[Affective-sexual development in people with autistic spectrum disorders]. / Desarrollo afectivo-sexual en las personas con trastornos del espectro autista.

Autistic spectrum disorders (ASD) are neurodevelopmental disorders that affect social communication and present repetitive, stereotyped and inflexible behaviour. A third of the people with a diagnosis of ASD also have intellectual disability associated and two thirds present an intellectual capacity within the average range. The nuclear autistic and others associated symptoms can affect the affective and sexual development. This article exposes which are the problems people with ASD present in the affective and sexual development, the most frequently described and brief guides for evaluation and support for an adequate affective-sexual development in people with ASD.

Los trastornos del espectro autista (TEA) son trastornos del neurodesarrollo que afectan la comunicación social y que presentan patrones de conducta repetitiva, estereotipada o/y inflexible. Un tercio de los casos diagnosticados de TEA tienen discapacidad intelectual y 2/3 una capacidad intelectual dentro de la norma. Los síntomas nucleares de autismo y otros asociados pueden afectar el desarrollo afectivo-sexual. En este artículo se expone qué dificultades en el desarrollo afectivo-sexual pueden presentar las personas con TEA y cuáles son las más frecuentemente descritas. Se propone de una manera breve, guías dirigidas a la evaluación y a la ayuda para un desarrollo afectivo-sexual satisfactorio en las personas con autismo-TEA.

Desarrollo afectivo-sexual en las personas con trastornos del espectro autista / Affective-sexual development in people with autistic spectrum disorders

Los trastornos del espectro autista (TEA) son trastornos del neurodesarrollo que afectan la comunicación social y que presentan patrones de conducta repetitiva, estereotipada o/y inflexible. Un tercio de los casos diagnosticados de TEA tienen discapacidad intelectual y 2/3 una capacidad intelectual dentro de la norma. Los síntomas nucleares de autismo y otros asociados pueden afectar el desarrollo afectivo-sexual. En este artículo se expone qué dificultades en el desarrollo afectivo-sexual pueden presentar las personas con TEA y cuáles son las más frecuentemente descritas. Se propone de una manera breve, guías dirigidas a la evaluación y a la ayuda para un desarrollo afectivo-sexual satisfactorio en las personas con autismo-TEA.

Autistic spectrum disorders (ASD) are neurodevelopmental disorders that affect social communication and present repetitive, stereotyped and inflexible behaviour. A third of the people with a diagnosis of ASD also have intellectual disability associated and two thirds present an intellectual capacity within the average range. The nuclear autistic and others associated symptoms can affect the affective and sexual development. This article exposes which are the problems people with ASD present in the affective and sexual development, the most frequently described and brief guides for evaluation and support for an adequate affective-sexual development in people with ASD.

CR-19-0950: Event-related responses to alcohol-related stimuli in Mexican-American young adults: Relation to age, gender, comorbidity and "dark side" symptoms.

BACKGROUND: Electrophysiological variables may represent sensitive biomarkers of vulnerability to or endophenotypes for alcohol use disorders (AUD). METHODS: Young adults (age 18-30 yrs, n = 580) of Mexican American heritage were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism and event-related oscillations (EROs) generated in response to a task that used pictures of objects, food, and alcohol-related and non-alcohol-related drinks as stimuli. RESULTS: Decreases in energy in the alpha and beta frequencies and higher phase synchrony within cortical brain areas were seen in response to the alcohol-related as compared to the non-alcohol-related stimuli. Differences in ERO energy and synchrony responses to alcohol-related stimuli were also found as a function of age, sex, AUD status and comorbidity. Age-related decreases in energy and increases in synchrony were found. Females had significantly higher energy and lower synchrony values than males. Participants with AUD had higher synchrony values specifically in the beta frequencies, whereas those with a lifetime diagnosis of conduct disorder and/or antisocial personality disorder had lower alpha power and synchrony, and those with any affective disorder had lower ERO energy in the beta frequencies. Those with substance-associated affective "dark-side" symptoms had slower reaction times to the task, lower energy in the beta frequencies, lower local synchrony in the theta frequencies, and higher long-range synchrony in the delta and beta frequencies. CONCLUSIONS: These findings suggest that EROs recorded to alcohol-related stimuli may be biomarkers of comorbid risk factors, symptoms and disorders associated with AUD that also can differentiate those with "dark-side symptoms".

