An fMRI study of cognitive regulation of reward processing in generalized anxiety disorder (GAD).

BACKGROUND: Cognitive regulation can affect the process of decision making. Generalized anxiety disorder (GAD) patients seem to have an impairment in cognitive regulation of reward processing concerning food stimuli. This study aims to explore the impact of GAD in cognitive regulation of food-related rewards. METHODS: GAD patients (n=11) and healthy controls (n=15) performed a cognitive regulation craving task with food images while undergoing a functional magnetic resonance imaging (fMRI) acquisition. Between-group differences in functional connectivity were measured using dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) seeds during cognitive regulation. RESULTS: During cognitive regulation, there was a significant interaction for functional connectivity between the right dlPFC and bilateral vmPFC with the thalamus. GAD patients had lower functional connectivity for cognitive regulation conditions (distance and indulge) than for the non-regulated condition in these clusters, while control participants presented the opposite pattern. GAD group presented fixed food valuation scores after cognitive regulation. CONCLUSIONS: GAD participants showed inflexibility while valuating food images, that could be produced by cognitive regulation deficits underpinned by functional connectivity alterations between prefrontal regions and the thalamus. These results show cognitive inflexibility and difficulty in the modulation of cognitive responses during decision making in GAD patients.

[Mirtazapine-Induced Mania: A Case Report]. / Mania Induzida por Mirtazapina: Um Caso Clínico.

Manic and hypomanic states associated with antidepressant treatments are relatively common; however, when specifically considering mirtazapine, those side effects are infrequent. The authors report a clinical case regarding a manic episode with dysphoric features in a patient with no personal or family previous psychiatric history. It began two weeks after starting treatment with mirtazapine up to 30 mg/day. This episode was treated discontinuing mirtazapine and initiating olanzapine (10 mg), with symptomatic remission. Mirtazapine has a specific pharmacodynamics, blocking not only post-synaptic serotonergic receptors but also α2-presynaptic adrenergic receptors. Taking this into consideration, it was hypothesized that this case could be attributed to a noradrenergic syndrome, characterized by dysphoria, irritability, insomnia and psychomotor agitation.

O desenvolvimento de estados maníacos e hipomaníacos associado ao uso de antidepressivos é relativamente comum. Contudo, no caso da mirtazapina, este é um efeito secundário raro. Os autores descrevem um caso clínico de um episódio maníaco de características disfóricas, num doente sem antecedentes psiquiátricos pessoais ou familiares, com instalação duas semanas após início de tratamento com mirtazapina até 30 mg/dia. Uma vez suspensa a mirtazapina e iniciada olanzapina (10 mg) verificou-se remissão sintomática. A mirtazapina apresenta uma farmacodinâmica particular, sendo antagonista não só de recetores serotoninérgicos póssinápticos, mas também de recetores adrenérgicos pré-sinápticos α2. Neste sentido, colocou-se a hipótese de se tratar de uma síndrome noradrenérgica, caracterizada por disforia, irritabilidade, insónia e agitação psicomotora.

Un caso de comorbilidad de síndrome de Capgras y síndrome de Fregoli / A case of comorbid Capgras and Fregoli syndromes

No disponible

Characterization of suicidal behavior among children in a depressive episode: case series study / Caracterização do comportamento suicida em crianças em episódio depressivo: estudo de série de casos

Abstract Introduction Child suicidal behavior is related to specific childhood variations, constituting risk factors, including predisposing factors, internal factors, and environmental factors. Objective To characterize suicidal behavior among children aged 5 to 12 years diagnosed with a depressive episode. Methods Fifteen participants, aged 5 to 12, were assessed at a child and adolescent mental health center in Belo Horizonte, state of Minas Gerais, Brazil. All participants had a history of suicide attempt and were in a depressive episode at the time of assessment. Results Vulnerabilities related to the children themselves were self-harm, aggression, loss of an important family figure, sexual abuse, sexuality disorders, use of alcohol or other drugs, and ill-treatment. Factors of family structure and dynamics found were psychiatric illness in family members, family conflict or violence, abandonment or rejection, history of suicidal behavior in family, parents users of alcohol and other drugs, and separated parents. Factors related to school were bullying, school difficulties/delays, high school performance, bad behavior, physical aggression, school dropout, and aggressiveness. The main methods used in suicide attempts were injury by sharp or blunt objects and intentional self-poisoning. Conclusions Psychiatric comorbidities and a previous history of disturbances in the family and at school are important factors to consider with relation to suicidal behavior by children with depressive episodes.

