The burden of caregivers of schizophrenia outpatients during the COVID-19 pandemic: A same-sample comparison with the pre-pandemic burden.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has affected the vulnerable Brazilian population. In this study, we investigated the burden of COVID-19 on caregivers for patients with schizophrenia. OBJECTIVE: This study assessed objective and subjective burden of caregivers for patients with schizophrenia during the COVID-19 pandemic and compared the measurements obtained in the study to that before the pandemic. METHODS: The study included 50 caregivers who were assessed using the Sociodemographic Questionnaire, and the Family Burden Interview Schedule, Brazilian version (FBIS-BR). An adaptation of the Clinical Global Impression-Improvement (CGI-I) was made, in which caregivers evaluated their 'clinical' impression about the patient during the COVID-19 pandemic in comparison to pre-pandemic mental status. RESULTS: Most caregivers were female, aged between 24 and 80 years, who were in contact with the patient for about 88.56 hours/week. In relation to caregiver burden, there was a significant increase in the total subjective burden (p < .001), but not in the total objective burden. The following subjective domains of the burden showed a significant increase: assistance in daily life (p < .001) and worries about patients' present and future life (p = .033). There was a decrease in the objective burden related to supervision of patients' problematic behaviors (p = .031). Although the caregiver's income did not change significantly during the COVID-19 pandemic, there was an increase in the percentage of caregivers who perceived the frequency of financial burden imposed by the patient as 'very frequent' and 'always or almost always'; conversely there was a significant decrease in the subjective perception of the caregiver that the patient imposed financially 'no burden' or a 'seldom burden' (from 34% to 4%). CONCLUSION: Although the objective burden of the caregivers, during the pandemic, was similar the pre-pandemic levels, caregivers' subjective burden increased reinforcing the need for special attention to the caregiver in this global emergency.

Burden on caregivers of schizophrenia outpatients in Brazil: Relationship to symptomatology and functioning.

BACKGROUND: To investigate the objective and subjective burden on caregivers of schizophrenia outpatients and their associations with sociodemographic factors, symptomatology, and functioning. METHODS: This study included 60 schizophrenic outpatients aged 18 to 65 years who were clinically stable for at least 6 months, and 60 caregivers aged 18 to 80 years who were in contact with the patient for ⩾30 hours/week. The patients were assessed using a sociodemographic questionnaire, the Clinical Global Impression Scale for Schizophrenia (CGI-SCH), and the Personal and Social Performance scale (PSP). The caregivers were assessed using a sociodemographic questionnaire and the Family Burden Interview Schedule, Brazilian version (FBIS-BR). RESULTS: The objective burden was positively correlated with CGI-SCH cognitive symptom scores (p = .032) and number of hours spent weekly with the patient (p = .028), and negatively correlated with PSP score (r = -.346, p = .007). The subjective burden showed a negative correlation with age of disease onset (r = -.338, p = .08). The independent variables included in the regression model were family income (p = .005), PSP score (p = .009), patient marital status (p = .012), patient gender (p = .046), and reception of financial benefit (p = .027) for objective burden; and disease duration (p = .045) and father/mother or sibling relationship (p = .001) for subjective burden. The coefficient of determination (R2) of the linear regression model for objective burden was 39.4%; subjective burden, 21.6%. CONCLUSION: Caring for female, single patients with longer disease duration, more severe cognitive symptoms, impaired functioning, and more caregiving time required per week were associated with higher caregiver burden levels.

Cortical surface abnormalities are different depending on the stage of schizophrenia: A cross-sectional vertexwise mega-analysis of thickness, area and gyrification.

BACKGROUND: Brain magnetic resonance imaging studies have not investigated the cortical surface comprehensively in schizophrenia subjects by assessing thickness, surface area and gyrification separately during the first-episode of psychosis (FEP) or chronic schizophrenia (ChSch). METHODS: We investigated cortical surface abnormalities in 137 FEP patients and 240 ChSch subjects compared to 297 Healthy Controls (HC) contributed by five cohorts. Maps showing results of vertexwise between-group comparisons of cortical thickness, area, and gyrification were produced using T1-weighted datasets processed using FreeSurfer 5.3, followed by validated quality control protocols. RESULTS: FEP subjects showed large clusters of increased area and gyrification relative to HC in prefrontal and insuli cortices (Cohen's d: 0.049 to 0.28). These between-group differences occurred partially beyond the effect of sample. ChSch subjects displayed reduced cortical thickness relative to HC in smaller fronto-temporal foci (d: -0.73 to -0.35), but not beyond the effect of sample. Differences between FEP and HC subjects were associated with male gender, younger age, and earlier illness onset, while differences between ChSch and HC were associated with treatment-resistance and first-generation antipsychotic (FGA) intake independently of sample effect. CONCLUSIONS: Separate assessments of FEP and ChSch revealed abnormalities that differed in regional distribution, phenotypes affected and effect size. In FEP, associations of greater cortical area and gyrification abnormalities with earlier age of onset suggest an origin on anomalous neurodevelopment, while thickness reductions in ChSch are at least partially explained by treatment-resistance and FGA intake. Associations of between-group differences with clinical variables retained statistical significance beyond the effect of sample.