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders.

INTRODUCTION: Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. OBJECTIVE: To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. METHODS: In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. RESULTS: The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. CONCLUSION: Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders / O papel da psicoterapia psicodinâmica de longo prazo na melhora de padrões de apego, estilos de defesa e alexitimia em pacientes com transtornos depressivos e de ansiedade

Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.

Metacognition, Personal Distress, and Performance-Based Empathy in Schizophrenia.

Background: People with schizophrenia experience significant deficits in the kinds of empathic skills that are the foundation for interpersonal relationships. Researchers have speculated that deficits in empathic skills in schizophrenia may be related to disturbances in metacognition and heightened levels of personal distress. To explore this issue, this study examined whether better metacognition and reduced personal distress would be associated with improved performance on cognitive and affective empathy tasks. Further, we tested whether metacognition moderated the relationship between personal distress and empathy. Method: Fifty-eight participants with schizophrenia-spectrum disorders receiving community-based treatment completed a self-report questionnaire of personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognitive capacity. Results: Correlation analyses revealed that metacognitive capacity, but not personal distress, was significantly associated with cognitive and affective empathy performance. Moderation results suggest the relationship between personal distress and affective empathy performance was significant for those with low metacognition, but that the relationship was the opposite of hypotheses-increased personal distress predicted better performance. This relationship changed at higher levels of metacognition, when increased personal distress became associated with reduced performance. Conclusions: This study is the first of its kind to examine performance-based empathy with metacognition and personal distress. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills.

The influence of affective state on exogenous attention to emotional distractors: behavioral and electrophysiological correlates.

The interplay between exogenous attention to emotional distractors and the baseline affective state has not been well established yet. The present study aimed to explore this issue through behavioral measures and event-related potentials (ERPs). Participants (N = 30) completed a digit categorization task depicted over negative, positive or neutral distractor background pictures, while they experienced negative, positive and neutral affective states elicited by movie scenes. Behavioral results showed higher error rates and longer reaction times for negative distractors than for neutral and positive ones, irrespective of the current emotional state. Neural indices showed that the participants' affective state modulated N1 amplitudes, irrespective of distractor type, while the emotional charge of distractors modulated N2, irrespective of the emotional state. Importantly, an interaction of state and distractor type was observed in LPP. These results demonstrate that exogenous attention to emotional distractors is independent from modulating effects of the emotional baseline state at early, automatic stages of processing. However, attention to emotional distractors and affective state interact at later latencies.

Towards a neurobiological understanding of alexithymia. / Hacia una comprensión neurobiológica de la alexitimia.

Although the specialized literature on the etiology of alexithymia is controversial, neurobiological research has shown relevant advances. The aim of this review is to analyze the available evidence regarding the neurophysiological bases of alexithymia. A comprehensive review of available articles from Medline/PubMed, EBSCO and SciELO was conducted. Previously, alexithymia was linked to a reduced interhemispheric brain connection. From a childhood traumatic perspective, the right prefrontal cortex and the default mode network would experience alterations, first hypermetabolic (dopaminergic and glutamatergic dysregulation) and then hypometabolic-dissociative (serotonergic and opioid dysregulation), resulting in a distorted interoceptive and emotional awareness. Mirror neurons are the essential neurobiological substrate of theory of mind and social cognition, intrinsically linked to alexithymia, involving parietal, temporal, premotor, and cingulate cortices, and inferior frontal gyrus. Other structures involved are the amygdala (facial expression and emotional reactivity), the insula (interoception, emotional integration and empathy) and the cerebellum (limbic cerebellum and somatosensory awareness). Molecular genetics has detected polymorphisms in genes of the serotonin transporter, in the enzyme genes of dopaminergic metabolism and brain-derived neurotrophic factor, while the role of oxytocin is controversial. To sum up, we found several studies demonstrating the overwhelming evidence of a neurobiological basis underlying alexithymia; nevertheless, research is still inconclusive and must include environmental, traumatic, social, and psychological factors that contribute to the origin of the alexithymia.

