RESUMO
BACKGROUND Antibodies against tumor necrosis factor alpha (anti-TNF-alpha) are currently widely used in the treatment of inflammatory bowel diseases (IBD), despite a number of reported adverse effects. Diverse neurologic syndromes, including the Guillain-Barre syndrome (GBS), an immune-mediated disease characterized by evolving ascending limb weakness, sensory loss, and areflexia, have been described in association with anti-TNF-alpha therapy. CASE REPORT A 45-year-old White woman was in follow-up with fistulizing ileocolonic Crohn disease using combination therapy (infliximab plus azathioprine) as CD maintenance therapy. After 3 years of this immunosuppressive therapy, she presented with symmetrical and ascending paresis in the lower limbs, and later in the upper limbs, in addition to reduced reflexes in the knees, 1 day after an infliximab infusion. The patient was hospitalized and treatment for CD was suspended. Neurophysiology studies demonstrated a pattern compatible with acute inflammatory demyelinating polyradiculopathy, with predominantly motor involvement, consistent with Guillain-Barre syndrome (GBS). Clinical, laboratory, and imaging exams were unremarkable. She was treated with intravenous immunoglobulins, with a progressive and complete resolution of neurological symptoms. After 1-year follow-up, she presented with active Crohn disease, and we opted for treating her with vedolizumab, with which she achieved clinical and endoscopic remission. CONCLUSIONS Patients receiving biological therapy with anti-TNF-alpha agents should be monitored for central or peripheral neurological signs and symptoms. The development of GBS can be secondary to anti-TNF-alpha treatment. The positive temporal relationship with TNF-alpha therapy and onset of neurological symptoms reinforces this possibility.
Assuntos
Doença de Crohn , Síndrome de Guillain-Barré , Infliximab , Fator de Necrose Tumoral alfa , Humanos , Síndrome de Guillain-Barré/induzido quimicamente , Síndrome de Guillain-Barré/diagnóstico , Feminino , Doença de Crohn/tratamento farmacológico , Doença de Crohn/complicações , Pessoa de Meia-Idade , Infliximab/efeitos adversos , Infliximab/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
RESUMO Objetivo Investigar o risco de suicídio nos pacientes com transtorno de ansiedade generalizada (TAG). Métodos Estudo transversal com 253 pacientes dos ambulatórios de Psiquiatria, Nefrologia e Cardiologia do Hospital Universitário da Universidade Federal de Alagoas. O instrumento utilizado foi o MINI 5.0.0 (Mini-International Neuropsychiatric Interview). Resultados Os indivíduos com TAG corresponderam a 16,6% da amostra, sendo 30,8% nos pacientes entrevistados no ambulatório de psiquiatria e 11,3% nos pacientes entrevistados nos demais ambulatórios. A maioria é do sexo feminino (83,3%), casada (53,8%), sendo a média de idade de 44 (±12,2) anos. Houve comorbidade psiquiátrica em 88,1% dos entrevistados; 54,8% possuíam duas ou mais e 33,3% tinham apenas uma. A mais prevalente foi depressão maior (53,7%), seguida de distimia (21,4%) e depressão recorrente (14,6%). O risco de suicídio foi observado em 54,8% dos indivíduos com TAG. Conclusão A prevalência de TAG foi significativamente maior que na população geral, principalmente no ambulatório de psiquiatria. A maioria dos pacientes apresentou comorbidade psiquiátrica, especialmente transtornos de humor, além de risco de suicídio. O TAG mostrou elevada correlação com transtornos de humor e significativa associação com o risco de suicídio.
ABSTRACT Objective Investigate the risk of suicide in patients with generalized anxiety disorder (GAD) Methods Cross-sectional study with 253 outpatients from the Psychiatry, Nephrology, and Cardiology units of the University Hospital of the Federal University of Alagoas. The instrument used was MINI 5.0.0 (Mini-International Neuropsychiatric Interview). Results GAD was present in 16.6% of the sample, which were 30.8% from the psychiatric unit and 11.3% in the outpatients of the other clinics. The majority were females (83.3%), married (53.8%), with a mean age of 44 (±12.2) years old. There was psychiatric comorbidity in 88.1% of the evaluated patients, of which 54.8% had two or more and 33.3% had only one. Major depression was the most prevalent (53.7%), followed by dysthymia (21.4%) and recurrent depression (14.6%). The risk of suicide was observed in 54.8% of subjects with GAD. Conclusion The prevalence of GAD in outpatient clinical samples was significantly higher than in the general population, mainly in the psychiatric clinic. The majority of the patients presented psychiatric comorbidity, especially mood disorders besides presenting risk of suicide. GAD showed high correlation with mood disorders and significant association with risk of suicide.