Polycystic Ovary Syndrome and Psychotic Disorder.

Polycystic ovary syndrome (PCOS), a disease that usually emerges during adolescence, is characterized by hormonal imbalance and ovarian dysfunction. The prevalence can vary between 5.6 to 21.3% in women and 6% in adolescent girls. This discrepancy is related to the population studied and the diagnostic criteria used. The underlying pathophysiology of PCOS is not fully understood, but it can lead to a number of co-morbidities, including hypertension, diabetes, dyslipidemia, and also, mental health disorders. Clinical and preclinical data indicate neuroendocrine involvement with dysfunction in gamma-Aminobutyric acid (GABA) signaling and neuronal androgen receptors that might reduce hypothalamic sensitivity and lead to an impairment of estradiol and progesterone feedback. Based on these assumptions, the aims of this paper are to review the association of PCOS and psychotic disorders in order to address the burden of women comorbid for both conditions.

First manic episode in a patient with breast cancer.

Mental disorders occur in as much as 50% of patients with cancer, impairing the oncologic prognosis and quality of life. The diagnostic investigation and treatment planning of this comorbidity impose a clinical challenge once complications related to the neoplasm, such as brain metastasis and paraneoplastic syndromes, must be excluded. In addition, psychotropic medications may interfere with oncologic treatment. We report the case of a 39-year-old female patient who presented with a first episode of psychotic mania after having been recently diagnosed with breast cancer. Also, we present a literature review of this comorbidity and point out a possible pathophysiological link between the two diseases.

Estudo parcial da validação do Atlas do Rorschach Sistema Compreensivo em amostra de pacientes psiquiátricos de São Paulo / Partial validation study of the Rorschach Comprehensive System atlas on a sample of psychiatric patients of São Paulo / Estudio parcial de la validación del Atlas del Rorschach Sistema Comprensivo en muestra de pacientes psiquiátricos de São Paulo

Este trabalho é parte do estudo de validação do atlas de localização e da lista de qualidade formal brasileiros do Rorschach Sistema Compreensivo em amostra de pacientes psiquiátricos da cidade de São Paulo, comparando as variáveis X+%, XA%, WDA%, X-% e Xu% dos pacientes com os valores encontrados na amostra normativa brasileira. Foram avaliados 45 pacientes, e os instrumentos de seleção foram a entrevista clínica estruturada para diagnóstico do DSM-IV (SCID-I) e a Escala das Síndromes Positiva e Negativa (PANSS). 23 pacientes preencheram critério pela SCID-I para transtornos psicóticos e, destes, 19 foram considerados psicóticos pela PANSS. Todos os protocolos foram classificados segundo as classificações norte-americanas e brasileiras. Foi realizada ANOVA, comparando amostras normativas e o grupo de pacientes. As variáveis XA% e X-% mostraram-se sensíveis para detectar as nuances perceptivas entre as pessoas. As áreas de localização e lista de qualidade formal brasileiras se mostraram válidas para discriminar graus de comprometimento perceptivo.

This is part of a validation study of the Brazilian Rorschach Comprehensive System location manual and form quality list, by testing it on a sample of psychiatric patients. The variables X+%, XA%, WDA%, X-% and Xu% of the patients is compared to those encountered in the Brazilian normative sample. The evaluation was conducted with 45 patients. The selection instruments were Structured Clinical Interview for Diagnostic (SCID-I) and The Positive and Negative Syndrome Scale (PANSS). 23 patients met the SCID-I criteria for psychotic disorder, and 19 of them were considered psychotic by PANSS. The protocols were classified according to both the North American and Brazilian lists. ANOVA were made comparing normative samples and the group of patients. The variables XA% and X-% proved to be sensitive in detecting the perceptive nuances among the people involved. The Brazilian lists proved to be valid for distinguishing degrees of impaired perception.