Resumo Introdução O comportamento suicida infantil está relacionado com vicissitudes específicas da infância, representadas por fatores de risco, incluindo fatores predisponentes, internos e ambientais. Objetivo Caracterizar o comportamento suicida em crianças de 5 a 12 anos com diagnóstico de episódio depressivo. Métodos Quinze participantes, com idades entre 5 e 12 anos, foram avaliados em um centro de saúde mental da infância e adolescência de Belo Horizonte, MG, Brasil. Todos os participantes tinham histórico de tentativa de suicídio e estavam em um episódio depressivo no momento da avaliação. Resultados As vulnerabilidades relacionadas às próprias crianças foram automutilação, agressão, perda de uma figura familiar importante, abuso sexual, distúrbios da sexualidade, uso de álcool ou outras drogas e maus-tratos. Em relação a estrutura e dinâmica familiar, foram encontrados fatores como doença psiquiátrica na família, conflito ou violência familiar, abandono ou rejeição, histórico de comportamento suicida na família, pais usuários de álcool e outras drogas e pais separados. Os fatores relacionados à escola foram assédio moral, dificuldades/atrasos escolares, bom desempenho escolar, mau comportamento, agressão física, abandono escolar e agressividade. Os principais métodos utilizados nas tentativas de suicídio foram lesões por objetos pontiagudos ou contundentes e autoenvenenamento intencional. Conclusão As comorbidades psiquiátricas e o histórico prévio de distúrbios na família e na escola são fatores importantes a serem considerados em relação ao comportamento suicida em crianças com episódios depressivos.

Aripiprazole induced myopia - case report and literature review: Aripiprazole induced myopia.

INTRODUCTION: Aripiprazole is an antipsychotic used in the treatment of different disorders. The most common side effects are dizziness, insomnia, akathisia, activation, nausea and vomiting. Ophthalmologic side effects are rare. We report a case of myopia induced by aripiprazole. METHODS: Case study and literature review on aripiprazole-induced myopia. RESULTS: a 21-year-old male, with a first psychotic episode, developed myopia two weeks after initiating aripiprazole 20 mg/day. The symptoms of blurred vision were solved eight to ten days after switching to paliperidone. To date, seven cases of aripiprazole-induced myopia were reported in literature, all of them related to the oral formulation. DISCUSSION: in the present case, as seen in seven previously reported cases, the patient presented with myopia after the initiation of aripiprazol and the problem was solved after discontinuation of the drug. Apparently, this effect is not dose dependent, since the eight patients described were medicated with different dosages, from 3 to 20 mg per day. The onset of the symptoms was within a month, from three to thirty days, and the resolution after discontinuation was reported to be from three to fourteen days. Psychiatrists and ophthalmologists should be alert to the possibility of aripiprazole-induced myopia. When an ophthalmologist detects this problem, the patient should be referred to his psychiatrist to proceed with the prescription changes.

Characterization of suicidal behavior among children in a depressive episode: case series study.

INTRODUCTION: Child suicidal behavior is related to specific childhood variations, constituting risk factors, including predisposing factors, internal factors, and environmental factors. OBJECTIVE: To characterize suicidal behavior among children aged 5 to 12 years diagnosed with a depressive episode. METHODS: Fifteen participants, aged 5 to 12, were assessed at a child and adolescent mental health center in Belo Horizonte, state of Minas Gerais, Brazil. All participants had a history of suicide attempt and were in a depressive episode at the time of assessment. RESULTS: Vulnerabilities related to the children themselves were self-harm, aggression, loss of an important family figure, sexual abuse, sexuality disorders, use of alcohol or other drugs, and ill-treatment. Factors of family structure and dynamics found were psychiatric illness in family members, family conflict or violence, abandonment or rejection, history of suicidal behavior in family, parents users of alcohol and other drugs, and separated parents. Factors related to school were bullying, school difficulties/delays, high school performance, bad behavior, physical aggression, school dropout, and aggressiveness. The main methods used in suicide attempts were injury by sharp or blunt objects and intentional self-poisoning. CONCLUSIONS: Psychiatric comorbidities and a previous history of disturbances in the family and at school are important factors to consider with relation to suicidal behavior by children with depressive episodes.

