Sintomas depressivos em crianças e adolescentes com anemia falciforme

Prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease: a review

ABSTRACT Objective: To assess the prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease. Methods: A systematic search was performed in the electronic databases PubMed®, LILACS and SciELO, with the following inclusion criteria: cross-sectional studies that assessed the prevalence of depression in patients with sickle cell disease, published in English or Portuguese in the last 10 years. The selection of the articles was performed in two stages by two independent researchers following the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) recommendations. The first stage consisted on screening the titles and abstracts, and in the second stage the full text was appraised, both following the pre-defined inclusion and exclusion criteria. Results: From the 42 articles available, nine were included in this review. Seven instruments were used to screen for depression with different cutoff points, and the Patient Health Questionnaire-9 (PHQ-9) was the most used instrument. The worldwide prevalence of clinical manifestations suggestive of depression ranged from 11 to 40%, according to several variables. Conclusion: The prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease is higher compared to the prevalence of depression in the general population. Thus, the multidisciplinary follow-up for these people, with a focus on mental health, is of great importance.

Clinical and care profiles of children and adolescents with Sickle Cell Disease in the Brazilian Northeast region

Abstract Objectives: to describe the clinical epidemiological and care profiles of pediatric patients with sickle cell disease. Methods: a descriptive study of all (48) children and adolescents with sickle cell disease, assisted at a public referral hospital in Paraíba State. The information were obtained from the patients’ medical records and interviews were analyzed by using the Epi-Info program 7.2 version, frequency tables were built for the categorical variables and the central measurements and dispersion tendencies were calculated for the variables related to age and hospitalizations. Results: the patients’ age ranged from 15 months to 19 years old (median 8.6 years old); 91.7% considered their skin color mixed/black; 81.3% belong to D and E social class; 48% of the responsible guardians reported to have less than nine years of schooling; 70.9% lived in other cities; 93.8% received late diagnosis and 87.5% had irregular outpatient follow-up, 62,5% had an incomplete or outdated vaccination record. There were 226 hospitalizations; painful crises were the most common causes (55.7%). Each patient was hospitalized, about 5.2 times in the period; the median of total days for being hospitalized was 28. There were no deaths. Cardiac (56.2%) and hepatobiliary (54.3%) were the most common chronic compli-cations. Conclusions: sickle cell disease is a neglected clinical condition in the Brazilian Northeast region, where the appropriate political support for the patients is not fulfilled.

Screening for neuropathic pain in patients with sickle cell disease: is a single assessment scale sufficient?

Background

The objectives of this study were to delineate the clinical-epidemiological profile of patients with neuropathic pain (NP) in the groups of SCD patients, from each of the three questionnaires used DN-4, painDETECT - PDQ, LANSS and to compare these three questionnaires in NP evaluation in SCD carriers. This cross-sectional study evaluated 83 patients with symptomatic SCD, aged 14 years or older. Clinical and laboratory data were extracted from the patients’ charts and from information obtained from the patients during the interview before the application of the questionnaire. The calculations were performed using the statistical software Epi InfoTM 7. Pearson’s correlation coefficient was used to compare the neuropathic pain evaluation scales with the software BioEstat 5.3.

Results

The use of two or more questionnaires may increase the suspicion of NP in patients with SCD and, with a confirmed diagnosis, adequate treatments will benefit patients.

Avaliação do coping da dor em crianças com Anemia Falciforme

Resumo O enfrentamento (coping) da dor desempenha um papel importante na adaptação à doença crônica e seus efeitos. Este estudo analisou o coping da Anemia Falciforme em 12 crianças com idade entre oito e dez anos, que frequentavam um Hospital Universitário de Vitória, Espírito Santo, pelo Instrumento Informatizado de Avaliação do Enfrentamento da Hospitalização e da Dor. Os resultados mostram que as estratégias de enfrentamento mais frequentes foram ruminação, solução de problemas e reestruturação cognitiva. Observa-se, assim, uma ativa busca de estratégias para a solução de problemas, procurando-se redirecionar o pensamento para aspectos mais positivos da situação estressante; contudo, a maior frequência da ruminação indica que as crianças estão controladas por aspectos negativos da doença, condição de risco para o desenvolvimento de transtornos de comportamento internalizante. Discute-se esta proposta de avaliação do coping da dor nessa população com base na Teoria Motivacional do Coping e suas contribuições para intervenções na área.

Neuropathic pain in patients with sickle cell disease: a cross-sectional study assessing teens and young adults

Chronic pain conditions are little studied and may be underestimated in sickle cell disease (SCD). The aim of this study was to identify the occurrence and characteristics of neuropathic pain (NP) in SCD patients. A sample of 56 patients was chosen from a total of 554 patients submitted to the inclusion criteria between 2015 and 2016. The Leeds assessment of neuropathic symptoms and signs scale was used for detecting NP. The groups with and without NP were compared by sex, age, use of hydroxyurea, and sensory changes through Chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis tests. The average age was 20.6 years (SD ± 4.6), 51.8% of the patients were male, and 14 patients (25%) suffered from NP. Most commonly, the pain was reported to be in the lower back area (53.6%). Age was positively related to NP: the average age in the group with NP was 22.7 years (SD ± 4.1) and in the group without NP was 19.8 years (SD ± 4.5), p < 0.05. Higher rates of NP occurred in patients aged 19 years or older, compared with that in teens (p < 0.01). There was a positive association between NP and the use of hydroxyurea (p < 0.05). An association was found between NP and sensitive neurological changes (p < 0.01). Therefore, screening for NP may result in faster and more effective diagnoses and consequently initiate appropriate treatment.

Depressive symptoms and suicidal ideation in adolescents accompanying a parent in recyclable trash collection

The relationship between mental health and poverty has been well documented in adults. However, few studies have addressed how low socioeconomic status and psychosocial vulnerabilities may influence depressive symptoms in adolescents. The current study was carried out in a non-randomly selected sample of 239 adolescents whose parents work as ragpickers (waste collectors for recycling) in Brazil. In-person interviews were conducted, and the presence of depressive symptoms and suicidal ideation were assessed using the Children's Depression Inventory (CDI). We observed that 23% (CI ± 5.34) of the adolescents presented with depressive symptoms and 35% (CI ± 6.05) had suicidal ideation. Fatigue or loss of energy (p = .012) and irritable mood (p = .013) were significantly higher among boys than girls according to DSM-IV criteria. However, we found no gender differences in DSM-IV criteria for Major Depressive Disorders (MDD) or Dysthymic Disorder (DD) in diminished interest or pleasure, weight loss or weight gain, decreased appetite, sleep problems, feelings of worthlessness, diminished concentration or ability to think, recurrent thoughts of death, suicidal ideation, or low self-esteem. There were no significant gender differences in total CDI score, however a greater percentage of girls presented with depressed mood than boys (29.9% vs. 17.1%, p < .05).