Avaliação da qualidade de vida em portadores de esclerose múltipla: impacto da fadiga, ansiedade e depressão
DOI:
https://doi.org/10.1590/1809-2950/17005426042019Palavras-chave:
Esclerose múltipla, Qualidade de vida, Fadiga, Depressão, AnsiedadeResumo
O objetivo do estudo foi avaliar a percepção da qualidade de vida em pacientes com esclerose múltipla (EM) e verificar se há associação com fadiga, ansiedade e depressão. Trata-se de um estudo transversal com amostra composta por 100 indivíduos com diagnóstico de EM cadastrados no Centro de Referência para Atenção ao Paciente Portador de Doença Desmielinizante do Hospital da Restauração. Foram aplicadas: a escala de determinação funcional da qualidade de vida na EM (Defu), a escala modificada do impacto da fadiga (MFIS-BR) e a escala hospitalar de ansiedade (HAD-a) e depressão (HAD-d). Os pacientes com a forma clínica primariamente progressiva apresentaram pior percepção da qualidade de vida (66,90±3,47) quando comparados às formas secundariamente progressivas (71,65±5,92) e remitente-recorrente (79,00±6,62), com diferença estatística significativa (p<0,001). Houve forte correlação positiva entre os escores da Defu e da MFIS-BR (r=0,84), e forte correlação negativa entre Defu e HAD-a (r=−0,85) e Defu e HAD-d (r=−0,82). A diminuição da percepção da qualidade de vida em pacientes com EM é mais crítica nas formas progressivas da doença e tem associação com a presença de fadiga, depressão e ansiedade.
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Referências
Garg N, Smith TW. An update on immunopathogenesis,
diagnosis, and treatment of multiple sclerosis. Brain Behav.
;5(9):e00362. doi: 10.1002/brb3.362
Marques VD, Passos GR, Mendes MF, Callegaro D, LanaPeixoto MA, Comini-Frota ER, et al. Brazilian consensus for
the treatment of multiple sclerosis: Brazilian Academy of
Neurology and Brazilian Committee on Treatment and Research
in Multiple Sclerosis. Arq Neuropsiquiatr. 2018;76(8):539-54.
doi: 10.1590/0004-282x20180078
Thompson AJ, Banwell BL, Barkhof F, Carrol WM, Coetzee T,
Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of
the McDonald criteria. Lancet Neurol. 2018;17(2):162-73. doi:
1016/S1474-4422(17)30470-2
Tintore M, Rovira À, Río J, Otero-Romero S, Arrambide G, Tur C,
et al. Defining high, medium and low impact prognostic factors
for developing multiple sclerosis. Brain. 2015;138(7):1863-74.
doi: 10.1093/brain/awv105
Raggi A, Covelli V, Schiavolin S, Scaratti C, Leonardi M, Willems
M. Work-related problems in multiple sclerosis: a literature
review on its associates and determinants. Disabil Rehabil.
;38(10):936-44. doi: 10.3109/09638288.2015.1070295
Rae-Grant A, Bennett A, Sanders AE, Phipps M, Cheng E, Bever
C. Quality improvement in neurology: multiple sclerosis quality
measures: executive summary. Neurology. 2015;85(21):1904-8.
doi: 10.1212/WNL.0000000000001965
Ysrraelit MC, Fiol MP, Gaitán MI, Correale J. Quality of life
assessment in multiple sclerosis: different perception between
patients and neurologists. Front Neurol. 2018;8:729. doi:
3389/fneur.2017.00729
Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G,
Wenderoth N. et al. Pathophysiological and cognitive
mechanisms of fatigue in multiple sclerosis. J Neurol Neurosurg
Psychiatry. 2019;90(6):642-51. doi: 10.1136/jnnp-2018-320050
Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O.
Multiple sclerosis. Lancet. 2018;391(10130):1622-36. doi: 10.1016/
S0140-6736(18)30481-1
Reich DS, Lucchinetti CF, Calabresi PA. Multiple sclerosis.
N Engl J Med. 2018;378:169-80. doi: 10.1056/NEJMra1401483
Brownlee WJ, Hardy TA, Fazekas F, Miller DH. Diagnosis
of multiple sclerosis: progress and challenges. Lancet.
