A relação entre odontologia e medicina é perceptível na literatura especializada. Por outro lado,... more A relação entre odontologia e medicina é perceptível na literatura especializada. Por outro lado, os odontopediatras lidam em suas atividades com muitos desa os de cunho psicológico. Deparam-se com fobias, não cooperação de pacientes, dinâmicas familiares complexas, questões referentes à oralidade, à amamentação, aos hábitos de sucção, à maternagem, à sexualidade, à agressividade, entre outros exemplos. Para Klatchoian (1992), a relação entre dentista e criança é fundamental à pro laxia do medo e ao atendimento odontopediátrico. Os desenhos relacionais, de suma importância para as atividades odontológicas que
Background. A number of scales are used to estimate the severity of depression. However, differen... more Background. A number of scales are used to estimate the severity of depression. However, differences between selfreport and clinician rating, multi-dimensionality and different weighting of individual symptoms in summed scores may affect the validity of measurement. In this study we examined and integrated the psychometric properties of three commonly used rating scales. Method. The 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI) were administered to 660 adult patients with unipolar depression in a multi-centre pharmacogenetic study. Item response theory (IRT) and factor analysis were used to evaluate their psychometric properties and estimate true depression severity, as well as to group items and derive factor scores. Results. The MADRS and the BDI provide internally consistent but mutually distinct estimates of depression severity. The HAMD-17 is not internally consistent and contains several items less suitable for outpatients. Factor analyses indicated a dominant depression factor. A model comprising three dimensions, namely 'observed mood and anxiety', ' cognitive ' and 'neurovegetative', provided a more detailed description of depression severity. Conclusions. The MADRS and the BDI can be recommended as complementary measures of depression severity. The three factor scores are proposed for external validation.
Este trabalho objetiva fazer articulações da psicanálise com a odontologia para bebês, destacando... more Este trabalho objetiva fazer articulações da psicanálise com a odontologia para bebês, destacando que a internalização de contribuições psicanalíticas é primordial para uma ampliação do pensamento no que concerne à área de saúde, mais especificamente à odontologia para bebês. São enfatizadas concepções de sofrimento e ambiente suficientemente bom para trabalhos ampliados no terreno interdisciplinar dessas áreas.
This paper aims to discuss some psychoanalytic contributions to Pediatric Dentistry in the field ... more This paper aims to discuss some psychoanalytic contributions to Pediatric Dentistry in the field of communication. The Pediatric Dentistry is a branch of Dentistry that faces many psychological challenges. The dental care of children includes the dentist, his team, the patient and his companion at different places, which draws several dynamics. Play is present in the pediatric dentist’s office. The paranoid fantasies are very common. It’s a different approach when the pediatric dentist is looking for expanding the communication with his patient and developing his listening in dental practices. In some situations it is important to recommend that the psychoanalyst see the patient. Whatever the case the Psychoanalysis has many interfaces to build with Pediatric Dentistry
Resumo: Introdução: um aspecto fundamental a ser considerado no desenvolvimento de sistemas de ap... more Resumo: Introdução: um aspecto fundamental a ser considerado no desenvolvimento de sistemas de apoio ao diagnóstico médico é a modelagem lógica do conhecimento. Objetivo: o objetivo desse trabalho é verificar se a lógica fuzzy constitui uma ferramenta eficaz para representar um modelo de conhecimento médico especializado em epilepsia. Material e Métodos: foram feitas entrevistas gravadas com um especialista em Neurofisiologia e o conhecimento foi transcrito em regras lógicas e validado pelo especialista. Resultados e Discussão: a lógica fuzzy não foi suficiente para captar nuances do conhecimento do especialista; acrescentou-se a lógica paraconsistente e verificou-se que interpretações intuitivas importantes se perdiam. Acrescentou-se à lógica fuzzy operadores lógicos de possibilidade e a modelagem apresentou os resultados esperados.
