Quality of life, depression and anxiety in children and adolescents with CKD and their primary caregivers / Qualidade de vida, depressão e ansiedade em crianças e adolescentes com DRC e seus cuidadores primários

ABSTRACT Introduction: Chronic kidney disease (CKD) requires long-lasting treatments and severe changes in the routine of children, which may favor a low quality of life (QoL) and damage to their mental health and that of their primary caregivers (PC). The present study aimed to investigate the presence of anxiety and depression and to analyze the QoL of children and adolescents diagnosed with CKD at stages 3, 4, and 5, and their PC. Methods: We carried out an observational case-control study with 29 children and adolescents and their PC as the case group and 53 as the control group. International instruments, validated for the Brazilian population, were used: Child Anxiety Inventory (STAI-C), Pediatric Quality of Life Inventory (PEDSQL), Child Depression Inventory (CDI), Beck Anxiety and Depression Inventory (BAI; BDI), and the WHOQOL-bref. Results: The study identified statistically significant differences in the PEDSQL total score (control group, 72.7 ± 19.5; case group, 63.3 ± 20.6; p = 0.0305) and in the psychosocial (control group, 70.5 ± 20.5 and case group, 61.4 ± 19.7; p = 0.0420) and school health dimensions (control group, 72.9 ± 21.0 and case group, 55.2 ± 19.8; p = 0.0003) and the presence of psychiatric comorbidity (depression and anxiety symptoms) in the case group (p = 0.02). As for PC, the study showed statistical significance for the prevalence of depression (p = 0.01) and anxiety (p = 0.02) symptoms. Conclusion: Patients with CKD have lower QoL indices and more psychiatric comorbidities, and their PC are affected by the disease, with higher indices of depression and anxiety.

RESUMO Introdução: A doença renal crônica (DRC) requer tratamentos duradouros e alterações severas na rotina de crianças, o que pode favorecer baixa qualidade de vida (QV) e danos à sua saúde mental e à de seus cuidadores primários (CP). O presente estudo teve como objetivo investigar a presença de ansiedade e depressão e analisar a QV de crianças e adolescentes diagnosticados com DRC nos estágios 3, 4, 5, e seus CP. Métodos: Realizamos estudo observacional de caso-controle com 29 crianças e adolescentes e seus CP como grupo de casos e 53 como grupo controle. Utilizamos instrumentos internacionais, validados para a população brasileira: Inventário de Ansiedade Traço-Estado Infantil (IDATE-C), Questionário Pediatric Quality of Life (PEDSQL), Inventário de Depressão Infantil (CDI), Inventário de Ansiedade e Depressão de Beck (BAI; BDI), e o WHOQOL-bref. Resultados: O estudo identificou diferenças estatisticamente significativas no escore total do PEDSQL (grupo controle, 72,7 ± 19,5; grupo de casos, 63,3 ± 20,6; p = 0,0305), no psicossocial (grupo controle, 70,5 ± 20,5; grupo de casos, 61,4 ± 19,7; p = 0,0420), nas dimensões de saúde escolar (grupo controle, 72,9 ± 21,0; grupo de casos, 55,2 ± 19,8; p = 0,0003) e na presença de comorbidade psiquiátrica (sintomas de depressão e ansiedade) no grupo de casos (p = 0,02). Quanto aos CP, o estudo demonstrou significância estatística para a prevalência de sintomas de depressão (p = 0,01) e ansiedade (p = 0,02). Conclusão: Pacientes com DRC apresentam índices mais baixos de QV e mais comorbidades psiquiátricas, e seus CP são afetados pela doença, com índices maiores de depressão e ansiedade.

Quality of life, depression and anxiety in children and adolescents with CKD and their primary caregivers.

INTRODUCTION: Chronic kidney disease (CKD) requires long-lasting treatments and severe changes in the routine of children, which may favor a low quality of life (QoL) and damage to their mental health and that of their primary caregivers (PC). The present study aimed to investigate the presence of anxiety and depression and to analyze the QoL of children and adolescents diagnosed with CKD at stages 3, 4, and 5, and their PC. METHODS: We carried out an observational case-control study with 29 children and adolescents and their PC as the case group and 53 as the control group. International instruments, validated for the Brazilian population, were used: Child Anxiety Inventory (STAI-C), Pediatric Quality of Life Inventory (PEDSQL), Child Depression Inventory (CDI), Beck Anxiety and Depression Inventory (BAI; BDI), and the WHOQOL-bref. RESULTS: The study identified statistically significant differences in the PEDSQL total score (control group, 72.7 ± 19.5; case group, 63.3 ± 20.6; p = 0.0305) and in the psychosocial (control group, 70.5 ± 20.5 and case group, 61.4 ± 19.7; p = 0.0420) and school health dimensions (control group, 72.9 ± 21.0 and case group, 55.2 ± 19.8; p = 0.0003) and the presence of psychiatric comorbidity (depression and anxiety symptoms) in the case group (p = 0.02). As for PC, the study showed statistical significance for the prevalence of depression (p = 0.01) and anxiety (p = 0.02) symptoms. CONCLUSION: Patients with CKD have lower QoL indices and more psychiatric comorbidities, and their PC are affected by the disease, with higher indices of depression and anxiety.

