Modern neurosurgical techniques for psychiatric disorders.

Psychosurgery refers to an ensemble of more or less invasive techniques designed to reduce the burden caused by psychiatric diseases in patients who have failed to respond to conventional therapy. While most surgeries are designed to correct apparent anatomical abnormalities, no discrete cerebral anatomical lesion is evident in most psychiatric diseases amenable to invasive interventions. Finding the optimal surgical targets in mental illness is troublesome. In general, contemporary psychosurgical procedures can be classified into one of two primary modalities: lesioning and stimulation procedures. The first group is divided into (a) thermocoagulation and (b) stereotactic radiosurgery or recently introduced transcranial magnetic resonance-guided focused ultrasound, whereas stimulation techniques mainly include deep brain stimulation (DBS), cortical stimulation, and the vagus nerve stimulation. The most studied psychiatric diseases amenable to psychosurgical interventions are severe treatment-resistant major depressive disorder, obsessive-compulsive disorder, Tourette syndrome, anorexia nervosa, schizophrenia, and substance use disorder. Furthermore, modern neuroimaging techniques spurred the interest of clinicians to identify cerebral regions amenable to be manipulated to control psychiatric symptoms. On this way, the concept of a multi-nodal network need to be embraced, enticing the collaboration of psychiatrists, psychologists, neurologists and neurosurgeons participating in multidisciplinary groups, conducting well-designed clinical trials.

Declaração de óbito: preenchimento pelo corpo clínico de um hospital universitário / Certificado de defunción: cumplimentación por el cuerpo médico en un hospital universitario / Death certificate: filling by the medical staff of a university hospital

Esta pesquisa analisou o preenchimento das declarações de óbito em um hospital universitário. O estudo objetivou avaliar, em prontuários médicos, as declarações de óbito dos anos 2009 e 2011 e as dificuldades dos médicos do corpo clínico em preenchê-las. Realizou-se pesquisa documental e aplicação de questionários aos médicos. Das 528 declarações de óbito analisadas, 265 (50,18%) estavam incompletamente preenchidas. Dos 34 médicos participantes, 34,14% referiram como principal dificuldade de preenchimento as mortes sem assistência médica; 26,47% consideraram ter tido um aprendizado ruim durante a graduação e somente 50% conheciam o documento que orienta o preenchimento da declaração. Como conclusão, infere-se a necessidade de aprimorar o ensino na graduação acerca da declaração de óbito, bem como incentivar a atualização médica sobre este importante aspecto...

Esta investigación analizó la cumplimentación de los certificados de defunción en un hospital universitario. El objetivo fue evaluar, en registros médicos, los certificados de defunción de los años 2009 y 2011 y las dificultades para el personal médico en cumplimentarlos. Se realizó la investigación documental y encuestas a los médicos. De los 528 certificados de defunción analizados, 265 (50,18%) fueron incompletamente cumplimentados. De los 34 médicos participantes, el 34,14% apuntó que la principal dificultad en la cumplimentación fueron las muertes sin asistencia médica; el 26,47% consideró escasa su aprendizaje durante la graduación y; sólo el 50% conocía el documento guía que orienta la cumplimentación del certificado. En conclusión, se infiere la necesidad de perfeccionar la enseñanza en el pregrado acerca del certificado de defunción, así como promover la actualización médica sobre este importante aspecto...

This investigation analyzed the contents from death certificates filled in by a university hospital. The study aimed to evaluate in medical records the death certificates of the years 2009 and 2011, in the database, and the difficulties of the medical clinical staff to fill them in. A documental research was done as well as interviews with the doctors. In the 528 death certificates analyzed, it was found that 265 (50.18%) were incomplete. From the 34 clinical physicians who answered the questionnaire, 34.14% reported that deaths without medical assistance constitute the major difficulty in filling the document; 26.47% mentioned that they believe their learning during the undergraduate course was not good, and only half of them knew the guideline to fill in the certificate. In conclusion, it is inferred the need to improve the teaching during de undergraduate course and encourage the updating of doctors when it comes to this important aspect...