Fractionating Executive Functions of Adults With ADHD.

OBJECTIVE: To evaluate the performance of adults with ADHD considering the fractionation of executive functions into six different domains. METHOD: Participants were adult ADHD patients who were not under the acute effects of medication ( n = 48). Their performance was compared with that of a healthy control group ( n = 20) of comparable age, education, and nonverbal intelligence quotient. The cognitive domains assessed were executive shifting, updating, inhibition of prepotent responses, dual-task performance, planning, and access to long-term memory. We also assessed the symptoms of inattention, hyperactivity/impulsivity, anxiety, and depression by validated questionnaires. RESULTS: Compared with controls, patients reported more symptoms related to ADHD, anxiety and depression symptoms and were impaired in the shifting cost measure and phonemic fluency (measure of access to long-term memory). CONCLUSION: ADHD in adults selectively impaired executive shifting and access to long-term memory, domains that may alter performance in a wide range of daily tasks.

Ego Defense Mechanisms and Types of Object Relations in Adults With ADHD.

OBJECTIVE: This research evaluates the personality structure of adults with ADHD from a psychodynamic perspective. The hypothesis was that possible structural characteristics in personality could be correlated with this syndrome. METHOD: Assessment tools for ego functions (Bell Object Relations and Reality Testing Inventory [BORRTI-Form O], Defense Style Questionnaire ( DSQ-40)) were applied to a sample of 90 adults with ADHD, recruited in a specialized clinic. RESULTS: Among the ADHD sample, 84.4% of the participants were identified as having object relations pathologies. Pathological elevations were observed mainly in the Alienation, Egocentricity, and Insecure Attachment subscales. Statistically, significant differences were found especially in the use of immature and neurotic defense mechanisms, compared with normative data. CONCLUSION: The findings indicate that adults with ADHD make more use of immature and neurotic defense mechanisms, and presented pathological internalized object relations that are typical of an archaic and poorly structured egoic structure.

The physician's quality of life: Relationship with ego defense mechanisms and object relations.

OBJECTIVE: To assess whether ego defense mechanisms and object relations (the way an individual subjectively experiences his/her relationships with others) are related to quality of life among physicians. METHODS: In this cross-sectional mail survey, 602 physicians from Botucatu, SP, Brazil, were sent a socio-demographic questionnaire, the Bell Object Relations and Reality Testing Inventory-Form O (BORRTI-O), the Defense Style Questionnaire-40 (DSQ-40), and the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF). RESULTS: 198 questionnaires (33%) with valid responses were obtained. High BORRTI-O scores (indicative of pathology) on the alienation, egocentricity and insecure attachment subscales were associated with reduced WHOQOL-BREF scores for the psychological health and social relationship domains. Immature ego defense mechanisms were associated with lower WHOQOL-BREF scores for all domains. No significant associations of WHOQOL-BREF scores with working hours, workplace or monthly income were observed in the study population CONCLUSIONS: WHOQOL-BREF scores correlated with mature defense mechanisms and normal object relations, suggesting an association between psychological maturity and quality of life among physicians.

Mindfulness Meditation Improves Mood, Quality of Life, and Attention in Adults with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention. Mood in ADHD can be improved by mindful awareness practices (MAP), but results are mixed regarding the enhancement of attentional performance. Here we evaluated MAP-induced changes in quality of life (QoL), mood, and attention in adult ADHD patients and controls using more measures of attention than prior studies. METHODS: Twenty-one ADHD patients and 8 healthy controls underwent 8 weekly MAP sessions; 22 similar patients and 9 controls did not undergo the intervention. Mood and QoL were assessed using validated questionnaires, and attention was evaluated using the Attentional Network Test (ANT) and the Conners Continuous Performance Test (CPT II), before and after intervention. RESULTS: MAP enhanced sustained attention (ANT) and detectability (CPT II) and improved mood and QoL of patients and controls. CONCLUSION: MAP is a complementary intervention that improves affect and attention of adults with ADHD and controls.

