O Transtorno da Depressão Maior (MDD) é uma doença muito difundida em todo mundo e com uma alta prevalência, principalmente em mulheres. Transtornos de humor são recorrentes e ameaçam a vida, devido ao risco de suicídio. Apesar disso, a etiologia do MDD ainda é pouco entendida e diversas hipóteses foram desenvolvidas na tentativa de explicá-la. Uma delas está ligada ao estresse. Distúrbios no eixo hipotálamo-hipófiseadrenal (HPA) estão presentes em cerca 70% de pacientes com depressão. Ao buscar um melhor modelo animal para estudo do impacto do estresse no desenvolvimento da depressão, chegamos ao estresse leve crônico (CMS). Em estudos prévios desenvolvidos neste laboratório, observamos que há diferenças entre tipos de estressores e os mediadores secretados na resposta do eixo HPA, isto é, durante o estresse físico é secretado o mediador vasopressina, enquanto que no estresse psicológico, é secretado o mediador CRF; já nos estresses considerados mistos (como nado forçado), ambos os mediadores estão presentes. Assim, propusemos estabelecer protocolos de CMS baseados no protocolo original de Paul Willner, pesquisador que desenvolveu este modelo, empregando estressores do tipo físico ou psicológico, separadamente. O que observamos foi que nenhum dos dois tipos de estressores conseguiu levar os animais à anedonia (queda na preferência por sacarose). No entanto, ao observar o ganho de peso dos animais ao longo do tempo e o mapeamento cerebral com citocromo c oxidase, notamos que o estresse teve seu impacto no animais. Comparados a outros modelos de depressão, o CMS tem a premissa de desenvolver um estado depressivo nos animais antes do teste com drogas antidepressivas, fazendo com que tenha uma alta validade preditiva. Ele também pode incorporar outros endpoints para avaliar outros comportamentos, além da anedonia, que possam demonstrar o estado depressivo no animal. Por exemplo, observamos no mapeamento cerebral que a substância negra e a PAG estiveram mais ativas no estresse físico e elas podem estar implicadas na busca por recompensa e na modulação de dor, respectivamente. Concluímos que o modelo de CMS é apropriado, embora ainda necessite de estudos quanto à equivalência de intensidade de estressores / Major Depressive Disorder (MDD) is a widespread disease all over the world with a high prevalence, especially among women. Mood disorders are recurrent and life threatening, due to suicide risk. Despite those, MDD etiology is poorly understood and several hypotheses have been developed to try and explain it. One of them is connected to stress. Disorders on the hypothalamus-pituitary-adrenal (HPA) axis are present in up to 70% of patients with depression. While searching for a better animal model to study the impact that stress might have on depression onset, we came across the Chronic Mild Stress (CMS) model. During previous studies developed in this lab, weve observed that there are differences between types of stressors and mediators involved in the HPA axis response, i.e. during physical stress, the mediator secreted is vasopressin, whereas during psychological stress, the mediator is CRF; on mixed stress (like forced swim), both mediators are present. That way, we proposed to set up CMS protocols based on Paul Willner (the researcher who developed this model)s original one, employing physical or psychological stressors separately. None of the types of stressors were able to induce anhedonia (decrease in sucrose preference) in the animals. However, noticing the animals weight gain over time, and cerebral mapping with cytochrome c oxidase, we could see that stress had impact over the animals. Compared to other depression models, CMS has the presupposition of leading the animals to a depressive-like state before testing antidepressant drugs, which gives it a high predictive validity. The model can also incorporate different endpoints to assess other behaviors, besides anhedonia, that may show the animals depressive-like state. For instance, we observed in the brain mapping that substantia nigra and PAG were more activated in physical stress and they can be implicated in reward seeking and pain modulation, respectively. So, we conclude that the CMS model is appropriate, although it still needs more research regarding the intensity of stressors equivalence

