MARA CRISTINA SOUZA DE LUCIA
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article Cognitive deficits in patients with mild to moderate traumatic brain injury (vol 68, pg 862, 2010)(2011) MIOTTO, Eliane Correa; CINALLI, Fernanda Zanetti; SERRAO, Valeria Trunkl; BENUTE, Glaucia Guerra; LUCIA, Mara Cristina Souza; SCAFF, MilbertoTraumatismo craniencefálico (TCE) é uma das causas mais freqüentes de lesão cerebral. São relatados na literatura déficits cognitivos após TCE moderado-grave relacionados à memória, linguagem, funções executivas, atenção e velocidade de processamento de informações. Estudos em pacientes com TCE leve são escassos embora alterações neuropsicológicas sejam encontradas nestes pacientes. OBJETIVO: Investigar o funcionamento cognitivo de pacientes com TCE leve e moderado através de um protocolo abrangente (PN01) de testes neuropsicológicos. MÉTODO: Foram avaliados 12 pacientes com TCE leve e moderado. RESULTADOS: Foram identificados déficits graves de memória episódica verbal para evocação imediata, tardia e de reconhecimento, de memória episódica visuo-espacial para evocação imediata e tardia, nomeação, fluência verbal nominal e velocidade de processamento de informações. CONCLUSÃO: Os resultados do estudo argumentam a favor da importância de avaliação neuropsicológica abrangente mesmo em casos de TCE leve a fim de se identificar funções comprometidas e preservadas, proporcionando condutas e programas de reabilitação adequados a cada caso.- Stroke lesion in cortical neural circuits and post-stroke incidence of major depressive episode: A 4-month prospective study(2011) TERRONI, Luisa; AMARO JR., Edson; IOSIFESCU, Dan V.; TINONE, Gisela; SATO, Joao Ricardo; LEITE, Claudia Costa; SOBREIRO, Matildes F. M.; LUCIA, Mara Cristina Souza; SCAFF, Milberto; FRAGUAS, RenerioObjective. Little is known about the relevance of lesion in neural circuits reported to be associated with major depressive disorder. We investigated the association between lesion stroke size in the limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit and incidence of major depressive episode (MDE). Methods. We enrolled 68 patients with first-ever ischemic stroke and no history of major depressive disorder. Neurological and psychiatric examinations were performed at three time-points. We diagnosed major depressive episode, following DSM-IV criteria. Lesion location and volume were determined with magnetic resonance imaging, using a semi-automated method based on the Brodmann Cytoarchitectonic Atlas. Results. Twenty-one patients (31%) experienced major depressive episode. Larger lesions in the left cortical regions of the LCSPT circuit (3,760 vs. 660 mm(3); P = 0.004) were associated with higher incidence of MDE. Secondary analyses revealed that major depressive episode was associated with larger lesions in areas of the medial prefrontal cortex including the ventral (BA24) and dorsal anterior cingulate cortex (BA32) and subgenual cortex (BA25); and also the subiculum (BA28/36) and amygdala (BA34). Conclusions Our findings indicate that depression due to stroke is aetiologically related to the disruption of the left LCSPT circuit and support the relevance of the medial prefrontal cortex dysfunction in the pathophysiology of depression.
- Association among depression, cognitive impairment and executive dysfunction after stroke(2012) TERRONI, Luisa; SOBREIRO, Matildes F.M.; CONFORTO, Adriana B.; ADDA, Carla C.; GUAJARDO, Valeri D.; LUCIA, Mara Cristina S. de; FRÁGUAS, RenérioABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.
- Twin Pregnancies: Evaluation of Major Depression, Stress, and Social Support(2013) BENUTE, Glaucia R. G.; NOZZELLA, Debora C. R.; PROHASKA, Cecilia; LIAO, Adolfo; LUCIA, Mara C. S. de; ZUGAIB, MarceloBackground: Twin pregnancies are at increased physiological and psychosocial risks. Objective: To investigate the prevalence of major depression in twin pregnancies and correlate with stress and social support. Method: The study included 51 pregnant women under specialized prenatal care who were evaluated by a Portuguese version of the semi-structured questionnaire Primary Care Evaluation of Mental Disorders (PRIME-MD) for Major Depression, and the Prenatal Psychosocial Profile (PPP) for evaluation of stress and social support. Results: Major depression was found in 33.3% of pregnant women, and prevailing symptoms were fatigue or loss of energy (100%), insomnia or hypersomnia (82.4%), changes in appetite (82.4%), decreased interest in daily activities (82.4%), and psychomotor agitation or retardation (82.4%). Among pregnant women who were diagnosed depressive, 76.5% also had a high level of stress and 47.1% complained about lack of social support. Statistical significance was found when correlating depression with perception of negative aspects of having twins and belief in significant body changes during pregnancy (p = .005 and .03, respectively). Marital status, occupation, and pregnancy planning were not significantly associated with the diagnosis of depression. Conclusion: Major depression occurs in one-third of pregnant women expecting twins and is associated with higher levels of stress and lack of social support. A multidisciplinary approach in these cases is fundamental to minimize further risks and complications.