Este trabajo es parte del estudio de validación del atlas de localización y de la lista de calidad formal brasileña del Rorschach Sistema Comprensivo en muestra de pacientes psiquiátricos de la ciudad de São Paulo-Brasil, comparando las variables X+%, XA%, WDA%, X-% y Xu% de los pacientes con los valores encontrados en la muestra normativa brasileña. Fueron evaluados 45 pacientes, los instrumentos de selección fueron la Entrevista clínica estructurada para diagnóstico del DSM-IV (SCID-I) y la Escala de las Síndromes Positiva y Negativa (PANSS). 23 pacientes lograron criterio por la SCID-I para trastornos psicóticos y de estos 19 fueron considerados psicóticos por la PANSS. Todos los protocolos fueron clasificados según las clasificaciones norteamericanas y brasileñas. Fue realizada ANOVA, comparando muestras normativas y el grupo de pacientes. Las variables XA% y X-% se mostraron sensibles para detectar los matices perceptivos entre las personas. Las áreas de localización y lista de calidad formal brasileñas se mostraron válidas para discriminar grados de comprometimiento perceptivo.

Estudo parcial da validação do Atlas do Rorschach Sistema Compreensivo em amostra de pacientes psiquiátricos de São Paulo / Partial validation study of the Rorschach Comprehensive System atlas on a sample of psychiatric patients of São Paulo / Estudio parcial de la validación del Atlas del Rorschach Sistema Comprensivo en muestra de pacientes psiquiátricos de São Paulo

Este trabalho é parte do estudo de validação do atlas de localização e da lista de qualidade formal brasileiros do Rorschach Sistema Compreensivo em amostra de pacientes psiquiátricos da cidade de São Paulo, comparando as variáveis X+%, XA%, WDA%, X-% e Xu% dos pacientes com os valores encontrados na amostra normativa brasileira. Foram avaliados 45 pacientes, e os instrumentos de seleção foram a entrevista clínica estruturada para diagnóstico do DSM-IV (SCID-I) e a Escala das Síndromes Positiva e Negativa (PANSS). 23 pacientes preencheram critério pela SCID-I para transtornos psicóticos e, destes, 19 foram considerados psicóticos pela PANSS. Todos os protocolos foram classificados segundo as classificações norte-americanas e brasileiras. Foi realizada ANOVA, comparando amostras normativas e o grupo de pacientes. As variáveis XA% e X-% mostraram-se sensíveis para detectar as nuances perceptivas entre as pessoas. As áreas de localização e lista de qualidade formal brasileiras se mostraram válidas para discriminar graus de comprometimento perceptivo.(AU)

This is part of a validation study of the Brazilian Rorschach Comprehensive System location manual and form quality list, by testing it on a sample of psychiatric patients. The variables X+%, XA%, WDA%, X-% and Xu% of the patients is compared to those encountered in the Brazilian normative sample. The evaluation was conducted with 45 patients. The selection instruments were Structured Clinical Interview for Diagnostic (SCID-I) and The Positive and Negative Syndrome Scale (PANSS). 23 patients met the SCID-I criteria for psychotic disorder, and 19 of them were considered psychotic by PANSS. The protocols were classified according to both the North American and Brazilian lists. ANOVA were made comparing normative samples and the group of patients. The variables XA% and X-% proved to be sensitive in detecting the perceptive nuances among the people involved. The Brazilian lists proved to be valid for distinguishing degrees of impaired perception.(AU)

Este trabajo es parte del estudio de validación del atlas de localización y de la lista de calidad formal brasileña del Rorschach Sistema Comprensivo en muestra de pacientes psiquiátricos de la ciudad de São Paulo-Brasil, comparando las variables X+%, XA%, WDA%, X-% y Xu% de los pacientes con los valores encontrados en la muestra normativa brasileña. Fueron evaluados 45 pacientes, los instrumentos de selección fueron la Entrevista clínica estructurada para diagnóstico del DSM-IV (SCID-I) y la Escala de las Síndromes Positiva y Negativa (PANSS). 23 pacientes lograron criterio por la SCID-I para trastornos psicóticos y de estos 19 fueron considerados psicóticos por la PANSS. Todos los protocolos fueron clasificados según las clasificaciones norteamericanas y brasileñas. Fue realizada ANOVA, comparando muestras normativas y el grupo de pacientes. Las variables XA% y X-% se mostraron sensibles para detectar los matices perceptivos entre las personas. Las áreas de localización y lista de calidad formal brasileñas se mostraron válidas para discriminar grados de comprometimiento perceptivo.(AU)

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study.