by Wong Chi-ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 62-69 (2nd gp.)). / ABSTRACT --- p.ii / ACKNOWLEDGEMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.viii / LIST OF APPENDICES --- p.ix / Chapter CHAPTER I - --- INTRODUCTION --- p.1 / Definition of Somatization --- p.2 / A Model of Somatization --- p.5 / Somatization in the Correctional Setting --- p.8 / The Study --- p.12 / Chapter CHAPTER II- --- METHOD --- p.14 / Subjects --- p.14 / Measures --- p.15 / Pilot Study --- p.21 / Main Study --- p.21 / Chapter CHAPTER III - --- RESULTS --- p.23 / Validity of Protocols --- p.23 / Descriptive Statistics and the Sociodemographic and Custodial Profile of the Subjects --- p.23 / Reliability of Scales Used in this Study --- p.26 / Data Transformation --- p.26 / Principal Components Analyses of Variables on Psychological Distress and Somatization --- p.28 / Predictors of Somatization --- p.30 / Differences among Subjects with Different Levels of Somatization and Psychological Distress --- p.35 / Differences among Somatizers Who Attribute Differently --- p.47 / Chapter CHAPTER IV - --- DISCUSSION --- p.51 / Somatization and Psychological Distress Among Prisoners --- p.51 / Other Correlates of Somatization among Prisoners --- p.51 / Patterns of Somatization under Different Levels of Psychological Distress --- p.55 / "Comparison between ""True"", ""Facultative"", and ""Initial"" Somatizers" --- p.56 / Management Implications --- p.58 / Chapter CHAPTER V - --- CONCLUSION AND LIMITATION --- p.60 / REFERENCES --- p.62 / APPENDICES --- p.70

Background. Depression and anxiety are common and debilitating disorders, and at least one third of patients do not respond to available interventions. Morita Therapy, a Japanese psychological therapy which contrasts with established Western approaches, is currently untested in the UK and may represent a potentially effective alternative approach. Aim. To optimise and investigate the feasibility and acceptability of Morita Therapy as a treatment for depression and anxiety in the UK. Design. Three studies were undertaken in line with the MRC framework (2008) for complex interventions. Study One: scoping and systematic review to describe the extent, range and nature of Morita Therapy research activity reported in English. Study Two: intervention optimisation study, integrating literature synthesis with qualitative research, to develop the UK Morita Therapy outpatient protocol. Study Three: mixed methods feasibility study encompassing a pilot randomised controlled trial (RCT) and embedded qualitative interviews to prepare for a fully-powered RCT of Morita Therapy versus treatment as usual (TAU). Results. Study One: 66 papers meeting the inclusion criteria highlighted heterogeneity in the implementation of Morita Therapy, and an absence of both UK-based research and relevant unbiased RCTs. Study Two: a potentially deliverable and acceptable therapy protocol and tailored therapist training programme were developed for a UK population. Study Three: 68 participants were recruited and 94% retained at four month follow-up; 70.6% of Morita Therapy participants adhered to the minimum treatment dose, and 66.7% achieved remission in depressive symptoms (compared to 30.0% in TAU). Qualitative and mixed methods findings indicated that Morita Therapy was broadly acceptable to therapists and participants, and highlighted potential moderators of acceptability, treatment adherence and outcomes. Conclusions. Patients in the UK can accept the premise of Morita Therapy and find the approach beneficial. It is feasible to conduct a large-scale UK-based trial of Morita Therapy with minor modifications to the pilot trial protocols.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-23T12:27:50Z No. of bitstreams: 2 Tese - Rodrigo Bernini de Brito - 2015.pdf: 2201255 bytes, checksum: a184a6bcdb4f9d15e5944a689b43f0e5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-23T12:33:46Z (GMT) No. of bitstreams: 2 Tese - Rodrigo Bernini de Brito - 2015.pdf: 2201255 bytes, checksum: a184a6bcdb4f9d15e5944a689b43f0e5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-02-23T12:33:46Z (GMT). No. of bitstreams: 2 Tese - Rodrigo Bernini de Brito - 2015.pdf: 2201255 bytes, checksum: a184a6bcdb4f9d15e5944a689b43f0e5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-08-26 / The aim of pharmacogenetics is to understand the hereditary basis