;389(10076):1336-46. doi: 10.1016/S0140-6736(16)30959-X
Comini-Frota ER, Vasconcelos CCF, Mendes MF. Guideline
for multiple sclerosis treatment in Brazil: consensus from the
Neuroimmunology Scientific Department of the Brazilian
Academy of Neurology. Arq Neuropsiquiatr. 2017;75(1):57-65.
doi: 10.1590/0004-282x20160185
Penner IK, Paul F. Fatigue as a symptom or comorbidity of
neurological diseases. Nat Rev Neurol. 2017;13(11):662-75. doi:
1038/nrneurol.2017.117
Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RPC, Carneiro NM,
Aguilar ACR, et al. Suicidal ideation, anxiety, and depression
in patients with multiple sclerosis. Arq Neuropsiquiatr.
;76(5):296-301. doi: 10.1590/0004-282X20180036
Finkelsztejn A, Lopes JS, Noal J, Finkelsztejn JM. The
prevalence of multiple sclerosis in Santa Maria, Rio Grande
do Sul, Brazil. Arq Neuropsiquiatr. 2014;72(2):104-6. doi:
1590/0004-282X20130216
Elbers RY, Rietberg MB, Van Wegen EE, Verhoef J, Kramer SF,
Terwee CB, et al. Self-report fatigue questionnaires in multiple
sclerosis, Parkinson’s disease and stroke: a systematic review
of measurement properties. Qual Life Res. 2012;21(6):925-44.
doi: 10.1007/s11136-011-0009-2
Jones SMW, Salem R, Amtmann D. Somatic symptoms of
depression and anxiety in people with multiple sclerosis. Int
J MS Care. 2018;20(3):145-52. doi: 10.7224/1537-2073.2017-069
Young-Blood MR, Chirichela IA, Pucci CR Filho, Camargo CHF,
Fonseca RCV. Ansiedade e depressão em pacientes com
esclerose múltipla. PsicoFAE. 2016;5(1):31-46.
Mendes MF, Balsimelli S, Stangehaus G, Tilbery CP. Validação
de escala de determinação funcional da qualidade de vida na
esclerose múltipla para a língua portuguesa. Arq Neuropsiquiatr.
;62(1):108-13. doi: 10.1590/S0004-282X2004000100019
Pavan K, Schmidt K, Marangoni B, Mendes MF, Tilbery CP, Lianza
S. Esclerose múltipla: adaptação transcultural e validação da
escala modificada de impacto de fadiga. Arq Neuropsiquiatr.
;65(3):669-73. doi: 10.1590/S0004-282X2007000400024
Botega NJ, Bio MR, Zomignani MA, Garcia C Jr, Pereira WAB.
Transtornos do humor em enfermaria de clínica médica
e validação da escala de medida (HAD) de ansiedade e
depressão. Rev Saude Publica. 1995;29(5):355-63. doi: 10.1590/
S0034-89101995000500004
Morrow SA. Anxiety is more important than depression in MS – Yes.
Mult Scler J. 2018;24(4):440-1. doi: 10.1177/1352458517751652
Al-Dughmi M, Siengsukon CF. The relationship between sleep
quality and perceived fatigue measured using the neurological
fatigue index in people with multiple sclerosis. Neurol Res.
;38(11):943-9. doi: 10.1080/01616412.2016.1232014
Lysandropoulos AP, Havrdova E, ParadigMS Group.
‘Hidden’ factors influencing quality of life in patients with
multiple sclerosis. Eur J Neurol. 2015;22(Suppl 2):28-33. doi:
1111/ene.12801
Fernández-Muñoz JJ, Morón-Verdasco A, Cigarán-Méndez M,
Muñoz-Hellín E, Pérez-de-Heredia-Torres M, Fernández-de-lasPeñas C. Disability, quality of life, personality, cognitive and
psychological variables associated with fatigue in patients with
multiple sclerosis. Acta Neurol Scand. 2015;132(2):118-24. doi:
1111/ane.12370
Salehi R, Shakhi K, Khiavi FF. Association between disability and
quality of life in multiple sclerosis patients in Ahvaz, Iran. Mater
Sociomed. 2016;28(3):215-9. doi: 10.5455/msm.2016.28.215-219
Baumstarck K, Pelletier J, Boucekine M, Auquier P, MusiQoL Study
Group. Predictors of quality of life in patients with relapsingremitting multiple sclerosis: a 2-year longitudinal study. Rev Neurol
(Paris). 2015;171(2):173-80. doi: 10.1016/j.neurol.2014.09.005
Abdelhak A, Weber MS, Tumani H. Primary progressive multiple
sclerosis: putting together the puzzle. Front Neurol. 2017;8:234.
