40; p < 0,01), depresión (r: 0.28; p < 0,01). La mayor asociación se encuentra entre la ansiedad y el dolor, seguida de la depresión y en menor grado nicturia y sialorrea. Existe una correlación positiva entre las dos subescalas de la HADS (depresión y ansiedad). Existe una alta prevalencia de alteración de la memoria inmediata como síntoma “no motor” (SNM) en nuestra serie (96,5%). En base a nuestros resultados el sexo femenino se asocia al dolor en la EP. Con respecto a la fenomenología el dolor en la EP es muy variable. Se percibe con mayor frecuencia como una corriente eléctrica (64%), calor (60%), frialdad (60%), punzante (52%), difuso (52%), interno (40%), acorchamiento u hormigueo (40%), La frecuencia de la cantidad de tipos de dolor es la siguiente: un tipo de dolor (12%), dos tipos de dolores (16%) y tres tipos de dolores (72%). La media de tipos de dolor en nuestro estudio es superior a 2 tipos (x ̅: 2,60 ± 0,63; rango: 1-3). En los casos que toman levodopa les sigue unas tres cuartas partes que lo perciben como palpitante, tirante, punzante. En los casos que toman agonista dopaminérgico lo perciben en un 75% como adormecimiento, interno, descarga eléctrica, frialdad y calor. El dolor en la EP respecto a su configuración es multimodal. Los parámetros neurofisiológicos están relacionados con los umbrales de dolor. La actividad simpática y la sensibilidad nociceptiva están disminuidas en la EP. Los enfermos con EP tienen un umbral menor para el frío según los datos del estudio del Cold-Ice. En lo referente a la terapéutica el tratamiento dopaminérgico es eficaz para el control del dolor en el 48% de los pacientes mientras que el tratamiento analgésico estándar prescrito mejora el dolor en un 78,8%. Por último, casi la mitad de la población de nuestro estudio (47,52%) evaluada con la EQ-5D tiene problemas en alguna de las dimensiones de la calidad de vida. Hay una relación positiva entre la escala analógica visual del dolor (EVA) y la EQ-5D que evalúa la CVRS y entre la intensidad de dolor y la CVRS (r:-0,298; p < 0,01). Es decir, una mayor vivencia de dolor empeora la CVRS del paciente con EP. Conclusiones: En la enfermedad de Parkinson el dolor es un síntoma no motor de elevada prevalencia, íntimamente relacionado con la afectación de los sistemas afectivos y autonómicos medido con test neuro-vegetativos específicos. El presente estudio confirma su relación con el lado más afecto de la enfermedad, las fluctuaciones motoras, el tiempo de evolución, con la situación anímica (depresión y ansiedad) y con el sexo femenino, así como su carácter multimodal y gran variedad de expresión sintomática. Es muy llamativa su asociación con el déficit mnésico. Por último esta vivencia repercute en forma llamativa en la calidad de vida relacionada con la salud por lo que sería importante conocer y manejar mejor estos aspectos de la enfermedad de Parkinson.

Perspectiva dinâmica da melancolia: O vazio branco e frio que congela na ausência da presença do objecto

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção do grau de Mestre na especialidade de Psicologia Clínica

The Hitchcok boy: treating aggressive acting out in child therapy

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Retour post-isolement en milieu psychiatrique : développement, implantation et évaluation d’une intervention en soins aigus