Si bien la literatura especializada sobre la etiología de la alexitimia es controvertida, la investigación neurobiológica sobre el fenómeno ha demostrado importantes avances. El objetivo de esta revisión es analizar la evidencia disponible en relación a las bases neurofisiológicas de la alexitimia. Se realizó una revisión exhaustiva de artículos disponibles en MEDLINE/PubMed, EBSCO y SciELO. Inicialmente, se vinculó a la alexitimia con una conexión cerebral interhemisférica reducida. Desde la perspectiva traumática infantil, la corteza prefrontal derecha y la red neuronal por defecto experimentarían alteraciones, primero hipermetabólicas (desregulación dopaminérgica y glutamatérgica) y luego hipometabólicas-disociativas (desregulación serotoninérgica y opioide), resultando en una consciencia interoceptiva y emocional distorsionada. Las neuronas espejo son el sustrato neurobiológico fundamental de la teoría de la mente y la cognición social, intrínsecamente vinculadas con la alexitimia, involucrando cortezas como la parietal, la temporal, la premotora, la cingulada y el giro frontal inferior. Otras estructuras involucradas son amígdala (expresión facial y reactividad emocional), ínsula (interocepción, integración emocional y empatía) y cerebelo (cerebelo límbico y consciencia somatosensorial). La genética molecular ha detectado polimorfismos en el gen del transportador de serotonina, en los genes de las enzimas del metabolismo dopaminérgico y del factor neurotrófico derivado del cerebro, mientras que el rol de la oxitocina es controvertido. En conclusión, numerosos estudios demuestran contundentemente la existencia de una neurobiología subyacente a la alexitimia. Sin embargo, la investigación es aún poco concluyente y debe considerar los factores ambientales, traumáticos, sociales y psicológicos que contribuyen al origen del fenómeno.

[The amygdala and its relation to autism, behavioural disorders and other neurodevelopmental disorders]. / La amígdala y su relación con el autismo, los trastornos conductuales y otros trastornos del neurodesarrollo.

The amygdala is related with the recognition of the emotional meaning of stimuli, long-term memory, the orientation of social stimuli and the perception of gaze orientation. It plays a fundamental role in the recognition of faces, especially those expressing fear, and makes it possible to comprehend different emotional states, which will facilitate an appropriate social cognition. Dysfunctions of the amygdala have been associated to a number of different neurodevelopmental disorders as well as neurocognitive and behavioural disorders in specific neurogenetic entities. A number of studies focused on the amygdalic complex have allowed researchers to understand many pathophysiological aspects and to formulate new hypotheses regarding their origins. Given that the disorders or conditions in which the role of the amygdala has been evoked are becoming increasingly more extensive, this article refers the reader to those that have aroused the most interest in recent years. Thus, they can be divided into two groups: developmental and behavioural disorders (autism, anxiety disorders, bipolar disorder, alexithymia and anorexia nervosa) and specific neurogenetic entities (fragile X, Rett, Prader-Willi and Williams syndromes), in which structural or dysfunctional alterations have been observed that may be related with their neurocognitive and behavioural symptoms. It is important to remember that the amygdala is a highly connected structure that forms truly functional networks and has been associated to different disorders with varied explanations and includes several different pathophysiological phenomena. Its role must not, therefore, be simplified in a reductionistic manner, but also placed upon a hierarchy of dysfunctions in other areas that interact with it.