Neurofibromatosis type 1 and attention deficit hyperactivity disorder: a case study and literature review.

BACKGROUND: The cognitive profile of children with neurofibromatosis type 1 (NF1) and attention deficit hyperactivity disorder (ADHD) has been well characterized, but few studies have evaluated the cognitive abilities of adults with NF1 and ADHD. OBJECTIVES: We investigated 1) the cognitive profile of an adult patient with NF1 and inattention problems, 2) changes in his cognition after 14 months of follow-up, and 3) whether the patient exhibited comorbid NF1 and ADHD or secondary ADHD-like symptoms. METHODS: We administered neuropsychological tests of executive function, attention, verbal and visual memory, visuospatial function, and language during two evaluations separated by 14 months. RESULTS: We found no changes in sustained attention, language, or verbal memory. Visual memory, verbal learning, selective attention inhibitory control, and problem solving declined over time, whereas visual search, psychomotor speed, visuospatial function, and mental flexibility improved. CONCLUSION: Our patient exhibited a cognitive profile characteristic of both NF1 and ADHD, leading to the hypothesis that the patient had comorbid ADHD instead of secondary ADHD-like symptoms. More studies are necessary to characterize the cognition of patients with NF1 and ADHD.

Weight gain, metabolic disturbances, and physical health care in a Brazilian sample of outpatients with schizophrenia.

BACKGROUND: In the last few decades, a large number of studies have produced compelling evidence that patients with schizophrenia are at increased risk for developing several medical conditions and diseases, including obesity, metabolic disturbances, and cardiovascular diseases. Several protocols have been designed with the aim of reducing such risk. OBJECTIVE: To investigate current physical health status in a population of outpatients with schizophrenia. METHODS: A cross-sectional study was conducted in our outpatient clinic, selecting subjects who met DSM-IV diagnosis criteria for schizophrenia. Data were collected regarding clinical characteristics, lifestyle, medication in use, and biometric and laboratory parameters. RESULTS: A total of 261 patients were included. We found a high prevalence of elevated body mass index (BMI . 25) (70%), dyslipidemia (73.2%), and metabolic syndrome (28.7%). Patients' ages were associated with worsened lipid profiles, but other variables, such as disorder duration or type of antipsychotic in use, were not associated with any metabolic disturbance. Despite the increased prevalence of these conditions, only a small portion of the sample was under regular medical treatment. CONCLUSION: Outpatients with schizophrenia show signs of poor physical health conditions. These findings reinforce the need for an intensive and appropriate approach to assure that these patients receive adequate clinical referral and treatment.

A multicenter, open-label trial to evaluate the quality of life in adults with ADHD treated with long-acting methylphenidate (OROS MPH): Concerta Quality of Life (CONQoL) study.

UNLABELLED: The available literature provides few studies on the effectiveness of methylphenidate in improving quality of life in individuals with ADHD. OBJECTIVE: To assess the effectiveness of methylphenidate OROS formulation (OROS MPH) through QoL in adults with ADHD. METHOD: A 12-week, multicenter, open-label trial involving 60 patients was used. The measures used were Adult Self-Rating Scale, Adult ADHD Quality of Life Scale (AAQoL), State and Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression (CGI), and safety measures. A significance statistic level of 5% was adopted. RESULTS: Analyses included 60 patients (66.7% male; M age = 31.1 years) for safety and 58 patients for effectiveness. All AAQoL subscales improved from baseline to Week 12 (p < .0001), as well as the Total AAQoL (p < .0001). A significant reduction on Clinical Global Impression-Improvement (CGI-I), HAM-D, STAI, and ASRS scores was observed (p < .0001). No serious adverse event was reported. CONCLUSION: Treatment of adult ADHD patients with OROS MPH improves QoL.

Long-acting injectable risperidone in partially adherent and nonadherent patients with schizophrenia.

