FUNCTIONAL STATUS IN PERIPHERAL ARTERIAL DISEASE: REHABILITATED VERSUS NON-REHABILITATED.

OBJECTIVE: to analyze patient perception of functional status related to activity and participation of rehabilitated and non-rehabilitated individuals with PAD. METHODS: Cross-sectional study assessing the activity and participation domain using the Human Activity Profile (HAP) questionnaire and the Participation Scale (P-scale), respectively. Groups were compared using Chi-square test and unpaired t-test. RESULTS: A total of 87 individuals (36 rehabilitated) with 65.28 ± 8.29 years (66.7% male) were included. HAP classified 58.6% of individuals with weak or inactive physical activity level, and approximately half of the sample did not have participation restriction. HAP scores and P-scale (locomotion inside and outside home) were lower in non-rehabilitated than rehabilitated individuals. CONCLUSION: Individuals with PAD presented little participation restriction and a great activity limitation, the last one being more evident among non-rehabilitated.

Comparison of home-based rehabilitation and a centre-based exercise in terms of functional capacity, muscle oxygenation and quality of life in people with peripheral arterial disease: a protocol for a randomised controlled trial.

INTRODUCTION: Peripheral arterial disease (PAD) is increasingly prevalent, and supervised physical exercise programmes are recommended as the first-line treatment. However, these programmes are underused. Alternative delivery models may be able to expand treatment coverage. The objective of this study was to compare a home-based exercise programme (HBEP) and a centre-based exercise (CBE) in terms of their effects on functional capacity, peripheral muscle oxygenation and quality of life in individuals with PAD. METHODS AND ANALYSIS: This single-blind, parallel randomised clinical trial will consist of two groups: HBEP and CBE. A qualitative analysis will be carried out to investigate acceptability and satisfaction. The primary outcome will be functional capacity, assessed by the incremental shuttle walk test. Secondary outcomes will include functional capacity, assessed by a treadmill walking test; peripheral muscle oxygenation and quality of life; and self-reported functional impairment, risk factors, morbidity, level of physical activity, adherence, acceptability and satisfaction. The intervention protocols will consist of 12 weeks of intermittent walking until claudication symptoms, three times a week. Participants randomly assigned to the CBE group will participate in supervised face-to-face sessions. The HBEP group will perform exercises at home with remote supervision, monitored by a pedometer and heart rate monitor, and subjective perception of effort during each session will be recorded by participants in a training diary; follow-up will be conducted by telephone calls. Statistical analyses will follow the intention-to-treat principle. Participants allocated to the HBEP group will be interviewed about their experience of remote treatment using a qualitative approach. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of the Universidade Federal de Minas Gerais. The results will be disseminated in a peer-reviewed journal and presented at international congresses. This research has the potential to improve the care of people with PAD because if home-based rehabilitation demonstrates effectiveness, it could be considered an alternative or support resource to the usual centre-based treatment models, expanding access, coverage and participation in vascular physiotherapy TRIAL REGISTRATION: https://ensaiosclinicos.gov.br/rg/RBR-97vy9n7 on 14 April 2022.

Pro- and anti-inflammatory cytokines and osteoclastogenesis-related factors in peri-implant diseases: systematic review and meta-analysis.

BACKGROUND: Pro- and anti-inflammatory cytokines are acknowledged, during inflammatory bone destruction, as key regulators of osteoclast and osteoblast differentiation and activity. However, evidence regarding the exact role of pro- and anti-inflammatory cytokines and osteoclastogenesis-related factors in peri-implant diseases is unclear. We aimed to execute a systematic review and meta-analysis about the pro- and anti-inflammatory cytokines and osteoclastogenesis-related factors levels in peri-implant diseases. METHODS: The focused question was elaborated to summarize the levels of pro-and anti-inflammatory cytokines and osteoclastogenesis-related factors in tissue samples (mRNA) and biofluids (protein levels) of patients with/without peri-implant diseases. Electronic searches of the PubMed, Cochrane Controlled Trials Registry, Web of Science, EMBASE, Scopus and Google scholar databases were conducted for publications up to March 2023. Meta-analysis evaluating the mediator´s levels (protein levels by ELISA) in peri-implant crevicular fluid (PICF) were made. The effect size was estimated and reported as the mean difference. The 95% confidence interval was estimated for each mediator, and the pooled effect was determined significant if two-sided p-values < 0.05 were obtained. RESULTS: Twenty-two publications were included in the systematic review (qualitative analysis), with nine of these subjected to meta-analyses (quantitative analysis). In the qualitative analysis, higher pro-inflammatory cytokines [Interleukin (IL)-1ß, IL-6] and pro-osteoclastogenic mediator [Receptor Activator of Nuclear Factor-Kappa B ligand (RANKL)] levels were observed in PICF of individuals with peri-implant diseases in comparison to healthy individuals. Higher RANKL/osteoprotegerin (OPG) ratios were observed in PICF from individuals with peri-implant diseases in comparison to healthy individuals. Meta-analysis showed higher RANKL levels in diseased groups compared to controls. CONCLUSIONS: The results showed that the levels of IL-1ß, IL-6, IL-10, and RANKL/OPG are not balanced in peri-implant disease, suggesting that these mediators are involved in the host osteo-immunoinflammatory response related to peri-implantitis.

Patients and physician's self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study / Autoavaliação de pacientes e médicos em relação à estabilidade clínica em transtornos mentais graves: um estudo transversal

OBJECTIVE: This study explores the relationship between patients' self-assessment and physicians' evaluation regarding clinical stability. METHODS: This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient's physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician's global clinical impression over the six previous months. The patients' self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients' self-evaluation was considered as our standard. RESULTS: The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians' evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. CONCLUSION: The data analysis confirms our hypothesis that the self- -assessment made by patients with SMD was accurate regarding their health condition, and that the self- -assessment made by patients who considered themselves stable agree with the physicians' evaluation.

