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      Avaliação do funcionamento psicossocial na esclerose múltipla: características psicométricas de quatro medidas de auto-relato Translated title: Assessment of psychosocial functioning in multiple sclerosis: psychometric characteristics of four self-report measures

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          Abstract

          A depressão maior e a subsindrômica são altamente prevalentes na esclerose múltipla (EM). A avaliação do funcionamento psicossocial requer instrumentos psicométricos validados. As medidas de auto-relato oferecem várias vantagens, mas não existe um questionário preciso e válido para diagnosticar os sintomas depressivos na EM. O Inventário de Depressão de Beck (IDB) e o Questionário de Saúde Geral (QSG) foram validados e são amplamente usados no contexto neuropsicológico brasileiro. No IDB sintomas de EM podem ser interpretados como sintomas de depressão. Nós examinamos as propriedades psicométricas do IDB, QSG e dois questionários de auto-relato para fadiga (CPF-MS) e auto-eficácia (MSSE) na EM. Todas as escalas apresentaram exceletentes coeficientes de consistência interna.O IDB e o QSG discriminaram a amostra de EM de um grupo controle. Intercorrelações significativas foram observadas entre os escores nas diversas escalas de auto-relato, mas não entre estas e indicadores tradicionais de déficit neurológico (IA e EDSS). Os sintomas depressivos e a fadiga podem representar uma dimensão de comprometimento neurológica distinta dos déficits físicos e sensoriais. Questionários de auto-relato podem ser úteis no diagnóstico de depressão e sofrimento psíquico, mesmo quando estes não atingem níveis sindrômicos compatíveis com um diagnóstico categorial.

          Translated abstract

          Major and subsyndromic depression are highly prevalent in multiple sclerosis(MS). Assessment of psychosocial functioning in MS requires sound psychometric instruments. Self-report measures offer several advantages, but a valid and reliable depression self-report diagnostic measure is lacking. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ) have been validated and widely used in Brazilian neuropsychological context. BDI use in MS may confound depressive symptoms with somatic disease manifestations. We examined the psychometric properties of the BDI, QSG and two additional self-report measures of fatigue (CPF-MS) and self-efficacy (MSSE). All scales presented excellent reliability coefficients. BDI and GHG discrimanted MS from control participants. Intercorrelations were observed between depression, general mental health, fatigue and self-efficacy scores, but not between these and traditional indices of neurological impairment such as AI and EDSS. Depressive symptoms and fatigue may represent a different dimension of neurological impairment, unrelated to sensory and motor deficits. Self-report scales are useful in diagnosing subsyndromic distress symptoms in a MS sample.

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            Measuring self-efficacy in people with multiple scleoris a validation study

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              Depression associated with multiple sclerosis. Looking beyond diagnosis to symptom expression.

              While it is recognised that patients with multiple sclerosis have a high lifetime risk for major depression, less is known about sub-syndromal presentations of affective instability, i.e., irritability, sadness and tearfulness and how these symptoms of emotional dyscontrol may affect a subject's overall degree of psychological distress. A consecutive sample of 100 out-patients with clinically definite multiple sclerosis attending their yearly neurological examination were assessed for major depression [Structured Clinical Interview for DSM-IV (SCID-1)], pathological laughing and crying [Pathological Laughing and Crying Scale (PLACS)], self report questionnaires documenting mood [Beck Depression Inventory (BDI)] and overall psychological distress [the 28 item General Health Questionnaire (GHQ)]. Seventeen percent of subjects received a diagnosis of major depression, 8% had pathological laughing and crying (PLC), 48% had symptoms of emotional dyscontrol without meeting criteria for a formal psychiatric diagnosis and 27% had minimal psychiatric symptoms (emotionally stable). The groups did not differ with respect to neurological variables. However, on a validated index of psychological distress (i.e., GHQ scores > or =5), there were significantly more subjects with major depression and emotional dyscontrol than those deemed emotionally stable (P<0.0001). The small number of patients with PLC (N=8) curtailed statistical power when it came to analysing this sub-group. Clinicians should be sensitive to complaints such as irritability and sadness in patients with multiple sclerosis, even when symptoms do not fulfil criteria for formal, psychiatric diagnoses. Our data demonstrate that such complaints are associated with levels of psychological distress that approach those experienced by patients with major depression. Given that these sub-syndromes of affective instability respond well to pharmacotherapy, detection and treatment can significantly reduce one important aspect of morbidity associated with multiple sclerosis.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                anp
                Arquivos de Neuro-Psiquiatria
                Arq. Neuro-Psiquiatr.
                Academia Brasileira de Neurologia - ABNEURO (São Paulo )
                1678-4227
                June 2004
                : 62
                : 2a
                : 282-290
                Affiliations
                [1 ] Universidade Federal de Minas Gerais Brazil
                [2 ] Universidade Federal de Minas Gerais Brazil
                [3 ] Hospital Israelita Albert Einstein Brasil
                [4 ] Universidade Federal de Minas Gerais Brazil
                [5 ] Universidade Federal de Minas Gerais Brazil
                [6 ] Universidade Federal de Minas Gerais Brazil
                [7 ] Universidade Federal de Minas Gerais Brazil
                Article
                S0004-282X2004000200017
                10.1590/S0004-282X2004000200017
                320a81e6-abec-451c-aa30-9ff5e9fa7902

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-282X&lng=en
                Categories
                NEUROSCIENCES
                PSYCHIATRY

                Neurosciences,Clinical Psychology & Psychiatry
                multiple sclerosis,depressive symptoms,stress,fatigue,self-efficacy,self-report,esclerose múltipla,sintomas depressivos,fadiga,auto-eficácia,auto-relato

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