OBJECTIVES: To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES). METHOD: From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral. RESULTS 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at follow-up (OR 2.88; IC 95% 1.33-6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036-1.61; p = 0.475). CONCLUSIONS: Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months.

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study / Adesão ao tratamento farmacológico e ao encaminhamento ambulatorial em um serviço psiquiátrico de emergência: um estudo de seguimento

OBJECTIVES: To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES). METHOD: From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral. RESULTS 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at follow-up (OR 2.88; IC 95% 1.33-6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036-1.61; p = 0.475). CONCLUSIONS: Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months.

OBJETIVOS: Avaliar a adesão ao tratamento farmacológico prescrito e ao encaminhamento em pacientes atendidos em um Serviço de Emergências Psiquiátricas (SEP). MÉTODO: Foram coletados dados demográficos e clínicos de 330 pacientes atendidos em um SEP durante um ano. Sessenta dias após o atendimento, a adesão ao tratamento farmacológico e a continuidade do tratamento em caráter ambulatorial foram avaliadas através de contato telefônico. RESULTADOS: 227 pacientes (68,8%) receberam prescrição de medicações psicotrópicas. Todos os pacientes foram encaminhados para serviços psiquiátricos ambulatoriais. Cento e setenta e cinco pacientes concordaram em receber o contato telefônico. Desses pacientes, 97 (63,4%) estavam usando a medicação prescrita e 83 (54,2%) haviam marcado consulta após 60 dias. Os pacientes que receberam uma prescrição tiveram maior chance de estar em uso de medicações psicotrópicas no contato do seguimento (RC 2,88; IC 95% 1,33-6,22; p = 0,007). Entretanto, a prescrição não foi associada ao agendamento de consulta ambulatorial (RC 0,76; IC 95% 0,036-1,61; p = 0,475). CONCLUSÕES: Medicações psicotrópicas são prescritas rotineiramente para pacientes atendidos em SEP, mas esta prática não aumentou a adesão ao encaminhamento para tratamento ambulatorial após dois meses.

The Experience of Caregiving Inventory for first-episode psychosis caregivers: validation of the Brazilian version.

Family members of first-episode psychosis (FEP) patients are regarded as key components of the patient's evaluation, recovery and treatment. This paper aimed to investigate 75 FEP caregivers' appraisal, psychological morbidity and quality of life in the initial phase of treatment in a specialized FEP outpatient program in São Paulo, Brazil, and evaluate the validation of the Brazilian version of the Experience of Caregiving Inventory (ECI). Caregivers were also scored through Self Report Questionnaire-20 and Short Form-36. It was found that 29% of them might be a case for minor psychiatric disorder, that the worst domains of quality of life concerned emotional aspects, vitality and bodily pain, and that they were particularly affected by patients' negative symptoms, dependency and difficult behaviors. Additionally, internal consistency of ECI was very satisfactory (Cronbach's alpha=0.95) with subscales ranging from 0.57 (stigma) to 0.94 (total negative score). The Brazilian version of the ECI is not only a facile, reliable and valid instrument to describe the experience of caring for a relative with serious mental illness. It offers mental health professionals an opportunity to access caregivers' global experience and their evaluation of a severe mental disease, as well as to predict their psychological suffering, which is harmful to both patient and caregiver.

Multi-family group intervention in a programme for patients with first-episode psychosis: a Brazilian experience.