L’isolement avec ou sans contention (IC) en milieu psychiatrique touche près d’un patient sur quatre au Québec (Dumais, Larue, Drapeau, Ménard, & Giguère-Allard, 2011). Il est pourtant largement documenté que cette pratique porte préjudice aux patients, aux infirmières et à l’organisation (Stewart, Van der Merwe, Bowers, Simpson, & Jones, 2010). Cette mesure posant un problème éthique fait l’objet de politiques visant à la restreindre, voire à l’éliminer. Les études sur l’expérience de l’isolement du patient de même que sur la perception des infirmières identifient le besoin d'un retour sur cet évènement. Plusieurs équipes de chercheurs proposent un retour post-isolement (REPI) intégrant à la fois l’équipe traitante, plus particulièrement les infirmières, et le patient comme intervention afin de diminuer l’incidence de l’IC. Le REPI vise l’échange émotionnel, l’analyse des étapes ayant mené à la prise de décision d’IC et la projection des interventions futures. Le but de cette étude était de développer, implanter et évaluer le REPI auprès des intervenants et des patients d’une unité de soins psychiatriques aigus afin d’améliorer leur expérience de soins. Les questions de recherche étaient : 1) Quel est le contexte d’implantation du REPI? 2) Quels sont les éléments facilitants et les obstacles à l’implantation du REPI selon les patients et les intervenants? 3) Quelle est la perception des patients et des intervenants des modalités et retombées du REPI?; et 4) L’implantation du REPI est-elle associée à une diminution de la prévalence et de la durée des épisodes d’IC? Cette étude de cas instrumentale (Stake, 1995, 2008) était ancrée dans une approche participative. Le cas était celui de l’unité de soins psychiatriques aigus pour premier épisode psychotique où a été implanté le REPI. En premier lieu, le développement du REPI a d’abord fait l’objet d’une documentation du contexte par une immersion dans le milieu (n=56 heures) et des entretiens individuels avec un échantillonnage de convenance (n=3 patients, n=14 intervenants). Un comité d’experts (l’étudiante-chercheuse, six infirmières du milieu et un patient partenaire) a par la suite développé le REPI qui comporte deux volets : avec le patient et en équipe. L’évaluation des retombées a été effectuée par des entretiens individuels (n= 3 patients, n= 12 intervenants) et l’examen de la prévalence et de la durée des IC six mois avant et après l’implantation du REPI. Les données qualitatives ont été examinées selon une analyse thématique (Miles, Huberman, & Saldana, 2014), tandis que les données quantitatives ont fait l’objet de tests descriptifs et non-paramétriques. Les résultats proposent que le contexte d’implantation est défini par des normes implicites et explicites où l’utilisation de l’IC peut générer un cercle vicieux de comportements agressifs nourris par un profond sentiment d’injustice de la part des patients. Ceux-ci ont l’impression qu’ils doivent se conformer aux attentes du personnel et aux règles de l’unité. Les participants ont exprimé le besoin de créer des opportunités pour une communication authentique qui pourrait avoir lieu lors du REPI, bien que sa pratique soit variable d’un intervenant à un autre. Les résultats suggèrent que le principal élément ayant facilité l’implantation du REPI est l’approche participative de l’étude, alors que les obstacles rencontrés relèvent surtout de la complexité de la mise en œuvre du REPI en équipe. Lors du REPI avec le patient, les infirmières ont pu explorer ses sentiments et son point de vue, ce qui a favorisé la reconstruction de la relation thérapeutique. Quant au REPI avec l’équipe de soins, il a été perçu comme une opportunité d’apprentissage, ce qui a permis d’ajuster le plan d’intervention des patients. Suite à l’implantation du REPI, les résultats ont d’ailleurs montré une réduction significative de l’utilisation de l’isolement et du temps passé en isolement. Les résultats de cette thèse soulignent la possibilité d’outrepasser le malaise initial perçu tant par le patient que par l’infirmière en systématisant le REPI. De plus, cette étude met l’accent sur le besoin d’une présence authentique pour atteindre un partage significatif dans la relation thérapeutique, ce qui est la pierre d’assise de la pratique infirmière en santé mentale. Cette étude contribue aux connaissances sur la prévention des comportements agressifs en milieu psychiatrique en documentant le contexte dans lequel se situe l’IC, en proposant un REPI comportant deux volets de REPI et en explorant ses retombées. Nos résultats soutiennent le potentiel du développement d’une prévention tertiaire qui intègre à la fois la perspective des patients et des intervenants.

Neurobehavioral burden of multiple sclerosis with nanotheranostics

Multiple sclerosis (MS) is a chronic demyelinating neurological disorder affecting people worldwide; women are affected more than men. MS results in serious neurological deficits along with behavioral compromise, the mechanisms of which still remain unclear. Behavioral disturbances such as depression, anxiety, cognitive impairment, psychosis, euphoria, sleep disturbances, and fatigue affect the quality of life in MS patients. Among these, depression and psychosis are more common than any other neurological disorders. In addition, depression is associated with other comorbidities. Although anxiety is often misdiagnosed in MS patients, it can induce suicidal ideation if it coexists with depression. An interrelation between sleep abnormalities and fatigue is also reported among MS patients. In addition, therapeutics for MS is always a challenge because of the presence of the blood-brain barrier, adding to the lack of detailed understanding of the disease pathology. In this review, we tried to summarize various behavioral pathologies and their association with MS, followed by its conventional treatment and nanotheranostics.