of therapeutic response and side effects of pharmacological agents for each individual. Antipsychotics and antidepressants are effective drugs for schizophrenia and major depressive disorder (MDD) treatment, respectively. Although a number of patients respond satisfactorily to antipsychotics and antidepressants, 20-40% of them present inadequate response, and the treatment with ineffective medication may take weeks of unremitted illness, potential adverse drug reactions and nonadherence to treatment. This study aims to identify polymorphisms in genes that potentially influence the treatment response to clozapine in schizophrenic patients and the treatment with escitalopram in MDD patients. This approach involved the study of CYP1A2 and CYP2C19 genes related to the metabolism of these drugs and which may to affect the efficacy of treatment. It was studied 54 schizophrenic patients taking clozapine and 31 patients with MDD treated with escitalopram, both for long term. The investigated polymorphisms, CYP1A2*1F in schizophrenic patients and CYP2C19*2 and CYP2C19*17 in depressive patients, were analyzed by polymerase chain reaction (PCR), followed by sequencing (CYP1A2*1F) or by restriction fragment length polymorphism (RFLP) (CYP2C19*2 and *17) techniques. The results pointed for the association between CYP1A2*1F polymorphism and super-refractory clozapine treatment and for the association between CYP2C19*17 polymorphism and the decreased response to escitalopram treatment. No association was observed between CYP2C19*2 and the response to escitalopram treatment. These findings suggest that these genetic variants have an important influence on the treatment effectiveness of antipsychotics and antidepressants in psychiatric disorders, as schizophrenia and MDD. The pharmacogenetics may be useful to the psychiatrists helping in the choice of drugs and doses more efficient for each patient, reducing suffering and costs and contributing to improve the quality of life for patients and families. / A farmacogenética busca compreender a base hereditária da variabilidade da resposta e dos efeitos adversos dos agentes farmacológicos entre os indivíduos. Os medicamentos antipsicóticos e antidepressivos são utilizados em tratamentos bastante efetivos para a esquizofrenia e transtorno depressivo maior (TDM), respectivamente. Embora boa parte dos pacientes responda às terapias com antipsicóticos e antidepressivos, 20-40% mostram resposta inadequada, e o custo de cada tentativa de medicação não-efetiva para os pacientes pode levar a semanas de permanência da doença, ocorrência de efeitos adversos potenciais e nãoaderência ao tratamento. Este estudo teve como objetivo identificar polimorfismos genéticos que podem potencialmente influenciar a resposta ao tratamento à clozapina em pacientes esquizofrênicos e ao escitalopram em pacientes com TDM. Essa abordagem envolveu o estudo de genes das enzimas metabolizadoras de fármacos CYP1A2 e CYP2C19, potencialmente envolvidas no metabolismo desses fármacos e que podem afetar a eficácia do tratamento. Foram estudados 54 pacientes esquizofrênicos em uso de clozapina e 31 pacientes com TDM em tratamento com escitalopram, ambos por longo prazo. Os polimorfismos investigados, CYP1A2*1F em pacientes esquizofrênicos e CYP2C19*2 e CYP2C19*17 em pacientes depressivos, foram estudados por métodos baseados na reação em cadeia da polimerase (PCR) seguido por sequenciamento (CYP1A2*1F) ou pela técnica de polimorfismo no comprimento de fragmentos de restrição (RFLP) (CYP2C19*2 e *17). Os resultados encontrados apontam a associação do polimorfismo CYP1A2*1F com a super-refratariedade ao tratamento à clozapina e a associação do polimorfismo CYP2C19*17 com resposta diminuída ao tratamento com escitalopram. Não foi encontrada associação entre o polimorfismo CYP2C19*2 e a resposta ao tratamento ao escitalopram. Os resultados obtidos sugerem que as variantes genéticas CYP1A2*1F e CYP2C19*17 podem desempenhar um papel importante na efetividade do tratamento com antipsicóticos e antidepressivos em transtornos psiquiátricos incapacitantes como a esquizofrenia e o TDM. A farmacogenética pode auxiliar na psiquiatria como ferramenta para a escolha de medicamentos e doses mais adequadas para cada paciente, diminuindo o sofrimento, reduzindo custos e trazendo qualidade de vida a pacientes e familiares.

