Associação entre temperamento e o uso de práticas da medicina alternativa e complementar / Association between temperament and the use of complementary and alternative medicine practices / Asociación entre temperamento y uso de prácticas de medicina alternativa y complementaria

Trata-se de um estudo brasileiro, transversal, mediado pela Internet com o objetivo de descrever como diferenças temperamentais associam-se ao uso de oito práticas de medicina alternativa e complementar (MAC): ioga, meditação, reiki, acupuntura, massagem, tai chi chuan, homeopatia e floral. A amostra foi composta por 22.415 indivíduos, sendo 69,5% mulheres, com idade média de 28,8 anos (DP = 9,1). As práticas mais utilizadas foram massagem e ioga e as variáveis sexo, idade, renda e diagnóstico psicopatológico ao longo da vida associaram-se a todas as práticas, exceto com tai chi chuan. Análise inferencial se baseou em modelo de regressão logística e os resultados foram calculados com base na razão de chances com intervalo de confiança de 95%. Observou-se que manifestações adaptativas de traços e de tipos psicológicos, associaram-se a maiores chances de praticar MAC. Resultados sugerem que perfis com maior regulação emocional tendem a utilizar mais frequentemente MAC e, possivelmente, obter benefícios. (AU)

The present study is a cross-sectional web-based survey conducted in Brazil aiming to describe how individual differences in temperament traits and types could predict the use of the following eight categories of complementary and alternative medicine (CAM): yoga, meditation, reiki, acupuncture, massage, tai chi chuan, homeopathy, and flower remedies. The sample consisted of 22,415 individuals, 69.5% of whom were women, with a mean age of 28.8 years (SD= 9.1). The most commonly used practices were massage and yoga and the variables sex, age, income, and psychopathological diagnosis throughout life were associated with all practices, except tai chi chuan. The inferential analysis relied on logistic regressions and results were calculated based on the odd ratios with 95% confidence intervals. Adaptive manifestations of psychological traits and types were associated with greater use of complementary and alternative medicine practices. Results suggested that profiles with greater emotional regulation tend to use CAM more frequently and possibly obtain benefits. (AU)

Se trata de un estudio brasileño, transversal, mediado por Internet, con el objetivo de describir cómo las diferencias temperamentales se asocian con el uso de ocho prácticas de medicina alternativa y complementaria (MAC): yoga, meditación, reiki, acupuntura, masaje, tai chi chuan, homeopatía y floral. La muestra estuvo compuesta por 22.415 individuos, de los cuales 69,5 % eran mujeres, con una edad media de 28,8 años (DS= 9,1). Las prácticas más utilizadas fueron el masaje y el yoga, y las variables sexo, edad, renta y diagnóstico psicopatológico a lo largo de la vida se asociaron a todas las prácticas, excepto al tai chi chuan. El análisis inferencial se basó en un modelo de regresión logística y los resultados se calcularon con base en la odds ratio con un intervalo de confianza del 95 %. Se observó que las manifestaciones adaptativas de rasgos y tipos psicológicos se asociaron con mayores posibilidades de practicar MAC. Los resultados sugieren que los perfiles con mayor regulación emocional tienden a usar MAC con mayor frecuencia y, posiblemente, obtienen beneficios. (AU)

Allopurinol for fibromyalgia pain in adults: A randomized controlled trial.

