4 results
The Missing 'p' in Chronic Pain Management
- A. Pestana Santos, J. Silva Ribeiro, J. Amílcar Teixeira
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- Journal:
- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Chronic pain is one of the most underestimated and undertreated health care problems worldwide. It has major consequences either on the quality of life of the sufferer or on the health care system. Consequently, social burden is very high. The main reasons for this rely on inadequate evaluation and understanding of pain as well as lack of knowledge about the psychiatric disorders that may occur in many pain conditions.
AimsThe authors aim to define the role of psychiatrists in chronic pain management.
MethodsLiterature review in PubMed and Cochrane databases using the following words: 'chronic pain', 'psychiatric disorders', 'comorbidities' and 'pain treatment'.
DiscussionThere is a clearly established link between chronic pain syndromes and psychopathology. The influence of chronic pain is especially prevalent in depression, anxiety, personality disorders, substance abuse and posttraumatic stress disorder. There are several reasons for including the psychiatrist in the management of chronic pain syndromes: 1) the high prevalence of psychopathology: 2) psychiatrists are more skilled to understand and evaluate the role of the cognitive and affective dimensions of pain as well as to identify susceptibility traits to the patient's experience, such as sexual abuse and neglect that predispose individuals to pain, substances use and concurrent mental health disorders.
ConclusionsTreatment of the patient with chronic pain is often ineffective. Chronic pain management requires a comprehensive workup and thoughtful treatment plan which balances comfort with function and rehabilitation. For this, it is necessary an interdisciplinary approach, in which psychiatry can play an important role.
Neurocognitive Impairment in Major Depressive Disorder
- J. Silva Ribeiro, A. Pestana Santos, L. Rosa, J. Amilcar
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- Journal:
- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Neurocognitive impairment has been widely reported in major depressive disorder. Patients with major depressive disorder are known to present cognitive deficits, namely in verbal and visual memory, verbal fluency, attention, working memory. Some studies related these deficits with antidepressants, although those were also described in medication-free patients. Other studies suggested that in some groups of patients there may be significant residual cognitive deficits despite an overall positive treatment response with remission of depressive episodes.
Objectives/AimsThe authors aim to contextualize cognitive deficits in patients with major depressive disorder and treatment options that could preserve/improve the cognitive functions.
MethodsScientific literature search and review on the PubMed database with the keywords: 'major depressive disorder', 'cognition', 'neurocognitive impairment', 'memory', 'executive function', 'attention'.
ResultsGiven the perception of impaired neurocognitive functioning in patients with major depressive disorder even in the remission phases, there has been an increased interest in attempting to treat those deficits during the last decade.
Studies suggest that different types of deficits are found in patients medicated with different types of antidepressants and medication-free patients. Some new treatment approaches have been used such as cognitive remediation therapy which is more frequently used in schizophrenia. Recent studies suggest that cognitive enhancing treatments could be an approach which should be further investigated.
ConclusionsCurrently, the mechanisms underlying neurocognitive deficits in patients with major depressive disorder are not fully understood. Since these symptoms have a major impact on patients' lives this issue will remain an area of ??interest in the near future.
Cognitive and Emotional Modulation of Pain
- A. Pestana Santos, J. Silva Ribeiro, J. Amílcar Teixeira
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- Journal:
- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Pain is a personal experience that widely varies between people and even within an individual. It dependson numerous factors which can change over the time. The psychological state of the person, such as cognitive and emotional factors, has an important influence on pain perception. In chronic pain it can occur anatomical and functional alterations in regions involved both in pain control and cognitive or emotional functioning.
AimsThe authors aim to clarify the role of cognition and emotion in pain modulation and its disruption in chronic pain.
MethodsLiterature review in PubMed database using the following key words: 'pain”, 'chronic pain”, 'pain modulation”,'emotion” and 'cognition”.
DiscussionRecent studies demonstrate that cognitive – attentional variations – and emotional factors can modulate pain perception. The attentional state changes the perceived intensity of pain, while emotional state changes the perceived unpleasantness of the pain without changing its intensity. Such evidence takes usback to that cognition and emotion modulates pain by different mechanisms. Emotional state activates anterior cingulatecortex, prefrontal cortex and periaqueductal gray. On the other hand, attention activates projections from the superiorparietal lobe to the primary somatosensory cortex and insula. Cross-sectional studies have demonstrated that chronicpain can change these modulatory pathways.
ConclusionsDespite the personal and interpersonal differences in pain perception, it is established that cognitive and emotional factors are important in pain modulation and perception. However, in chronic pain there are changes in these mechanisms which need to be clarified.
Medical Comorbidity in Schizophrenia
- A. Pestana Santos, J. Amílcar Teixeira
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S276
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People with schizophrenia have higher prevalence of physical disease and its lifespan is shortened when compared with general population. On average, they die 10 to 25 years earlier than general population.
AimThe authors aim to identify the main comorbidities in people with schizophrenia and define strategies to prevent it.
MethodsLiterature review on Medline database.
ResultsPeople with schizophrenia have higher risk to have hepatitis, cardiovascular diseases, diabetes, overweight, sexual dysfunction and obstetric complications. This high vulnerability is associated with higher rates of preventable risk factors, such as smoking, alcohol consumption, use of street drugs, poor dietary habits and lack of exercise. Moreover, some antipsychotic medications used to treat schizophrenia have been associated with higher incidence of physical disease. At last, there are risk factors attributable to patients and healthcare services. Psychiatrists are often not trained in detection and treatment of physical disease. Despite this, there are several attitudes that can reduce the associated morbidity and mortality in people with schizophrenia, such as improving access to healthcare services, integrated healthcare interventions to enable early diagnosis and promotion of healthy habits.
ConclusionsDiagnosis and management of morbidity in people with schizophrenia are more difficult because obstacles related to the patient, the illness, the medical attitudes and the structure of the healthcare services. Regardless these difficulties, the increased frequency of physical disease in people with schizophrenia must be valued due to improved detection and treatment of medical disease will have significant benefits for their psychosocial function and overall quality of life.
Disclosure of interestThe authors have not supplied their declaration of competing interest.