Prevalência de comportamento suicida em estudantes de Medicina / Prevalence of suicidal behavior in Medical students

Resumo: Introdução: Médicos e alunos de Medicina são grupos de risco para o suicídio e comportamento suicida. Comportamentos suicidas abrangem fenômenos que vão desde pensamentos, planejamentos, tentativas e até a morte por suicídio. Sabe-se pouco sobre o comportamento suicida entre estudantes de Medicina brasileiros. Objetivo: Este estudo teve como objetivos avaliar a prevalência de ideação, planejamentos e tentativas suicidas em uma amostra de estudantes de graduação em Medicina do Brasil, e identificar os fatores sociodemográficos, de vida estudantil e de saúde mais associados a esses comportamentos. Método: Participaram do estudo 722 alunos do curso de Medicina da Unicamp, durante os anos de 2017 e 2018, que responderam de forma voluntária e anônima a um questionário amplo, que incluía dados sociodemográficos, de vida acadêmica e de comportamento suicida. A análise estatística foi realizada por meio do teste de qui-quadrado, do teste de Mann-Whitney e da regressão logística múltipla. Adotou-se o nível de significância estatística de 95%. Resultado: As prevalências de pensamentos, planejamento e tentativas de suicídio ao longa da vida foram respectivamente 196 (27,3%), 64 (8,9%) e 26 (3,6%). Nos 30 dias que antecederam a pesquisa, 36 (5%) pensaram seriamente em pôr fim à própria vida, e 11 (1,5%) planejaram concretamente colocar fim a própria vida. Bullying, presença de transtorno mental, procura de assistência em saúde mental na universidade, uso de calmante sem prescrição médica, baixo nível socioeconômico, morar sozinho, religião (ateus, agnósticos e espiritualistas) e grau de religiosidade são os fatores que, conjuntamente, melhor explicam a chance de comportamento suicida. Conclusão: Alunos de Medicina apresentam prevalências importantes de comportamento suicida.

Abstract: Introduction: Physicians and medical students constitute groups at risk for suicide and suicidal behavior. Suicidal behaviors encompass phenomena ranging from thoughts, planning, and finally death by suicide. Little is known about suicidal behavior among Brazilian medical students. Objective: The aim of this study was to assess the prevalence of suicidal ideation, planning and suicide attempt in a sample of undergraduate medical students in Brazil, as well as to identify the sociodemographic, student life aspects and health factors most often associated with suicidal behavior. Method: A total of 722 medical students at Unicamp, during 2017 and 2018, voluntarily and anonymously answered a broad questionnaire, including sociodemographic data, aspects of academic life and suicidal behavior. A statistical analysis was performed using the chi-square test, Mann-Whitney test, and multivariate logistic regression. A statistical significance level of 95% was adopted. Results: The lifetime prevalence rates of suicidal thoughts, planning and attempts were respectively 196 (27.3%), 64 (8.9%), and 26 (3.6%). In the 30 days prior to the survey, 36 (5%) seriously thought about ending their own lives, and 11 (1.5%) concretely planned to end their own lives. Bullying, presence of mental disorder, seeking mental health care at the university, use of sedatives without a prescription, low socioeconomic level, living alone, religion (atheists, agnostics and spiritualists) and degree of religiousness are the factors that, together, best explain the chance of suicidal behavior. Conclusion: Medical students show important prevalence rates of suicidal behavior.

We need to talk about the use of methylphenidate by medical students - review of the literature / Precisamos falar sobre uso de Metilfenidato por estudantes de medicina - revisão da literatura

Abstract: Introduction: Studies methylphenidate (MPH) has been used by medical students to increase their mental activity and improve the performance required during undergraduate school, generating concern regarding the risks to their physical and mental health. This scenario indicates the need for specifically aimed measures in medical schools. Objective: To review the literature about the use of MPH without medical indication amongst medical students. Method: A thorough review of the literature published in English, Spanish, and Portuguese, between 2013 and 2019, based on data made available by Pubmed and Scielo, utilizing keywords in the three above languages, along the four stages of the selection process. Results and Discussion: Altogether, 224 articles were found, of which 25 were selected after reading, dealing with the use of MPH or 'cognition enhancer' by undergraduate medical students without a doctor's prescription. The research indicated significant variability in the frequency of consumption, related to the investigated pattern of use, use with or without indication, before or after entering University and country where the study was carried out. The most frequent justification for the use without medical indication was to attain improvement in academic performance. A lack of research with a fair appraisal of the cognition, behavioral and psychic risks involved, among them addiction and the approach of the topic in medical schools, was noted. Conclusion: The high rates of usage of MPH by medical students aiming at cognitive enhancement strengthens the importance of preventative actions in medical schools. The strategies must consider information concerning the risks of use (of MPH) without medical indication; non-pharmacological interventions for performance improvement; sleep hygiene measures organization for adequate study activities; broad discussions about ethical aspects and curricular structure.

