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Abstract(s)
Introdução: A esclerose múltipla é uma doença crónica complexa que acomete o sistema nervoso central em múltiplos focos e que consiste em inflamação, desmielinização, gliose e perda neuronal. Afeta cerca de 2,5 milhões de pessoas em todo o mundo, contudo, a sua prevalência difere nas várias regiões. A inexistência de um tratamento curativo e o carácter incerto desta patologia gera estados de angústia e stress, que têm repercussões biopsicossociais na vida dos indivíduos. Posto isto, investigações recentes demonstraram que a depressão é o transtorno psiquiátrico mais comum e mais avaliado na esclerose múltipla e que o risco de um paciente com esclerose múltipla vir a desenvolver depressão ao longo da vida é cerca de 50%, contrastando o risco de 10% da população em geral.
Objetivos: Investigar a prevalência da depressão em pacientes com esclerose múltipla, num intervalo de cerca de 10 anos. Descrever as características sociodemográficas e clínicas, tanto gerais quanto referentes à esclerose múltipla e à depressão, em pacientes com esclerose múltipla. Identificar a existência de relação entre as características sociodemográficas e clínicas, gerais e referentes à esclerose múltipla, e a depressão, em pacientes com esclerose múltipla.
Materiais e Métodos: Estudo de investigação observacional, transversal, retrospetivo e analítico. A recolha de dados de pacientes portadores de esclerose múltipla, referentes ao intervalo de janeiro de 2006 a julho de 2016, que frequentam a Consulta de Doenças Desmielinizantes no Centro Hospitalar Cova da Beira, foi efetuada de forma sistemática com recurso ao iMed®, Versão 6.1, e ao SClínico® Hospitalar. Após aplicados os critérios de inclusão e de exclusão foram considerados 86 pacientes que integraram o estudo. A análise estatística foi realizada através do software SPSS®, Versão 23.0, para Windows®. Aplicaram-se os testes do qui-quadrado de Pearson, exato de Fisher, t-Student e de Mann Whitney, para avaliar a associação entre as variáveis sociodemográficas e clínicas e a depressão. O modelo de regressão logístico foi usado com o intuito de estudar a influência dessas variáveis na depressão.
Resultados: Dos 86 participantes, 74,4% eram do sexo feminino, a média de idades era de aproximadamente 48 anos (48,41±11,336) e 53 (61,6%) foram diagnosticados com depressão, sendo o escitalopram (60,4%) o fármaco mais prescrito para o tratamento da mesma. A depressão está associada ao sexo, à atividade profissional, ao nível de escolaridade e às patologias neurológicas e é mais frequente no sexo feminino (83,0%), nos reformados (47,9%) e em pacientes com o ensino secundário (58,3%). A idade, o número de anos desde o início da esclerose múltipla até ao diagnóstico confirmado, a idade do diagnóstico confirmado de esclerose múltipla e o número de terapias modificadoras da doença usadas ao longo do tempo são significativamente superiores nos pacientes com depressão. O modelo de regressão logístico aplicado permitiu concluir que um paciente que tenha tido mais um surto de esclerose múltipla, tem uma chance 1,201 vezes superior de ter depressão e um paciente que tenha mais um ano de idade aquando do diagnóstico confirmado de esclerose múltipla, tem uma possibilidade 1,095 vezes superior de apresentar esta patologia.
Conclusão: Os achados do estudo corroboram a prevalência moderada a elevada da depressão na esclerose múltipla, sendo esta, neste estudo, ligeiramente superior aos resultados presentes até então na literatura existente. Constatou-se que a existência de depressão estava relacionada com várias características dos pacientes, porém, ao compará-las com as informações dos estudos existentes até então, apurou-se que estas associações variam discretamente. Posto isto, são necessárias abordagens inovadoras por equipas multidisciplinares para que se faça um diagnóstico e tratamento precoces da depressão no contexto da esclerose múltipla. Além disto, mais estudos neste âmbito também são requeridos para que a associação entre estas duas patologias seja melhor explorada.
