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Integration of the program of assistance, teaching and research on stress and affective diseases from the assessment of the history of childhood maltreatment in health services for the treatment of Mood Disorders in Adults in the different levels of care in mental health


The stressful life events have been associated with a variety of physical and mental disorders. Depression and Mood Disorders are complex frames that constitute a challenge for public health because of the high rates of recurrence and mortality being the most disabling disorders in public health. Among the factors associated with depression in adulthood, are exposure to stressors in childhood, evidence indicates that the abandonment, mistreatment and abuse in childhood and adolescence are risk factors for mood disorders. As the hypothalamic-pituitary-adrenal (HPA) is activated in response to stressors, stressful events early in life may also play a significant role in HPA axis abnormalities found in people experiencing mood disorders. However, further studies are needed so that we can elucidate the mechanisms underlying the link between childhood maltreatment and the development of psychopathology in adulthood. The objective of this study is to evaluate the correlation between stressful life events in the early stages of development as maltreatment (physical abuse, sexual, neglect or stress early) childhood and specific changes in the different subtypes of depression. This project aims to integrate the organization of primary care and specialist mental health services in diagnostic and therapeutic Mood Disorders, like Depression and Bipolar, reorganizing and integrating care network of the Outpatient unit with the Day Hospital of partial hospitalization for these patients with a history of early life stress. METHODOLOGY: This is a project to assess the history of childhood maltreatment in Adults in treatment of Mood Disorders in different levels of care, samples from patients with mood disorders will be evaluated at the Psychiatric Day Hospital and Outpatient Unit of Mood Disorders HC-FMRP/USP, but also in the system of different levels networked Mental Health Services in Psychiatry, HC-FMRP-USP (primary, secondary and tertiary) (continue Attached). Will be recruited three groups: one group of patients with a history of childhood maltreatment, neglect and / or early life stress and depressive episode currently diagnosed with unipolar and / or bipolar, a group of patients with no history to childhood maltreatment and neglect / or stress early diagnosis and current depressive episode for unipolar and / or bipolar and a group of healthy controls. Patients will be assessed by the Structured Clinical Interview for Disorders of Axis I and II DSM-IV (SCID-I and II) for the diagnosis of depression, to assess the severity of psychopathology be used the Scale Hamilton Depression Rating and the Beck Depression Inventory II. Is also used the Beck Anxiety Inventory, the Beck Suicide Inventory and the Beck Hopelessness Scale, and the Barratt Impulsiveness Scale and the SCL-90. The presence of Early Stress will be confirmed by applying the Questionnaire about Childhood Traumas (CTQ). Ali subjects will collect samples of salivary cortisol, these will be collected upon awakening (time 0), 30 and 60 minutes after waking and before psychometric assessments. We can prepare the hypothesis that, in the face of a stressor as early grave maltreatment within the family, the individual with biological vulnerability has increased likelihood of Mood Disorders such as Depression and Bipolar Disorder. What undoubtedly will develop the knowledge, supporting decision making for health policies adopted by SUS regarding the diagnosis and treatment of Mood Disorders and provide, directly and indirectly, improvements in quality of life of these patients, their families and our community. (AU)

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