A presença de tentativas de suicídio vem sendo associada à comorbidade com transtornos de ansiedade, tanto em estudos retrospectivos como nos prospectivos em pacientes com transtorno depressivo maior e naqueles com transtorno bipolar, embora os estudos apresentem resultados conflitantes. O objetivo deste estudo foi avaliar, prospectivamente, o impacto da presença da comorbidade com os transtornos ansiosos na presença de tentativas de suicídio em pacientes com transtornos do humor, durante o seguimento de 2 anos. Foram avaliados 667 pacientes, divididos em dois grupos: um grupo com comorbidade com transtorno ansioso (N+229, 34,3% e outro sem a comorbidade (N=438, 65,7%) em um estudo prospectivo com duração de 2 anos. As avaliações foram realizadas à entrada do estudo, após 3 meses, 12 meses e 24 meses. As escalas utilizadas nas avaliações foram: Escala de Depressão de Hamilton-24 itens, Escala de Desesperança de Beck, Escala de Ideação Suicida de Beck, Escala de Impulsividade de Barrat, BrownGoodwin Aggression Inventory, Buss-Durkeee Hostility Inventory e a Columbia Suicide History Form para avaliação da presença de tentativas de suicídio. Sintomas ansiosos foram avaliados por meio dos subitens: agitação, ansiedade psíquica, ansiedade somática e hipocondria presentes na Escala de Depressão de Hamilton. A medida de desfecho foi a presença de tentativa de suicídio durante o seguimento. Curvas de sobrevivência de Kaplan-Meier foram utilizadas para avaliar a relação entre a presença de tentativas de suicídio no seguimento e a presença de comorbidade com transtorno ansioso à entrada do estudo. A regressão de Cox foi empregada para avaliar quais outros fatores de risco incluindo os sintomas ansiosos estariam associados à presença de tentativas de suicídio no seguimento. Os resultados mostraram que 63 pacientes (13,1%) tiveram tentativa durante o seguimento. Não houve diferença entre os pacientes com e sem comorbidade com transtorno ansioso (log-rank 0,269 p=0.604. Na regressão de Cox, sexo feminino (HR 4.088 p <= 0.001), tentativas de suicídio prévias (HR 3,17, p=0,002), e escores de hostilidade (HR 1,06 p <= 0,001) foram preditores de tentativas de suicídio durante o seguimento. A presença de sintomas hipocondríacos foi um fator protetor para tentativas durante o seguimento (HR 0,60, p=0,011). Contrariamente a alguns estudos retrospectivos, neste estudo a comorbidade com transtornos ansiosos não foi um fator de risco para tentativas de suicídio no seguimento em pacientes com transtornos de humor / Suicide attempts have been associated with comorbidity with anxiety disorders in cross-sectional studies in both major depression and bipolar disorder, although not all studies agree. Our aim was to prospectively test the impact of comorbid anxiety disorders on future suicide attempts in a sample of mood disordered patients. A two-year prospective study evaluated 667 patients divided in two groups: patients with comorbid anxiety disorders (N=229, 34.3%) and patients without the comorbidity (N=438, 65.7%) Assessments were performed at baseline and after 3, 12 and 24 months. The main outcome was the occurrence of suicide attempts during follow-up. The scales used in the patient\'s evaluation were: Hamilton Depression Rating Scale-24 items, Beck Hopelessness Scale, Scale for Suicide Ideation, Barrat Impulsiveness Scale, Brown-Goodwin Aggression Inventory, Buss-Durkeee Hostility Inventory and Columbia Suicide History Form To evaluate the presence of attempts. Anxiety symptoms were evaluated using the sub-items agitation, psychic anxiety, somatic anxiety and hypochondria. Kaplan-Meier survival curves were used to elucidate the relationship between presence of lifetime anxiety disorders and subsequent suicide attempts. Cox proportional Hazard regression was performed to investigate other risk factors associated with suicide attempts during follow-up, including anxiety symptoms at baseline (somatic anxiety, psychic anxiety, agitation and hypochondriasis). There were 63 patients (13.1%) with suicide attempts during follow-up. There were no differences in survival curves for presence of comorbid anxiety disorders ( log-rank test 0.269 p= 0.604). In the Cox proportional hazard regression female sex (HR 4.088 p <= 0.001), past suicide attempts (HR 3.17, p=0.002), and hostility scores (HR 1.06 p <= 0.001) were the strongest predictors for suicide attempts. Hypochondriac symptoms were a protective factor for future suicide attempts (HR 0.60, p=0.011). Contrary to some cross-sectional studies, our results suggest that comorbidity with anxiety disorders is not a risk factor for future suicide attempts in patients with MDD or BD