Resumo: Introdução: Estudos mostram que o metilfenidato (MPH) tem sido utilizado por estudantes de medicina para aumentar sua atividade mental e melhorar o desempenho exigido durante a graduação, gerando preocupações quanto aos riscos à sua saúde física e mental. Esse cenário indica a necessidade de medidas especificamente direcionadas nas escolas médicas. Objetivo: Revisar a literatura sobre o uso de MPH sem indicação médica entre estudantes de medicina. Método: Revisão minuciosa da literatura publicada em inglês, espanhol e português, entre 2013 e 2019, com base em dados disponibilizados pelo PUBMED e SCIELO, utilizando palavras-chave nos três idiomas acima, ao longo das quatro etapas do processo de seleção. Resultados e Discussão: Ao todo, foram encontrados 224 artigos, dos quais 25 foram selecionados após leitura, tratando do uso de MPH ou 'potencializador da cognição' por graduandos de medicina sem prescrição médica. A pesquisa indicou variabilidade significativa na frequência de consumo, relacionada ao padrão de uso investigado, uso com ou sem indicação, antes ou após a entrada na Universidade e país onde o estudo foi realizado. A justificativa mais frequente para o uso sem indicação médica foi a de obter melhora no desempenho acadêmico. Notou-se a carência de pesquisas com uma avaliação adequada dos riscos cognitivos, comportamentais e psíquicos envolvidos, entre eles o risco de adição e a abordagem do tópico nas escolas médicas. Conclusão: As altas taxas de uso do MPH por estudantes de medicina visando o aprimoramento cognitivo reforça a importância de ações preventivas nas escolas médicas. As estratégias devem considerar informações sobre os riscos do uso (do MPH) sem indicação médica; intervenções não farmacológicas para melhoria do desempenho cognitivo; medidas de higiene do sono; organização para atividades de estudo adequadas; amplas discussões sobre aspectos éticos e estrutura curricular.

Das psicoses associadas a infecções no Brasil: 100 anos da contribuição psicopatológica de Antonio Austregésilo / On psychoses associated with infections in Brazil: 100 years of the psychopathological contribution by Antonio Austregésilo / De las psicosis asociadas a infecciones en Brasil:1 00 años de la contribución psicopatológica de AntonioAustregésilo / Sur les psychoses associées aux infections au Brésil: 100 ans de contribution psychopathologique de Antônio Austregésilo

No presente trabalho, analisa-se a contribuição do neurologista e neuropsiquiatra Antonio Austregésilo (1876--1960) para o estudo psicopatológico e sistematização das chamadas psicoses infecciosas, no Brasil. Baseando-se em Emil Kraepelin e lançando mão de observações clínicas em doenças infecciosas globais e tropicais, Austregésilo revela detalhado conhecimento clínico e intervém no debate sobre etiologia, especificidades de fatores causais e curso da doença, na fronteira entre as doenças físicas infecciosas e os transtornos mentais.

The present article analyzes the contribution of neurologist and neuropsychiatrist Antonio Austregésilo (1876-1960) for the psychopathological study and systematization of so-called infectious psychoses in Brazil. Based on Emil Kraepelin and using clinical observations on global and tropical infectious diseases, Austregésilo built detailed clinical knowledge and took part in the debate on etiology, specificities of causal factors and the course of the disease, which is located on the edge between infectious physical diseases and mental disorders.

Cet article analyse la contribution du neurologue et neuropsychiatre Antonio Austregésilo (1876-1960) à l'étude psychopathologique et à la systématisation des psychoses dites infectieuses au Brésil. Basé sur Emil Kraepelin et en utilisant des observations cliniques sur les maladies infectieuses mondiales et tropicales, Austregésilo construit un savoir clinique détaillé et participe au débat sur l'étiologie, les spécificités des facteurs causals et le cours de la maladie, à la frontière entre les maladies physiques infectieuses et les troubles mentaux.

En el presente trabajo, analizamos la contribución del neurólogo y neuropsiquiatra Antonio Austregésilo (1876-1960) al estudio psicopatológico y a la sistematización de las llamadas psicosis infecciosas en Brasil. Basándose en Emil Kraepelin y utilizando observaciones clínicas sobre enfermedades infecciosas globales y tropicales, Austregésilo revela conocimientos clínicos detallados e interviene en el debate sobre la etiología, las especificidades de los factores causales y el curso de la enfermedad, en la frontera entre las enfermedades físicas infecciosas y los trastornos mentales.

Evidence of Validity of the Autism Mental Status Examination (AMSE) in a Brazilian Sample.

This study investigated the psychometric properties of the Autism Mental Status Examination (AMSE) in a Brazilian sample of children and adolescents with autism spectrum disorder (ASD). A sample of 260 children and adolescents, comprising 56 (21.5%) females and 204 (78.5%) males, was assessed. The participants were submitted to both the childhood autism rating scale (CARS-BR) and the AMSE. The CARS-BR was used to estimate ASD severity and the cutoff point on the AMSE. Spearman's correlation test was employed to determine the correlation between the AMSE and CARS-BR scales. The cutoff values were calculated using the ROC (receiver operating characteristic) curve, identifying the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The homogeneity of the items of the AMSE was determined using Cronbach´s alpha. The AMSE exhibited good internal consistency (0.74), sensitivity (0.91) and specificity (0.98); and high correlation with the CARS-BR (ρ = 0.91, p < 0.01). Preliminary results showed that the AMSE is a tool with good psychometric properties for ASD screening.

Resilience and mental health problems in children and adolescents who have been victims of violence.