BACKGROUND: Patients' relatives are considered crucial for treatment and recovery in psychosis but family intervention studies have shown contradictory results in first-episode psychosis. The aims of this study were to survey caregivers' satisfaction with the multi-family intervention delivered by our programme and to verify if knowledge acquisition about illness and treatment provided by the family intervention was considered enough and understandable. METHODS: Sixty five family members of 46 first-episode patients were invited to answer a satisfaction questionnaire about the intervention. RESULTS: Forty individuals returned the questionnaire: 31 women (77.5%) and nine men (22.5%). Most (82.5%) had daily contact with the patient and 19 (47.5%) were mothers. Regarding knowledge acquisition, approximately one third did not improve their understanding of the illness. Nonetheless, 90% of the participants believed the meetings helped them to cope with their ill relative and 95% approved the multi-family format. CONCLUSIONS: Non-specific aspects of the intervention were seen as the most useful part of the programme. An important target of treatment would be to improve the way in which the specific psychoeducational components are delivered to individuals with low formal education.

Predictive factors for vesicoureteral reflux and prenatally diagnosed renal pelvic dilatation.

PURPOSE: We sought to identify predictive factors for primary vesicoureteral reflux among infants with prenatally detected renal pelvic dilatation. MATERIALS AND METHODS: A total of 250 neonates were diagnosed with isolated renal pelvic dilatation between 1999 and 2008, and followed prospectively. The main event of interest was presence of moderate to severe reflux (grade III to V). Diagnostic odds ratio, sensitivity, specificity, and diagnostic accuracy (assessed by AUC) of fetal and postnatal renal pelvic dilatation were determined. Severity of dilatation was classified by Society for Fetal Urology grade. Binary logistic regression was performed to identify variables significantly associated with vesicoureteral reflux. RESULTS: A total of 23 patients (9.2%) had primary vesicoureteral reflux, of whom 16 had grade III to V disease. Diagnostic accuracy was 0.70 (95% CI 0.63 to 0.75) for fetal and 0.65 (95% CI 0.59 to 0.71) for postnatal renal pelvic dilatation. Combined results of fetal and postnatal renal pelvic dilatation were also assessed. When both tests less than 10 mm were considered negative indicators of moderate to severe vesicoureteral reflux sensitivity increased to 97% and diagnostic odds ratio to 19.1. After adjustment by logistic regression only Society for Fetal Urology grade greater than I and ureteral dilatation were variables independently associated with grade III to V reflux. CONCLUSIONS: Fetal and postnatal renal pelvic dilatation was a poor predictor of vesicoureteral reflux. Nevertheless, diagnostic accuracy regarding clinically significant vesicoureteral reflux improved when fetal and postnatal renal pelvic dilatation less than 10 mm was considered a negative indicator of reflux.

Acute splenic sequestration in a cohort of children with sickle cell anemia / Sequestro esplênico agudo em coorte de crianças com anemia falciforme

OBJETIVO: Analisar o sequestro esplênico agudo (SEA) em crianças com anemia falciforme, provindas da triagem neonatal de Minas Gerais e acompanhadas pelo Hemominas de Belo Horizonte (MG). MÉTODOS: Coorte retrospectiva de 255 crianças com hemoglobinopatia SS/Sβº, nascidas entre 01/01/2000 e 31/12/2004 e acompanhadas até 31/12/2006. Os dados foram extraídos dos prontuários médicos. RESULTADOS: Oitenta e nove pacientes apresentaram 173 eventos de SEA (10,2 primeiros eventos por 100 pacientes/ano), sendo que 75% dos primeiros episódios de SEA ocorreram até 2 anos de vida. A probabilidade estimada de ocorrência do primeiro episódio de SEA foi de 40%. A recorrência atingiu 57,3%. Após o primeiro episódio de SEA, a esplenectomia foi indicada em apenas 12,4% dos casos; após o segundo, em 60,4% dos casos. Após o terceiro episódio, 41,7% dos casos ainda permaneceram sob observação clínica. A mediana do tempo entre indicação e realização da esplenectomia foi de 2 meses. Nesse intervalo, 37,2% das crianças tiveram novo episódio de SEA e uma delas faleceu. A letalidade no primeiro episódio foi de 1,1% e de 7,8% em episódios subsequentes. Entre as 255 crianças ocorreram 19 óbitos: 36,8% devido a infecções e 26,3% após SEA. CONCLUSÕES: O SEA é um evento comum na anemia falciforme, principalmente nos 2 primeiros anos de vida, com recidiva em mais da metade dos casos. Predominou conduta conservadora na indicação da esplenectomia. Embora a letalidade tenha sido baixa, o SEA representou a segunda causa de óbito. Isso aponta para fragilidades estruturais do sistema de saúde de MG e para a necessidade de melhor capacitação profissional na abordagem do problema.

