Binge eating disorder, frequency of depression, and systemic inflammatory state in individuals with obesity - A cross sectional study

ABSTRACT Objective: Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity. Its association with factors that control hunger and satiety has not yet been elucidated. We evaluated whether levels of inflammatory markers, frequency of psychiatric comorbidities, and appetite-related hormones levels differ between individuals with obesity with and without BED. Materials and methods: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 - Clinician Version (SCID-5-CV), Binge Eating Scale, and Hospital Anxiety and Depression Scale were evaluated in 39 individuals with obesity. Plasma levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results: Individuals of the BED group exhibited significantly higher percentages of altered eating patterns (hyperphagia, bingeing, post-dinner eating, feeling "stuffed", and emotional eating), higher depressive symptom scores and levels of leptin, CRP, and TNF-α, compared to those from the non-BED group. Logistic regression showed that BED was independently associated with depressive symptoms and CRP levels. Conclusions: Individuals with obesity and BED showed greater psychiatric comorbidity, worse eating patterns and worse inflammatory profile than those without BED. BED should be assessed as an indicator of clinical severity in patients with obesity.

Binge eating disorder, frequency of depression, and systemic inflammatory state in individuals with obesity - A cross sectional study.

Introduction: Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity. Its association with factors that control hunger and satiety has not yet been elucidated. We evaluated whether levels of inflammatory markers, frequency of psychiatric comorbidities, and appetite-related hormones levels differ between individuals with obesity with and without BED. Subjects and methods: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 - Clinician Version (SCID-5-CV), Binge Eating Scale, and Hospital Anxiety and Depression Scale were evaluated in 39 individuals with obesity. Plasma levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results: Individuals of the BED group exhibited significantly higher percentages of altered eating patterns (hyperphagia, bingeing, post-dinner eating, feeling "stuffed", and emotional eating), higher depressive symptom scores and levels of leptin, CRP, and TNF-α, compared to those from the non-BED group. Logistic regression showed that BED was independently associated with depressive symptoms and CRP levels. Conclusion: Individuals with obesity and BED showed greater psychiatric comorbidity, worse eating patterns and worse inflammatory profile than those without BED. BED should be assessed as an indicator of clinical severity in patients with obesity.

Avaliação do comportamento suicida em estudantes de Medicina / Assessment of suicidal behavior in medical students

OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de comportamento suicida (ideação, plano e tentativa) nos últimos 12 meses e ao longo da vida e fatores associados entre alunos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). MÉTODOS: Um estudo seccional foi desenvolvido em uma amostra representativa e aleatória (n = 324) de 1.217 estudantes de Medicina da UFRJ entre abril e novembro de 2019. Os dados foram coletados por cinco pesquisadores em uma entrevista presencial com 296 alunos (taxa de participação de 91,4%), usando um questionário do Estudo Multicêntrico de Intervenção no Comportamento Suicida para avaliar o comportamento suicida, o PHQ-9 (Questionário de Saúde do Paciente-9) para avaliar o episódio depressivo maior e o ASSIST (Teste de Triagem do Envolvimento com Substâncias) para aferir o uso e abuso de substâncias. Para a avaliação das associações, utilizou-se o modelo de regressão logística. RESULTADOS: As prevalências nos últimos 12 meses foram de 18,9% (IC de 95%: 14,9-23,8) para ideação, 6,1% (IC de 95%: 3,9-9,4) para plano e 1,7% (IC de 95%: 0,7- 4,1) para tentativa de suicídio. As prevalências ao longo da vida foram de 27,7% (IC de 95%: 22,9-33,0) para ideação, 12,5% (IC de 95%: 9,2-16,7) para plano e 5,7% (IC de 95%: 3,6-9,0) para tentativa de suicídio. Os resultados encontrados foram maiores que os achados dos estudos nacionais. O episódio depressivo maior e o tratamento psicológico atual foram associados ao comportamento suicida na análise final. CONCLUSÕES: A associação com tratamento em saúde mental e episódio depressivo maior sugere que as universidades deveriam implementar programas para a prevenção do comportamento suicida.