OBJECTIVE: To understand the process of resilience (social support and resources of the family environment) and the chance of mental health problems in children and adolescents (9-16 years) who have been victims of domestic violence, assisted in specialized services (Group 1 - G1) and in school services without reports of domestic violence (Group 2 - G2). METHODS: Various semi-structured instruments were applied to the pairs (guardian and child or adolescent): the Strengths and Difficulties Questionnaire (SDQ); the Resiliency Scales for Children and Adolescents (RSCA), including Scale I (SI - sense of control), Scale II (SII - relationship skills) and Scale III (SIII - emotional reactivity); the Social Support Appraisals; the Home Environment Resources Scale and a questionnaire created by the authors to characterize the population. RESULTS: There was no difference in the prevalence of resilience between G1 and G2. Children and adolescents of both groups had a higher chance of low resilience in the absence of perception of social support from the teacher (SI; SIII) and other people in the community (SI; SII). Girls had higher chance of low resilience (SIII). The establishment of routine or rules in the lives of the children and adolescents facilitated the development of resilience (SIII). In G1, the prevalence of mental health problems was 65% for the self-application version of the SDQ for children and adolescents (SDQ/CA) and 54% for the version answered by the guardians (SDQ/G). In G2, it was 33% for SDQ/CA and 37.9% for SDQ/G. Domestic violence against children and adolescents was a risk factor for the development of mental disorders (SDQ/G). Subjects with low resilience (SI) had a higher chance of developing mental health problems (SDQ/CA). Despite originating from the same regions, the groups had socioeconomic differences, which showed no relationship with resilience. CONCLUSIONS: The quality and perception of social support and resources present in the home environment may have facilitated the development of resilience in the studied children and adolescents. Violence may have increased the chance of mental health problems, domestic violence being an aggravating factor. There is need for research on aspects that predict resilience and investment in intervention strategies for this population, as a way to promote mental health.

Resilience and mental health problems in children and adolescents who have been victims of violence / Resiliência e problemas de saúde mental em crianças e adolescentes vítimas de violência

ABSTRACT OBJECTIVE: To understand the process of resilience (social support and resources of the family environment) and the chance of mental health problems in children and adolescents (9-16 years) who have been victims of domestic violence, assisted in specialized services (Group 1 - G1) and in school services without reports of domestic violence (Group 2 - G2). METHODS: Various semi-structured instruments were applied to the pairs (guardian and child or adolescent): the Strengths and Difficulties Questionnaire (SDQ); the Resiliency Scales for Children and Adolescents (RSCA), including Scale I (SI - sense of control), Scale II (SII - relationship skills) and Scale III (SIII - emotional reactivity); the Social Support Appraisals; the Home Environment Resources Scale and a questionnaire created by the authors to characterize the population. RESULTS: There was no difference in the prevalence of resilience between G1 and G2. Children and adolescents of both groups had a higher chance of low resilience in the absence of perception of social support from the teacher (SI; SIII) and other people in the community (SI; SII). Girls had higher chance of low resilience (SIII). The establishment of routine or rules in the lives of the children and adolescents facilitated the development of resilience (SIII). In G1, the prevalence of mental health problems was 65% for the self-application version of the SDQ for children and adolescents (SDQ/CA) and 54% for the version answered by the guardians (SDQ/G). In G2, it was 33% for SDQ/CA and 37.9% for SDQ/G. Domestic violence against children and adolescents was a risk factor for the development of mental disorders (SDQ/G). Subjects with low resilience (SI) had a higher chance of developing mental health problems (SDQ/CA). Despite originating from the same regions, the groups had socioeconomic differences, which showed no relationship with resilience. CONCLUSIONS: The quality and perception of social support and resources present in the home environment may have facilitated the development of resilience in the studied children and adolescents. Violence may have increased the chance of mental health problems, domestic violence being an aggravating factor. There is need for research on aspects that predict resilience and investment in intervention strategies for this population, as a way to promote mental health.

RESUMO OBJETIVO: Compreender o processo de resiliência (suporte social e recursos do ambiente familiar) e a chance de problemas de saúde mental em crianças e adolescentes (9-16 anos) vítimas de violência doméstica acompanhados em serviços especializados (Grupo 1 - G1) e em escolares sem relatos de situações de violência doméstica (Grupo 2 - G2). MÉTODOS: Diversos instrumentos semiestruturados foram aplicados às díades (responsável e criança ou adolescente): Strengths and Difficulties Questionnaire (SDQ); Resiliency Scales for Children and Adolescents (RSCA), incluindo a Escala I (EI - sentido do controle), a Escala II (EII - capacidade de relacionamento) e a Escala III (EIII - reatividade emocional); Social Support Appraisals; Inventário de Recursos no Ambiente Familiar e um questionário elaborado pelos autores para caracterizar a população. RESULTADOS: Não houve diferença na prevalência de resiliência entre G1 e G2. As crianças e adolescentes de ambos os grupos tiveram maior chance de baixa resiliência na ausência de percepção do suporte social do professor (EI; EIII) e de outras pessoas da comunidade (EI; EII). Meninas apresentaram maior chance de baixa resiliência (EIII). O estabelecimento de rotina ou regras na vida das crianças e adolescentes facilitou o desenvolvimento da resiliência (EIII). No G1 a prevalência de problemas de saúde mental foi de 65% pela versão de autoaplicação do SDQ para crianças e adolescentes (SDQ/CA) e de 54% pela versão respondida pelos responsáveis (SDQ/R). No G2 foi de 33% pelo SDQ/CA e de 37,9% pelo SDQ/R. A violência doméstica infanto-juvenil foi fator de risco para o desenvolvimento de transtornos mentais (SDQ/R). Os sujeitos com baixa resiliência (EI) apresentaram maior chance de problemas de saúde mental (SDQ/CA). Embora provenientes das mesmas regiões, os grupos apresentaram diferenças socioeconômicas, as quais não apresentaram relação com a resiliência. CONCLUSÕES: A qualidade e percepção do suporte social e de recursos presentes no ambiente familiar podem ter facilitado o desenvolvimento da resiliência nas crianças e adolescentes estudados. A violência pode ter aumentado a chance de problemas de saúde mental, sendo a violência doméstica um agravante. Há necessidade de pesquisas sobre os aspectos preditores de resiliência e de investimento em estratégias de intervenção para esta população, como forma de promover a saúde mental.