OBJECTIVE: To analyze acute splenic sequestration (ASS) in children with sickle cell anemia diagnosed through a newborn screening program in the state of Minas Gerais, Brazil, and followed up at the hematology center in the city of Belo Horizonte, Minas Gerais, Brazil. METHODS: Retrospective cohort of 255 children with sickle cell anemia (Hb SS/Sβº) born between January 01, 2000, and December 31, 2004, and followed up until December 31, 2006. Data were abstracted from the patients' medical records. RESULTS: A total of 89 patients had 173 episodes of ASS (10.2 first episodes per 100 patient-years); 75% of the first episodes occurred before 2 years of age. The estimated probability of occurrence of the first episode of ASS during the study period was 40%. Recurrence rate reached 57.3%. After the first episode, splenectomy was indicated in only 12.4% of the cases; after the second, in 60.4% of the cases. After the third episode, 41.7% of the patients remained under clinical observation. The median time between indication for splenectomy and the actual surgical procedure was 2 months. During the intervening period, 37.2% of the children suffered a new episode of ASS and one child died. Case-fatality rate was 1.1% for the first episode and 7.8% for the subsequent episodes. Among a total of 255 children, 19 died: 36.8% due to infections and 26.3% after ASS. CONCLUSIONS: ASS is relatively common in sickle cell anemia, mainly in the first 2 years of life; relapse occurs in more than half of the cases. Conservative management instead of immediate splenectomy was the method of choice. Although the case-fatality rate was low, ASS was the second most common cause of death. These results disclose some fragilities of the health system in the state of Minas Gerais and the need for better professional education to approach ASS crises.

Acute splenic sequestration in a cohort of children with sickle cell anemia.

OBJECTIVE: To analyze acute splenic sequestration (ASS) in children with sickle cell anemia diagnosed through a newborn screening program in the state of Minas Gerais, Brazil, and followed up at the hematology center in the city of Belo Horizonte, Minas Gerais, Brazil. METHODS: Retrospective cohort of 255 children with sickle cell anemia (Hb SS/Sbeta(0)) born between January 01, 2000, and December 31, 2004, and followed up until December 31, 2006. Data were abstracted from the patients' medical records. RESULTS: A total of 89 patients had 173 episodes of ASS (10.2 first episodes per 100 patient-years); 75% of the first episodes occurred before 2 years of age. The estimated probability of occurrence of the first episode of ASS during the study period was 40%. Recurrence rate reached 57.3%. After the first episode, splenectomy was indicated in only 12.4% of the cases; after the second, in 60.4% of the cases. After the third episode, 41.7% of the patients remained under clinical observation. The median time between indication for splenectomy and the actual surgical procedure was 2 months. During the intervening period, 37.2% of the children suffered a new episode of ASS and one child died. Case-fatality rate was 1.1% for the first episode and 7.8% for the subsequent episodes. Among a total of 255 children, 19 died: 36.8% due to infections and 26.3% after ASS. CONCLUSIONS: ASS is relatively common in sickle cell anemia, mainly in the first 2 years of life; relapse occurs in more than half of the cases. Conservative management instead of immediate splenectomy was the method of choice. Although the case-fatality rate was low, ASS was the second most common cause of death. These results disclose some fragilities of the health system in the state of Minas Gerais and the need for better professional education to approach ASS crises.

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.