OBJECTIVE: The aim of this paper is to analyze the lifetime and past 12-month prevalence rates of suicidal behavior (suicidal ideation, suicide plans and suicidal attempt) and associated factors among medical students at the Federal University of Rio de Janeiro. METHODS: Sectional study was applied to a representative and random set (n = 324) of 1,217 medical students between April and November of 2019. The data were collected by five researchers through in-person interviews with 296 of 324 volunteers (participation rate of 91.4%), using the Multisite Intervention Study on Suicidal Behavior interview to assess suicidal behavior, the PHQ-9 (Patient Health Questionnaire-9) to assess major depressive episode, and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) to assess substance use and abuse. A logistic regression model was used to calculate associations. RESULTS: The rates of past-12 month were found to be 18.9% (CI 95%: 14.9-23.8) for ideation, 6.1% (CI 95%: 3.9-9.4) for suicide plans and 1.7% (CI 95%: 0.7-4.1) for suicidal attempts. The lifetime prevalence rates were 27.7% (CI 95%: 22,9-33,0) for suicidal ideation, 12.5% (CI 95%: 9.2-16.7) for plans and 5.7% (CI 95%: 3.6-9.0) for suicidal attempts. These rates are higher than the measured results among medical students in Brazil. The factors associated in the final analysis were the major depressive episode and current psychological treatment. CONCLUSIONS: The association between mental health treatment and major depressive episode suggest that the universities should implement suicidal behavior prevention programs.

Implementation of a telemental health service for medical students during the COVID-19 pandemic / Implementação de teleatendimento em saúde mental para estudantes de Medicina durante a pandemia da Covid-19

Abstract: Introduction: The COVID-19 pandemic can be considered a severely stressful event and trigger negative repercussions on the mental health of medical students, such as psychological distress and the development or worsening of mental disorders, harming the academic, social and professional life of these students. As a result of the interruption of classes and the social distancing measures advocated by health agencies during the pandemic, the mental health care sector for medical students at the Federal University of Rio de Janeiro (UFRJ) needed to cancel the face-to-face care at the Clementino Fraga Filho University Hospital in early March 2020 and think of other forms of mental health care for these students. Experience report: This is an experience report about the implementation of telemental health care for medical students at UFRJ during the pandemic, for the continuity of mental health care program using remote assistance, started in late March 2020. The service is being offered by a team of five psychiatrists, a psychologist and a social worker, all university employees. Discussion: The teleservice has served as an important space for listening and embracement in face of these students' psychosocial demands, whose challenge consists in overcoming some barriers that hinder the availability of and access to mental health services on the university campus, including the preservation of the doctor-patient relationship, the guarantee of confidentiality and quality, and the offer of a space for mental health care when the physical presence is not possible. Conclusion: Despite the difficulties inherent in the rapid process of implementing this service, the potential of technology to help the population at this critical moment is perceived, especially regarding the attention to the mental health of specific groups, such as medical students. The telehealth represents a potential for learning and change in the ways how the access to care is offered, with the perspective of bringing benefits to the students' mental health, even after the current period of the pandemic, with the goal of expanding these services to other courses of the UFRJ.