Dopamine D2 receptor gene polymorphisms and externalizing behaviors in children and adolescents.

BACKGROUND: Dopamine is involved in several cerebral physiological processes, and single nucleotide polymorphisms (SNP) in the dopamine D2 receptor gene (DRD2) have been associated with numerous neurological and mental disorders, including those involving alterations in cognitive and emotional processes. METHODS: The aim of this study was to evaluate the association between the SNPs c.957C > T (rs6277) and c.-585A > G (rs1799978) in the DRD2 gene and behavioral characteristics of children and adolescents based on an inventory of the Child Behavior Checklist (CBCL). Children and adolescents between 8 and 20 years old who were clinically followed-up were genotyped for the SNPs c.957C > T and c.-585A > G, and related to data of the CBCL/6-18 scale assessment performed with the help of caregivers. The chi-squared test was used to assess the differences in the frequencies of the C and T alleles in the polymorphism c.957C > T and of the A and G alleles in the polymorphism c.-585A > G with respect to the grouped CBCL scores at a significance level of 5%. Multiple logistic regression models were performed, to control whether sex and/or ethnicity could influence the results. RESULTS: Eighty-five patients were assessed overall, and the presence of the T allele (C/T and T/T) of DRD2 c.957C > T polymorphism was found to be significantly associated with the occurrence of defiant and oppositional problems and with attention and hyperactivity problems. There were no associations detected with polymorphism DRD2 c.-585A > G polymorphism. Both SNPs were in Hardy-Weinberg-equilibrium. CONCLUSIONS: Although the findings of this study are preliminary, due to its small number of participants, the presence of T allele (C/T, T/T) in c.957C > T SNP was associated with difficulty in impulse control, self-control of emotions, and conduct adjustment, which can contribute to improving the identification of mental and behavioral phenotypes associated with gene expression.

Corrigendum to "Pharmacogenetics of Risperidone and Cardiovascular Risk in Children and Adolescents".

[This corrects the article DOI: 10.1155/2016/5872423.].

Pharmacogenetics of Risperidone and Cardiovascular Risk in Children and Adolescents.

Objective. To identify the frequency of obesity and metabolic complications in child and adolescent users of risperidone. Potential associations with clinical parameters and SNPs of the HTR2C, DRD2, LEP, LEPR, MC4R, and CYP2D6 genes were analyzed. Methods. Samples from 120 risperidone users (8-20 years old) were collected and SNPs were analyzed, alongside assessment of chronological and bone ages, prescribed and weight-adjusted doses, use of other psychotropic drugs, waist circumference, BMI z-scores, blood pressure, HOMA-IR index, fasting levels of serum glucose, insulin, cholesterol, triglycerides, transaminases, and leptin. Results. Thirty-two (26.7%) patients were overweight and 5 (4.2%) obese. Hypertension was recorded in 8 patients (6.7%), metabolic syndrome in 6 (5%), and increased waist circumference in 20 (16.7%). The HOMA-IR was high for 22 patients (18.3%), while total cholesterol and triglycerides were high in 20 (16.7%) and 41 (34.2%) patients, respectively. SNP associations were found for LEP, HTR2C, and CYP2D6 with BMI; CYP2D6 with blood pressure, ALT, and HOMA-IR; HTR2C and LEPR with leptin levels; MC4R and DRD2 with HOMA-IR; HTR2C with WC; and LEP with ALT. Conclusions. Although not higher than in the general pediatric population, a high frequency of patients was overweight/obese, with abnormalities in metabolic parameters and some pharmacogenetic associations.

Hyperprolactinemia in Children and Adolescents with Use of Risperidone: Clinical and Molecular Genetics Aspects.