Weight gain, dyslipidemia and altered parameters for metabolic syndrome on first episode psychotic patients after six-month follow-up

OBJECTIVES: Obesity and metabolic abnormalities are frequent in psychotic patients, including first-episode psychosis. We evaluated weight and metabolic parameters in first-episode psychotic outpatients from the First Episode Psychosis Program, Universidade Federal de São Paulo. METHOD: Weight, height, waist and hip circumferences, glucose and lipid levels were measured at baseline and after a six-month period. RESULTS: Fifty-seven patients were included and 44 (77.2 percent) of them finished the study. Patients had a median age of 26.3 years, 60 percent were men and 43 percent had a diagnosis of schizophrenia at the endpoint. Weight and BMI values increased significantly during the follow-up (p < 0.01). The average weight gain at the follow-up was 10.1 percent of the baseline weight (SD = 11.9). Only women presented significant waist abnormalities: at the first assessment the waist mean was 79.12 cm (SD = 10.68) and 6 months later it had increased to 89.65 cm (SD = 11.19, z = -3.182, p = 0.001). After 6 months, the total cholesterol (p = 0.004), and triglyceride levels (p = 0.016) increased, while HDL-cholesterol levels decreased (p = 0.025). During the follow-up period one patient (2.3 percent) developed diabetes mellitus, one (2.3 percent) presented altered fasting glucose, 12 (27.2 percent) patients developed at least two altered parameters for metabolic syndrome and 3 (6.8 percent) patients developed metabolic syndrome (p = 0.001). DISCUSSION: The results of this study showed that in a short period of time individuals under antipsychotic treatment had their weight increased significantly and developed important metabolic abnormalities. CONCLUSIONS: Clinicians should be aware of these risks, choose an antipsychotic that causes less weight gain and should monitor these patients carefully, and recommend prophylactic measures as diet restriction and physical activities.

OBJETIVOS: Obesidade e alterações metabólicas são freqüentes em pacientes psicóticos, inclusive no primeiro episódio psicótico. Foram avaliados peso e parâmetros metabólicos em pacientes em tratamento no Programa de Episódio Psicótico da Universidade Federal de São Paulo. MÉTODO: Peso, altura, medida de cintura e quadril, glicemia e perfil lipídico foram avaliados no início do tratamento e após seis meses. RESULTADOS: Cinqüenta e sete pacientes foram incluídos no estudo e 44 (72 por cento) concluíram o estudo. Os pacientes apresentavam em média 26,3 anos, 60 por cento eram do sexo masculino e, ao final do estudo, 43 por cento apresentavam diagnóstico de esquizofrenia. Houve aumento significativo do peso e índice de massa corporal durante o estudo (p < 0,01). Em média, o peso aumentou 10,1 por cento do peso inicial (SD = 11,9). Apenas mulheres apresentaram alterações na medida da cintura: no início, a média da cintura era de 79,12 cm (SD = 10,68) e, após seis meses, houve um aumento para 89,65 cm (SD = 11,19, z = -3,182, p = 0,001). Após seis meses, houve aumento do colesterol total (p = 0,004) e triglicérides (p = 0,016), e diminuição dos níveis de colesterol HDL (p = 0,025). No período, um paciente (2,3 por cento) desenvolveu diabetes mellitus, um paciente (2,3 por cento) apresentou glicemia de jejum alterada, 12 (27,2 por cento) desenvolveram pelo menos dois parâmetros alterados para síndrome metabólica, e 3 (6,8 por cento) apresentaram síndrome metabólica (p = 0,001). DISCUSSÃO: Os resultados deste estudo mostram que em um curto período de tempo pacientes em tratamento com antipsicóticos aumentaram substancialmente o peso e desenvolveram importantes alterações metabólicas. CONCLUSÃO: Os clínicos devem estar atentos a esses riscos, escolher medicações que causem menor ganho de peso, devendo monitorar esses pacientes cuidadosamente e recomendar medidas profiláticas como restrição dietética e atividade física.

Weight gain, dyslipidemia and altered parameters for metabolic syndrome on first episode psychotic patients after six-month follow-up.