Esta dissertação analisa os impactos de fatores socioeconômicos e psicossociais sobre a prevalência da depressão no Brasil através de modelos probit e da decomposição de Oaxaca-Blinder aplicados às bases de dados dos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD Saúde) e da Pesquisa Nacional de Saúde 2013 (PNS 2013). Neste trabalho, foram usados dois critérios básicos de identificação de indivíduos deprimidos: os que referiram ter recebido o diagnóstico de depressão de algum profissional de saúde e os que obtiveram um escore superior a 4 no teste PHQ-9 (cujas perguntas constam na PNS 2013). Foram obtidos resultados estatisticamente significativos, evidenciando a maior probabilidade da depressão entre mulheres e a relação inversa do transtorno com as variáveis renda domiciliar, desemprego, escolaridade e idade. Fatores como doenças físicas, doenças mentais e deficiências demonstraram uma relação direta com a depressão, embora as quantificações de suas magnitudes tenham sido sensíveis à especificação dos modelos. Também mostraram uma relação direta com o transtorno depressivo variáveis associadas a traumas e estresse emocional (como ter perdido um filho, ter sofrido algum tipo de violência, ter um filho com problemas de saúde, etc.). Outras variáveis como raça e região geográfica apresentaram resultados ambivalentes, também sensíveis às diferentes especificações de modelo. Ainda, variáveis referentes ao mercado de trabalho como o tipo de vínculo empregatício e setor de atividade apresentaram resultados inconclusivos. Por fim, outra conclusão importante foi que o critério de identificação dos indivíduos com depressão é determinante nos resultados. / This dissertation analyses the impacts of socioeconomic and psychosocial factors over the prevalence of depression in Brazil through probit models and the Oaxaca-Blinder decomposition applied to the data in Brazilian National Household Survey Health Supplement (PNAD Saúde) and the National Health Survey (PNS 2013). In this dissertation, two basic criteria were used to identify individuals with depression: those who declared to have received a depression diagnosis from a health professional and those who scored more than 4 in the PHQ-9 depression test (whose questions are included in PNS 2013). Statistically significant results were found, showing a higher probability of depression among women and an inverse relationship between the disorder and household income, unemployment, education and age. Factors such as chronic physical diseases, mental illnesses and deficiencies have showed a direct relationship with depression, although the quantification of such effects had a rather high sensitivity to model specification. Also, variables associated with emotional stress (such as having lost a child, being victim of some sort of violence, having a child with health problems) showed a direct relationship with depressive disorder. Other variables such as race and geographic region showed ambivalent results also very sensitive to different model specifications. Furthermore, labor market variables like type of work contract and activity sector show inconclusive results. Finally, another important finding is that the criteria for identifying individuals with depression were determinant for the results and conclusions.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-05-17T12:35:39Z No. of bitstreams: 1 Rosiene (2) (1).pdf: 1412096 bytes, checksum: eca79137111d0656bc5f944d945626b1 (MD5) / Made available in DSpace on 2018-05-17T12:35:40Z (GMT). No. of bitstreams: 1 Rosiene (2) (1).pdf: 1412096 bytes, checksum: eca79137111d0656bc5f944d945626b1 (MD5) Previous issue date: 2017-11-30 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq# / #-2555911436985713659# / #600 / Introduction: Dropout in psychotherapy is a recurrent outcome in both scientific research and clinical practice, its prevalence is around 17.5%, being one of the most frequent and serious negative outcomes. Aim: to verify associated factors with dropout in two brief psychotherapy models for depression in adults patients attended at an outpatient clinic