OBJECTIVE: In children and adolescents treated with risperidone, hyperprolactinemia is a frequent complication that may have clinical repercussions. Several genes have been associated with this occurrence. The aim of this study was to evaluate the frequency of hyperprolactinemia in children and adolescents treated with risperidone, and its associations with clinical and pharmacological data and certain polymorphisms of the following genes: Dopamine receptor D2 (DRD2), 5-hydroxytryptamine (serotonin) receptor 2C (HTR2C), cytochrome P450, family 2, subfamily D, polypeptide 6 (CYP2D6), leptin (LEP), leptin receptor (LEPR), melanocortin 4 receptor (MC4R), and scavenger receptor class B, member 2 (SCARB2). METHODS: The study included patients using risperidone (8-20 years old) and healthy subjects not exposed to the medication. Psychopathological symptoms, doses, and duration of treatment with risperidone, sex, skin color, body mass index (BMI), use of other psychotropic drugs, and polymorphisms of DRD2, HTR2C, CYP2D6, LEP, LEPR, MC4R, and SCARB2 genes were evaluated. RESULTS: There were 120 patients and 197 individuals not exposed to risperidone who were evaluated. Among patients, hyperprolactinemia was found in 79 (65.8%) cases, with no differences regarding sex, skin color, or being in monotherapy with risperidone (26.7% of total patients) or not. The level of prolactin was not correlated, either in case or control groups, with chronological age, bone age, prescribed dose of risperidone, weight-adjusted dose of risperidone, or BMI (p > 0.05), but was negatively correlated with the treatment duration (r = -0.352, p = 0.001 among cases; and r = -0.324, p = 0.039 among controls). There were significant differences in use of risperidone between patients and healthy subjects without the medication in the frequency of the polymorphisms of the DRD2, HTR2C, and LEP genes. Considering both sexes together and also specifically among females, the occurrence of hyperprolactinemia was higher in the presence of the C allele of the rs6318 single nucleotide polymorphisms (SNP) of the HTR2C gene. CONCLUSIONS: This group of children and adolescents with or without isolated use of risperidone presented with a high frequency of hyperprolactinemia, although asymptomatic, and associated, when considering only females or both sexes together, with being a carrier of the C allele of the rs6318 SNP of the HTR2C gene.

Violência doméstica e risco para problemas de saúde mental em crianças e adolescentes / Domestic violence and risk for mental health in childhood and adolescence

A literatura demonstra que sofrer violência doméstica na infância e juventude é um risco para o desenvolvimento das psicopatologias. Este estudo utilizou o Strenghts and Difficulties Questionnarie (SDQ) e encontrou prevalência de 65,5% de possibilidades de problemas de saúde mental em crianças e adolescentes (4-16 anos), vítimas de violência doméstica, acompanhados em Serviços de Referência, todos residentes em um município brasileiro. O resultado encontrado foi considerado elevado, se comparado à população geral. A violência doméstica foi observada como fator de risco para problemas de saúde mental nas crianças e adolescentes estudados, agravada pelo uso preocupante de bebida alcoólica pelo responsável, ou este estar fora do processo produtivo. Não foram encontrados fatores de proteção efetivos, principalmente em relação à rede de proteção. Esses resultados sinalizam a necessidade de implementação de mecanismos que avaliem a efetividade de programas específicos nas áreas de saúde mental e violência doméstica.

Literature shows that experiencing domestic violence in childhood and young adulthood is a risk for the development of psychopathology. This study used the Strengths and Difficulties Questionnaire (SDQ) and found a prevalence of 65.5% of possibility of mental health problems in children and adolescents (4-16 years old) who were victims of domestic violence followed in Referral Services in a Brazilian city. The result found was considered high when compared to the general population. Domestic violence was observed as a risk factor for mental health problems among the studied children and adolescents, aggravated by caregivers' alcoholism or unemployment. No effective protective factors were found, mainly regarding the protection network. These results indicate the need for reassessing the effectiveness of specific programs in the areas of mental health and domestic violence.

Charles Darwin: um observador do desenvolvimento humano / Charles Darwin: observer of human development / Charles Darwin: observateur du développement humain / Charles Darwin: observador del desarrollo humano

Os autores traduzem, pela primeira vez para o português, o artigo de Charles Darwin “A Biographical Sketch of an Infant”, publicado no periódico Mind em julho de 1877. Utilizando anotações de observações do desenvolvimento de seus filhos, especialmente de seu filho mais velho William Erasmus (Doddy), Darwin descreve e estuda, a partir de seu enfoque naturalista, o filhote humano, narrando os primeiros indicativos comportamentais de emoções tais como raiva e medo, curiosidade e senso moral, o brincar e o prazer envolvido nesta atividade, a capacidade de imitação e os primeiros indícios daquilo que hoje conhecemos como“teoria da mente”. Colocando-se questões sobre as capacidades do bebê,como eles aprendem e como se comunicam e levantando hipóteses sobre possíveis significados de certos comportamentos, questões ainda hoje fundamentais para o estudo do desenvolvimento humano, Darwin mostra--se também um pioneiro no estudo do bebê e da criança pequena, numa época na qual as capacidades dos bebês eram extremamente subestimadas e desconsideradas.

The authors provide the first translation into Portuguese of Charles Darwin’sarticle “A Biographical Sketch of an Infant,” published in the journal Mind in July of1877. Using notes from observations of the development of his children, especially hisoldest son William Erasmus (Doddy), Darwin uses his naturalistic approach to describeand study “human puppies,” providing the first behavioral indicators of emotions suchas anger and fear, curiosity and moral sense. He also notes the play and pleasureinvolved in these activities, along with the ability to imitate and the earliest indicatorsof what we refer to today as “theory of the mind.” Darwin raises questions about thecapabilities of babies, how they learn and how they communicate and generate hypotheses about possible meanings of certain behaviors. These issues are still criticalto the study of human development. This shows that he was also a pioneer in the studyof babies and young children at a time when the capacity of babies was underestimated and ignored.

