Psychiatry disorders and dengue: Is there a relationship?

Article Arq Neuropsiquiatr 2011;69(6):920-923 Psychiatry disorders and dengue Is there a relationship? Leonardo Caixeta1, Paulo Verlaine Borges Azevedo2, Marcelo Caixeta3, Cláudio Henrique Ribeiro Reimer2 ABSTRACT Objective: The aim of this study was to examine the relationship of compulsive hoarding with dengue. Method: Fifty two adults notified by health vigilance authorities because of inappropriate trash accumulation in vacant lots in Goiânia, Central Brazil, completed a questionnaire regarding the presence and severity of hoarding behavior (Hoarding Rating Scale-Interview HRS-I). Five dimensions of hoarding are evaluated with this instrument: difficulty using spaces due to clutter, difficulty discarding possessions, excessive acquisition of objects, emotional distress and functional impairment due to hoarding behaviors. Results: The sample was primarily male, with an average age of 49 years. Eighty six percent of the sample scored 14 or greater on the HRS-I, indicating pathological hoarding. The medias of the five HRS-I domains were high, indicating severeness of all dimentions of pathological hoarding. Conclusion: These results highlight the relationship between psychiatric disorder and actions upon environmental conditions that favors dengue, as well as its associated public health burden. Key words: dengue, psychiatry, compulsive hoarding, public heath. Transtornos psiquiátricos e dengue: existe uma correlação? RESUMO Objetivo: O objetivo deste estudo foi examinar a relação entre colecionismo compulsivo e a dengue. Método: Cinquenta e dois adultos notificados pelas autoridades de vigilância sanitária por causa do acúmulo inadequado de lixo em lotes vagos em Goiânia, no Brasil Central, completaram um questionário sobre a presença e gravidade de comportamentos de colecionismo (Hoarding Rating Scale - Interview - HRS-I). Cinco dimensões de colecionismo são avaliadas com esse instrumento: a dificuldade de utilização do espaço devido à intensa desorganização, dificuldade de descartar pertences sem função, aquisição excessiva de objetos, distúrbios emocionais e comprometimento funcional devido a comportamentos de colecionismo. Resultados: A amostra foi predominantemente do sexo masculino, com idade média de 49 anos. Oitenta e seis por cento da amostra atingiu 14 pontos ou mais na HRS-I, indicando colecionismo patológico. As médias dos cinco domínios do HRS-I foram altas, indicando gravidade de todas as dimensões de colecionismo patológico. Conclusão: Estes resultados ressaltam a relação entre transtorno psiquiátrico e as ações sobre as condições ambientais que favorecem a disseminação da dengue, bem como o problema de saúde pública associado. Palavras-Chave: dengue, psiquiatria, colecionismo compulsivo, saúde pública. Correspondence Leonardo Caixeta Instituto da Memória e do Comportamento Av. Cristo Rei 626 / Setor Jaó 74674-290 Goiânia GO - Brasil E-mail: Received 28 January 2011 Received in final form 1 July 2011 Accepted 8 July 2011 920 Compulsive hoarding is defined, in most cases, as ‘the inability to resist the urge to acquire possessions and to dis- card possessions’1,2. Hoarding is currently categorized as a symptom of both obsessive-compulsive disorder (OCD) and ob- Programa de Pós-Graduação em Saúde Pública do Instituto de Patologia Tropical e Saúde Pública e Programa de Ciências da Saúde da Universidade Federal de Goiás (UFG), Goiânia GO, Brazil: 1Professor Associado de Neuropsiquiatria do Curso de Medicina da UFG; 2Professor Titular de Psiquiatria da Pontifícia Universidade Católica (PUC-GO), Goiânia GO, Brazil; 3Médico Assistente do Hospital das Clínicas da UFG. Dengue: psychiatry disorders Caixeta et al. Arq Neuropsiquiatr 2011;69(6) sessive-compulsive personality disorder. The prevalence of compulsive hoarding in the community has been estimated at between 2 and 5%3, significantly higher than the rates of OCD and other disorders, such as panic disorder and schizophrenia. Dengue fever is considered to be one of the major public health problems in Brazil. In fact, Brazil has become the country that reports the largest number of cases in the world to the WHO, accounting for over 70% of cases reported in the Americas4. In the process of occupying space in modern cities, particularly in developing countries like Brazil, humans have created the conditions for the occurrence of many diseases, and in the specific case of dengue these conditions (mainly accumulation of garbage in living urban areas) are extremely favorable for its biological cycle (virus-vector-man)4,5. We aimed with this study to detect pathological behaviors, most specifically compulsive hoarding, as a contributor to the habit of accumulating garbage and keeping trash, creating favorable environmental conditions to the dengue proliferation. METHOD Between August 2010 and December 2010 we interview the owners of 60 vacant lots in Goiânia, GO, who have been notified by local sanitary regulatory agency because of the garbage accumulation in their vacant lots, in the context of a program designed to prevent dengue in this capital. Goiânia has been reported as one of the most affected cities by dengue in Brazil5. All participants were invited to sign the informed consent before conducting the search. Eight subjects have refused to participate. The remaining 52 subjects answered a questionnaire designed to diagnosis and pontuate the severity of compulsive hoarding: the Hoarding Rating Scale-Interview (HRS-I)6. The sample size was then defined from the total cases sequentially notified by health authorities during the stipulated study period. The HRS-I consists of five questions intended to reflect the proposed dimensions of hoarding: difficulty using urban spaces due to clutter, difficulty discarding possessions, excessive acquisition of objects, emotional distress due to hoarding behaviors, and functional impairment due to hoarding behaviors. Each item is rated on a ninepoint scale from 0 (none) to 8 (extreme). The interviewer asks the initial questions, probing with follow-up questions (based on clinician judgment) as needed to make an independent rating of severity. A total HRS-I score was derived by calculating the sum of all five items. All raters were psychiatrists trained in the use of the HRS-I by one of the study authors (LC) who has extensive experience interviewing hoarders. The HRS-I has shown high internal consistency and cross-context reliability, correlates strongly with other measures of hoarding, and reliably discriminates hoarding from nonhoarding participants (an optimal cutoff of 14 shows sensitivity and specificity of 0.97)6. We use forward-translations and back-translations (provided by an independent translator, whose mother tongue is English) in order to use HRS-I. After that, we conducted a group discussion and formal evaluation of semantic equivalence between the original English version and the Brazilian one. Then we pre-test the instrument on the target popula (...truncated)