ISSNIP Biosignals and Biorobotics Conference 2011, 2011
The scientific researches in the field of rehabilitation engineering are increasingly providing m... more The scientific researches in the field of rehabilitation engineering are increasingly providing mechanisms in order to help people with disability to perform simple tasks of day-today. Several studies have been carried out highlighting the advantages of using muscle signal in order to control rehabilitation devices, such as experimental prostheses. This paper presents a study investigating the use of forearm surface electromyography (sEMG) signals for classification of several movements of the arm using just three pairs of surface electrodes located in strategic places. The classification is done by an artificial neural network to process signal features to recognize performed movements. The average accuracy reached for the classification of six different movements was 68%-88%.
BackgroundA number of scales are used to estimate the severity of depression. However, difference... more BackgroundA number of scales are used to estimate the severity of depression. However, differences between self-report and clinician rating, multi-dimensionality and different weighting of individual symptoms in summed scores may affect the validity of measurement. In this study we examined and integrated the psychometric properties of three commonly used rating scales.MethodThe 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery–Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI) were administered to 660 adult patients with unipolar depression in a multi-centre pharmacogenetic study. Item response theory (IRT) and factor analysis were used to evaluate their psychometric properties and estimate true depression severity, as well as to group items and derive factor scores.ResultsThe MADRS and the BDI provide internally consistent but mutually distinct estimates of depression severity. The HAMD-17 is not internally consistent and contains sever...
The objective of the Genome-based Therapeutic Drugs for Depression study is to investigate the fu... more The objective of the Genome-based Therapeutic Drugs for Depression study is to investigate the function of variations in genes encoding key proteins in serotonin, norepinephrine, neurotrophic and glucocorticoid signaling in determining the response to serotonin-reuptake-inhibiting and norepinephrine-reuptake-inhibiting antidepressants. A total of 116 single nucleotide polymorphisms in 10 candidate genes were genotyped in 760 adult patients with moderate-to-severe depression, treated with escitalopram (a serotonin reuptake inhibitor) or nortriptyline (a norepinephrine reuptake inhibitor) for 12 weeks in an open-label part-randomized multicenter study. The effect of genetic variants on change in depressive symptoms was evaluated using mixed linear models. Several variants in a serotonin receptor gene (HTR2A) predicted response to escitalopram with one marker (rs9316233) explaining 1.1% of variance (P ¼ 0.0016). Variants in the norepinephrine transporter gene (SLC6A2) predicted response to nortriptyline, and variants in the glucocorticoid receptor gene (NR3C1) predicted response to both antidepressants. Two HTR2A markers remained significant after hypothesis-wide correction for multiple testing. A false discovery rate of 0.106 for the three strongest associations indicated that the multiple findings are unlikely to be false positives. The pattern of associations indicated a degree of specificity with variants in genes encoding proteins in serotonin signaling influencing response to the serotonin-reuptake-inhibiting escitalopram, genes encoding proteins in norepinephrine signaling influencing response to the norepinephrine-reuptake-inhibiting nortriptyline and a common pathway gene influencing response to both antidepressants. The single marker associations explained only a small proportion of variance in response to antidepressants, indicating a need for a multivariate approach to prediction.
The principal objective of this study was to evaluate the occurrence of various dissociative phen... more The principal objective of this study was to evaluate the occurrence of various dissociative phenomena in patients with major depressive disorder (MDD) and their possible implications in manifestation and course of depression. We administered the Dissociative Experiences Scale (DES) and a self-questionnaire of life events to 27 patients with MDD and to 40 healthy participants in order to collect information on traumatic events. Patients who scored >or= 20 on the DES were also assessed to determine the presence of dissociative disorder. Patients with MDD reported a significantly higher mean score on the DES than the comparison healthy participants. In all, 12 out of 27 patients with MDD reported childhood trauma, and their mean score on the DES representing absorption and imaginative involvement was significantly higher than that of participants without childhood trauma. Also, 7% of our MDD patients were diagnosed with dissociative disorder during this study. The principal limitations of the study were its small sample size and the use of a nonstandardized trauma measure. These findings indicate that dissociative phenomena should not be overlooked in MDD. Screening methods and structured interview for dissociative disorders are useful in psychiatric and psychological practice. Further studies should analyze the role and clinical consequence of different forms of dissociation experiences.
