Navegando por Palavras-chave "primeiro episódio psicótico"
Agora exibindo 1 - 3 de 3
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosBiomarcadores periféricos nos transtornos psicóticos: a influência de características clínicas, estágio da doença e tratamento(Universidade Federal de São Paulo (UNIFESP), 2015-10-16) Noto, Cristiano de Souza [UNIFESP]; Brietzke, Elisa Macedo Brietzke [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Schizophrenia is a chronic disease, with considerable impact on live of individuals and their families. Its origin is related to a complex interaction between genetic and environmental factors during brain development. Despite advances in research, there are no biological markers to confirm the diagnosis, indicate the prognosis, or assist in therapeutic decision. Changes in immune system and oxidation processes have been consistently associated with schizophrenia and markers of these processes emerge as promising biomarkers. However, the current literature is still heterogeneous, and the role of factors such as the use of medication or phenotypic variability remain a challenge to be surmounted. This thesis presents seven studies investigating biomarkers related to inflammation and oxidative stress in different aspects of the disorder. AIMS: To investigate psychotic disorders longitudinally, with a multi-phase and multimodal approach, taking into account clinical heterogeneity. Hence, it was explored the immunological profile and oxidative biomarkers, by evaluating different subgroups of the disease (first episode, drug-naïve patients, the presence of depression, before and after treatment, treatment-resistance). It was also evaluated the relationship between inflammation, oxidative and genetic biomarkers. METHODS: Patients were recruited in their first psychotic episode (FEP), drug-naïve, and followed for an average period of 8 weeks under risperidone. It was also evaluated patients in advanced stages, with more than 1 year of disease. Patients were diagnosed by SCID, with psychopathological evaluation by PANSS and CDSS. RESULTS: FEP patients have increased levels of interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-alpha when compared to healthy controls. They also have increased total reactive antioxidant potential (TRAP) and decreased activity of paraoxonase (PON) 1. Those in FEP with depression had higher levels of IL-4 and TNFalfa compared to those without depression, and increased expression of COMT and decrease expression NDEL1. After treatment with risperidone, the three mentioned cytokines, and additionally, IL-4 reduced significantly, and lipid hydroperoxides (LOOH) levels decreased and PON1 activity increased. Next, it was demonstrated that the combination of five biomarkers (sTNF-R1, sTNF-R2, CCL11, IP-10, IL-4) may predict the diagnosis of schizophrenia with a sensitivity of 70.0% and a specificity of 89 4%. Treatment resistance patients showed distinct inflammatory profile, with an increase in increased levels of sTNF-R1, sTNF-R2, and MCP-1. Finally, increased levels of IL-6 was associated with reduced expression of AKT1 and DROSHA, while an increase of IL-10 was associated with increased expression NDEL1, DISC1 and MBP. IL-6 also significantly increased expression of AKT1, DICER1, DROSHA and COMT induced by risperidone. DISCUSSION: It was shown that a disorder in the immune system and oxidative balance is already present from the onset of schizophrenia, before the use of antipsychotic drugs. Moreover, it was suggested that risperidone has antioxidative and anti-inflammatory effects. Features such as depression and treatment resistance also presented a specific immunological profile. Finally, it was showed that inflammatory cytokines play an important role in the regulation of oxidative processes and gene expression. Using an innovative approach and seeking for convergence between different methodologies, the results generated new perspectives in understanding the pathophysiological mechanisms underpinning the neurobiology of schizophrenia.
- ItemSomente MetadadadosInvestigação da associação entre tempo de psicose não-tratada e sintomas negativos em paciente em primeiro episódio psicótico(Universidade Federal de São Paulo (UNIFESP), 2013-02-21) Martins, Loraine Marcela Leal [UNIFESP]; Bressan, Rodrigo Affonseca Bressan [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introdução: A identificação de preditores clínicos de prognóstico em paciente em Primeiro Episódio Psicótico (PEP) representa um desafio para o desenvolvimento de intervenções precoces mais efetivas. Tempo de psicose não-tratada (TPNT) é o período desde o início das manifestações dos primeiros sintomas psicóticos até o começo do tratamento adequado. Maior intensidade de sintomas negativos é um importante preditor de prejuízo funcional e tempos maiores de TPNT foram associados a pior prognóstico. A relação entre essas duas características e sua associação com prognóstico foi pouco estudada, sobretudo em amostras de pacientes em PEP sem uso prévio de medicação. Objetivos: Investigar se a intensidade dos sintomas negativos na avaliação inicial de pacientes em primeiro episódio psicótico (PEP), antes do uso de antipsicóticos, está relacionada a um maior TPNT. Investigar se a intensidade destes sintomas prediz a resposta terapêutica e funcionamento global no seguimento de dois meses de tratamento. Métodos: Selecionados pacientes entre 18 e 40 anos, que preenchiam critérios do DSM IV para transtornos do espectro da esquizofrenia, sem uso prévio de antipsicóticos. Na avaliação inicial foram coletados dados sócio-demográficos e escores de PANSS, CDSS, CGI e GAF. TPNT foi mensurado retrospectivamente, definido como o período em semanas desde o início dos sintomas psicóticos até a admissão hospitalar. Os pacientes foram reavaliados após oito semanas de seguimento através de PANSS, CGI e GAF. Resultados: Os resultados não encontraram relação significativa entre TPNT e sintomas negativos na avaliação inicial, porém essa associação tornou-se significativa após seguimento de dois meses, com associação positiva entre maior TPNT e maiores escores de sintomas negativos. Não foi encontrada associação significativa entre maior TPNT e gravidade de psicopatologia geral após o tratamento de dois meses avaliada através da redução total da PANSS e da CGI. Não houve diferenças significativas nas variáveis de desfecho (PANSS total, CGI e GAF) entre os grupos de TPNT curto e longo. Não foi encontrada associação entre sintomas negativos na avaliação inicial e resposta terapêutica, avaliada através da PANSS e CGI, ou funcionamento global, avaliado através da GAF. Os resultados sugerem uma associação entre maior TPNT e pior funcionamento global avaliado pela GAF após o período de seguimento. Conclusão: Maior TPNT em paciente de PEP sem uso prévio de antipsicóticos está relacionado a maior gravidade de sintomas negativos após seguimento de dois meses, sugerindo um subgrupo de pacientes com sintomas negativos persistentes com pior resposta terapêutica nesta dimensão de sintomas e provável pior recuperação funcional.