BACKGROUND: Allopurinol is a potent inhibitor of the enzyme xanthine oxidase used in the treatment of hyperuricemia and gout. Because it is well known that purines exert multiple affects on pain transmission, we hypothesized that the inhibition of xanthine oxidase by allopurinol could be a valid strategy to treat pain in humans. This study aimed to compare the analgesic efficacy of oral allopurinol versus placebo as an adjuvant therapy in patients displaying fibromyalgia. METHODS: This randomized, double-blinded, placebo-controlled study included 60 women with the diagnosis of fibromyalgia. Patients were randomly assigned to receive either oral allopurinol 300 mg (n = 31) or placebo (n = 29) twice daily during 30 days. The patients were submitted to evaluation for pain sensitivity, anxiety, depression, and functional status before treatment, and 15 and 30 days thereafter. RESULTS: Oral administration of allopurinol 300 mg twice daily was ineffective in improving pain scores measured by several tools up to 30 days of treatment (P > 0.05). Additionally, no significant effects of allopurinol over anxiety, depressive symptoms, and functional status of fibromyalgia patients were observed in the present study. CONCLUSIONS: Although previous findings indicated that allopurinol could present intrinsic analgesic effects in both animals and humans, this study showed no benefit of the use of oral allopurinol as an adjuvant strategy during 30 days in women displaying fibromyalgia. However, considering previous promising results, new prospective studies are still valid to further investigate allopurinol and more selective purine derivatives in the management of pain syndromes.

Does caffeine change the effect of sleep deprivation on moderate to severe depressed patients?

INTRODUCTION: Sleep deprivation (SD) has been used as an alternative approach to treat major depressive disorder (MDD). Caffeine, due to its stimulating effect, could be an alternative to promote sleep deprivation. However, there are no data about its potential influence on the antidepressive effect of SD. The objective of this study is to assess the effect of caffeine on SD in non-psychotic patients with moderate to severe unipolar depression. METHODS: Randomized, double-blind, crossover clinical trial comparing caffeine and placebo in moderate to severe depressed patients who underwent total sleep deprivation (SD). The patients were assessed with items of the Bond-Lader scale, the 6-item Hamilton Depression Rating Scale (HAMD-6), and the Clinical Global Impression (CGI)-Severity/Improvement. RESULTS: Twenty patients participated in this study. The patients who consumed caffeine presented the same level of energy before and after sleep deprivation (lethargic-energetic item of the Bond-Lader scale), while the patients in the placebo group had a reduced level of energy after sleep deprivation (p=0.0045). There was no difference between the caffeine and placebo groups in the other items of the Bond-Lader scale. CONCLUSION: The combined use of caffeine and SD can be a useful strategy to keep the patient awake without impairing the effect of SD on depressed outpatients. However, further studies involving patients who have responded to SD are needed in order to verify if caffeine also does not interfere with the results in this group.

P50 sensory gating in panic disorder.

Previous studies with prepulse inhibition in panic disorder (PD) have suggested that the early stages of sensory information processing are abnormal in patients with PD. To further investigate sensory gating function in panic disorder we performed a case-control study in a sample of 28 patients with PD, compared to 28 normal subjects and 28 schizophrenic subjects evaluating auditory mid-latency evoked potential P50 in a double-click paradigm as a measure of sensory gating. PD subjects showed weaker sensory gating as evidenced by higher P50 ratios as compared to normal subjects (62.5% vs. 45.4%, p=0.03) and higher S2 (test) amplitude (3.5 microV vs. 2.1 microV, p=0.01). Schizophrenic subjects when compared to healthy controls showed higher P50 ratios as compared to normal subjects (79.2% vs. 45.4%, p<0.01) and higher S2 amplitude (3.3 microV vs. 2.1 microV, p=0.01), but were not statistically different from PD subjects (p>0.1). The present study corroborates recent findings of sensory gating dysfunction in PD. Further studies are still necessary to better understand the pathophysiology of this neurophysiological dysfunction and its nature as a trait or a state marker.

Atypical antipsychotic profile of flunarizine in animal models.

