RESUMO
Background and Hypothesis: When occurring in adolescence, psychotic experiences (PE), subclinical psychotic symptoms, can be an early marker of mental illnesses. Studies with high-risk populations for psychosis show that anxiety symptoms often precede the onset of psychosis. Although anxiety symptoms are frequently experienced across the continuum of psychosis, no previous study has analyzed this association using a cross-lagged panel model (CLPM) longitudinally to identify if anxiety can be a predictor of PE over time or vice versa. The aim of the current study was to investigate whether one symptom domain predicts the other over time. Study Design: 2194 children from the Brazilian High-Risk Cohort (BHRC) were evaluated at baseline (T 0), and 76.5% completed a 3-year follow-up (T 1) interview. Childhood anxiety symptoms and PE were assessed using a standardized self-report questionnaire at both time points. Cross-lagged panel models evaluated time-lagged associations between PE and anxiety longitudinally. Study Results: Higher levels of anxiety in childhood predicted an increase in PE levels in adolescence. The cross-lagged effect of anxiety scores at T 0 on PE scores at T 1 was significant (ßâ =â .03, SEâ =â 0.01, P ≤ .001) and PE in childhood did not increase levels of anxiety in adolescence, when controlling for sociodemographic and clinical characteristics. Conclusions: Our findings reinforce that anxiety may represent an early marker of psychosis proneness, not a consequence of already presenting PE, which can help to develop better screening approaches. Therefore, future studies should focus on identifying biological or other clinical markers to increase prediction accuracy.
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Psychosis can be considered a dimension that in its most severe extreme can be expressed with alterations in sensory perception, mainly hallucinations. Their presence is a fact that is frequently observed in severe psychiatric pathologies such as schizophrenia (EZQ) and bipolar disorder (BD) where they can be markers of severity. However, sensory-perceptual disturbances are not pathognomonic of these disorders, nor do they signal any of these illnesses as an isolated event. Such symptomatology can be described in a variety of situations both within and outside psychopathology. In this sense, proposing a direct line between hallucinations and diseases such as CZS or TB disregards their occurrence in other pathologies, as is the case of Borderline Personality Disorder (BPD). It is feasible that we may find the expression of pseudo hallucinations or hallucinations in patients with this disorder and their presence may have etiological, clinical and therapeutic connotations that should be reviewed and taken into account in our clinical practice.
La psicosis puede ser considerada una dimensión que en su extremo de mayor gravedad puede expresarse con alteraciones en la sensopercepción, principalmente alucinaciones. Su presencia es un hecho que se constata con frecuencia en patologías psiquiátricas severas como la esquizofrenia (EZQ) y el trastorno bipolar (TB) donde pueden ser marcadores de gravedad. No obstante, las alteraciones sensoperceptivas no son patognomónicas de estos trastornos ni señalan ninguna de estas enfermedades como un hecho aislado. Dicha sintomatología puede ser descripta en diversas situaciones dentro y fuera de la psicopatología. En este sentido, proponer una línea directa entre las alucinaciones con enfermedades tales como la EZQ o el TB desestima su ocurrencia en otras patologías, como es el caso del Trastorno límite de la personalidad (TLP). Es factible que constatemos la expresión de alucinaciones en pacientes con este trastorno y su presencia puede tener connotaciones etiológicas, clínicas y terapéuticas que deben ser revisadas para tener en cuenta en nuestra práctica clínica.