Resumo: Introdução: A pandemia provocada pela Covid-19 pode ser considerada um evento estressante grave e desencadear repercussões negativas na saúde mental dos estudantes de Medicina, como sofrimento psíquico e desenvolvimento ou agravamento de transtornos mentais, trazendo prejuízos à vida acadêmica, social e profissional desses alunos. Em consequência da interrupção das aulas e do distanciamento social preconizado pelos órgãos de saúde durante a pandemia, o Setor de Atendimento em Saúde Mental destinado aos alunos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) necessitou cancelar os atendimentos presenciais do Hospital Universitário Clementino Fraga Filho no início de março de 2020 e pensar em outras formas de cuidado em saúde mental para esses alunos. Relato de experiência: Trata-se de um relato de experiência acerca da implementação do teleatendimento em saúde mental destinado aos estudantes de Medicina da UFRJ durante a pandemia, para a continuidade do cuidado em saúde mental de forma remota, iniciado no final de março de 2020. O atendimento está sendo ofertado por uma equipe de cinco psiquiatras, uma psicóloga e uma assistente social, todos funcionários da universidade. Discussão: O teleatendimento tem servido como um espaço importante de escuta e acolhimento diante das demandas psicossociais desses alunos e tem como desafio ultrapassar algumas barreiras que dificultam o acesso e a disponibilidade de serviços de saúde mental no campus universitário, incluindo a preservação da relação médico-paciente, a garantia da confidencialidade e qualidade, e a oferta de um espaço de cuidado em saúde mental quando a presença física não é possível. Conclusão: Apesar das dificuldades inerentes ao rápido processo de implementação desse serviço, percebe-se o potencial da tecnologia em auxiliar a população nesse momento crítico, em especial na atenção à saúde mental de grupos específicos como os estudantes de Medicina. O teleatendimento representa um potencial de aprendizado e mudança nas formas de como o acesso ao cuidado é ofertado, com a perspectiva de trazer benefícios à saúde mental dos estudantes, mesmo após o período atual da pandemia, com a meta de expansão desses atendimentos para outros cursos da UFRJ.

Influence of Depression and Use of Alcohol and / or Tobacco by Parents in the Oral Health of Children with Disabilities

ABSTRACT Objective: To investigate the influence of parental depression and substance use in the oral health care of children with disabilities. Material and Methods: A cross-sectional study was conducted involving 151 children with disabilities and their parents/caregivers. To detect the presence of depression and alcohol or tobacco use, the parents/caregivers answered three questionnaires: two versions of the Patient Health Questionnaire (PHQ), AUDIT (Alcohol Use Disorders Identification Test), and the Fagerstrom Test for Nicotine Dependence (FTND). Then, the children with disabilities underwent oral examination to evaluate biofilm control, gingival condition and the dental carie index (decayed, missing, and filled teeth - dmft ̸ DMFT). Results: There was a statistically significant association between tobacco use and dental caries in deciduous teeth (p=0.046). The children of smokers had six times greater need for dental treatment than that of non-smokers (OR= 6.36; CI= 1.3-30.5). There was no statistically significant association between the oral health of the children with disabilities and parental alcohol consumption and depression (p>0.05). Children with medical condition had a higher need for dental treatment than children with intellectual disability (p=0.003). Conclusion: Parental smoking habits increase dental caries in the deciduous teeth of children with disabilities, but parental depression and alcohol use do not influence the oral health of children with disabilities. Children with medical condition have more treatment needs than children with intellectual disability.

Is weight regain after bariatric surgery associated with psychiatric comorbidity? A systematic review and meta-analysis.

Bariatric surgery has been recognized as the gold standard treatment for severe obesity. Although postbariatric surgery patients usually achieve and maintain substantial weight loss, a group of individuals may exhibit weight regain. Several factors are proposed to weight regain, including psychiatric comorbidity. The objective of the study is to conduct a systematic review and meta-analysis of studies investigating the relationship between psychiatric comorbidity and weight regain. A systematic review through PubMed, Web of Science, Cochrane Library, Scopus, and PsycINFO was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After a stepwise selection, 13 articles were included in the qualitative analysis and 5 were included for a meta-analysis. Women was majority in most of the studies (87.6%), and a bypass procedure was the bariatric intervention most evaluated (66.8%), followed by gastric banding (32.1%) and sleeve (1.1%). Higher rates of postbariatric surgery eating psychopathology were reported in patients with weight regain. However, the association between general psychopathology and weight regain was not consistent across the studies. In the meta-analysis, the odds of eating psychopathology in the weight regain group was higher compared with the nonweight regain group (OR = 2.2, 95% CI 1.54-3.15). Postbariatric surgery eating psychopathology seems to play an important role in weight regain.