Catechol-O-methyltransferase (COMT) has been suggested to be involved in the pathogenesis and pha... more Catechol-O-methyltransferase (COMT) has been suggested to be involved in the pathogenesis and pharmacological treatment of affective disorders. The nonsynonymous single nucleotide polymorphism (SNP) in exon 4 (Val108/158Met; rs4680) influences the COMT enzyme activity. Inconsistent results were found between Val158Met polymorphism (rs4680) and treatment response phenotypes in genetic association studies. However, the haplotype combinations of alleles at the Val108/158Met SNP with the other synonymous SNPs in the COMT gene region have shown association between enzyme activity/ amount and COMT-dependent phenotypes. We carried out this study to define the functional impact of COMT genotypes/haplotypes on susceptibility and on treatment response phenotypes of major depressive disorder (MDD). Three hundred and ninety-six patients with MDD diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [(DSM)-IV] and 295 healthy controls were recruited for this study and genotyped for the seven COMT SNPs (rs2075507, rs737865, rs6269, rs4633, rs4818, rs4680, and rs165599). This is the first study with all these SNPs to investigate for MDD and treatment response phenotypes. Our results show that none of the seven SNPs, including the rs4680, was significantly associated with MDD after permutation correction in single SNP analyses. Although several haplotype combinations showed significance, the combinations of G-T-G-G haplotype for rs6269, rs4633, rs4818 and rs4680 were only present in the MDD group
Methods: Cross sectional observational study in general practice outpatients in Belgium. Eight co... more Methods: Cross sectional observational study in general practice outpatients in Belgium. Eight consecutive patients consulting with a complaint of pain were assessed by 112 GP's for the presence of Major depression or an anxiety disorder using the PHQ. The severity of anxious and depressive symptoms were measured using the HAD. The Brief Pain inventory (BPI) was used to assess the severity and impact of pain. In addition socioeconomic parameters as well information on current treatment were collected. Student t-test, Mann-Whitney and chi-square test were applied. Odds ratios (OR) and their 95% confidence intervals (95% CI) were derived from the analysis of 2 by 2 contingency tables in order to estimate the strength of the association between depression or anxiety disorder and other variables. Results: A total of 659 patients are included in the analysis. Demographic data are presented. Based on the PHQ, 37.8% (95% CI: 34.1−41.5%) of patients consulting the GP with a painful symptom were also suffering from depression and 25.2% (95% CI: 21.9−28.5%) had an anxiety disorder. 14.9% (95% CI:12.2−17.6) of patients had both depression and anxiety. Odds ratio's (95% CI) associated with depression in patients suffering from pain are 4.0 (2.7−6.1) (P < 0.001) for pain longer than 3 months, 4.2 (2.1−8.2) (P < 0.001) for multiple pain locations (6/ < 6), 2.2 (1.4−3.4) (P = 0.001) [3.0 (2.1−4.3) (P < 0.001) for 3/<3] for comorbid physical conditions, 1.8 (1.3−2.5) (P < 0.001) for BMI > 25. For anxiety disorders in patients with pain the odds ratio's are 2.8 (1.8−4.4) for pain longer than 3 months, 5.8 (3.0−11.1) (P < 0.001) for multiple pain locations (6/ < 6), 1.1 (0.7−1.7) (NS) [2.7 (1.8−4.0) (P < 0.001) for 3/<3] for comorbid physical conditions, 0.4 (0.3−0.6) (P < 0.001) for BMI > 25. Sociodemographic factors associated with depression and/or anxiety disorder in patients with pain were sex (48% depression in F versus 19% in males (P < 0.001)), marital status (45% depression, 30% anxiety in "married" versus 26% and 18% within "living alone" (P < 0.001)), employment (highest proportions of depression in unemployed people (89%) or in blue collars (70%) (P < 0.001) and highest proportions of anxiety disorders in workmen (50%), retired (44%) and blue collars (42%) (P < 0.001) and educational level (89% depression in those without diploma versus 8% in those with university diploma (P < 0.001)). The presence of depression and anxiety were associated with absence at work (P < 0.001 for depression and anxiety disorders; subjects with anxiety disorders had a significantly higher median of days lost (P = 0.035). Conclusion: The presence of depression and/or anxiety is very frequent in patients with chronic pain. The RAPSODY study provides information on the risk factors for the presence of depression and/or anxiety in patients with painful symptoms in primary care.