Assuntos
Transtorno Bipolar , Transtorno da Personalidade Borderline , Alucinações , Esquizofrenia , Humanos , Transtorno da Personalidade Borderline/complicações , Esquizofrenia/complicações , Alucinações/etiologia , Transtorno Bipolar/complicações , Psicologia do EsquizofrênicoRESUMO
Para além de sua sintomatologia clássica, o Transtorno Depressivo Maior (TDM) pode cursar com episódios únicos ou recorrentes de quadros psicóticos, marcados pela presença de delírios e alucinações cujos conteúdos associam-se frequentemente a ideias negativas e depressivas de morte, ruína, culpa e punição merecida. Esta condição está fortemente conectada a alto risco suicida, motivo pelo qual deve-se diagnosticar e intervir de maneira positiva o mais precocemente possível, a fim de que a vida, o sentido e a qualidade de viver do indivíduo possam ser restaurados e preservados. O caso relatado refere-se a uma paciente com diagnóstico atual de TDM grave e recorrente com sintomas psicóticos e alta intencionalidade suicida. Apresenta o humor constantemente deprimido, choro fácil e frequente, hipobulia, distúrbios do sono e sentimentos de menos-valia. Ademais, seu quadro cursa com sonhos e sensações estranhas relacionados a entidades malignas, assim como com alucinações visuais persistentes e delírios religiosos de pecado, culpa exagerada e punição divina. Frente à resistência dos sintomas ao tratamento farmacológico inicial, foram discutidas outras possibilidades de abordagem, conduta e diagnósticos diferenciais paralelamente à avaliação constante do risco de suicídio. [au]
In addition to its classic symptomatology, Major Depressive Disorder (MDD) may go through single or recurring episodes of psychotic events marked by the presence of delusions and hallucinations, with contents which are frequently associated to negative and depressive ideas about death, ruin, guilt and deserved punishment. This condition is strongly linked to high suicide risks, constituting the main reason why it is necessary to diagnose and positively intervene as soon as possible in order to restore and preserve the person's life, meaning and quality of life. The case reported herein refers to a female patient with a current diagnosis of severe and recurrent MDD with psychotic episodes and high suicidal tendencies. This patient constantly presents depressed mood, frequent and easy crying, hypobulia, sleep disorders and devaluation of herself. Furthermore, her case occurs with strange dreams and sensations related to evil entities, along with persistent visual hallucinations and religious delusions of sin, excessive guilt and divine punishment. Due to the symptoms resistance to the initial pharmacological treatment, other possibilities of approach, conduct and differential diagnoses were discussed in parallel to a continual evaluation of the suicide risk. [au]
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Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child's report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents. Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6-14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents' information about the child's positive attributes and levels of psychopathology and psychologist assessment of blunted affect. Results: Most associations were qualitatively similar, and there was a dose-response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening. Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.
RESUMO
Os autores apresentam o caso de uma paciente de 61 anos, com antecedentes depressivos e história de síncopes, que desenvolve, no espaço de meio ano, alterações de comportamento pautadas por hiper-religiosidade, ideias delirantes de grandiosidade e fenômenos compatíveis com déjà vu. Nesse contexto, foi referenciada pelo médico de família para a urgência de psiquiatria, tendo sido realizada investigação orgânica e identificada epilepsia do lobo temporal após realização de eletroencefalograma. Foi medicada com valproato de sódio, na dose de 750 mg/dia, com esbatimento progressivo da sintomatologia psicótica. Com este trabalho, os autores pretendem sublinhar a importância da exploração orgânica dos sintomas neuropsiquiátricos, antes de atribuir um diagnóstico psiquiátrico ao paciente.
The authors report the case of a 61 years-old woman, with history of depressive episodes and syncope, who developed hyperreligiosity, grandiose delusions and déjà vu. She was admitted to a psychiatry emergency and the electroencephalogram identified temporal lobe epilepsy. She was medicated with valproate sodium 750 mg/day with remission of psychotic symptoms and return to premorbid function. The purpose of this work is to highlight the importance of organic investigation in the assessment of neuropsychiatric symptoms.
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BACKGROUND: The international prevalence of psychotic symptoms in older subjects without dementia varies from 0.9% to 8.0%. However, an analysis of these symptoms in developing countries has not been undertaken. AIMS: To determine the prevalence and to correlate these symptoms with socioeconomic and clinical characteristics. METHOD: A community-based sample aged 60 years and older was evaluated. Those who screened positive for dementia, cognitive and functional impairment or significant depressive symptoms were excluded, resulting in 1125 individuals. RESULTS: The prevalence of psychotic symptoms was 9.1% (visual/tactile hallucinations, 7.8%; auditive hallucinations, 7.5%; persecutory delusions, 2.9%). Subjects with psychotic symptoms had lower Mini Mental State Examination and The Bayer Activities of Daily Living Scale scores, fewer years of schooling, belonged to lower socioeconomic classes compared with non-psychotic subjects, and 80% had clinical comorbidities. CONCLUSIONS: The prevalence was in the upper range of international data. Significant relationships were found between psychotic symptoms and lower Mini Mental State Examination score, fewer years of schooling and lower socioeconomic class. Clinical comorbidity was also very frequent.
Assuntos
Transtornos Psicóticos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Transtornos Psicóticos/etiologia , Fatores de Risco , Fatores SocioeconômicosRESUMO
Se considera la propuesta del Grupo de Trabajo en Psicosis del DSM‑5 de incluir el ®síndrome de síntomas psicóticos atenuados¼ (previamente: ®riesgo de psicosis¼) como categoría diagnóstica. Es un paso necesario, ya que el DSM‑IV no posibilita diagnosticar formas psicóticas menores o en fase inicial, pero el intento evidencia que la nosología actual no permite hacerlo. Los criterios diagnósticos propuestos son semejantes a los criterios nucleares de los trastornos psicóticos del DSM‑IV, con dos variantes: a) que los síntomas son atenuados y con prueba de realidad conservada y b) que la sumatoria propuesta es dimensional y no categorial (estructural), como lo es la sumatoria algorítmica y disyuntiva del DSM‑IV. Para que la construcción de la categoría diagnóstica exprese la realidad clínica que fundamenta la propuesta son necesarios principios psicopatológicos diferentes a los que organizan el proyecto del DSM‑5.