Los autores traducen por primera vez para el portugués el artículo de CharlesDarwin “A Biographical Sketch of an Infant”, publicado en la revista Mind, en juliode 1877. Utilizando las notas de las observaciones del desarrollo de sus hijos,especialmente la de su hijo mayor, William Erasmus (Doddy), Darwin estudia y describe, desde su enfoque naturalista, el cachorro humano. Describe las primeras conductas indicadoras de emociones como ira y miedo, la curiosidad y el sentido moral, el juegoy el placer en participar en esa actividad, la capacidad de imitar y el comienzo de loque conocemos como “la teoría de la mente”. Planteándose cuestiones sobre lacapacidad del bebé, sobre como aprenden y sobre como se comunican y levantandohipótesis sobre los posibles significados de determinadas conductas; problemas quesiguen siendo críticos para el estudio del desarrollo humano, mostrando que Darwintambién fue un pionero en el estudio de los bebés y niño pequeño, en una época en quelas capacidades de los bebés eran extremamente desconsideradas.

Les auteurs ont effectués la traduction inédite en portugais de l’article de CharlesDarwin, “A Biographical Sketch of an Infant” publié dans la revue Mind en Juillet1877. En utilisant les notes d’observations sur le développement de ses enfants,notamment de son fils aîné, William Erasmus (Doddy), Darwin étudie et décrit l’enfanthumain de son point-de-vue naturaliste. Il décrit ainsi les premiers indicateurs du comportement sentimental, comme la colère et la peur, la curiosité et le sens moral, lejeu et le plaisir qu’implique cette activité, la capacité d’imiter et le début de ce que nousappelons aujourd'hui la “théorie de l’esprit”. Dans cet article, Darwin pose desquestions sur les capacités de l’enfant, leur façon d'apprendre et de communiquer. Ilcrée des hypothèses sur les possibles significations de certains comportements, questionsqui sont encore aujourd’hui critiques à l’étude du développement humain et quimontrent que Darwin fut également un pionnier des études sur les bébés et les petitsenfants à une époque où la capacité des bébés était gravement sous-estimée et négligée.

Charles Darwin: um observador do desenvolvimento humano / Charles Darwin: observer of human development

Os autores traduzem, pela primeira vez para o português, o artigode Charles Darwin “A Biographical Sketch of an Infant”, publicado noperiódico Mind em julho de 1877. Utilizando anotações de observaçõesdo desenvolvimento de seus filhos, especialmente de seu filho mais velhoWilliam Erasmus (Doddy), Darwin descreve e estuda, a partir de seuenfoque naturalista, o filhote humano, narrando os primeiros indicativoscomportamentais de emoções tais como raiva e medo, curiosidade e sensomoral, o brincar e o prazer envolvido nesta atividade, a capacidade deimitação e os primeiros indícios daquilo que hoje conhecemos como“teoria da mente”. Colocando-se questões sobre as capacidades do bebê,como eles aprendem e como se comunicam e levantando hipóteses sobrepossíveis significados de certos comportamentos, questões ainda hojefundamentais para o estudo do desenvolvimento humano, Darwin mostra--se também um pioneiro no estudo do bebê e da criança pequena, numaépoca na qual as capacidades dos bebês eram extremamentesubestimadas e desconsideradas.AU

The authors provide the first translation into Portuguese of Charles Darwin’sarticle “A Biographical Sketch of an Infant,” published in the journal Mind in July of1877. Using notes from observations of the development of his children, especially hisoldest son William Erasmus (Doddy), Darwin uses his naturalistic approach to describeand study “human puppies,” providing the first behavioral indicators of emotions suchas anger and fear, curiosity and moral sense. He also notes the play and pleasureinvolved in these activities, along with the ability to imitate and the earliest indicatorsof what we refer to today as “theory of the mind.” Darwin raises questions about thecapabilities of babies, how they learn and how they communicate and generatehypotheses about possible meanings of certain behaviors. These issues are still criticalto the study of human development. This shows that he was also a pioneer in the studyof babies and young children at a time when the capacity of babies was underestimatedand ignored.AU

Los autores traducen por primera vez para el portugués el artículo de CharlesDarwin “A Biographical Sketch of an Infant”, publicado en la revista Mind, en juliode 1877. Utilizando las notas de las observaciones del desarrollo de sus hijos,especialmente la de su hijo mayor, William Erasmus (Doddy), Darwin estudia y describe, desde su enfoque naturalista, el cachorro humano. Describe las primeras conductasindicadoras de emociones como ira y miedo, la curiosidad y el sentido moral, el juegoy el placer en participar en esa actividad, la capacidad de imitar y el comienzo de loque conocemos como “la teoría de la mente”. Planteándose cuestiones sobre lacapacidad del bebé, sobre como aprenden y sobre como se comunican y levantandohipótesis sobre los posibles significados de determinadas conductas; problemas quesiguen siendo críticos para el estudio del desarrollo humano, mostrando que Darwintambién fue un pionero en el estudio de los bebés y niño pequeño, en una época en quelas capacidades de los bebés eran extremamente desconsideradas.