- ItemSomente MetadadadosQualidade de vida de cuidadores de indivíduos em um primeiro episódio psicótico(Universidade Federal de São Paulo (UNIFESP), 2016-11-28) Jorge, Rita de Cassia Ferreira de Araujo [UNIFESP]; Chaves, Ana Cristina Chaves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The first psychotic episode psychosis is a critical period of great suffering for the affected individuals and their caregivers. With the community-based treatment implementation worldwide, families have been the primary caregivers, taking responsibility for addressing the needs the care recipient. Quality of life among these caregivers is low in various countries and different socio-cultural systems. Quality of life is related to a person?s perceptions of their position in life, within their own cultural context, system of values, goals, expectations, standards and concerns. Understanding the impact of caring for patients with first episode psychosis means recognizing that the caregiver needs care. Such a view will be instrumental in developing future personalized interventions that will benefit the actors of this care. To our knowledge, the present is the first Brazilian study on quality of life of caregivers of individuals experiencing a first psychotic episode. Objectives: (1) Brazilian Portuguese translation and validation of the Experience Caregiving Inventory; and (2) Evaluation of the Quality of Life predictors of primary caregivers of individuals with first episodic psychosis. Two papers have been developed for the preparation of this thesis. Methods: Longitudinal study with eighty individuals experiencing first episodic psychosis and their primary caregivers, consecutively recruited from the First Episodic Psychosis Outpatient Service of the Federal University of São Paulo / UNIFESP, and followed over a year. These caregivers were directly involved in the management of patients, not paid to provide care, over eighteen years of age, and submitted to sociodemographic and economic surveys, Short-Form 36, Self-Report Questionnaire-20 and Experience of Caring Inventory at time zero and 1 year. To meet the first objective, the process of translation / adaptation of the scale followed the recommendations for semantic, idiomatic, experimental and conceptual equivalences by using backtranslation, review committee, evaluation by a committee of judges, pre-testing techniques and review of weight / value of the scores. Regarding the second objective of this study, we tested the impact of the Self-Report Questionnaire-20 and the Experience of Caring Inventory on caregiver quality of life. The first step was to determine how the variables interrelated through a bivariate correlation (sum of "Yes" of the Self Report Questionnaire-20, Experience of caring Inventory, and positive and negative scores and domains of the Short Form-36). Spearman correlation was used for non-normal distributions between variables, or Pearson's correlation when the variables showed normal distribution. The Kolmogorov-Smirnov test was used to verify the normality of distribution. Next, we extracted a single quality of life variable through principal component analysis, a statistical technique used to reduce data, thereby decreasing the complexity of the interrelations between the 8 domains of the Short Form-36 to a relatively small number of combinations. The resulting component, called "Essential Quality of Life " was used as a result of linear regression models: one with non-adjusted covariates (each covariate individually calculated) and the other with the adjusted covariate (regression of all predictors together to the extracted component of quality of life as a result). Results: (1) We obtained good internal consistency and a reliable version of the Experience of Caring Inventory. (2) The strongest predictor of caregivers? low quality of life at one-year follow-up was the high score of the Self-Report Questionnaire 20 at time zero, with worse mental health related to lower quality of life. Conclusion: The Brazilian version of the Experience of Caring Experience Inventory is a valid tool to describe the experience of caring for a family member with severe mental illness in our culture, the main advantage of this scale is that it assesses the positive and negative aspects of care. Our study supports the idea that the well-being of individuals caring for and living with a family member with first psychotic episode is affected right at the onset of the disease and that their mental health is predictor of their quality of life.