Trajectory and predictors of quality of life in first episode psychotic mania

BACKGROUND: Little is known about the trajectory of quality of life (QoL) following a first episode of psychotic mania in bipolar disorder (BD). This 18-month longitudinal study investigated the trajectory of QoL, and the influence of premorbid adjustment and symptoms on 18-month QoL in a cohort of young people experiencing a first episode of psychotic mania. METHODS: As part of an overarching clinical trial, at baseline, sixty participants presenting with a first episode of psychotic mania (BD Type 1 - DSM-IV) completed symptomatic and functional assessments in addition to the Premorbid Adjustment Scale - General Subscale. Symptom measures were repeated at 18-month follow up. QoL was rated using the Quality of Life Scale (QLS) at designated time points. RESULTS: Mean QLS scores at initial measurement (8 weeks) were 61% of the maximum possible score, increasing significantly to 70% at 12 months, and 71.2% at 18-month follow-up. Premorbid adjustment and 18-month depressive symptoms were significantly associated with QoL at 18-month follow-up. LIMITATIONS: Study limitations include the small sample size, inclusion of participants with psychotic mania only, use of measures originally designed for use with schizophrenia spectrum disorders, and lack of premorbid or baseline measurement of QoL. CONCLUSIONS: Results suggest that QoL can be maintained early in BD, and reinforce the importance of assertively treating depressive symptoms throughout the course of this disorder. The emergence of a link between premorbid adjustment and poorer QoL in this cohort highlights the importance of assessing facets of adjustment when planning psychological interventions.

Distribution entropy analysis of epileptic EEG signals

It is an open-ended challenge to accurately detect the epileptic seizures through electroencephalogram (EEG) signals. Recently published studies have made elaborate attempts to distinguish between the normal and epileptic EEG signals by advanced nonlinear entropy methods, such as the approximate entropy, sample entropy, fuzzy entropy, and permutation entropy, etc. Most recently, a novel distribution entropy (DistEn) has been reported to have superior performance compared with the conventional entropy methods for especially short length data. We thus aimed, in the present study, to show the potential of DistEn in the analysis of epileptic EEG signals. The publicly-accessible Bonn database which consisted of normal, interictal, and ictal EEG signals was used in this study. Three different measurement protocols were set for better understanding the performance of DistEn, which are: i) calculate the DistEn of a specific EEG signal using the full recording; ii) calculate the DistEn by averaging the results for all its possible non-overlapped 5 second segments; and iii) calculate it by averaging the DistEn values for all the possible non-overlapped segments of 1 second length, respectively. Results for all three protocols indicated a statistically significantly increased DistEn for the ictal class compared with both the normal and interictal classes. Besides, the results obtained under the third protocol, which only used very short segments (1 s) of EEG recordings showed a significantly (p <; 0.05) increased DistEn for the interictal class in compassion with the normal class, whereas both analyses using relatively long EEG signals failed in tracking this difference between them, which may be due to a nonstationarity effect on entropy algorithm. The capability of discriminating between the normal and interictal EEG signals is of great clinical relevance since it may provide helpful tools for the detection of a seizure onset. Therefore, our study suggests that the DistEn analysis of EEG signals is very promising for clinical and even portable EEG monitoring.

Classification of 5-S epileptic EEG recordings using distribution entropy and sample entropy

Epilepsy is an electrophysiological disorder of the brain, the hallmark of which is recurrent and unprovoked seizures. Electroencephalogram (EEG) measures electrical activity of the brain that is commonly applied as a non-invasive technique for seizure detection. Although a vast number of publications have been published on intelligent algorithms to classify interictal and ictal EEG, it remains an open question whether they can be detected using short-length EEG recordings. In this study, we proposed three protocols to select 5 s EEG segment for classifying interictal and ictal EEG from normal. We used the publicly-accessible Bonn database, which consists of normal, interical, and ictal EEG signals with a length of 4097 sampling points (23.6 s) per record. In this study, we selected three segments of 868 points (5 s) length from each recordings and evaluated results for each of them separately. The well-studied irregularity measure-sample entropy (SampEn)-and a more recently proposed complexity measure-distribution entropy (DistEn)-were used as classification features. A total of 20 combinations of input parameters m and τ for the calculation of SampEn and DistEn were selected for compatibility. Results showed that SampEn was undefined for half of the used combinations of input parameters and indicated a large intra-class variance. Moreover, DistEn performed robustly for short-length EEG data indicating relative independence from input parameters and small intra-class fluctuations. In addition, it showed acceptable performance for all three classification problems (interictal EEG from normal, ictal EEG from normal, and ictal EEG from interictal) compared to SampEn, which showed better results only for distinguishing normal EEG from interictal and ictal. Both SampEn and DistEn showed good reproducibility and consistency, as evidenced by the independence of results on analysing protocol.