Acesso das pessoas com deficiência mental aos direitos e garantias previstos na Lei Brasileira de Inclusão por meio do Sistema Único de Assistência Social / Access of persons with mental disabilities to the rights and guarantees provided for in the Brazilian Inclusion Law through the Unified Social Assistance System

RESUMO Desde 2005, está previsto na Constituição o Sistema Único de Assistência Social (Suas), descentralizado e participativo, que tem por função a gestão da assistência social no campo da proteção social brasileira. Em 2015, foi promulgada a Lei Brasileira de Inclusão da Pessoa com Deficiência destinada a assegurar e a promover o exercício dos direitos e liberdades fundamentais por pessoa com deficiência, visando a sua inclusão social e a sua cidadania, em cumprimento à Convenção Internacional sobre os Direitos das Pessoas com Deficiência. Assim como a saúde e a previdência, a assistência social é um direito social do cidadão e dever do Estado; suas ações fazem parte da Política de Seguridade Social não contributiva. Buscou-se, portanto, investigar o acesso e o recebimento de informações, das pessoas com deficiência mental, aos direitos e garantias previsto no Suas, em Campo Grande, bairro da Zona Oeste do município do Rio de Janeiro, por meio da pesquisa documental e de campo, com entrevista individual semiestruturada. Constatou-se falta de conhecimento, de informação adequada, de educação continuada dos profissionais, de estrutura física. Conclui-se que, não obstante as normas avançadas, protetivas de direitos humanos, o Estado ainda não reduziu, efetivamente, as desigualdades sociais, especialmente para as pessoas com deficiência mental.

ABSTRACT Since 2005, the decentralized and participatory Unified Social Assistance System (Usas) is provided for in the Constitution, whose function is the management of Social Assistance in the field of Brazilian social protection. In 2015, the Brazilian Law on the Inclusion of Persons with Disabilities was enacted to ensure and promote the exercise of fundamental rights and freedoms by persons with disabilities, with a view to their social inclusion and citizenship, in compliance with the International Convention on Human Rights of People with Disabilities. Like health and social security, social assistance is a social right of the citizen and a duty of the state; its actions are part of the non-contributory Social Security Policy. Therefore, we sought to investigate the access and reception of information, by people with mental disabilities, to the rights and guarantees provided by Usas, in Campo Grande, neighborhood of the West side of Rio de Janeiro, through documentary and field research, with semi-structured individual interview. There was a lack of knowledge, of adequate information, of continuing education of professionals, of physical structure. It is concluded that, however advanced the protective human rights norms, the State has not yet effectively reduced social inequalities, especially for people with mental disabilities.

Implantação dos serviços clínicos farmacêuticos na atenção primária à saúde do distrito / Implantation of pharmaceutical clinical services in the primary health care of the federal district

Introdução: a implantação dos serviços clínicos farmacêuticos visa qualificar a assistência à saúde da população do DF e está em consonância com as Portarias 77 e 78 de 2017, que estabelecem e regulamentam a Política de Atenção Primária à Saúde do DF.Objetivo: descrever a experiência de implantar os serviços clínicos farmacêuticos no âmbito da Atenção Primária à Saúde do DF.Métodos: o trabalho é descritivo com modalidade de relato de experiência de implantação dos serviços clínicos farmacêuticos, a qual foi organizado em 6 etapas: 1. Seleção das UBS e farmacêuticos; 2. Capacitação dos Farmacêutico; 3. Pactuação com os Gestores regionais e locais; 4. Implantação do serviço, 5. Monitoramento e avaliação dos resultados e 6. Multiplicação para demais UBS.Resultados: capacitação de 100% dos profissionais; a publicação da Nota Técnica nº 2/2017, criada e elaborada em conjunto com os gestores das regiões de saúde, que estabelece os instrumentos para organização do Cuidado Farmacêutico nas Unidades Básicas de Saúde da SES/DF; e serviço clínico executado em 100% das UBS selecionadas.Conclusão: a implantação do cuidado farmacêutico reorganiza a Assistência Farmacêutica, traz resolutividade e qualificação para os serviços de saúde, uma vez que a farmácia passa a prestar serviços clínicos somados aos serviços de logística.