OBJECTIVES: Obesity and metabolic abnormalities are frequent in psychotic patients, including first-episode psychosis. We evaluated weight and metabolic parameters in first-episode psychotic outpatients from the First Episode Psychosis Program, Universidade Federal de São Paulo. METHOD: Weight, height, waist and hip circumferences, glucose and lipid levels were measured at baseline and after a six-month period. RESULTS: Fifty-seven patients were included and 44 (77.2%) of them finished the study. Patients had a median age of 26.3 years, 60% were men and 43% had a diagnosis of schizophrenia at the endpoint. Weight and BMI values increased significantly during the follow-up (p < 0.01). The average weight gain at the follow-up was 10.1% of the baseline weight (SD = 11.9). Only women presented significant waist abnormalities: at the first assessment the waist mean was 79.12 cm (SD = 10.68) and 6 months later it had increased to 89.65 cm (SD = 11.19, z = -3.182, p = 0.001). After 6 months, the total cholesterol (p = 0.004), and triglyceride levels (p = 0.016) increased, while HDL-cholesterol levels decreased (p = 0.025). During the follow-up period one patient (2.3%) developed diabetes mellitus, one (2.3%) presented altered fasting glucose, 12 (27.2%) patients developed at least two altered parameters for metabolic syndrome and 3 (6.8%) patients developed metabolic syndrome (p = 0.001). DISCUSSION: The results of this study showed that in a short period of time individuals under antipsychotic treatment had their weight increased significantly and developed important metabolic abnormalities. CONCLUSIONS: Clinicians should be aware of these risks, choose an antipsychotic that causes less weight gain and should monitor these patients carefully, and recommend prophylactic measures as diet restriction and physical activities.

Primeiro episódio psicótico: uma janela de oportunidade para tratamento? / First episode psychosis: a window of treatment opportunity?

CONTEXTO: Programas específicos para a pesquisa e assistência ao primeiro episódio psicótico foram desenvolvidos ao redor do mundo cujos pressupostos básicos são: identificação precoce do episódio psicótico, tratamento intensivo da crise e prevenção de recaídas. OBJETIVO: Este artigo pretende dar uma visão sobre a abordagem atual do paciente no primeiro episódio psicótico. MÉTODO: Revisão de pesquisas sobre primeiro episódio psicótico em centros internacionais e nacionais. RESULTADOS: Programas para identificação precoce do episódio psicótico podem diminuir o tempo de psicose não tratada e intervenções intensivas no primeiro episódio psicótico devem incluir tratamento intensivo do paciente e de seus familiares. CONCLUSÃO: Em alguns países os serviços já foram incorporados à rede de saúde pública. Existem poucas pesquisas e serviços especializados para primeiro episódio em nosso meio mostrando a necessidade de desenvolvimento de novas pesquisas nessa área.

BACKGROUND: Specific first episode programs were developed around the world aiming to: early detection, intensive crises care and relapse prevention. OBJECTIVE: This article intends to outline this new first episode psychosis approach. METHOD: To review study findings from international and national centers. RESULTS: Early education programs can lower the duration of untreated psychosis and interventions in first episode psychosis should include patient and family intensive care. CONCLUSION: In some countries these services have already been incorporated in the health system. There are few research and services in our country, showing the need to develop research in this area.

Fertility and fecundity of an outpatient sample with schizophrenia

OBJECTIVE: To determine reproductive rates among patients with schizophrenia who attended the outpatient clinic at the Universidade Federal de São Paulo. METHOD: All patients with schizophrenia completed a semi-standardized questionnaire, and data from the Brazilian census was used for comparing population rates. RESULTS: 167 patients completed the questionnaires and of these 33 (19.8 percent) were or had been married and 32 reported being a parent. The fertility rate (number of individuals who had had at least one child divided by the total number of individuals) was 19.4 percent (25 percent for females, 15.8 percent for males, p = 0.14). Fecundity rate was 1.75 for males and 1.69 for females (p = 0.85). A logistic regression analysis identified an association between the later date of the onset of illness and higher rate of marriage (p = 0.003). Gender and the interaction between gender and marital status were significant predictors for fertility (p < 0.05 and p = 0.024, respectively). CONCLUSIONS: Patients with schizophrenia showed lower rates for marital status, fertility and fecundity when compared to standard population rates. However, many patients will become parents during their life time. Therefore, it is imperative to develop services that fulfill their needs, mainly in Brazil, a middle-income country, where resources are scarce and there is no policy for dealing with this reality.