S.09. Bipolar disorder: special issues in diagnosis and treatment illness (M:D ratio = 39:1). Thu... more S.09. Bipolar disorder: special issues in diagnosis and treatment illness (M:D ratio = 39:1). Thus, the management of depression in bipolar illness is an important, but unfortunately often neglected therapeutic priority. Resolution of affective episodes in bipolar illness with ongoing residual symptoms is highly associated with rapid episode relapse and future course chronicity. Thus it is only when episodes are resolved fully (asymptomatic) that true episode recovery is achieved, which, in turn, is also associated with a benign, less severe future course of illness and a significant delay in episode relapse or recurrence.
BackgroundAdverse drug reactions are important determinants of non-adherence to antidepressant tr... more BackgroundAdverse drug reactions are important determinants of non-adherence to antidepressant treatment but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures.AimsTo evaluate a simple self-report measure and describe adverse reactions to antidepressants in a large sample.MethodThe newly developed self-report Antidepressant Side-Effect Checklist and the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly administered to 811 adult participants with depression in a part-randomised multicentre open-label study comparing escitalopram and nortriptyline.ResultsThere was good agreement between self-report and psychiatrists' ratings. Most complaints listed as adverse reactions in people with depression were more common when they were medication-free rather than during their treatment with antidepressants. Dry mouth (74%), constipation (33%) and weight gain (15%) were associated with nortriptyline treatment. Diarrhoea...
BackgroundTricyclic antidepressants and serotonin reuptake inhibitors are considered to be equall... more BackgroundTricyclic antidepressants and serotonin reuptake inhibitors are considered to be equally effective, but differences may have been obscured by internally inconsistent measurement scales and inefficient statistical analyses.AimsTo test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression.MethodIn a multicentre part-randomised open-label design (the Genome Based Therapeutic Drugs for Depression (GENDEP) study) 811 adults with moderate to severe unipolar depression were allocated to flexible dosage escitalopram or nortriptyline for 12 weeks. The weekly Montgomery–Åsberg Depression Rating Scale, Hamilton Rating Scale for Depression, and Beck Depression Inventory were scored both conventionally and in a more novel way according to dimensions of observed mood, cognitive symptoms and neurovegetative symptoms.ResultsMixed-effect linear regression showed no difference between escitalopram an...
Bipolar disorder is a serious illness, distinguished by marked variations in mood, energy and fun... more Bipolar disorder is a serious illness, distinguished by marked variations in mood, energy and functional capability. The primary goals in the management of bipolar disorder are to treat acute episodes and to prevent recurrence. Many studies have demonstrated that atypical antipsychotic drugs can provide alternatives to traditional mood stabilizers in the treatment of this disorder. Risperidone is an atypical antipsychotic that is approved in the USA and in most European countries for use in bipolar mania or bipolar I disorder-manic/mixed episode. Preliminary data exist on the efficacy of risperidone in long-term treatment. However, randomized controlled trials are required to confirm the role of this agent in bipolar depression, and to validate efficacy as in the maintenance setting. This article focuses on the use of risperidone in the treatment of bipolar disorder, with an emphasis on randomized, placebo-controlled trials, and presents a brief overview of other atypical antipsycho...
