Patients with Schizophrenia Undergoing Gastric Bypass Surgery: a Case Series Study.

PURPOSE: Obesity affects approximately 45-55% of persons with schizophrenia and is more difficult to manage in these individuals than in the general population, apart from being an additional factor for morbidity and premature mortality. Although bariatric surgery is considered the most effective long-term treatment for severe obesity, there are few reports on the outcomes of this procedure in persons with schizophrenia. This study aimed to evaluate weight loss and psychiatric symptoms in persons with obesity and schizophrenia after bariatric surgery. MATERIALS AND METHODS: Five persons with schizophrenia and moderate to severe obesity who underwent bariatric surgery were followed up for 2 years. Anthropometric data were collected, and psychiatric symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), which assessed the pre- and postoperative occurrence and severity of symptoms of schizophrenia. RESULTS: The mean body mass index before surgery was 43.5 ± 5.2 kg/m2 and decreased to 28.1 ± 1.9 kg/m2 1 year postoperatively. The mean percentage of total postoperative weight loss was 30.7 ± 6.8% after 6 months, 34.7 ± 7.9% after 1 year, and 34.3 ± 5.5% after 2 years. Before surgery, all subjects were in remission based on the PANSS. Postoperative evaluations showed that the participants had no relapse of psychiatric symptoms (p > 0.05 for the three PANSS dimensions throughout the follow-up period). There were no considerable changes in their medication regimens. CONCLUSIONS: These findings suggest that bariatric surgery may be a viable treatment option for stable patients with schizophrenia if they have a preoperative assessment and close management and involvement by mental health professionals throughout the course of treatment.

Patients with psychoactive substance use disorders treated in a psychiatric emergency unit / Pacientes com transtornos relacionados ao uso de substâncias psicoativas atendidos em uma unidade de emergência psiquiátrica

To describe the socio demographic and clinical profile of patients with mental and behavioral disorders due to psychoactive substance (PAS) use, evaluated by the Psychiatric team of the Referenced Emergency Unit (REU) at the State University Clinical Hospital of Campinas (UNICAMP-HC). Methods and casuistic: This is a descriptive and quantitative study, which analyzed patients with mental and behavioral disorders due to PAS use, evaluated by the Psychiatricteam of the REU-HC-UNICAMP during a period of 12 months, starting on May 2010. Results: There were evaluated 350 patients with PAS related disorders, representing 23.8% of those who sought psychiatric care. Most were males and younger than other patients of the emergency unit. The main reason for seeking help was psychiatric complaint other than PAS related disorders (23.1%), followed by desire to be treated oneself/being admitted to inpatient psychiatric treatment (20.8%) and intoxication (12.5%); 38.5% had a diagnosis of multiple PAS dependence and 34.8% were diagnosed with isolated alcohol dependence; 36% had psychiatric comorbidities and, when compared to other patients, they received more medications during attendance and were less directed to primary care units. Conclusion: There is a high rate of consultations of patients with PAS related problems in the psychiatric emergency unit. Data on the profile of the evaluated these patients can contribute to the improvement of care to this population...

Descrever o perfil sócio demográfico e clínico de pacientes com transtornos relacionados ao uso de substâncias psicoativas (SPA) atendidos pela Psiquiatria da Unidade de Emergência Referenciada (UER) do Hospital de Clínicas (HC) da UNICAMP. Métodos e casuística: Estudo descritivo e quantitativo, que avaliou os pacientes com transtornos relacionados ao uso de SPA atendidos pela Psiquiatria da UER do HC-UNICAMP no período de 12 meses a partir de maio de 2010. Resultados: Foram avaliados 350 pacientes com transtornos por uso de SPA, representando 23.8% do total dos que procuraram atendimento psiquiátrico. Maioria do sexo masculino e mais jovens do que os demais pacientes. O principal motivo de atendimento foi queixa psiquiátrica outra que não o uso de SPA (23,1%), seguido do desejo de se tratar/internar (20,8%) e intoxicação (12,5%).38,5% tinham diagnóstico de dependência de múltiplas SPA e 34,8% dependência exclusiva de álcool;36% apresentavam comorbidade psiquiátrica. Quando comparados com os demais pacientes avaliados pela Psiquiatria, receberam mais medicações no atendimento e foram menos encaminhados à atenção primária. Conclusão: Há elevada taxa de atendimento de pessoas com problemas relacionados ao uso de SPA na emergência psiquiátrica. Dados sobre o perfil dos atendidos podem contribuir para a melhoria da assistência a esta população...

Psychiatric evaluation of women who were assisted at a university referral center in Campinas, Brazil, following an experience of sexual violence.