Blood Levels of Glutamate and Glutamine in Recent Onset and Chronic Schizophrenia.

Converging evidence indicates that dysfunctions in glutamatergic neurotransmission and in the glutamate-glutamine cycle play a role in the pathophysiology of schizophrenia. Here, we investigated glutamate and glutamine levels in the blood of patients with recent onset schizophrenia or chronic schizophrenia compared to healthy controls. Compared with healthy controls, patients with recent onset schizophrenia showed increased glutamine/glutamate ratio, while patients with chronic schizophrenia showed decreased glutamine/glutamate ratio. Results indicate that circulating glutamate and glutamine levels exhibit a dual behavior in schizophrenia, with an increase of glutamine/glutamate ratio at the onset of schizophrenia followed by a decrease with progression of the disorder. Further studies are warranted to elucidate the mechanisms and consequences of changes in circulating glutamate and glutamine in schizophrenia.

O transtorno da compulsão alimentar (TCA) tem impacto no reganho de peso após a cirurgia bariátrica? Relato de caso / The binge eating disorder (BED) could influence the weight regain after bariatric surgery? Case report

RESUMO A cirurgia bariátrica (CB) é considerada o tratamento mais eficaz para obesidade grave em longo prazo. Apesar de estar associada à resolução ou melhora das comorbidades clínicas, um desfecho possível é o reganho de peso. Um conjunto de evidências aponta a presença do transtorno da compulsão alimentar (TCA) como um dos fatores de risco associados ao reganho de peso pós-operatório. O objetivo desta apresentação de casos clínicos é discutir o possível impacto dos episódios de compulsão alimentar em pacientes submetidos à CB. Serão apresentados os seguintes casos (1): uma mulher de 41 anos, avaliada após 8 anos da cirurgia, apresentando um reganho de 22,9 kg e psicopatologia alimentar compatível com TCA; (2): um homem de 48 anos, avaliado no pós-operatório de 7 anos, com um reganho de 30 kg e exibindo queixas de beliscamento alimentar, porém sem sintomas compatíveis com TCA; (3): uma mulher de 44 anos, avaliada no pós-operatório de 3 anos, mantendo peso estável sem reganho e que exibia à avaliação TCA. Os autores discutem, a partir destes três casos, as evidências relacionadas ao impacto da compulsão alimentar no resultado da CB. Apesar de não haver, no momento, um consenso definitivo quanto ao real impacto dos transtornos alimentares neste recrudescimento ponderal, fica claro que o clínico deve estar atento ao TCA e sua possível associação com o reganho de peso.

ABSTRACT Bariatric surgery (BS) is the most effectiveness long term treatment to severe obesity. However being associated with resolution or improvement of clinic comorbidities, one possible outcome is weight regain. A group of evidences appoint to the presence of BED (binge eating disorder) as one risk factor associated to post-surgery weight regain. The aim of this case report is to discuss a possible impact of binge eating in patients submitted to BS. The following cases will be presented: (1): 41 years woman, evaluated after 8 years post-surgery, showing weight regain of 22.9 kg and compatible eating psychopathology with BED; (2): 48 years men, evaluated 7 years post-surgery, with weight regain of 30 kg and showing grazing complaints, although without compatible BED symptomatology; (3): 44 years woman, evaluated 3 years post-surgery, maintaining stable weight without weight regain and BED exhibited in evaluation. The authors discuss, from these three index cases, the associated evidences related to the impact of the binge eating in the BS result. Although, for the moment, any definitely consensus on the real impact of eating disorders in weight recrudescence is not possible, it is clear that the clinician need to be alert to BED and possible association with weight regain.

