PubMed Health⌕ Search

Biomedical subjects

Marcelo P A Fleck

Publications and source records attributed to Marcelo P A Fleck.

11 recordsLinked to original sources
PubMed2006

Double depression in adult psychiatric outpatients in Brazil: distinct from major depression?

This study examines whether distinct symptom profiles, patterns of comorbidity, and suicidal symptoms uniquely characterize individuals diagnosed with double depression (DD) by comparing Brazilians with DD to those with major depressive disorder (MDD). One hundred forty two psychiatric outpatients (ages 20-77 mean=48.8, S.D.=13.2; DD, n=23; MDD, n=119) participated in structured diagnostic interviews and completed self-report measures of depressive symptoms, suicidality, and family history of mental disorders. Patients with DD exhibited a more severe symptom profile than those with MDD, as evidenced by a higher number of depressive symptoms and more intense suicidal ideation. They also appeared to be qualitatively different from individuals with MDD, as evidenced by distinct comorbidity patterns, quality of life reports, and anhedonic features. These results may be important in understanding the phenomenology of DD in psychiatric outpatients by informing diagnostics, psychotherapy, and psychotherapeutic treatment of DD.

Adult↗
PubMed2005

Reliability and validity of the WHOQOL BREF in a sample of Brazilian outpatients with major depression.

The present study assessed the psychometric properties of the Brazilian version of the World Health Organization's Quality of Life Instrument--Short Version (WHOQOL BREF) in a sample of 89 adult outpatients with major depression. After analyses, the WHOQOL BREF showed good internal consistency, and was sensitive to improvement after treatment with antidepressants. Convergent validity between the WHOQOL BREF and the Beck Depression Inventory was statistically significant, as well as WHOQOL BREF's ability to discriminate between outpatients on the basis of their level of depression. In conclusion, the WHOQOL BREF seems to be a psychometrically valid and reliable instrument that it is suitable for evaluating the quality of life of Brazilian-speaking depressed outpatients.

Adult↗
PubMed2005

Four studies on how past and current suicidality relate even when "everything but the kitchen sink" is covaried.

T. E. Joiner's (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.

Humans↗
PubMed2004

"Quality of life": a brand new concept for research and practice in psychiatry.

Since the '70s, the assessment of quality of life (QOL) has grown from a 'small cottage' industry to a formal discipline within a coherent theoretical framework, accepted methods, and manifold applications. In recent years, QOL has become increasingly popular as a useful variable tailored to assess the overall impact of diseases and medical treatments from the patient's point of view. In this updating paper, we describe the most frequently used instruments, and discuss the conceptual and practical issues concerning QOL evaluation, as applied to the study of mental disorders. In addition, we present a unifying definition of QOL that has recently been developed by the World Health Organization. Finally, we conclude that QOL measures are potentially useful methods to be applied to research and clinical practice in psychiatry -- especially when used to demonstrate the impact of mental illnesses and the possible benefits of therapeutic interventions.

Biomedical Research↗
PubMed2004

Quality of life in unipolar and bipolar depression: are there significant differences?

In the present investigation, we compared the impact of illness on quality of life (QOL) in adult outpatients with unipolar (N = 89) and bipolar (N = 25) depression. While attending a university hospital in southern Brazil, patients completed the WHO's QOL Instrument-Short Version and the Beck Depression Inventory. After analyses, patients with bipolar depression reported significantly lower scores on the psychological QOL domain (p = .013) than patients with unipolar depression. There were no significant differences between the study groups in terms of social and demographic variables, in the other QOL domains assessed (i.e., physical health, social relationships, and environmental), and in the severity of depressive symptoms. In conclusion, our findings suggest that patients with bipolar and unipolar depressions have different QOL profiles, and that this difference is probably independent of the severity of the mood disturbance and might be related to the higher rates of suicide observed in the bipolar population.

Adult↗
PubMed2003

[WHOQOL-OLD Project: method and focus group results in Brazil].

OBJECTIVES: Exploring the conditions that allow satisfactory quality of life in old age is an issue of scientific and social relevance. Thus, the objective of the study was to describe a quality of life assessment method for the elderly and present the results from focus groups conducted among old people in good health and ill health, as well as their caregivers. METHODS: The methodology used in the WHOQOL-OLD project is the same as utilized in the development of other WHOQOL modules. Five focus groups were conducted in Brazil. The sampling procedure was done according to convenience. Eighteen old people and five caregivers took part in the focus groups. All the focus groups followed a pre-established methodology. RESULTS: A tendency towards making an association between quality of life and wellbeing and feeling well was observed. The responses spontaneously included the 6 domains proposed in WHOQOL-100, thus corroborating the multidimensional nature of this construction. Nineteen out of the 24 original facets of this instrument were cited as relevant, and the five facets not spontaneously remembered were not concentrated in a single domain. When questioned about the importance of each of the 24 facets of WHOQOL-100, the groups considered all of them to be relevant. However, suggestions for modifications to five facets were made. Additional items were also examined and considered relevant for assessing quality of life among the elderly, by both the old people and the caregivers. CONCLUSIONS: The results corroborate the hypothesis that old people constitute a particular group and, as such, they have relevant specific characteristics. Thus, an appropriate instrument for assessing quality of life among the elderly needs to consider such matters.

Aged↗
PubMed2003

Notes on antipsychiatry.

The present paper aims to provide a review of the history and basic principles of the antipsychiatric movement, as well as to discuss the work of its most important theorists. The authors searched recent literature, as well as drawing upon some of the basic antipsychiatric texts. Antipsychiatry emerged as an international movement during the 1960s as part of the historic tumult of the period rather than as a result of the evolution of scientific ideas. Antipsychiatrists radically opposed what they understood as a hospital-centered medical specialty legally empowered to treat and institutionalize mentally disordered individuals. Indeed, many antipsychiatrists argued against the very existence of mental disorders themselves. After the 1970s, the antipsychiatry movement became increasingly less influential, due in particular to the rejection of its politicized and reductionistic understanding of psychiatry.

History, 20th Century↗
PubMed2003

Psychache and suicidality in adult mood disordered outpatients in Brazil.

Shneidman (e.g., 1998) has theorized that psychache--general psychological and emotional pain that reaches intolerable intensity--is an important suicide-related variable, and indeed, represents a source of suicidal behavior. This conceptualization, while prominent and clinically and intuitively appealing, has received relatively little empirical scrutiny. In this study, we determined whether an index closely related to psychache, psychological quality of life, would display a special and resilient association to suicidality among 60 adult psychiatric outpatients in Brazil. All patients underwent structured clinical interviews and completed various clinical and quality-of-life measures. We found that the association between psychological quality of life and suicidality remained, even when depression, hopelessness, and other domains of quality of life were controlled. Psychache appears to deserve its place among key suicide-related variables, and deserves the attention of clinicians working with suicidal people.

Adolescent↗
PubMed2003

[Posttraumatic stress disorder and major depression].

Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly recognized and not well treated. PTSD commonly co-occurs with other psychiatric disorder, especially with major depression. However, the relationship between these disorders and the treatment of this complex clinical entity are only now being addressed in the specialized literature. Some authors argued that they are two distinct entities, whereas others defended the hypothesis that the high prevalence of this comorbidity may represent an artifact derived from the diagnostic criteria currently used. Regarding the treatment of PSTD comorbid with major depression, the available data from controlled studies are insufficient to point out for a specific approach, although some small trials reported the usefulness of combining selective serotonin reuptake inhibitors and cognitive therapy.

Depressive Disorder↗