Disfunção Executiva na Depressão: Uma Revisão Sistemática
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Resumo
Dentre as alterações observadas na depressão, a redução volumétrica do córtex pré-frontal é frequentemente relatada e afeta as funções executivas (FE), embora isso ainda não tenha sido avaliado sistematicamente. Para preencher essa lacuna, realizamos uma revisão sistemática utilizando o protocolo PRISMA, com o objetivo de avaliar a presença de disfunção executiva (DE) em indivíduos com depressão. As buscas foram realizadas nas bases de dados PubMed, Embase e Scielo, por meio de uma estratégia de busca que combinou os termos “Depression” e “Executive Dysfunction”, sem restrições quanto à data de publicação ou idioma. Foram elegíveis estudos longitudinais ou transversais analíticos que avaliaram as FE utilizando escalas e testes padronizados ou consolidados, envolvendo pacientes sem comorbidades equiparados a controles. Revisões de literatura, estudos com pacientes com comorbidades psiquiátricas e modelos não-humanos foram excluídos. Nossa busca identificou 672 artigos na PubMed, 51 na Embase e 4 na Scielo (total n=727), dos quais 22 foram selecionados para leitura completa. Seis desses estudos incluíam pacientes com comorbidades, resultando na inclusão de dezesseis estudos. A maioria dos estudos mostrou comprometimento das FE na depressão e o desempenho das FE parece proporcionalmente inverso ao nível de estresse induzido pelos sintomas. Evidências sugerem que a DE pode dificultar a chance de remissão, embora intervenções psicoterapêuticas atenuem os prejuízos executivos. Além disso, a DE parece persistir mesmo após a remissão, com efeitos mais pronunciados em adultos mais velhos. Esses achados destacam a necessidade de investigação adicional sobre a DE na depressão, que pode servir como um potencial marcador biológico do transtorno.
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