OBJECTIVE: To present the sociodemographic characteristics and psychiatric symptoms of women who have been raped. METHODS: Between 2006 and 2010, a retrospective study was conducted of 468 women who underwent psychiatric evaluation at a university referral center in Brazil after an experience of sexual violence. RESULTS: The women had a mean age of 24.1 years; were predominantly white, unmarried, childless, and employed; had 9-11 years of education; and had a religion. Rape was the first sexual intercourse for 124 (26.8%) of 462 for whom data were available; 53 (13.6%) of 389 had a personal history of sexual violence and 29 (8.0%) of 361 had a family history. No psychiatric symptoms were reported in 146 (32.9%) of 444 women, mild/short-term symptoms were reported in 107 (24.1%), and a psychiatric diagnosis was made for 191 (43.0%). Psychiatric comorbidity was seen in 59 (12.6%) women, and 174 (38.0%) received pharmacologic treatment. All follow-up consultations were attended by 215 (45.9%) of 468 women; 166 (35.5%) attended some, and 87 (18.6%) attended only one during the 6-month follow-up period. CONCLUSION: The frequency and severity of psychiatric symptoms and mental disorders among women who have been raped highlights the importance of mental health monitoring.

Hazardous use of alcohol among undergraduate students at a public university

BACKGROUND. The potentially harmful consequences of alcohol use among undergraduates have become a growing concern in recent years. OBJECTIVES. This study aimed to determine the prevalence of hazardous use of alcohol in this population and to identify demographic and psychosocial factors associated with this pattern of consumption. METHODS. This was a cross-sectional study using an anonymous and self-completed questionnaire in the classroom. The questionnaire was administered to 1,290 enrolled male and female students, which comprised a proportional sample of the main areas of knowledge at University of Campinas. The questionnaire produced sociodemographic and psychosocial profiles and the Alcohol Use Disorders Identification Test was used to detect hazardous use of alcohol. RESULTS. The prevalence of hazardous use of alcohol among the study participants was 24%. Male gender, subjective perceived social support in case of difficulties, being sexually active, not dating, having smoked tobacco cigarettes or marijuana, and having used other illicit psychoactive substances were associated with hazardous use of alcohol. DISCUSSION. Variables related to gender, sexuality, affective partnerships, and consumption of other psychoactive substances were associated with hazardous use of alcohol, which was identified in a quarter of the evaluated students, and indicate the need for strategies to prevent and to treat problems.

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence.

OBJECTIVE: To evaluate posttraumatic stress disorder (PTSD), depression, and hopelessness in women 1 and 6 months after they experienced sexual violence. METHODS: This prospective study, in which the clinician-administered PTSD scale, the Beck depression inventory, and the Beck hopelessness scale were used, included 67 women at 1 month and 52 women at 6 months after they experienced sexual violence. RESULTS: Overall, 77.6% of the women were ≤ 24years of age, and 52% were adolescents; 15% had a history of drug abuse, and 13.5% had a history of previous sexual violence. The aggressor was unknown in 76% of cases, and there was more than 1 aggressor in 9% of cases. In the first month, 43% of the women had moderate or very severe PTSD; 52.2% had moderate or severe depression; and 22.4% had moderate or severe hopelessness, which decreased to 21%, 20% and 10%, respectively, at 6 months. In the first month, severity of PTSD was associated with moderate or severe depression, and at 6 months severity of PTSD was associated with multiple aggressors and previous psychiatric disorders. All scores decreased in the sixth month. CONCLUSION: Severe mental health disorders were still present 6 months after women had experienced sexual violence.

Naltrexona na dependência de álcool: ensaio clínico aberto / Naltrexone in alcohol dependence: open clinical trial

Vinte e sete pacientes do sexo masculino, dependentes de álcool, com elevado padrão de ingesta alcoólica, participaram de ensaio clínico aberto com cloridrati de naltrexona (50 mg/dia) por seis meses no Ambulatório de Substâncias Psicoativas (Aspa) do Hospital das Clínicas da Universidade Estadual de Campinas (HU/UNICAMP). Foi facultada a participação dos mesmos em grupos informativos e de prevenção da recaída. Os pacientes foram avaliados oito vezes durante o estudo. Resultado: Abstinentes (ou com lapso, sem recaída) = 7 (25,9 por cento); <= 3 recaídas = 4 (14,8 por cento); >= 4 recaídas, porém com redução de consumo >= 50 por cento = 7 (25,9 por cento); manutenção/aumento do consumo etílico = 3 (11,1 por cento); abandonaram o estudo = 6 (22,2 por cento). Tempo médio para primeira recaída = 60 dias (mediana = 90 dias). A análise estatística (método das equações de estimativa generalizada) encontrou associação significativa do resultado abstinência com: uso reguçlar de naltrexona, diminuição do escore do craving, menor idad dos pacientes, tratamento médico prévio para dependência e redução da y-glutamiltransferase (y=GT)