ABSTRACT
Estudos sobre pacientes com lesões cerebrais têm oferecido subsídios para se compreender a fisiopatologia de distúrbios mentais e de personalidade. Antônio Damásio, em O erro de Descartes, discute a importância de se superar a dicotomia mente-corpo / razão e emoção, focalizando seus estudos na compreensão dos complexos processos funcionais envolvidos nas tomadas de decisão do quotidiano. Toma como paradigma o caso de Phineas Gage, que sofreu lesão cerebral que não atingiu a linguagem, motricidade ou inteligência, mas levou a perturbações profundas em seu comportamento nos processos de decisões e adaptação social. Nosso objetivo é apresentar o caso de um paciente com diagnóstico de encefalite e lesão ventro-mesial, analisando-o do ponto de vista neuropsicológico e de personalidade. Instrumentos: provas envolvendo funções corticais superiores; entrevistas com paciente e esposa. Conclusão: relativa preservação de funções cognitivas e, em contraste, alterações importantes em comportamento no ambiente doméstico, profissional e social. A presença de mudanças de personalidade conseqüentes a lesões ventro-mesiais nos oferece elementos importantes para se compreender melhor a necessidade de uma consonância razão-emoção nos processos de tomada de decisão baseados em metas e valores a longo prazo.AU
Patients with brain lesion have been offering subsidies for us to understand the physiopathology of mental and personality disorders. Antonio Damásio, in Descartes error, discusses the importance of overcoming the dichotomy between body and mind/emotion and reason, focusing his studies on the understanding of the complex functional processes involved in daily decision making processes. He bases himself on the case of Phineas Gage, who suffered a brain lesion which did not affect language, motor functions or intelligence, but led to deep behavior disorders regarding decision making processes and social adaptation. Our aim is to present the case of a patient with a diagnostic of encephalitis and ventral-mesial lesion, analyzing it according to the concepts of neuropsychology and personality. Instruments: tests involving higher cortical functions and interviews. Conclusion: There is preservation of the cognitive functions and, in contrast, an important alteration in the domestic, professional and social behavior. Personality changes related to ventral-mesial lesions offer important elements for a better understanding of the need for consonance between reason and emotion in daily decision making processes based on long-term goals values.AU
Subject(s)
Humans , Encephalitis , AIDS Dementia Complex , BehaviorABSTRACT
Background: Untreated GH-deficient adults have a diversity of dysfunctions (e.g. reduced muscle strength, emotional instability during strress, depressive symptons) that may cause deletrious effects on quality of life, and may be positively influenced by recombinant human growth hormone (rh-GH) therapy. Aim: To evaluate the impact of a clinical intervention with rh-GH therapy on GH-deficient adults. Method: The physical, psychiatric and neuropsychological status of 9 GH-deficient adults was determined before and after the administration of rh-GH (0.250 IU/Kg/week) in a double blind placebo-controlled trial for six months. Patients then received rh-GH for a further period of 6 months and their status was re-evaluated. Results: Rh-GH was significant better than placebo at 6th month (p<0.05), producing increased serum Insulin like growth factor-I (IGF-1) levels, reduced body mas index (BMI) and body fat, increased lean body mass and water, reduced wains/hip ratio and increased energy expenditure. The rh-GH therapy was also significantly better than placebo on depressive features as measured by the Hamilton Depression Scale (17-itens) (p=0.0431) and the Beck Depression Inventory (p=0.0431). Neuropsychological evaluations showed significant improvements in measures of Attention: Digit Backward (p=0.035), Verbal Flency (FAS) (p=0.02) and Cognitive Efficiency (WAIS-R tests): Vocabulary (p=0.027), Picture Arrangements (p=0.017), and Comprehension (p=0.01) following rh-GH therapy. Conclusion: The clinical, psychiatric, and neuropsychological impairements of untreated GH-deficient adults can be decresed by rh-GH therapy.