- Perceptual organization deficits in traumatic brain injury patients(2015) COSTA, Thiago L.; ZANINOTTO, Ana Luiza C.; BENUTE, Glaucia G.; LUCIA, Mara C. S. De; PAIVA, Wellingson S.; WAGEMANS, Johan; BOGGIO, Paulo S.Traumatic brain injury (TBI) is a prevalent condition and there is limited visual perception research with this population. Here, we investigated perceptual organization changes in a rather homogeneous sample of closed head TBI outpatients with diffuse axonal injury only and no other known comorbidities. Patients had normal or corrected visual acuity. Perceptual organization was measured with the Leuven Perceptual Organization Screening Test (L-POST), a coherent motion task (CM) and the Leuven Embedded Figures Test (L-EFT). These tests were chosen to screen for deficits in different aspects of perceptual organization (L-POST), to evaluate local and global processing (L-EFT) and grouping in a dynamic set of stimuli (CM). TBI patients were significantly impaired compared to controls in all measures for both response time and accuracy, except for CM thresholds and object recognition subtests. The TBI group was similarly affected in all aspects of the L-EFT. TBI was also similarly affected in all perceptual factors of the L-POST. No significant correlations were found between scores and time post-injury, except for CM thresholds (r(s)=-0.74), which might explain the lack of group-level differences. The only score significantly correlated to IQ was L-EFT response time (r(s)=-0.67). These findings demonstrate that perceptual organization is diffusely affected in TBI and this effect has no substantial correlations with IQ. As many of the neuropsychological tests used to measure different cognitive functions involve some level of visual discrimination and perceptual organization demands, these results must be taken into account in the general neuropsychological evaluation of TBI patients.
- Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital(2012) GASCON, Maria Rita Polo; RIBEIRO, Cristiana Mara; BUENO, Livia Maria de Araujo; BENUTE, Glaucia Rosana Guerra; LUCIA, Mara Cristina Souza de; RIVITTI, Evandro Ararigboia; FESTA NETO, CyroBACKGROUND: The objective of this study was to estimate the prevalence of depression and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in Sao Paulo, Brazil. OBJECTIVE: To assess the prevalence of mood and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in Sao Paulo. METHOD: A total of 75 patients, men and women, aged between 18 and 76 years, took part in the research. The study employed a descriptive, cross sectional and correlational method. The data was collected by means of a social demographic questionnaire and the PRIME-MD. RESULTS: It was found that 45.3 percent of the subjects presented with depressive symptoms, and 52 percent presented with symptoms of anxiety and that this survey showed moderate and high significant correlations (p<0,01; r= 0,616) for depression and anxiety. CONCLUSION: These facts could evidence the relationship between physical and psyche, just as the literature presents.
- The association of major depressive episode and personality traits in patients with fibromyalgia(2011) SANTOS, Danyella de Melo; LAGE, Lais Verderame; JABUR, Eleonora Kehl; KAZIYAMA, Helena Hideko Seguchi; IOSIFESCU, Dan V.; LUCIA, Mara Cristina Souza de; FRAGUAS, RenerioINTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e. g., harm avoidance). METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients.
- Fenômenos alucinatórios auditivos em pacientes com zumbido: relações afetivas e aspectos depressivos(2012) SANTOS, Rosa Maria Rodrigues dos; SANCHEZ, Tanit Ganz; BENTO, Ricardo Ferreira; LUCIA, Mara Cristina Souza deINTRODUCTION: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. AIMS: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. METHOD: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. RESULTS: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. CONCLUSIONS: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective.
- Psychogenic non-epileptic seizures and psychoanalytical treatment: results(2014) SANTOS, Niraldo de Oliveira; BENUTE, Glaucia Rosana Guerra; SANTIAG, Alessandra; MARCHIORI, Paulo Euripedes; LUCIA, Mara Cristina Souza deBackground: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes.
- Loss of interest, depressed mood and impact on the quality of life: Cross-sectional survey(2011) GUAJARDO, Valeri D.; SOUZA, Bruno P. F.; HENRIQUES, Sergio G.; LUCIA, Mara C. S.; MENEZES, Paulo R.; MARTINS, Milton A.; TARDIVO, Leila S. L. P. C.; GATTAZ, Wagner F.; FRAGUAS, RenerioBackground: Depressive symptoms and chronic disease have adverse effects on patients' health-related quality of life (H-RQOL). However, little is known about this effect on H-RQOL when only the two core depressive symptoms - loss of interest and depressed mood - are considered. The objective of this study is to investigate H-RQOL in the presence of loss of interest and depressed mood at a general medical outpatient unit. Methods: We evaluated 553 patients at their first attendance at a general medical outpatient unit of a teaching hospital. H-RQOL was assessed with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Depressed mood and loss of interest were assessed by the Primary Care Evaluation of Mental Disorders (PRIME-MD)Patient Questionnaire. A physician performed the diagnosis of chronic diseases by clinical judgment and classified them in 13 possible pre-defined categories. We used multiple linear regression to investigate associations between each domain of H-RQOL and our two core depression symptoms. The presence of chronic diseases and demographic variables were included in the models as covariates. Results: Among the 553 patients, 70.5% were women with a mean age of 41.0 years (range 18-85, SD +/- 15.4). Loss of interest was reported by 54.6%, and depressed mood by 59.7% of the patients. At least one chronic disease was diagnosed in 59.5% of patients; cardiovascular disease was the most prevalent, affecting 20.6% of our patients. Loss of interest and depressed mood was significantly associated with decreased scores in all domains of H-RQOL after adjustment for possible confounders. The presence of any chronic disease was associated with a decrease in the domain of vitality. The analysis of each individual chronic disease category revealed that no category was associated with a decrease in more than one domain of H-RQOL. Conclusion: Loss of interest and depressed mood were associated with significant decreases in H-RQOL. We recommend these simple tests for screening in general practice.