TITLE: La amigdala y su relacion con el autismo, los trastornos conductuales y otros trastornos del neurodesarrollo.La amigdala esta relacionada con el reconocimiento del significado afectivo del estimulo, la memoria a largo plazo, la orientacion del estimulo social y la percepcion de orientacion de la mirada. Desempeña un papel fundamental en el reconocimiento de caras, en especial la de temor, y permite la comprension de diversos estados emocionales, los cuales facilitaran una adecuada cognicion social. Disfunciones de la amigdala se han relacionado con diversos trastornos del neurodesarrollo y con alteraciones neurocognitivas y conductuales en entidades neurogeneticas especificas. Multiples estudios focalizados en el complejo amigdalino han permitido comprender muchos aspectos fisiopatologicos y formular nuevas hipotesis en relacion con su genesis. Dado que los trastornos o entidades en que se ha evocado el papel de la amigdala son cada vez mas extensos, este articulo remite a aquellos que han despertado mayor interes en los ultimos años, dividiendolos en dos grupos: trastornos del desarrollo y conductuales (autismo, trastornos de ansiedad, trastorno bipolar, alexitimia y anorexia nerviosa), y entidades neurogeneticas especificas (sindromes del cromosoma X fragil, Rett, Prader-Willi y Williams), en las cuales se han comprobado alteraciones estructurales o disfunciones que pueden relacionarse con la sintomatologia neurocognitiva y conductual de estas. Es importante recordar que la amigdala es una estructura altamente conectada que conforma verdaderas redes funcionales, se ha asociado a diversos trastornos cuya explicacion es variada e incluye diversos fenomenos fisiopatologicos, por lo que no debe simplificarse de una forma reduccionista su papel, sino tambien jerarquizar disfunciones de otras areas que interactuan con ella.

Effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women.

INTRODUCTION: Physiological and psychological alterations in the climacteric period frequently influence women's quality of life. Hot flushes, nocturia, mood alterations, respiratory disturbances, insomnia and restless leg syndrome all affect sleep, and the altered hormonal state in this period impacts the aging process. As hormonal therapy is not indicated in some cases, the search for complementary therapies, such as massage therapy, to improve insomnia in the climacteric period is increasing. OBJECTIVE: To evaluate the effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. METHODS: Forty-four volunteers were randomly distributed into three groups: therapeutic massage (TM), passive movement (PM) and control (CTL). The women received 32 therapeutic massage sessions and passive movement twice a week. Questionnaires were given in the pre-trial and the 16th and 32nd sessions. The Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Menopause Quality of Life questionnaire (MENQOL), Kupperman Menopausal Index and Lipp Symptoms of Stress Inventory were assessed. In addition, the women underwent polysomnography at baseline and post-treatment. Statistical analyses were calculated using Friedman and Wilcoxon non-parametric tests. The level of significance was fixed at p ≤ 0.05. RESULTS: There was an improvement in ISI in the TM group (p = 0.000) and in the PM group (p = 0.001). A decrease in the BDI occurred in the TM group (p = 0.004), and the MENQOL improved in the TM group (p = 0.015). Furthermore, there were no significant differences in polysomnography parameters in the TM group, with only an increase in minimal saturation (p = 0.053). CONCLUSION: The TM group exhibited improved subjective data considering the changes in symptoms according to the ISI and the MENQOL and a decrease in symptoms according to the BDI.

Neurobiology of apathy in Alzheimer's disease.

Apathy is considered the most frequent neuropsychiatric disturbance in dementia and its outcome is generally deleterious. Apathy can be related to a dysfunction of the anatomical-system that supports the generation of voluntary actions, namely the prefrontal cortex and/or the prefrontal-subcortical circuits. In Alzheimer's disease, pathological and neuroimaging data indicate that apathy is likely due to a dysfunction of the medial prefrontal cortex. Accordingly, in this review article, we propose a pathophysiological model to explain apathetic behavior in Alzheimer's disease, combining data from neuroimaging, neuropathology and experimental research on the role of orbito-frontal cortex, anterior cingulate cortex, basal ganglia and dopamine in decision-making neurobiology.

Neurobiology of apathy in Alzheimer's disease / Neurobiologia da apatia na doença de Alzheimer

Apathy is considered the most frequent neuropsychiatric disturbance in dementia and its outcome is generally deleterious. Apathy can be related to a dysfunction of the anatomical-system that supports the generation of voluntary actions, namely the prefrontal cortex and/or the prefrontal-subcortical circuits. In Alzheimer's disease, pathological and neuroimaging data indicate that apathy is likely due to a dysfunction of the medial prefrontal cortex. Accordingly, in this review article, we propose a pathophysiological model to explain apathetic behavior in Alzheimer's disease, combining data from neuroimaging, neuropathology and experimental research on the role of orbito-frontal cortex, anterior cingulate cortex, basal ganglia and dopamine in decision-making neurobiology.