for research and extension in mental health. Method: Clinical trial randomized with two models of psychotherapy for major depressive disorder (MDD): Cognitive Behavioral Therapy (CBT) and Supportive-Expressive Dynamic Psychotherapy (SEDP). Sociodemographic data will be collected from the sample through a questionnaire prepared by the research team, the economic class will be evaluated through the Brazilian Association of Research Companies (ABEP) classification. In addition, TDM and Anxiety Disorders will be evaluated through the Mini International Neuropsychiatric Interview - Plus (MINI Plus). Personality Disorders will be evaluated by the Millon Clinical Multiaxial Inventory III (MCMI-III). Finally, the severity of depressive symptoms will be measured using the Beck Depression Inventory (BDI) and resilience through Resilience Scale (RS). / Introdução: O abandono em psicoterapia é um desfecho recorrente tanto na pesquisa científica quanto na prática clínica, sua prevalência fica em torno de 17,5% sendo um dos desfechos negativos mais frequentes e graves. Objetivo: Analisar os fatores associados ao abandono do tratamento de psicoterapia breve por adultos com Transtorno Depressivo Maior (TDM) atendidos em um ambulatório de pesquisa e extensão em saúde mental na cidade de Pelotas. Método: Ensaio clínico randomizado com dois modelos de psicoterapia para TDM: Terapia Cognitivo Comportamental (TCC) e Psicoterapia Dinâmica Suportivo-expressiva (PDSE). Serão coletados dados sociodemográficos da amostra através de um questionário elaborado pela equipe de pesquisa, a classe econômica será avaliada através da classificação da Associação Brasileira de Empresas de Pesquisas (ABEP). Além disso, o TDM e os Transtornos de Ansiedade serão avaliados através da Mini International Neuropsychiatric Interview - Plus (MINI Plus). Os Transtornos de Personalidade serão avaliados pelo Millon Clinical Multiaxial Inventory III (MCMI-III). Por fim, a gravidade dos sintomas depressivos será mensurada através do Inventário de Depressão de Beck (BDI) e a resiliência através da Resilience Scale (RS)

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-04-18T12:38:31Z No. of bitstreams: 1 Sally Knevitz da Silva_ok.pdf: 2056051 bytes, checksum: 2da37b9dbf4e6fb43925245cf821fc34 (MD5) / Made available in DSpace on 2018-04-18T12:38:31Z (GMT). No. of bitstreams: 1 Sally Knevitz da Silva_ok.pdf: 2056051 bytes, checksum: 2da37b9dbf4e6fb43925245cf821fc34 (MD5) Previous issue date: 2017-11-24 / Introduction: Research has shown that depressive episodes are influenced by biological, psychosocial and socio-cultural aspects, that can determine the symptoms, course and treatment of depressive disorder. Among the biological aspects, are the neurotrophins, which can be considered as potential biomarkers for depression. Between psychosocial and socio-cultural aspects, are the sexual roles as cognitive structure of subject identity constructs for you. Objective: This thesis aims to develop the evaluation of Biopsychosocial Factors associated with the diagnosis and treatment of major depressive disorder (MDD), from the research on the influence of sexual roles and of neurotrophins in the diagnosis and treatment of this disorder. Methods: Two studies with patients between 18 and 65 years old, diagnosed with major depressive disorder by current Mini International Neuropsychiatric Interview (M.I.N.I.) Plus and met in the outpatient and research in Mental Health in the city of Pelotas, RS. The first study was developed by cross-sectional method, selecting as participants all patients diagnosed with TDM and who fulfilled the eligibility criteria for the randomized clinical trial, regardless of the model of psychotherapeutic treatment to which they were randomized (Psychodynamic or cognitive-behavioral therapy). In this study, we used as verification of depressive symptoms by the Beck Depression Inventory (BDI)-II, and the observation of sexual roles through the Right Sex Role Inventory (BSRI), both performed in the first date of treatment. The second study was developed by the quasi-experimental method, nested randomized clinical trial to evaluate the efficacy of two models of psychotherapy for Depression, considering only those patients randomized to the follow-up in therapy Cognitive-Behavioral (CBT). In this study, patients were followed-up with the measurement of depressive