RATIONALE: Flunarizine is known as a calcium channel blocker commonly used in many countries to treat migraine and vertigo. Parkinsonism has been described as one of its side-effects in the elderly, which is in agreement with its recently characterized moderate D2 receptor antagonism. OBJECTIVES: To perform a pre-clinical evaluation of flunarizine as a potential antipsychotic. METHODS: We evaluated the action of orally administered flunarizine in mice against hyperlocomotion induced by amphetamine and dizocilpine (MK-801) as pharmacological models of schizophrenia, induction of catalepsy as a measure for extrapyramidal symptoms and impairment induced by dizocilpine on the delayed alternation task for working memory. RESULTS: Flunarizine robustly inhibited hyperlocomotion induced by both amphetamine and dizocilpine at doses that do not reduce spontaneous locomotion (3-30 mg/kg). Mild catalepsy was observed at 30 mg/kg, being more pronounced at 50 mg/kg and 100 mg/kg. Flunarizine (30 mg/kg) improved dizocilpine-induced impairment on the delayed alternation test. CONCLUSIONS: These results suggest a profile comparable to atypical antipsychotics. The low cost, good tolerability and long half-life (over 2 weeks) of flunarizine are possible advantages for its use as an atypical antipsychotic. These results warrant clinical trials with flunarizine for the treatment of schizophrenia.

Clozapine, but not typical antipsychotics, correct P50 suppression deficit in patients with schizophrenia.

OBJECTIVE: To find out if there is a difference in P50 suppression between patients using typical antipsychotic drugs and those using clozapine, as well as to confirm the findings of abnormal P50 suppression in patients with schizophrenia, when compared to healthy volunteers. METHODS: Fifty patients with schizophrenia and 25 healthy volunteers were divided into 3 groups: group 1 - patients using typical antipsychotics; group 2 - patients using clozapine; group 3 - controls. Before the examination, all patients were interviewed by a psychiatrist using the Brief Psychiatry Rating Scale (BPRS). RESULTS: The average S2/S1 ratio was 0.82+/-0.45 in group 1, 0.57+/-0.41 in group 2, and 0.44+/-0.27 in group 3 (P=0.003). Statistical analysis showed a significant difference when the results of group 1 were compared to those of groups 2 (P=0.045) and 3 (P=0.001). There was no significant difference between groups 2 and 3 (P=0.182). There was a significant difference in the S1-S2 difference only between groups 1 and 3 (P=0.007), but a non-significant trend towards a similar difference was found between groups 1 and 2 (P=0.067). There was no correlation between the BPRS values and any P50 parameter. CONCLUSIONS: The suppression of P50 among patients using clozapine was significantly greater than that obtained in patients using typical antipsychotics. SIGNIFICANCE: This study confirms, in a more evident way, the improvement of the suppression of P50 potential in schizophrenics using clozapine. Additionally, it discusses the physiopathological mechanism involved.

The adenosine antagonist theophylline impairs p50 auditory sensory gating in normal subjects.

In the p50 suppression paradigm, when two auditory stimuli are presented 500 ms apart, the amplitude of the second response (S2), compared with the first (S1), is markedly attenuated in healthy subjects. This is an index of sensory gating. Most schizophrenic patients fail to inhibit the p50 response to the second stimulus, which is assumed to reflect an inhibitory deficit. Adenosine is a neuromodulator with mostly inhibitory activity which is released by physiological stimuli. Since this inhibitory pattern resembles the phenomenon of sensory gating, the contribution of adenosine to p50 suppression was investigated in normal volunteers after treatment with the adenosine antagonist theophylline or placebo. P50 recordings were conducted in thirteen healthy subjects at baseline and 5, 30, 60, and 90 min after oral administration of theophylline (0.66 mg/kg, maximum dose of 500 mg) or placebo in a cross-over design. Baseline results from 17 drug-treated schizophrenic patients were included for comparison. Compared with placebo, theophylline treatment significantly increased P50 ratio (S2/S1) from 0.28 +/- 0.03 to 0.82 +/- 0.11 at 30 min and 0.61 +/- 0.07 at 60 min (mean +/- SEM), which were not significantly different from the schizophrenia group (0.74 +/- 0.05). The increased p50 ratio by theophylline was due to a combined decrease in S1 and increase in S2 amplitude. The impairment of p50 suppression by theophylline in normal subjects suggests a modulatory role of adenosine in sensory gating, which may be related to p50 suppression deficit in schizophrenia and is in agreement with a hypoadenosinergic model of schizophrenia.