Les auteurs ont effectués la traduction inédite en portugais de l’article de CharlesDarwin, “A Biographical Sketch of an Infant” publié dans la revue Mind en Juillet1877. En utilisant les notes d’observations sur le développement de ses enfants,notamment de son fils aîné, William Erasmus (Doddy), Darwin étudie et décrit l’enfanthumain de son point-de-vue naturaliste. Il décrit ainsi les premiers indicateurs ducomportement sentimental, comme la colère et la peur, la curiosité et le sens moral, lejeu et le plaisir qu’implique cette activité, la capacité d’imiter et le début de ce que nousappelons aujourd'hui la “théorie de l’esprit”. Dans cet article, Darwin pose desquestions sur les capacités de l’enfant, leur façon d'apprendre et de communiquer. Ilcrée des hypothèses sur les possibles significations de certains comportements, questionsqui sont encore aujourd’hui critiques à l’étude du développement humain et quimontrent que Darwin fut également un pionnier des études sur les bébés et les petitsenfants à une époque où la capacité des bébés était gravement sous-estimée et négligée.AU

Paradoxo, objeto transicional e fetiche / Paradoja, objeto transicional y fetiche / Paradox, transitional objects and fetish

Tomando como ponto de partida a afirmação de que “em nenhum campo cultural é possível ser original, exceto numa base de tradição” (“d. w. w. por d. w. w”, 1967), este artigo visa rastrear a produção de autores contemporâneos de Winnicott e reconhecer possíveis influências que teriam contribuído para a “invenção” dos conceitos de objeto transicionale espaço potencial. Busca-se também, desta forma, neste vértice, trazer subsídios para a discussão sobre a possibilidade de a clínica e a teoria desenvolvidas por Winnicott constituírem um novo paradigma dentro do campo psicanalítico.(AU)

Tomando como punto de partida la aserción de que “no existe campo cultural en lo cual sea posible ser original excepto en la base de la tradición” (“d. w. w. por d. w. w”, 1967), este artículo tiene por objetivo rastrear la producción de autores contemporáneos de Winnicott y así comparar posibles influencias para la “invención” de los conceptos de “objeto transicional” y “espacio potencial”. Buscamos así, de esta forma, desde este punto de vista, traer subsidios para la discusión sobre la posibilidad de la clínica y la teoría propuestas por Winnicott formar un nuevo paradigma dentro del campo psicoanalítico.(AU)

Considering Winnicott’s thinking “in any cultural field it is not possible to be original except on a basis of tradition” (“d. w. w. by d. w. w”), this paper aims to follow the tracks of Winnicott’s contemporary authors and to delineate possible influences that could have contributed to the “invention” of the concepts of “transicional objects” and “potential space”. We looking for in this way, under this vertice, to bring informations to the discussion about the possibilities of the clinics and theories developed by Winnicott to make an new paradigm in the psychoanalytic field.(AU)

Paradoxo, objeto transicional e fetiche / Paradoja, objeto transicional y fetiche / Paradox, transitional objects and fetish

Tomando como ponto de partida a afirmação de que “em nenhum campo cultural é possível ser original, exceto numa base de tradição” (“d. w. w. por d. w. w”, 1967), este artigo visa rastrear a produção de autores contemporâneos de Winnicott e reconhecer possíveis influências que teriam contribuído para a “invenção” dos conceitos de objeto transicionale espaço potencial. Busca-se também, desta forma, neste vértice, trazer subsídios para a discussão sobre a possibilidade de a clínica e a teoria desenvolvidas por Winnicott constituírem um novo paradigma dentro do campo psicanalítico.

Tomando como punto de partida la aserción de que “no existe campo cultural en lo cual sea posible ser original excepto en la base de la tradición” (“d. w. w. por d. w. w”, 1967), este artículo tiene por objetivo rastrear la producción de autores contemporáneos de Winnicott y así comparar posibles influencias para la “invención” de los conceptos de “objeto transicional” y “espacio potencial”. Buscamos así, de esta forma, desde este punto de vista, traer subsidios para la discusión sobre la posibilidad de la clínica y la teoría propuestas por Winnicott formar un nuevo paradigma dentro del campo psicoanalítico.

Considering Winnicott’s thinking “in any cultural field it is not possible to be original except on a basis of tradition” (“d. w. w. by d. w. w”), this paper aims to follow the tracks of Winnicott’s contemporary authors and to delineate possible influences that could have contributed to the “invention” of the concepts of “transicional objects” and “potential space”. We looking for in this way, under this vertice, to bring informations to the discussion about the possibilities of the clinics and theories developed by Winnicott to make an new paradigm in the psychoanalytic field.

O Clube da Luta: narcisismo, identificação e psicologia das massas

Discute-se inicialmente a diferença entre interpretação psicanalítica e exercício de psicanálise aplicada. Este texto é um exemplo de psicanálise aplicada, pois utilizamos o filme O Clube da Luta para ilustrar os conceitos freudianos de identificação e narcisismo e fenômenos de massa estudados durante um seminário no Instituto. O objetivo do exercício é reconhecê-los em sua forma viva e encarnada no “material clínico” do filme, e ao mesmo tempo usá-los na compreensão do filme. Na primeira parte, o filme narra a psicotização do personagem, enquanto a segunda mostra os caminhos de sua lenta recuperação, isto é, da possibilidade de efetuar a discriminação e o luto pela perda da fusão com o ego ideal(AU)

Freud: um psicanalista de adolescentes / Freud: a psycho-analyst of adolescents

Os autores procuram, através de três verbetes: a adolescência de Freud, as pacientes adolescentes que ele atendeu e seus conceitos sobre adolescência, demonstrar a significativa importância que este autor dava a esta etapa do desenvolvimento emocional (AU)