Apatia é considerada a alteração neuropsiquiátrica mais freqüente nas demências e suas conseqüências são habitualmente deletérias. Apatia pode ser relacionada à disfunção do sistema anatômico responsável pela geração de ações voluntárias, conhecido com córtex pré-frontal e/ou circuitos pré-frontais-subcorticais. Na doença de Alzheimer, evidências neuropatológicas e de neuroimagem funcional indicam que a apatia é provavelmente decorrente da disfunção do córtex pré-frontal medial. Assim, neste artigo de revisão, apresentamos uma proposta de um modelo fisiopatológico para explicar o comportamento apático na doença de Alzheimer, combinando dados de neuropatologia, neuroimagem e experimentação animal sobre o papel do córtex órbito-frontal, cíngulo anterior, núcleos da base e dopamina na neurobiologia da tomada de decisão.

[Peripheral anticholinergic syndrome]. / Sindrome anticolinérgico periférico.

This is a case report of a woman of 38 years old, studied and analyzed at the service of allergy and immunology with clinical manifestations of allergic rhinitis; studies of laboratory, cabinet and intradermal test were made to corroborate this diagnosis and the treatment with specific hyposensitization, oral antihistaminines and inhaled steroids was started. Two years later the patient referred urinary retention without important antecedents, so, a peripheral anticholinergic syndrome (PAS) was suspected, a urodynamic test study was carried out consisting in a uroflujometry, static and dynamic urethral profile, cystometry, flow pressure study and electromyography, which diagnosed low urinary obstruction (functional) and vesical sphincter pseudodysfunction, demonstrating the PAS associated with oral antihistamines.

Tratamiento del síndrome de intestino irritable, estudio comparativo / Treatment of the irritated bowel syndrome

El síndrome de intestino irritable es la alteración gastrointestinal más frecuente y se considera que explica del 30 al 50 por ciento de todos los trastornos digestivos que se ven en las clínicas y consulta particular. En últimas fechas se ha recobrado el interés para estudiar la fisiopatología del padecimiento y la terapéutica. Por lo general, el tratamiento es ineficaz, quizá porque no se actúa contra un solo padecimiento y se requiere diversificar el tratamiento. En este estudio se seleccionó a pacientes de la consulta externa de gastroenterología, a los cuales se les diagnosticó síndrome de intestino irritable por exclusión de otras patologías abdominales. Se estudiaron dos grupos de pacientes femeninos; al grupo control se les dio tratamiento médico con base en dieta rica en fibra más procinéticos (metoclopramida 10 mg preparandial), mientras que el grupo en estudio se le dio igualmente tratamiento con base en dieta rica en fibra más procinético (metoclopramida 10 mg preprandial) y psicoterapia grupal. Los criterios en los que se basó el estudio fueron: la evolución de la intensidad de la sintomatología gastrointestinal: dolor abdominal, distensión abdominal, flatulencia y hábitos intestinales. Se observó que a los tres meses de tratamiento, el grupo en estudio mostró un mejoramiento significativo comparado con el grupo control, desapareció la sintomatología por completo en el 85 por ciento de los pacientes mientras que en el grupo control sólo se encotró mejoría en el 11.1 por ciento de los pacientes. Se concluye que el apoyo psiquiátrico es factible y efectivo en pacientes con síndrome de intestino irritable

O beijo e a transmissäo de doenças / The kiss and the diseases transmission

Especialistas discutem a transmissäo de doenças via oral e recomendam práticas para que, no próximo milênio, o país conquiste níveis satisfatórios de saúde bucal

Hallazgos laparoscópicos en pacientes con dolor pélvico crónico y dismenorrea / Laparoscopic findings in patients with chronic pelvic pain and dysmenhorrea

Fueron revisados en forma retrospectiva los hallazgos laparoscópicos de 49 pacientes que consultaron por dismenorrea y dolor pélvico crónico. A todoas ellas se les realizó laparoscopia con doble punción. Se encontró como causa principal del dolor a la endometriosis, seguida por la enfermedad pélvica inflamatoria crónica y las adherencias. El porcentaje de pacientes con una pelvis normal fue de 10.2 por ciento Por lo que se puede concluir que en la paciente con dolor pélvico crónico, la laparoscopia es el método más útil con el cual poder precisar el diagnóstico y así instituir el tratamiento más adecuado