doi: 10.3389/fneur.2017.00234
Boeschoten RE, Braamse AMJ, Beekman ATF, Cuijpers P, van
Oppen P, Dekker J, et al. Prevalence of depression and anxiety
in multiple sclerosis: a systematic review and meta-analysis.
J Neurol Sci. 2017;372:331-41. doi: 10.1016/j.jns.2016.11.067
Nogueira IC, Porto ACP, Silva EG, Melo PO, Belchior LD, Loiola
LMCV, et al. Avaliação da ansiedade, depressão e qualidade de
vida em pacientes com esclerose múltipla. Rev Inspirar Mov
Saúde. 2017;14(3):6-10.
Salehpoor G, Rezaei S, Hosseininezhad M. Quality of life in
multiple sclerosis (MS) and role of fatigue, depression, anxiety,
and stress: a bicenter study from north of Iran. Iran J Nurs
Midwifery Res. 2014;19(6):593-9.
Milinis K, Tennant A, Young CA, TONIC study group. Spasticity
in multiple sclerosis: associations with impairments and
overall quality of life. Mult Scler Relat Disord. 2016;5:34-9.
doi: 10.1016/j.msard.2015.10.007
Lee JY, Biemond M, Petratos S. Axonal degeneration in multiple
sclerosis: defining therapeutic targets by identifying the causes
of pathology. Neurodegener Dis Manag. 2015;5(6):527-48. doi:
2217/nmt.15.50
Butler E, Matcham F, Chalder T. A systematic review of anxiety
amongst people with multiple sclerosis. Mult Scler Relat Disord.
;10:145-68. doi: 10.1016/j.msard.2016.10.003
Goretti B, Viterbo RG, Portaccio E, Niccolai C, Hakiki B, Piscolla
E, et al. Anxiety state affects information processing speed in
patients with multiple sclerosis. Neurol Sci. 2014;35(4):559-63.
doi: 10.1007/s10072-013-1544-0
Berzins SA, Bulloch AG, Burton JM, Dobson KS, Fick GH, Patten
SB. Determinants and incidence of depression in multiple
sclerosis: a prospective cohort study. J Psychosom Res.
;99:169-76. doi: 10.1016/j.jpsychores.2017.06.012
Alhazzani AA, Alqahtani MS, Ogran H, Abuhawi OH, Asiri AY,
Al-Hanash AM, et al. Depression severity and its predictors
among multiple sclerosis patients in Saudi Arabia: a crosssectional study. Neuroimmunol Neuroinflammation. 2018;5:8.
doi: 10.20517/2347-8659.2017.55
Kidd T, Carey N, Mold F, Westwood S, Miklaucich M, Konstantara
E, et al. A systematic review of the effectiveness of selfmanagement interventions in people with multiple sclerosis
at improving depression, anxiety and quality of life. PLoS One.
;12(10):e0185931. doi: 10.1371/journal.pone.0185931
Ben-Zacharia A. Screening for depression in adult patients
with multiple sclerosis. J Mult Scler. 2015;2:140. doi:
4172/2376-0389.1000140
Akaishi T, Nakashima I, Misu T, Fujihara K, Aoki M. Depressive state
and chronic fatigue in multiple sclerosis and neuromyelitis optica.
J Neuroimmunol. 2015;283:70-3. doi: 10.1016/j.jneuroim.2015.05.007
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Copyright (c) 2019 Maria da Conceição Nascimento da Silva, Dominique Babini Albuquerque Cavalcanti
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