A relação entre odontologia e medicina é perceptível na literatura especializada. Por outro lado,... more A relação entre odontologia e medicina é perceptível na literatura especializada. Por outro lado, os odontopediatras lidam em suas atividades com muitos desa os de cunho psicológico. Deparam-se com fobias, não cooperação de pacientes, dinâmicas familiares complexas, questões referentes à oralidade, à amamentação, aos hábitos de sucção, à maternagem, à sexualidade, à agressividade, entre outros exemplos. Para Klatchoian (1992), a relação entre dentista e criança é fundamental à pro laxia do medo e ao atendimento odontopediátrico. Os desenhos relacionais, de suma importância para as atividades odontológicas que
Background. A number of scales are used to estimate the severity of depression. However, differen... more Background. A number of scales are used to estimate the severity of depression. However, differences between selfreport and clinician rating, multi-dimensionality and different weighting of individual symptoms in summed scores may affect the validity of measurement. In this study we examined and integrated the psychometric properties of three commonly used rating scales. Method. The 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI) were administered to 660 adult patients with unipolar depression in a multi-centre pharmacogenetic study. Item response theory (IRT) and factor analysis were used to evaluate their psychometric properties and estimate true depression severity, as well as to group items and derive factor scores. Results. The MADRS and the BDI provide internally consistent but mutually distinct estimates of depression severity. The HAMD-17 is not internally consistent and contains several items less suitable for outpatients. Factor analyses indicated a dominant depression factor. A model comprising three dimensions, namely 'observed mood and anxiety', ' cognitive ' and 'neurovegetative', provided a more detailed description of depression severity. Conclusions. The MADRS and the BDI can be recommended as complementary measures of depression severity. The three factor scores are proposed for external validation.
Este trabalho objetiva fazer articulações da psicanálise com a odontologia para bebês, destacando... more Este trabalho objetiva fazer articulações da psicanálise com a odontologia para bebês, destacando que a internalização de contribuições psicanalíticas é primordial para uma ampliação do pensamento no que concerne à área de saúde, mais especificamente à odontologia para bebês. São enfatizadas concepções de sofrimento e ambiente suficientemente bom para trabalhos ampliados no terreno interdisciplinar dessas áreas.
This paper aims to discuss some psychoanalytic contributions to Pediatric Dentistry in the field ... more This paper aims to discuss some psychoanalytic contributions to Pediatric Dentistry in the field of communication. The Pediatric Dentistry is a branch of Dentistry that faces many psychological challenges. The dental care of children includes the dentist, his team, the patient and his companion at different places, which draws several dynamics. Play is present in the pediatric dentist’s office. The paranoid fantasies are very common. It’s a different approach when the pediatric dentist is looking for expanding the communication with his patient and developing his listening in dental practices. In some situations it is important to recommend that the psychoanalyst see the patient. Whatever the case the Psychoanalysis has many interfaces to build with Pediatric Dentistry
Resumo: Introdução: um aspecto fundamental a ser considerado no desenvolvimento de sistemas de ap... more Resumo: Introdução: um aspecto fundamental a ser considerado no desenvolvimento de sistemas de apoio ao diagnóstico médico é a modelagem lógica do conhecimento. Objetivo: o objetivo desse trabalho é verificar se a lógica fuzzy constitui uma ferramenta eficaz para representar um modelo de conhecimento médico especializado em epilepsia. Material e Métodos: foram feitas entrevistas gravadas com um especialista em Neurofisiologia e o conhecimento foi transcrito em regras lógicas e validado pelo especialista. Resultados e Discussão: a lógica fuzzy não foi suficiente para captar nuances do conhecimento do especialista; acrescentou-se a lógica paraconsistente e verificou-se que interpretações intuitivas importantes se perdiam. Acrescentou-se à lógica fuzzy operadores lógicos de possibilidade e a modelagem apresentou os resultados esperados.