Introduction: The multiple sclerosis is a complex chronic disease that involves the central nervous system in multiples focuses and which consists in inflammation, demyelination, gliosis and neuronal loss. It affects about 2.5 million people around world, however, the prevalence of the disease differs between various regions. The absence of a curative treatment and the uncertain character of this pathology originates anxiety and stress, which have biopsychosocial repercussions in the patient’s life. Recent researches shown that depression is the most common psychiatric disorder in multiple sclerosis where the risk that a patient with multiple sclerosis had depression is around 50%, contrasting with the risk of the 10% in general population. Objectives: To investigate the prevalence of depression in multiple sclerosis patients, within 10 years. To describe sociodemographic and clinical characteristics, both general and concerning with multiple sclerosis and depression, in multiple sclerosis patients. To identify if there are relationship between sociodemographic and clinical characteristics, general and associated with multiple sclerosis, and depression, in patients with multiple sclerosis. Materials and Methods: This is an observational, transversal, retrospective and analytical research study. The data collection of the patients with multiple sclerosis, regarding the interval between January 2006 and July 2016, attending the Medical Consultation Demyelinating Diseases at the Centro Hospitalar Cova da Beira, was systematically performed using iMed®, Version 6.1, and SClínico® Hospitalar. After applying the inclusion and exclusion criteria, 86 patients were included in this study. The statistical analysis was performed by IBM® SPSS® Statistics Version 23.0 for Windows®. Pearson’s chi-square test, Fisher’s exact test, t-Student and Mann Whitney’s test were used to evaluate the association between the sociodemographic and clinical variables and the depression. The logistic regression model was used to study the influence of this variables in depression. Results: Of the 86 participants, 74,4% were female, the mean age was approximately 48 years (48,41±11,336) and 53 (61,6%) of these participants were diagnosed with depression, being escitalopram (60,4%) the most prescribed drug for the treatment of depression. The depression is associated with gender, professional activity, scholar level and neurological pathologies and it is more frequent in female (83,0%), retired people (47,9%) and in patients with high school education (58,3%). Age, number of years since the confirmed diagnosis of the multiple sclerosis, age of confirmed diagnosis of the multiple sclerosis and number of the modified therapies of the disease used over time are significantly higher in patients with depression. The logistic regression model applied allowed to conclude that a patient who has had one more multiple sclerosis relapses, has a 1,201 times higher chance of having depression and a patient who is one year older at the time of the confirmed diagnosis of multiple sclerosis, has a 1,095 times higher chance of having this pathology. Conclusion: The findings of this study support the moderate to high prevalence of depression in multiple sclerosis, which is slightly higher than the results presented in the existing literature. It was found that the depression was related with several patient's characteristics, however, comparing the results with the information of the existing studies until then, it was verified that this associations vary discreetly. Therefore, it is necessary innovative approaches by multidisciplinary teams to make early diagnosis and treatment of depression in the multiple sclerosis context. In addition, further studies in this field are required for the association between these two pathologies to be better explored.
Introduction: The multiple sclerosis is a complex chronic disease that involves the central nervous system in multiples focuses and which consists in inflammation, demyelination, gliosis and neuronal loss. It affects about 2.5 million people around world, however, the prevalence of the disease differs between various regions. The absence of a curative treatment and the uncertain character of this pathology originates anxiety and stress, which have biopsychosocial repercussions in the patient’s life. Recent researches shown that depression is the most common psychiatric disorder in multiple sclerosis where the risk that a patient with multiple sclerosis had depression is around 50%, contrasting with the risk of the 10% in general population. Objectives: To investigate the prevalence of depression in multiple sclerosis patients, within 10 years. To describe sociodemographic and clinical characteristics, both general and concerning with multiple sclerosis and depression, in multiple sclerosis patients. To identify if there are relationship between sociodemographic and clinical characteristics, general and associated with multiple sclerosis, and depression, in patients with multiple sclerosis. Materials and Methods: This is an observational, transversal, retrospective and analytical research study. The data collection of the patients with multiple sclerosis, regarding the interval between January 2006 and July 2016, attending the Medical Consultation Demyelinating Diseases at the Centro Hospitalar Cova da Beira, was systematically performed using iMed®, Version 6.1, and SClínico® Hospitalar. After applying the inclusion and exclusion criteria, 86 patients were included in this study. The statistical analysis was performed by IBM® SPSS® Statistics Version 23.0 for Windows®. Pearson’s chi-square test, Fisher’s exact test, t-Student and Mann Whitney’s test were used to evaluate the association between the sociodemographic and clinical variables and the depression. The logistic regression model was used to study the influence of this variables in depression. Results: Of the 86 participants, 74,4% were female, the mean age was approximately 48 years (48,41±11,336) and 53 (61,6%) of these participants were diagnosed with depression, being escitalopram (60,4%) the most prescribed drug for the treatment of depression. The depression is associated with gender, professional activity, scholar level and neurological pathologies and it is more frequent in female (83,0%), retired people (47,9%) and in patients with high school education (58,3%). Age, number of years since the confirmed diagnosis of the multiple sclerosis, age of confirmed diagnosis of the multiple sclerosis and number of the modified therapies of the disease used over time are significantly higher in patients with depression. The logistic regression model applied allowed to conclude that a patient who has had one more multiple sclerosis relapses, has a 1,201 times higher chance of having depression and a patient who is one year older at the time of the confirmed diagnosis of multiple sclerosis, has a 1,095 times higher chance of having this pathology. Conclusion: The findings of this study support the moderate to high prevalence of depression in multiple sclerosis, which is slightly higher than the results presented in the existing literature. It was found that the depression was related with several patient's characteristics, however, comparing the results with the information of the existing studies until then, it was verified that this associations vary discreetly. Therefore, it is necessary innovative approaches by multidisciplinary teams to make early diagnosis and treatment of depression in the multiple sclerosis context. In addition, further studies in this field are required for the association between these two pathologies to be better explored.
Description
Keywords
Depressão Distúrbios Psiquiátricos Doenças Neurológicas Esclerose Múltipla