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.(AU)

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.(AU)

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.(AU)

Quality of life in alopecia areata: a case-control study.

BACKGROUND: Although alopecia areata (AA) is typically seen by medical staff as a benign, not life-threatening cosmetic disease, some studies have found significant impairment in quality of life (QL) in AA patients. There are no studies that assess QL in Brazilian AA patients. OBJECTIVES: To evaluate QL in AA patients, using the 36-item Short-Form Health Survey (SF-36). The most affected SF-36 dimensions were compared to two culturally different AA QL studies. MATERIALS AND METHODS: We performed a case-control study with 37 AA patients and 49 age- and sex-matched volunteer blood donors. The results of a Turkish and a French study were compared to our results. RESULTS: The dimensions social functioning (P = 0,001), role emotional (P = 0,019), and mental health (P = 0,000) scored statistically lower in the AA group in relation to controls, suggesting a worse QL. Incomparison to the Turkish and French studies, we found: (1) On the dimension role emotional, QL was equally impaired; (2) on the dimension social functioning, it was not different than the Turkish study; (3) social life of French AA patients was more affected; and (4) vitality and mental health dimensions were significantly more affected in French and Turkish patients. CONCLUSIONS: Impairment in QL in AA patients affected psychological, emotional, and social aspects of theirlives. Despite the scores of SF-36 dimensions varied significantly among different cultural groups, impairment of QL was found in all three studies; thus, we can suppose that these findings are not linked to a specific culture.

O uso da sugestão no diagnóstico e tratamento de cegueira conversiva: um relato de caso / The use of suggestion in diagnosis and treatment of conversion blindness: a case report

O transtorno conversivo é definido pelo Manual Diagnóstico e Estatístico de Transtornos Mentais - Quarta Edição (DSM-IV) por sintomas que afetam a função sensorial ou motora voluntária, assemelhando-se a uma condição neurológica, mas que, após investigação, não podem ser explicados por essa condição, e sim por fatores psicológicos. Em raras ocasiões, o exame neurológico e os exames complementares não são suficientes para estabelecer o diagnóstico do transtorno conversivo. Este artigo descreve um caso para o qual a aplicação de uma técnica de sugestão (torpedeamento) confirmou o diagnóstico de cegueira conversiva e também se mostrou eficaz no tratamento. A sugestão, aliada a psicoterapia e psicofarmacologia, pode ser uma ferramenta valiosa no tratamento desses pacientes.

Conversion disorder is defined by Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) as symptoms affecting voluntary motor or sensory function, resembling a neurological condition, and, after investigation, cannot be explained by this condition, but by psychological factors. On rare occasions, neurological examination and laboratory tests are not sufficient to establish the diagnosis of conversion disorder. This article describes a case for which the use of a technique of suggestion (torpedoing) confirmed the diagnosis of conversion blindness and also proved to be effective for its treatment. Suggestion, combined with psychotherapy and psychopharmacology, can be a valuable tool in the treatment of these patients.

Cerebral calcifications and schizophreniform disorder / Calcificações cerebrais e transtorno esquizofreniforme

OBJECTIVES: Discuss pathophysiological aspects of cerebral calcifications (CC) and highlight its importance related to the occurrence of neuropsychiatric syndromes. METHOD: Single case report. RESULT: Man 52 years old, 20 years after going through a total thyroidectomy, starts showing behavioral disturbance (psychotic syndrome). He was diagnosed as schizophrenic (paranoid subtype) and submitted to outpatient psychiatric treatment. During a psychiatric admission to evaluate his progressive cognitive and motor deterioration, we identified a dementia syndrome and extensive cerebral calcifications, derived from iatrogenic hypoparathyroidism. CONCLUSION: The calcium and phosphorus disturbances, including hypoparathyroidism, are common causes of CC. Its symptoms can imitate psychiatric disorders and produce serious and permanent cognitive sequelae. The exclusion of organicity is mandatory in any psychiatric investigative diagnosis in order to avoid unfavorable outcomes, such as in the present case report.