symptoms through the BDI-II, in 3 different times along the psychotherapeutic monitoring (before starting, during, and after finishing). Also blood collections were performed to measure serum levels of three neurotrophins, which are factors of neuronal growth and development that can be associated with depressive symptoms and the course of the disorder, which were: Brain-Derived Neurotrophic Factor (BDNF), Glial cell-line Derived Neurotrophic Factor (GDNF) and beta-Nerve Growth Factor (NGF). Results: In the first study, it were not observed significantly differences between NGF levels, depressive symptoms and sexual roles. For the second study, patients had a significant change of severity symptoms after the treatment. It was not verified associations between depressive scores at Beck Depression Inventory II (BDI) and any independent variable, with statistical significance. Also, no correlations were observed between BDNF and GDNF levels, neither depressive scores at BDI pre-treatment and post-treatment, but we found a tendency of having statistical significance on the NGF levels. Conclusion: BDNF, NGF and GDNF were not influenciable by psychotherapy effects in symptomatology reduction. / Introdução: Pesquisas tem demonstrado que os episódios depressivos são influenciados por aspectos biológicos, psicossociais e socioculturais, que podem determinar a sintomatologia, o curso e o tratamento do transtorno depressivo. Entre os aspectos biológicos, estão as neurotrofinas, que podem ser consideradas potenciais biomarcadores para depressão. Entre os aspectos psicossociais e socioculturais, estão os papéis sexuais enquanto estrutura cognitiva de identidade que o sujeito constrói para si. Objetivo: Esta Tese tem por objetivo desenvolver a Avaliação de Fatores Biopsicossociais associados ao diagnóstico e tratamento do Transtorno Depressivo Maior (TDM), a partir da investigação sobre a influência dos papéis sexuais e das neurotrofinas no diagnóstico e tratamento deste transtorno. Métodos: Trata-se de dois estudos com pacientes entre 18 e 65 anos de idade, diagnosticados com Transtorno Depressivo Maior atual pela entrevista Mini Internacional Neuropsychiatric Interview (M.I.N.I.) Plus e atendidos no Ambulatório de Pesquisa e Extensão em Saúde Mental da cidade de Pelotas, RS. O primeiro estudo foi desenvolvido pelo método transversal, selecionando-se como participantes todos pacientes diagnosticados com TDM e que preencheram os critérios de elegibilidade para o Ensaio Clínico Randomizado, independente do modelo de tratamento psicoterapêutico para o qual foram randomizados (Psicodinâmica ou Terapia CognitivoComportamental). Neste estudo, utilizou-se como medidas a verificação dos sintomas depressivos pelo Beck Depression Inventory (BDI)-II e a observação dos papéis sexuais através do Bem Sex Role Inventory (BSRI), ambos realizados no primeiro encontro do tratamento. O segundo estudo foi desenvolvido pelo método quase-experimental, aninhado a Ensaio Clínico Randomizado para avaliar a eficácia de dois modelos de Psicoterapia para Depressão, considerando-se apenas os pacientes randomizados para o acompanhamento em Terapia Cognitivo-Comportamental (TCC). Neste estudo, os pacientes foram acompanhados com a mensuração dos sintomas depressivos também através do BDI-II, em 3 momentos distintos ao longo do acompanhamento psicoterapêutico (antes de iniciar, durante e após terminar). Também foram realizadas coletas de sangue para medir os níveis séricos de três neurotrofinas, as quais são fatores de crescimento e desenvolvimento neuronal que podem estar associadas à sintomatologia depressiva e ao curso do transtorno, que foram: Brain-Derived Neurotrophic Factor (BDNF), Glial cell-line Derived Neurotrophic Factor (GDNF) e beta-Nerve Growth Factor (NGF). Resultados: No primeiro estudo, não foram observadas diferenças estatisticamente significativas entre os níveis séricos de NGF, os sintomas depressivos e os papéis sexuais. No segundo estudo, foi observada redução significativa da severidade dos sintomas após o término do tratamento. Não foram verificadas associações significativas entre os escores de sintomatologia depressiva pelo BDI e qualquer uma das variáveis independentes. Em relação as neurotrofinas, não foram observadas correlações significativas dos níveis séricos de BDNF e GDNF com os escores de sintomas depressivos pré-tratamento e pós-tratamento.

