Efetividade terapêutica, personalidade marcadores bioquímicos em dois modelos de psicoterapia breve para depressão

Abstract

Depression is a serious disorder that causes major impairments to the individual and may affect general functioning, familial relations, social and occupational activities. Despite its high prevalence (worldwide and in the Brazilian population) and of the proved effectiveness of psychotherapy as a treatment modality, individuals who suffer from Depression frequently do not receive proper psychotherapeutic care due to the several structural complexities of the basic health systems. In addition, other characteristics, such as comorbidities (personality disorders included) may make the clinical improvement of these patients more difficult. Thus, it is crucial that psychotherapy strategies that may be applied to the public health system are identified and effectively proved in terms of biochemical and psychological measures. The general objective of this thesis is to evaluate general suffering, symptom distress, interpersonal relations, and social role performance accordingly to the presence of personality disorders. Moreover, it aims to verify the effectiveness of two brief psychodynamic and cognitive-behavioral psychotherapy models through the evaluation instruments and biochemical markers. The first work sought to associate inflammatory biomarkers (IL-6 and TNF-α) with the remission of depressive symptoms in the supportive-expressive dynamic psychotherapy (n=46). The evaluation of depressive symptoms was carried out through the Outcome Questionnaire-45 (OQ-45) and the Beck Depression Inventory-II (BDI). Results demonstrate the effectiveness of psychotherapy in reducing inflammatory biomarkers (p<0.001), as well as a correlation between the reduction of the TNF-α and the decrease observed in the social role performance scores from the OQ-45 (p<0.05). The second paper sought to respond to the general objective of this thesis and compared therapeutic results between patients with personality disorders (n=51) and patients without them (n=18) accordingly to the Millon Clinical Multiaxial 11 Inventory-III (MCMI-III). For this purpose, data from both therapeutic models have been used and the initial and final scores from the OQ-45 and the BDI were evaluated in both of the proposed groups. Results revealed a decrease of depressive symptom scores in both groups (p<0.05) and that, even though some initial and final scores from the group with personality disorders appeared to be higher than the ones in the group without personality disorders, this difference was not significant. Only a trend to significance (p<0.20) was observed in relation to the total score and symptom distress score from the OQ-45. In conclusion, data from both studies demonstrate the effectiveness of both of the short-term psychotherapy models on depressive symptoms, which is evidenced by biochemical markers and it is independent of the presence of personality disorders.