The proposal of the DSM‑5s Psychosis Work Group to include attenuated psychotic symp‑toms syndrome (previously: psychosis risksyndrome) as a diagnostic category is consi‑dered. To identify the first phase of psychosisis a necessary step, taking into account thatthe DSM‑IV does not allow to diagnose neitherminor psychotic forms, nor initial phase forms. However, the attempt makes evident that the current nosology does not enable to do so. The suggested diagnostic criteria are similar to the nuclear criteriafor Psychotic Disorders of theDSM‑IV, but with two variants: a) that the symptoms are in attenuated form with intact reality testing and b) that the proposed summationis dimensional and not categorical (structural),as well as the algorithmic and disjunctive sum‑mation of the DSM‑IV. In order to build the diagnostic category expressing the clinical reality underlying the proposal of the Psychosis WorkGroup, different psychopathological principlesthan those that organize the draft of the DSM‑5are required.
Assuntos
Humanos , Alucinações , Esquizofrenia/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Psicóticos/diagnósticoRESUMO
Se considera la propuesta del Grupo de Trabajo en Psicosis del DSM‑5 de incluir el «síndrome de síntomas psicóticos atenuados¼ (previamente: «riesgo de psicosis¼) como categoría diagnóstica. Es un paso necesario, ya que el DSM‑IV no posibilita diagnosticar formas psicóticas menores o en fase inicial, pero el intento evidencia que la nosología actual no permite hacerlo. Los criterios diagnósticos propuestos son semejantes a los criterios nucleares de los trastornos psicóticos del DSM‑IV, con dos variantes: a) que los síntomas son atenuados y con prueba de realidad conservada y b) que la sumatoria propuesta es dimensional y no categorial (estructural), como lo es la sumatoria algorítmica y disyuntiva del DSM‑IV. Para que la construcción de la categoría diagnóstica exprese la realidad clínica que fundamenta la propuesta son necesarios principios psicopatológicos diferentes a los que organizan el proyecto del DSM‑5.
Assuntos
Humanos , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Alucinações , Manual Diagnóstico e Estatístico de Transtornos MentaisRESUMO
In recent years, research on the comorbidity of personality disorders and other clinical conditions has increased. Nevertheless, it is quite surprising that very little research has been done in terms of personality and its disorders in patients with schizophrenia. Most of the studies related to the binomial construct of personality disorders and schizophrenia are limited to the study of premorbid personality, which emphasizes the importance of the interaction between trait-personality disorder-schizophrenia symptoms. The study of personality in patients with schizophrenia suggests several issues that must be considered, including the trait-state interactions and the role of personality in the course of schizophrenia. The conceptual definition of trait emerges from the dimensional classification of models of personality. In this way, knowing that some personality features are present in all individuals, we can assume that their deviation in a quantitative level results in abnormal personality features that constitute personality disorders or even can be expressed as a specific expression of some schizophrenia symptoms. Although there is growing evidence in the knowledge of schizophrenia, there are very few models that include the scientific neurobio-logical evidence of the disease and personality features. An inclusive model may promote our understanding of the relationship between schizophrenia symptoms and the personality features of the patient who suffers the disease. So far, we are still far from reaching scientific consensus to be unanimously shared by all researchers with respect to both issues. Nevertheless, the importance of personality in schizophrenia is undeniable, so future longitudinal that assess personality characteristics since illness onset should be warranted. These studies may be extremely useful to determine personality stability during the course of the illness and may help to determine the prognosis and treatment implications of personality in schizophrenia.