The purpose of this study was to compare outcomes for patients with Bipolar Disorder or Major Depressive Disorder based on severity of diagnosis. This study also compared psychotherapy providers and therapy modalities on total cost, number of sessions, and dropout. Our data set (N=136,439) came from Cigna, a national health care company. Results showed significant differences by severity of diagnosis. The comparison of providers showed that psychologists had higher costs and session numbers, while the other providers were not significantly different. However, all providers successfully provided low cost treatment on both MDD and BD. There is no support for the idea that one profession is more successful at providing low cost treatment for MDD and BD. Family therapy did significantly better on all outcomes except dropout rate when compared to individual or mixed (individual and family sessions) therapy. It is a low-cost option when treating MDD and BD, regardless of severity.

Bakgrund: Depression är lika vanligt som demens hos äldre, men ofta inte lika studerat eller diskuterat. I dagsläget finns det flertalet olika bedömningsformulär för att finna dessa patienter men depression hos äldre är ofta odiagnostiserat. Konsekvenserna med en depression i sen ålder kan vara mycket ogynnsamma, både för individen och samhället. Allt eftersom den äldre befolkningen kommer att öka så kommer även depression att öka.Syfte: Syftet med denna studie är att undersöka olika metoder för att lindra depressiva symtom hos den äldre befolkningen. Metod: Beskrivande design med litteraturöversikt med systematisk ansats som metod.Resultat: Tolv originalartiklar med kvantitativ experimentell metod inkluderades. Fyra artiklar tog upp självhjälp och hjälp till självhjälp av olika slag som intervention, fyra tog upp fysisk aktivitet som intervention, två tog upp KBT som intervention, en använde samtalsterapi som intervention och två artiklar hamnade under mer än en underrubrik. Nio av artiklarna hade interventioner som visade sig fungera för att lindra depressiva symtom. Slutsats: Att kombinera motion med socialt umgänge, rätt kost och en aktiv vardag kan lindra depressiva symtom i stor utsträckning. Det viktigaste arbetet borde vara att upptäcka och börja sätta in åtgärder i ett tidigt skede, för att förhindra att en depression utvecklas. Detta kan leda till minskat lidande för patienten och minskade kostnader för samhället. / Introduction: Depression is as common as dementia in the elderly, but often not as well studied or discussed. At present, there are several different assessment forms for finding these patients, but depression in the elderly is often undiagnosed. The consequences of a late-age depression can be vary unfavorable, both for the individual and society. As the older population increases, so will depression. Aim: The purpose of this study is to investigate various methods to relieve depressive symptoms in the elderly population. Methods: Descriptive design with literature review with systematic approach as method. Results: Twelve original articles with a quantitative experimental method were included. Four articles addressed self-help and self-help of various kinds as intervention, four took up physical activity as intervention, two took up KBT as intervention, one used conversational therapy as intervention and two articles ended up with more than one sub-heading. Nine of the articles had interventions that were found to work to relieve depressive symptoms. Conclusion: Combining exercise with social interaction, the right diet and an active everyday life can greatly alleviate depressive symptoms. However, the most important work should be to discover and take measures at an early stage, to prevent a depression to develop. This can lead to reduced suffering for the patient and reduced costs for society.