ISSNIP Biosignals and Biorobotics Conference 2011, 2011
The scientific researches in the field of rehabilitation engineering are increasingly providing m... more The scientific researches in the field of rehabilitation engineering are increasingly providing mechanisms in order to help people with disability to perform simple tasks of day-today. Several studies have been carried out highlighting the advantages of using muscle signal in order to control rehabilitation devices, such as experimental prostheses. This paper presents a study investigating the use of forearm surface electromyography (sEMG) signals for classification of several movements of the arm using just three pairs of surface electrodes located in strategic places. The classification is done by an artificial neural network to process signal features to recognize performed movements. The average accuracy reached for the classification of six different movements was 68%-88%.
BackgroundA number of scales are used to estimate the severity of depression. However, difference... more BackgroundA number of scales are used to estimate the severity of depression. However, differences between self-report and clinician rating, multi-dimensionality and different weighting of individual symptoms in summed scores may affect the validity of measurement. In this study we examined and integrated the psychometric properties of three commonly used rating scales.MethodThe 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery–Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI) were administered to 660 adult patients with unipolar depression in a multi-centre pharmacogenetic study. Item response theory (IRT) and factor analysis were used to evaluate their psychometric properties and estimate true depression severity, as well as to group items and derive factor scores.ResultsThe MADRS and the BDI provide internally consistent but mutually distinct estimates of depression severity. The HAMD-17 is not internally consistent and contains sever...
The objective of the Genome-based Therapeutic Drugs for Depression study is to investigate the fu... more The objective of the Genome-based Therapeutic Drugs for Depression study is to investigate the function of variations in genes encoding key proteins in serotonin, norepinephrine, neurotrophic and glucocorticoid signaling in determining the response to serotonin-reuptake-inhibiting and norepinephrine-reuptake-inhibiting antidepressants. A total of 116 single nucleotide polymorphisms in 10 candidate genes were genotyped in 760 adult patients with moderate-to-severe depression, treated with escitalopram (a serotonin reuptake inhibitor) or nortriptyline (a norepinephrine reuptake inhibitor) for 12 weeks in an open-label part-randomized multicenter study. The effect of genetic variants on change in depressive symptoms was evaluated using mixed linear models. Several variants in a serotonin receptor gene (HTR2A) predicted response to escitalopram with one marker (rs9316233) explaining 1.1% of variance (P ¼ 0.0016). Variants in the norepinephrine transporter gene (SLC6A2) predicted response to nortriptyline, and variants in the glucocorticoid receptor gene (NR3C1) predicted response to both antidepressants. Two HTR2A markers remained significant after hypothesis-wide correction for multiple testing. A false discovery rate of 0.106 for the three strongest associations indicated that the multiple findings are unlikely to be false positives. The pattern of associations indicated a degree of specificity with variants in genes encoding proteins in serotonin signaling influencing response to the serotonin-reuptake-inhibiting escitalopram, genes encoding proteins in norepinephrine signaling influencing response to the norepinephrine-reuptake-inhibiting nortriptyline and a common pathway gene influencing response to both antidepressants. The single marker associations explained only a small proportion of variance in response to antidepressants, indicating a need for a multivariate approach to prediction.
The principal objective of this study was to evaluate the occurrence of various dissociative phen... more The principal objective of this study was to evaluate the occurrence of various dissociative phenomena in patients with major depressive disorder (MDD) and their possible implications in manifestation and course of depression. We administered the Dissociative Experiences Scale (DES) and a self-questionnaire of life events to 27 patients with MDD and to 40 healthy participants in order to collect information on traumatic events. Patients who scored &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 20 on the DES were also assessed to determine the presence of dissociative disorder. Patients with MDD reported a significantly higher mean score on the DES than the comparison healthy participants. In all, 12 out of 27 patients with MDD reported childhood trauma, and their mean score on the DES representing absorption and imaginative involvement was significantly higher than that of participants without childhood trauma. Also, 7% of our MDD patients were diagnosed with dissociative disorder during this study. The principal limitations of the study were its small sample size and the use of a nonstandardized trauma measure. These findings indicate that dissociative phenomena should not be overlooked in MDD. Screening methods and structured interview for dissociative disorders are useful in psychiatric and psychological practice. Further studies should analyze the role and clinical consequence of different forms of dissociation experiences.