En los últimos años han proliferado las investigaciones y publicaciones sobre la comorbilidad de los trastornos de personalidad con otras entidades clínicas. En este marco sorprende la escasez de estudios que se centren en la personalidad y sus trastornos en los pacientes con esquizofrenia. Las investigaciones llevadas a cabo en el binomio trastorno de personalidad-esquizofrenia se han limitado al estudio de la personalidad premórbida, las cuales se orientan hacia la importancia de la interacción rasgo-trastorno de personalidad-síntomas en la esquizofrenia. El estudio de la personalidad en la esquizofrenia sugiere varias cuestiones que deben ser consideradas, incluyendo las interacciones rasgo-estado y la función de la personalidad en la esquizofrenia. El concepto de rasgo surge en los modelos dimensionales de clasificación de la personalidad. Si consideramos que los rasgos de la personalidad están presentes en todos los individuos, cabría decir que una desviación en el nivel cuantitativo de los mismos caracteriza los rasgos anormales que constituirán los trastornos de personalidad o en una expresión específica de los síntomas de la esquizofrenia. A pesar de los avances crecientes en el conocimiento de la esquizofrenia, existen pocos modelos que integren los avances neurobiológicos con la personalidad, lo cual permitiría un mayor entendimiento de la relación entre los síntomas de la esquizofrenia y la personalidad del individuo que la padece. Hasta el momento, aún nos encontramos lejos de poder alcanzar acuerdos científicos que sean compartidos unánimemente por todos los investigadores con respecto a ambas cuestiones. Sin embargo, la importancia de la personalidad en la esquizofrenia es innegable, lo que hace necesario la realización de estudios longitudinales que evalúen de forma específica las características de la personalidad desde el inicio de la esquizofrenia para poder determinar su estabilidad o variabilidad de acuerdo al curso del padecimiento y sus implicaciones pronósticas y de tratamiento.
RESUMO
This is a study on burden of caregivers of patients with Alzheimer's disease attended at a Reference Center for Cognitive Disorders. OBJECTIVE: To evaluate the profile and burden on caregivers of patients with Alzheimer's disease attended at a Reference Center for Cognitive Disorders. METHODS: We collected demographic information and data on the relationship with the patient from caregivers, and measured burden with the Zarit scale. The patients were evaluated with the following scales: the Cambridge Cognitive Test (CAMCOG); Mini Mental State Examination, the Neuropsychiatric Inventory for neuropsychiatry symptoms, and Functional Activities Questionnaire - FAQ for functional impairment. RESULTS: Of the 31 caregivers, 77.4% were female, predominantly, and daughters, having a mean age of 58.6 years, educational level of 8.1 years, 70% of caregivers co-resided with the patient and 71% did not work. The mean time as a caregiver was 3 years. Twenty-seven percent of the caregivers presented mild to severe burden. The variables presenting significant association with caregiver burden were scores on the NPI and CAMCOG. CONCLUSION: The social demographic characteristics of the sample were similar to those of studies performed in other countries. The average time as a caregiver and the frequency of caregivers with mild to intense burden were lower than those reported in international studies. Neuropsychiatric symptoms and severity of cognitive decline were the main factors associated to burden in this sample of mostly mild to moderate demented AD patients. Further studies are necessary to verify whether the burden is indeed less intense in our milieu.
Trata-se de um estudo sobre a sobrecarga do cuidador dos pacientes com doença de Alzheimer atendidos em Centro de Referência em Distúrbios Cognitivos. OBJETIVO: Avaliar o perfil e a sobrecarga do cuidador dos pacientes com doença de Alzheimer atendidos em Centro de Referência em Distúrbios Cognitivos. MÉTODO: Foram obtidos dados demográficos do cuidador e sobrecarga de acordo com a Escala de Sobrecarga de Zarit. Os pacientes foram avaliados com os seguintes testes e escalas: Teste Cognitivo Cambridge (CAMCOG); Mini-Exame do Estado Mental; Inventário Neuropsiquiátrico (NPI), para a presença de sintomas neuropsiquiátricos; e o Questionário de Atividades Funcionais (QAF), de Pfeffer, para o comprometimento funcional. RESULTADOS: Os 31 cuidadores eram predominantemente do sexo feminino, filhas, idade média 58,6 anos, escolaridade média de 8,1 anos; 70% dos cuidadores moravam com o paciente; 71% não trabalhavam. O tempo médio como cuidador foi de 3 anos. Vinte e sete por cento dos cuidadores apresentavam sobrecarga de intensidade leve a intensa. As variáveis que apresentaram associação significativa com a sobrecarga do cuidador foram os escores do NPI e do CAMCOG. CONCLUSÃO: As características sociodemográficas dos cuidadores foram semelhantes às de estudos feitos em outros países. Entretanto, sobrecarga foi menos freqüente do que em estudos internacionais. A intensidade dos transtornos neuropsiquiátricos e a gravidade do declínio cognitivo foram os principais fatores associados à sobrecarga nesta amostra constituída principalmente por pacientes com DA, com demência leve a moderada. Mais estudos são necessários para verificar se a sobrecarga do cuidador é menos intensa em nosso meio.