Introduction: The implementation of pharmaceutical clinical services aims to qualify the health care of the population of the Federal District and is in line with Directives 77 and 78 of 2017, which establish and regulate the Primary Health Care Policy of the Federal District.Objective: to describe the experience of implanting pharmaceutical clinical services within the Primary Health Care of the Federal District.Methods: the work is descriptive with experience modality of clinical pharmacy services, which was organized in 6 steps: 1. Selection of PHUs and pharmacists; 2. Pharmacist training; 3. Scheduling with Regional and Local Managers; 4. Implementation of the service, 5. Monitoring and evaluation of results and 6. Multiplication for other UBS.Results: training of 100% of professionals; the publication of Technical Note No. 2/2017, created and elaborated together with the managers of the health regions, which establishes the instruments for the organization of Pharmaceutical Care in the Basic Health Units of SES / DF; and clinical service performed in 100% of the selected UBS.Conclusion: the implementation of pharmaceutical care reorganizes the Pharmaceutical Assistance, brings resolution and qualification to the health services, once the pharmacy starts providing clinical services added to the logistics services.

Sintomas auditivos e não auditivos em trabalhadores expostos ao ruído / Auditory and non auditory symptoms among workers exposed to noise / Los sintomas auditivos y no auditivos en trabajadores expuestos al ruido

Níveis de pressão sonora elevados podem causar riscos à saúde auditiva, bem como à saúde geral dos trabalhadores expostos, exigindo medidas preventivas individuais e coletivas que favoreçam a diminuição ou anulação do risco ruído no ambiente de trabalho. O objetivo deste estudo é verificar a ocorrência de sintomas auditivos e não auditivos em trabalhadores expostos ao ruído ocupacional. Adotou-se o estudo transversal como metodologia de pesquisa. Os instrumentos de coleta de dados foram o questionário elaborado pelas pesquisadoras e exames de audiometria realizados quando da admissão dos participantes da pesquisa na empresa. Os resultados indicam que os sintomas auditivos mais relatados foram zumbido (27,27por cento), cujo aumento na ocorrência foi diretamente proporcional ao tempo na função, e incômodo a sons fortes (18,18por cento); entre os sintomas não auditivos, o mais relatado foi ansiedade (30,30por cento). Conclui-se que, quanto maior o tempo de exposição ao ruído, maior a ocorrência de sintomas. Assim, a implantação de um programa de conservação auditiva é de fundamental importância.

High sound pressure levels can cause hearing impairment and damage the general health of workers exposed to it as well. It requires individual and collective preventive measures, which reduce or null noise at the workplace. The aim of this study was to verify the occurrence of auditory symptoms and not hearing in workers exposed to occupational noises. A cross-sectional study was adopted. The data was collected through a questionnaire developed by the researches and through the results of audiometric test done with each employee upon hiring. The results showed that among the auditory symptoms, the most reported were tinnitus (27,27percent) whose increase in the occurrence was directly proportional to time the employee developed a function. The second most reported was discomfort to loud noise (18,18percent). Among the non-auditory symptoms, anxiety was the most reported (30,30percent). This study concludes that the longer the duration of noise exposure, the greater the occurrence of the symptoms. Therefore, the deployment of a hearing conservation program is very important.

Altos niveles de presión sonora pueden causar riegos a la salud auditiva, bien como a la salud general de los trabajadores bajo exposición, exigiendo medidas preventivas individuales y colectivas destinadas a favorecer la reducción del riesgo o anulación del ruido en el ambiente de trabajo. El objetivo de este estudio es verificar la ocurrencia de síntomas auditivos y no auditivos en trabajadores expuestos al ruido ocupacional. Como metodología de investigación se adoptó el estudio de corte transversal. Los instrumentos de recolección de datos fueron un cuestionario elaborado por las investigadoras y exámenes audiométricos realizados en la empresa por los participantes de la investigación al momento de la admisión. Los resultados indican que los síntomas auditivos más relatados fueron el zumbido (27,27por ciento), cuyo aumento de incidencia fue directamente proporcional al tiempo de permanencia en la función, e incomodidad a los sonidos fuertes (18,18por ciento); e, entre los síntomas no auditivos, el más relatado fue la ansiedad (30,30por ciento). Se concluye que, cuanto mayor es el tiempo de 550 exposición al ruido, mayor es la ocurrencia de los síntomas. De este modo, la aplicación de un programa de conservación auditiva es de fundamental importancia.