BACKGROUND: Long-acting injectable antipsychotics may improve medication adherence, thereby improving overall treatment effectiveness. This study aimed to evaluate the effectiveness, safety, and tolerability of risperidone long-acting injection in schizophrenic patients switched from oral antipsychotic medication. METHODS: In a 12-month, multicenter, open-label, noncomparative study, symptomatically stable patients on oral antipsychotic medication with poor treatment adherence during the previous 12 months received intramuscular injections of risperidone long-acting injection (25 mg starting dose) every 2 weeks. The primary endpoint was the change in Positive and Negative Syndrome Scale (PANSS) total score. RESULTS: Of the 60 patients who were screened, 53 received at least one injection (safety population), and 51 provided at least one postbaseline assessment. Mean PANSS total scores improved significantly throughout the study and at endpoint. Significant improvements were also observed in Clinical Global Impression of Severity, Personal and Social Performance, and Drug Attitude Inventory scales. Risperidone long-acting injection was safe and well-tolerated. Severity of movement disorders on the Extrapyramidal Symptom Rating Scale was reduced significantly. The most frequently reported adverse events were insomnia (22.6%), increased prolactin (17.0%), and weight gain (13.2%). CONCLUSION: Risperidone long-acting injection was associated with significant symptomatic improvements in stable patients with schizophrenia following a switch from previous antipsychotic medications.

Aripiprazole for patients with schizophrenia and schizoaffective disorder: an open-label, randomized, study versus haloperidol.

INTRODUCTION: Aripiprazole, a dopamine D2 receptor partial agonist, has also partial agonist activity at serotonin (5-HT)1A receptors and antagonist activity at 5-HT2A receptors. METHODS: In this 8-week, multicenter, randomized, parallel-group, open-label, flexible-dose study, patients diagnosed with schizophrenia or schizoaffective disorder were randomized to aripiprazole 15-30 mg/day or haloperidol 10-15 mg/day. RESULTS: Patients treated with both aripiprazole and haloperidol improved from baseline in Positive and Negative Syndrome Scale total, positive, and negative scores as well as in Clinical Global Impressions scores (all P<.001). At the end of the study, the percentage of patients classified as responders--according to >or=40% reduction in the Positive and Negative Syndrome Scale negative subscale score--was significantly higher in the aripiprazole group (20%) than in the haloperidol group (0%) (P<.05). Additionally, a higher number of patients receiving haloperidol required more anticholinergic medications (P<.001) than aripiprazole-treated patients, whereas more aripiprazole (45.5%) than haloperidol-treated patients (12.9%) required benzodiazepines (P=.002). At endpoint, rates of preference of medication were higher in the aripiprazole group (63.2%) than in the haloperidol group (21.7%), as expressed by patients and caregivers (P=.001). CONCLUSION: Aripiprazole and haloperidol had similar efficacy in terms of reduction of overall psychopathology. Although aripiprazole has been demonstrated to be superior concerning negative symptoms and in terms of tolerability (extrapyramidal symptoms) and preferred by patients and caregivers than haloperidol, significantly more aripiprazole-treated patients required benzodiazepines.

Detecção precoce: é possível prevenir a esquizofrenia? / Early detection: is it possible to prevent schizophrenia?

CONTEXTO:A detecção e a intervenção precoces na esquizofrenia são uma área nova de pesquisa em grande expansão. OBJETIVO: Revisar a literatura atual sobre a detecção e intervenção precoces em esquizofrenia. MÉTODO: A literatura foi pesquisada por meio do PubMed, manuais e referências bibliográficas utilizando termos como: "alto risco", "intervenção precoce", "detecção precoce", "esquizofrenia", "psicose precoce". RESULTADOS: Utilizando os paradigmas de prevenção seletiva e de prevenção indicada de outras áreas da Medicina, a detecção e a intervenção precoces na esquizofrenia procuram estudar as manifestações iniciais da esquizofrenia, antes que o quadro psicótico tenha se manifestado claramente. CONCLUSÃO: A detecção e a intervenção precoces de pessoas com risco de desenvolver psicose visam reduzir o tempo de psicose não-tratada, melhorar a evolução e o prognóstico da esquizofrenia e talvez evitar que a pessoa chegue a desenvolver a doença.

BACKGROUND: The early detection and intervention in schizophrenia are new areas of research in great expansion. OBJECTIVE: To review the literature about early detection and intervention in schizophrenia. METHOD: Literature was studied by means of PubMed, manuals and bibliographic references and used the search terms: "high risk", "early intervention", "early detection", "schizophrenia", "early psychosis". RESULTS: Using paradigms of selective and indicated prevention of other fields of Medicine, it studies the initial manifestations of schizophrenia, even before clear psychotic symptoms are manifest. CONCLUSION: Early detection and intervention of individuals at risk to develop psychosis aim to reduce the duration of untreated psychosis, to improve the course and outcome of the disease, and maybe prevent the manifestation of schizophrenia in predisposed individuals.