Catechol-O-methyltransferase (COMT) has been suggested to be involved in the pathogenesis and pha... more Catechol-O-methyltransferase (COMT) has been suggested to be involved in the pathogenesis and pharmacological treatment of affective disorders. The nonsynonymous single nucleotide polymorphism (SNP) in exon 4 (Val108/158Met; rs4680) influences the COMT enzyme activity. Inconsistent results were found between Val158Met polymorphism (rs4680) and treatment response phenotypes in genetic association studies. However, the haplotype combinations of alleles at the Val108/158Met SNP with the other synonymous SNPs in the COMT gene region have shown association between enzyme activity/ amount and COMT-dependent phenotypes. We carried out this study to define the functional impact of COMT genotypes/haplotypes on susceptibility and on treatment response phenotypes of major depressive disorder (MDD). Three hundred and ninety-six patients with MDD diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [(DSM)-IV] and 295 healthy controls were recruited for this study and genotyped for the seven COMT SNPs (rs2075507, rs737865, rs6269, rs4633, rs4818, rs4680, and rs165599). This is the first study with all these SNPs to investigate for MDD and treatment response phenotypes. Our results show that none of the seven SNPs, including the rs4680, was significantly associated with MDD after permutation correction in single SNP analyses. Although several haplotype combinations showed significance, the combinations of G-T-G-G haplotype for rs6269, rs4633, rs4818 and rs4680 were only present in the MDD group
Methods: Cross sectional observational study in general practice outpatients in Belgium. Eight co... more Methods: Cross sectional observational study in general practice outpatients in Belgium. Eight consecutive patients consulting with a complaint of pain were assessed by 112 GP's for the presence of Major depression or an anxiety disorder using the PHQ. The severity of anxious and depressive symptoms were measured using the HAD. The Brief Pain inventory (BPI) was used to assess the severity and impact of pain. In addition socioeconomic parameters as well information on current treatment were collected. Student t-test, Mann-Whitney and chi-square test were applied. Odds ratios (OR) and their 95% confidence intervals (95% CI) were derived from the analysis of 2 by 2 contingency tables in order to estimate the strength of the association between depression or anxiety disorder and other variables. Results: A total of 659 patients are included in the analysis. Demographic data are presented. Based on the PHQ, 37.8% (95% CI: 34.1−41.5%) of patients consulting the GP with a painful symptom were also suffering from depression and 25.2% (95% CI: 21.9−28.5%) had an anxiety disorder. 14.9% (95% CI:12.2−17.6) of patients had both depression and anxiety. Odds ratio's (95% CI) associated with depression in patients suffering from pain are 4.0 (2.7−6.1) (P < 0.001) for pain longer than 3 months, 4.2 (2.1−8.2) (P < 0.001) for multiple pain locations (6/ < 6), 2.2 (1.4−3.4) (P = 0.001) [3.0 (2.1−4.3) (P < 0.001) for 3/<3] for comorbid physical conditions, 1.8 (1.3−2.5) (P < 0.001) for BMI > 25. For anxiety disorders in patients with pain the odds ratio's are 2.8 (1.8−4.4) for pain longer than 3 months, 5.8 (3.0−11.1) (P < 0.001) for multiple pain locations (6/ < 6), 1.1 (0.7−1.7) (NS) [2.7 (1.8−4.0) (P < 0.001) for 3/<3] for comorbid physical conditions, 0.4 (0.3−0.6) (P < 0.001) for BMI > 25. Sociodemographic factors associated with depression and/or anxiety disorder in patients with pain were sex (48% depression in F versus 19% in males (P < 0.001)), marital status (45% depression, 30% anxiety in "married" versus 26% and 18% within "living alone" (P < 0.001)), employment (highest proportions of depression in unemployed people (89%) or in blue collars (70%) (P < 0.001) and highest proportions of anxiety disorders in workmen (50%), retired (44%) and blue collars (42%) (P < 0.001) and educational level (89% depression in those without diploma versus 8% in those with university diploma (P < 0.001)). The presence of depression and anxiety were associated with absence at work (P < 0.001 for depression and anxiety disorders; subjects with anxiety disorders had a significantly higher median of days lost (P = 0.035). Conclusion: The presence of depression and/or anxiety is very frequent in patients with chronic pain. The RAPSODY study provides information on the risk factors for the presence of depression and/or anxiety in patients with painful symptoms in primary care.