OBJETIVOS: Discutir aspectos fisiopatológicos das calcificações cerebrais (CC) e ressaltar sua importância na ocorrência de síndromes neuropsiquiátricas. MÉTODO: Relato de caso individual. RESULTADO: Homem 52 anos de idade, 20 anos após tireoidectomia total, iniciou com alteração comportamental (síndrome psicótica), foi diagnosticado como portador de esquizofrenia paranoide e encaminhado para ambulatório de psiquiatria. Durante internação psiquiátrica, para avaliação de importante deterioração cognitivo e motora, foi verificada a vigência de síndrome demencial e extensas CC, secundários a hipoparatiroidismo iatrogênico. CONCLUSÃO: Os distúrbios do metabolismo do cálcio e do fósforo, incluindo o hipoparatiroidismo, são causas frequentes de CC. Seus sintomas podem mimetizar transtornos psiquiátricos e provocar sequelas cognitivas permanentes. A exclusão de organicidade é mandatória durante toda investigação diagnóstica na psiquiatria, a fim de evitar desfechos desfavoráveis, como no presente relato de caso.

Cessação tabágica em paciente com tremor essencial / Smoking cessation in a patient with essential tremor

Existem pacientes que, apesar dos esforços da equipe do programa de cessação tabágica, mostram-se refratários à redução do tabagismo. Entre os motivos mais citados para isso, estão abuso de álcool, ansiedade e depressão. Além desses, o tremor essencial, frequentemente negligenciado pelos pacientes e médicos, tem implicações clínicas diretas e indiretas para aqueles que desejam parar de fumar. Antes entendida como uma doença benigna, o tremor essencial tem fortes associações com transtornos psiquiátricos, além de piorar com a abstinência de nicotina e com o uso de determinados medicamentos para a cessação. Descrevemos um caso de tremor essencial e comorbidades psiquiátricas no seu percurso para a abstinência tabágica. Com relação à associação entre nicotina e o curso do tremor essencial, maiores estudos são necessários. Mas diagnosticar sua presença apresenta relevância clínica, podendo ser um marcador de pior prognóstico para a cessação.

There are patients that are resistant to reducing tobacco use, despite the effort of the professionals helping them to quit. Among the most cited motives, there are alcohol abuse, anxiety and depression. Furthermore, frequently neglected by patients and doctors, essential tremor has direct and indirect clinical implications for those who want to stop smoking. Once known as a benign condition, essential tremor has strong association with psychiatric disorders and can get worse because of nicotine abstinence and certain medications used in smoking cessation. We report a case of essential tremor and psychiatric comorbidities on the path towards tobacco abstinence. Regarding the link between nicotine and the course of essential tremor, further studies are necessary. However, diagnosing its presence is clinically relevant and should be considered a marker of worse prognosis in smoking cessation.

Plasma levels of D-serine in Brazilian individuals with schizophrenia.

Changes in D-serine availability in the brain may contribute to the hypofunction of NMDA-glutamate receptors in schizophrenia; however, measurements of blood levels of D-serine in individuals with schizophrenia have not been consistent amongst previous studies. Here we studied plasma levels of D-serine and L-serine in 84 Brazilian individuals with schizophrenia and 75 gender- and age-matched controls. Plasma levels of D-serine and the ratio of plasma D-serine to total serine were significantly lower in individuals with schizophrenia as compared to the control group. Levels of D-serine were significantly and negatively correlated to the severity of negative symptoms of schizophrenia. We also observed that plasma levels of D-serine significantly decreased with aging in healthy controls. Our results suggest that the possible role of D-serine in the pathophysiology of schizophrenia should be further investigated, with possible implications for the drug treatment of this disorder.

Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life.

OBJECTIVES: To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health-related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. MATERIALS AND METHODS: In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. RESULTS: Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. CONCLUSIONS: sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.