Alterações cognitivas na esquizofrenia: conseqüências funcionais e abordagens terapêuticas / Cognitive deficits in schizophrenia: functional consequences and therapeutic approaches

CONTEXTO: Muitos pacientes com esquizofrenia apresentam prejuízos cognitivos significativos, especialmente em relação à memória, à atenção e ao funcionamento executivo. Esses prejuízos inevitavelmente têm um importante impacto sobre a conseqüência funcional da doença. OBJETIVO: Este artigo tem como foco os aspectos do funcionamento cognitivo na esquizofrenia, sua relação com as conseqüências funcionais e o efeito das medicações antipsicóticas sobre a cognição. MÉTODO: pesquisa de base de dados Medline/PubMed e Lilacs utilizando os termos esquizofrenia, cognição, neuropsicologia, desfecho, funcionamento, tratamento. RESULTADOS: Apesar de um grande número de pesquisas descrever alterações cognitivas na esquizofrenia, ainda não há uma concordância em relação ao padrão desses déficits. Contudo, alterações cognitivas têm apresentado correlação significante com o nível de prejuízo funcional. Os antipsicóticos de segunda geração parecem ter um impacto positivo na cognição, entretanto, o significado dessa melhora cognitiva no desempenho funcional e social dos pacientes ainda não é claro. Os resultados na área de reabilitação neuropsicológica, apesar de discretos, mostram-se promissores. CONCLUSÃO: A habilidade dos antipsicóticos de segunda geração de melhorar domínios específicos da cognição varia com o padrão de alterações apresentado por esses pacientes. Assim, estratégias para melhorar a cognição de pacientes com esquizofrenia incluem o uso dos antipsicóticos de segunda geração em associação com as abordagens de reabilitação neuropsicológica.

BACKGROUND: Many patients with schizophrenia have severe impairments in cognitive functions, especially in memory, attention and executive functions. These impairments inevitably have an important impact on the functional outcome of the disorder. OBJECTIVE: This article focuses on aspects of cognitive function in schizophrenia, their relationship to functional outcome and the effect of antipsychotics on cognition. METHOD: Research on databases such as Medline/PubMed and Lilacs using the terms schizophrenia, cognition, neuropsychology, outcome, functioning, treatment. RESULTS: Even though a great number of studies report cognitive impairments in schizophrenia, there is no agreement in relation to the pattern of these deficits. Nevertheless, cognitive impairments have a significant correlation with functional handicaps. Second generation antipsychotics seem to have a positive impact in cognition, although the meaning of this improvement on social and functional performance of the patients is not clear. Neuropsychological rehabilitation shows discrete, though promising, results. CONCLUSION: The ability of second generation antipsychotics to improve specific domains of cognition vary as does the pattern of deficits of the patients. Thus, strategies to improve cognition in schizophrenia include the use of second generation antipsychotics associated with neuropsychological rehabilitation.

Novos antipsicóticos para o tratamento da esquizofrenia / New antipsychotics for the treatment of schizophrenia

CONTEXTO: Os antipsicóticos de segunda geração representam o grande avanço na terapêutica da esquizofrenia das últimas décadas, porém nos últimos anos foram sintetizados novos antipsicóticos que estão abrindo maiores perspectivas no campo do tratamento da esquizofrenia. Alguns desses medicamentos já foram lançados, enquanto outros estão em fase de testes. OBJETIVO: Apresentar uma síntese do conhecimento dos novos antipsicóticos de segunda geração. MÉTODOS: Busca por meio do PubMed e literatura específica fornecida pelos fabricantes dos medicamentos. RESULTADOS E CONCLUSÕES: São apresentadas as principais características farmacológicas, de eficácia, segurança e tolerabilidade dos seguintes antipsicóticos: Asenapina, ACP-103, Bifeprunox, Paliperidona, Risperidona de Ação Prolongada e Sertindol.