OBJETIVO: Determinar as taxas de reprodução de pacientes com esquizofrenia em uma clínica de atendimento ambulatorial da Universidade Federal de São Paulo. MÉTODO: Todos os pacientes com diagnóstico de esquizofrenia preencheram um questionário semi-padronizado. Dados do censo Brasileiro foram utilizados para comparação com taxas populacionais. RESULTADOS: 167 pacientes completaram o questionário, dos quais 33 (19,8 por cento) foram alguma vez casados e 32 tiveram filhos. A taxa de fertilidade (indivíduos que tiveram ao menos um filho pelo total de indivíduos) foi de 19,4 por cento (15,8 por cento para homens, 25 por cento para mulheres, p = 0,14). A taxa de fecundidade foi de 1,75 para homens e 1,69 para mulheres (p = 0,85). Análise de regressão logística identificou associação entre idade de início da doença mais tardio com maior taxa de casamento (p = 0,003). Gênero e interação entre gênero e situação conjugal foram significantes preditores para fertilidade (p < 0,05 e p = 0,024; respectivamente). CONCLUSÕES: Pacientes com esquizofrenia mostraram menores taxas de casamento, fertilidade e fecundidade quando comparados com taxas populacionais. Contudo, muitos pacientes com esquizofrenia terão filhos durante a vida e há carência de serviços de saúde que atendam às necessidades destes indivíduos, principalmente no Brasil, um país de renda média, onde os recursos são escassos e não existem políticas que abordem esta realidade.

One-year stability of diagnosis in first-episode nonaffective psychosis: influence of sex.

OBJECTIVE: To determine whether sex influences the frequency and direction of diagnostic change 1 year after a first episode of nonaffective psychosis. METHOD: The subjects (n = 228) were individuals diagnosed with schizophrenia and other psychoses according to DSM-IV criteria at baseline and at 1 year. RESULTS: When diagnostic shifts occurred, men mainly shifted toward schizophrenia (84.6%), which was associated with more severe symptoms. In contrast, 72% of women in whom a diagnostic shift occurred shifted away from a schizophrenia spectrum disorder toward mood disorder. A shift to mood disorder in women was associated with an early age of illness onset. CONCLUSIONS: At initial presentation, nonaffective first-episode psychosis studies may underestimate the number of men and overestimate the number of women who will eventually receive a schizophrenia diagnosis.

Sex selection bias in schizophrenia antipsychotic trials.

The sex prevalence of schizophrenia is approximately equal, and yet clinical trials of new therapeutic drugs have been conducted, for the most part, with male participants. The authors reviewed the percentage of women in schizophrenia clinical trials of the new "atypical" antipsychotic medications. MEDLINE and Cochrane databases were searched for English-language randomized controlled trials involving risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Studies with a sample size of more than 50 and a subject diagnosis of schizophrenia, schizophrenia spectrum disorder, or broad psychosis were included for review. For each study, the following items were abstracted: source of support, pharmacotherapy, site location, treatment setting, patient phase, psychotic episode number, duration, number of men and women in the total sample, mean age of the sample, and the presence of women-specific inclusion/exclusion criteria. Sixty-seven published studies met criteria. The median percentage of women in the total sample was 33.3%, the minimum was 6.7%, and the maximum was 71.2%. A stepwise linear regression analysis showed that age (younger samples), center location (Unites States and Canada), treatment patient setting (inpatient), and ziprasidone trials were all associated with relatively lower percentages of women. Sex differences in antipsychotic pharmacokinetics and pharmacodynamics that may result in differential effectiveness and susceptibility to adverse effects cannot be ascertained when the percentage of women in clinical trials is as low as it is. The increasing shift toward outpatient rather than inpatient drug trials may help to increase the proportion of women.