Critérios de diagnóstico de demência com corpos de Lewy (DCL) na prática clínica de rotina no norte/nordeste de Portugal
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2011
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O presente estudo teve como finalidade fornecer um quadro geral dos critérios de diagnóstico de demência, particularmente de possível DCL, mais comumente utilizados na prática clínica de rotina no norte/nordeste de Portugal. Para tal, utilizou-se um roteiro estruturado de entrevista, realizada com os profissionais da saúde, que, reconhecidamente, desempenham um papel no processo de avaliação de suspeitas de alguma forma de demência. Participaram do estudo 89 profissionais de saúde, dos setores público e privado, entre os quais 34 médicos de família e clínicos gerais, 12 neurologistas, 14 psiquiatras e 29 psicólogos. As entrevistas foram gravadas e transcritas. As respostas a cada uma das perguntas foram categorizadas, sendo cada categoria de respostas quantificada em termos da sua frequência de ocorrência. Os resultados revelaram que os médicos de família e clínicos gerais, quando diante da suspeita de alguma forma de demência, tenderam a encaminhar os pacientes para os neurologistas, os quais, por sua vez, quando referiam algum critério de diagnóstico, tenderam a referir os Critérios de Consenso para cada uma das formas de demência. Os psiquiatras tenderam a recorrer aos critérios do DSM-IV, do CID-10 e ao encaminhamento dos pacientes para os psicólogos, os quais, por sua vez, quando forneceram respostas pertinentes, tenderam a referir o DSM-IV. Relativamente aos critérios de diagnóstico de possível DCL, os neurologistas tenderam a considerar a presença de demência associada a sinais extrapiramidais e alucinações, enquanto os psicólogos tenderam a demonstrar desconhecimento dos indicadores de possível DCL.
The present study aimed at describing the most commonly used diagnostic criteria for making the diagnosis of dementia, particularly of dementia with Lewy bodies (DLB), in routine clinical practice in the North/Northest of Portugal. A structured qualitative interview was carried out with health professionals enrolled in performing evaluations of dementia and agerelated cognitive change. Participated in the study 89 health professionals, from public and private sectors, among which 34 general practitioners (GP), 12 neurologists, 14 psychiatrists, and 29 psychologists. The interviews were tape recorded and transcribed. The answers were arranged into categories and categories' occurrence were computed. The results obtained showed that GP, when suspected the presence of some form of dementia, tended to opt for the patient's referral to the neurologist. Neurologists tended to adopt diagnostic criteria developed by expert groups. Psychiatrists tended to adopt the diagnostic criteria of DSM-IV and ICD- 10, and to seek information from the psychologist. Psychologists tended to adopt the diagnostic criteria of DSM-IV. When it comes to the diagnostic criteria for the diagnosis of possible DLB, neurologists tended to consider the presence of dementia associated to extrapyramidal symptoms and hallucination in general, while psychologists tended to show lack of knowledge or education on the indicators for the diagnosis of possible DLB.
The present study aimed at describing the most commonly used diagnostic criteria for making the diagnosis of dementia, particularly of dementia with Lewy bodies (DLB), in routine clinical practice in the North/Northest of Portugal. A structured qualitative interview was carried out with health professionals enrolled in performing evaluations of dementia and agerelated cognitive change. Participated in the study 89 health professionals, from public and private sectors, among which 34 general practitioners (GP), 12 neurologists, 14 psychiatrists, and 29 psychologists. The interviews were tape recorded and transcribed. The answers were arranged into categories and categories' occurrence were computed. The results obtained showed that GP, when suspected the presence of some form of dementia, tended to opt for the patient's referral to the neurologist. Neurologists tended to adopt diagnostic criteria developed by expert groups. Psychiatrists tended to adopt the diagnostic criteria of DSM-IV and ICD- 10, and to seek information from the psychologist. Psychologists tended to adopt the diagnostic criteria of DSM-IV. When it comes to the diagnostic criteria for the diagnosis of possible DLB, neurologists tended to consider the presence of dementia associated to extrapyramidal symptoms and hallucination in general, while psychologists tended to show lack of knowledge or education on the indicators for the diagnosis of possible DLB.
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Dissertação de Mestrado em Psicologia Clínica
Palavras-chave
Psicologia clínica , Critérios de diagnóstico , Demência com corpos de Lewy (DCL) , Prática clínica de rotina , Nordeste de Portugal