BACKGROUND: The second generation antipsychotics represent the great achievement in the treatment of schizophrenia of the last decades. However in the last years some new antipsychotics were synthesized and such new compounds may represent great perspectives for the field of the treatment of schizophrenia. Some of these compounds are in use while others are still on evaluation through clinical trials. OBJECTIVE: Summarize the current knowledge of new antipsychotics. METHODS: PubMed search as well literature provided by the manufactures. RESULTS AND CONCLUSIONS: We present the main pharmacological characteristics as well as profiles of efficacy, security and tolerability of the following compounds: Asenapine, ACP-103, Bifeprunox, Paliperidone, Long Acting Injectable Risperidone and Sertindole.

Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity.

OBJECTIVES: The objectives of this study were to describe the prevalence of neuropsychiatric symptoms of dementia in Alzheimer disease (AD) and cognitively impaired nondemented (CIND) subjects from a community-based Brazilian sample and to correlate these symptoms with severity of cognitive deficits. METHOD: A total of 1,563 randomly selected subjects were evaluated with the following screening tests: Mini-Mental Status Examination, Fuld Object Memory Evaluation, Informant Questionnaire on Cognitive Decline in the Elderly, and Activities of Daily Living-International Scale. Screen positives were submitted to a workup for dementia, physical and neurologic examination, cranial computed tomography or cerebral magnetic resonance imaging, the Cambridge Examination for Mental Disorders, Clinical Dementia Rating Scale (CDR), and the Neuropsychiatric Inventory (NPI). Diagnosis was made according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: Sixty patients with AD, 25 CIND, and 78 healthy elderly subjects were evaluated. Informants reported that 78.33% of patients with AD had one or more neuropsychiatric symptoms. Apathy (53.33%), depression (38.33%), sleep alterations (38.33%), and anxiety (25%) were the most prevalent disturbances in AD subjects. These disturbances were more prevalent in patients with AD than in the comparison group and CIND individuals. In the CIND group, the most frequent neuropsychiatric symptoms were anxiety and sleep alterations (both with 24%) followed by depression (16%). Total NPI scores were significantly different between AD and CIND groups, AD and comparison groups, and CIND and the comparison group. Apathy was the only neuropsychiatric symptom that was significantly different between the groups divided according to the CDR being more frequent in subjects with moderate to severe dementia. CONCLUSIONS: Neuropsychiatric symptoms seem to be as common in patients living in a developing country as they are in demented patients from the developed world. Indeed, the fact that some of our results are similar to other population-based studies may suggest that cultural factors play a minor role in the emergence of these symptoms, at least in a Latin American country like Brazil.

Maintenance treatment of severe tardive dyskinesia with clozapine: 5 years' follow-up.

\Drug-induced tardive dyskinesia (TD) affects approximately 20% to 30% of schizophrenic patients. Although it is usually mild, from 1% to 8% of patients may develop severe TD. Second-generation antipsychotics have demonstrated a lower risk of inducing TD. However, despite the advances brought by second-generation antipsychotics, the treatment strategies for TD remain problematic, given both the lack of an established therapeutic choice and the need for long-term use of antipsychotics in the treatment of schizophrenia. Clozapine is an atypical antipsychotic with minimal risk of inducing TD. Furthermore, it has been suggested that clozapine might actually improve the symptoms of TD. Accordingly, we evaluated the effects of clozapine on severe TD over 5 years. Seven patients meeting Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for chronic exacerbated schizophrenia (mean age 28.5 +/- 10.2 years) and presenting severe TD, defined as Abnormal Involuntary Movements Scale score above 13, were treated with clozapine and followed up for 5 years. Extrapyramidal Symptoms Rating Scale assessment was performed in all patients at baseline, after 6 months and 3 and 5 years. Mean Extrapyramidal Symptoms Rating Scale scores decreased 83% after 3 years and 87.5% after 5 years. Mean dose for all patients was 428 +/- 269 mg/d after 5 years. Results from this open-label study suggest that clozapine may be a further option for the treatment of TD over long term.

Dissociaçäo e transtornos dissociativos: modelos teóricos / Dissociation and dissociative disorders: Theoretical models

A compreensäo da experiência dissociativa e das origens dos transtornos dissociativos é difícil devido à complexidade da questäo. As contradições da classificaçäo säo decorrentes das dificuldades de se construir uma teoria da mente abrangente que unifique neurobiologia e psicodinâmica. Os autores discutem as bases conceituais da dissociaçäo com ênfase na integraçäo entre neurobiologia e fenomenologia. O papel do aprendizado é amplamente discutido, assim como as teorias atuais de neodissociaçäo, trauma e sociocognitivismo para os transtornos dissociativos