S.09. Bipolar disorder: special issues in diagnosis and treatment illness (M:D ratio = 39:1). Thu... more S.09. Bipolar disorder: special issues in diagnosis and treatment illness (M:D ratio = 39:1). Thus, the management of depression in bipolar illness is an important, but unfortunately often neglected therapeutic priority. Resolution of affective episodes in bipolar illness with ongoing residual symptoms is highly associated with rapid episode relapse and future course chronicity. Thus it is only when episodes are resolved fully (asymptomatic) that true episode recovery is achieved, which, in turn, is also associated with a benign, less severe future course of illness and a significant delay in episode relapse or recurrence.
BackgroundAdverse drug reactions are important determinants of non-adherence to antidepressant tr... more BackgroundAdverse drug reactions are important determinants of non-adherence to antidepressant treatment but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures.AimsTo evaluate a simple self-report measure and describe adverse reactions to antidepressants in a large sample.MethodThe newly developed self-report Antidepressant Side-Effect Checklist and the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly administered to 811 adult participants with depression in a part-randomised multicentre open-label study comparing escitalopram and nortriptyline.ResultsThere was good agreement between self-report and psychiatrists' ratings. Most complaints listed as adverse reactions in people with depression were more common when they were medication-free rather than during their treatment with antidepressants. Dry mouth (74%), constipation (33%) and weight gain (15%) were associated with nortriptyline treatment. Diarrhoea...
BackgroundTricyclic antidepressants and serotonin reuptake inhibitors are considered to be equall... more BackgroundTricyclic antidepressants and serotonin reuptake inhibitors are considered to be equally effective, but differences may have been obscured by internally inconsistent measurement scales and inefficient statistical analyses.AimsTo test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression.MethodIn a multicentre part-randomised open-label design (the Genome Based Therapeutic Drugs for Depression (GENDEP) study) 811 adults with moderate to severe unipolar depression were allocated to flexible dosage escitalopram or nortriptyline for 12 weeks. The weekly Montgomery–Åsberg Depression Rating Scale, Hamilton Rating Scale for Depression, and Beck Depression Inventory were scored both conventionally and in a more novel way according to dimensions of observed mood, cognitive symptoms and neurovegetative symptoms.ResultsMixed-effect linear regression showed no difference between escitalopram an...
Bipolar disorder is a serious illness, distinguished by marked variations in mood, energy and fun... more Bipolar disorder is a serious illness, distinguished by marked variations in mood, energy and functional capability. The primary goals in the management of bipolar disorder are to treat acute episodes and to prevent recurrence. Many studies have demonstrated that atypical antipsychotic drugs can provide alternatives to traditional mood stabilizers in the treatment of this disorder. Risperidone is an atypical antipsychotic that is approved in the USA and in most European countries for use in bipolar mania or bipolar I disorder-manic/mixed episode. Preliminary data exist on the efficacy of risperidone in long-term treatment. However, randomized controlled trials are required to confirm the role of this agent in bipolar depression, and to validate efficacy as in the maintenance setting. This article focuses on the use of risperidone in the treatment of bipolar disorder, with an emphasis on randomized, placebo-controlled trials, and presents a brief overview of other atypical antipsycho...
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