OBJETIVO: Este estudo explora a relação entre a autoavaliação dos pacientes e a avaliação dos médicos quanto à estabilidade clínica. MÉTODOS: Trata-se de um estudo transversal realizado no ambulatório do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) em uma ampla amostra de pacientes (1.447), dos quais 67,9% eram portadores de transtornos mentais graves (TMG). Coletamos informações por meio de um questionário estruturado desenvolvido para esse fim, preenchido pelo médico assistente. A estabilidade clínica foi avaliada por meio de cinco critérios de instabilidade psiquiátrica e pela impressão clínica global do médico, nos seis meses anteriores. A autoavaliação dos pacientes baseou-se em uma pergunta sobre como eles avaliavam seu estado de saúde: estável/melhor, pior, não sabe. Para as análises, a autoavaliação dos pacientes foi considerada como nosso padrão. RESULTADOS: A amostra foi composta por 824 (57%) mulheres, com idade média de 49 anos. Os diagnósticos mais prevalentes na categoria TMG corresponderam a 937 pacientes, dos quais 846 (90,3%) se avaliaram como estáveis/melhores. As avaliações dos médicos concordaram mais com pacientes portadores de transtorno bipolar e menos com esquizofrênicos em relação à estabilidade. Quanto aos pacientes com transtorno depressivo, os médicos concordaram mais com eles em relação à instabilidade. CONCLUSÃO: A análise dos dados confirma nossa hipótese de que a autoavaliação feita por pacientes com TMG foi precisa quanto à sua condição de saúde e que a autoavaliação feita por pacientes que se consideravam estáveis concorda com a avaliação dos médicos.

Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial.

BACKGROUND: The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM: To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN: Single-blind randomized control trial. SETTING: A university hospital. POPULATION: Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS: The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS: 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS: CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT: Home-CR can contribute to overcome participants' barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.

Evaluation of functional capacity and muscle metabolism in individuals with peripheral arterial disease with and without diabetes.

OBJECTIVE: Peripheral arterial disease (PAD) is characterized by intermittent claudication, which interferes with walking and leads to worsening of functional capacity. This mechanism has not been clearly defined in PAD. Thus, the aim of our study was to identify the muscular metabolism and vascular function variables using near-infrared spectroscopy (NIRS) and their possible associations with functional capacity in individuals with PAD and secondly to verify the differences in these variables between persons with PAD and diabetes mellitus (DM) and those with PAD without DM. METHODS: A total of 39 participants with intermittent claudication were enrolled, 14 of whom had DM. They were assessed for functional capacity by the total distance covered in the treadmill test with the speed and grade constant and for muscle function and metabolism using near-infrared spectroscopy at rest and during the treadmill test. The Spearman correlation coefficient was computed to assess the presence of an association between the variables, and multiple linear regression analysis was performed, considering the total test distance as the dependent variable. The assessment between groups was performed using the independent t test or Mann-Whitney U test. RESULTS: The near-infrared spectroscopy variables related to tissue oxygen saturation in the test recovery phase were correlated with the functional performance during the treadmill test. Thus, those with a longer or slower recovery time and those with greater tissue deoxygenation had walked a shorter distance. A significant difference (P = .049) was noted between those with PAD stratified by DM in the reoxygenation time required for an occlusion. CONCLUSIONS: These findings reinforce the hypothesis that peripheral factors related to vascular function and muscular metabolism can affect the walking capacity of persons with PAD and that microvascular dysfunction is more prevalent among those with PAD and DM.

A qualitative study of patient's perceptions of two cardiac rehabilitation models.

BACKGROUND: Understanding patients' perceptions about rehabilitation can guide healthcare administrators on modifications of program elements, which can ultimately improve cardiac rehabilitation (CR) use, adherence of heart-health behaviors, and improvements in clinical outcomes. OBJECTIVE: To examine the perception of patients about their participation in CR. METHODS: Qualitative study using semi-structured interviews, performed in a public CR center in Brazil. Twenty-eight patients were interviewed 2-years following participation in two CR models: exercise-based and comprehensive CR. RESULTS: Themes identified included: knowledge acquisition, improvement in functionality, and psychosocial well-being. It appeared that the perceived benefits of CR participation were overall positive and similar between the two models; however, those in the comprehensive CR identified additional subthemes: self-care need and knowledge transfer. CONCLUSIONS: This study suggested that patients from two different CR models perceived in the long term that the CR participation positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions seemed to be associated with improved participants' perception about CR, which could contribute to long-term maintenance of heart-health behavior and better outcomes.

Home-Based Cardiac Rehabilitation in Brazil's Public Health Care: Protocol for a Randomized Controlled Trial.

BACKGROUND: Coronary artery disease (CAD) is among the main causes of hospitalization and death worldwide, therefore, the implementation of programs to reduce its impact is necessary. Supervised cardiac rehabilitation has been shown to have positive effects on CAD control. However, there are barriers to patient participation in the traditional, face-to-face cardiac rehabilitation programs, mainly in low-resource environments. OBJECTIVE: This study aimed to verify patient compliance to a home-based cardiac rehabilitation program, which includes unsupervised health education and physical exercises, guided by telephone. Moreover, we compare this new method to the traditional supervised cardiac rehabilitation offered in most hospital centers. METHODS: We present here a two-arm, single-blinded, and randomized controlled design protocol, which compares the traditional cardiac rehabilitation (CenterRehab) with the home-based cardiac rehabilitation (Home-Based) in 72 patients affected by CAD. The primary outcome is the compliance to the cardiac rehabilitation sessions. The secondary outcomes (to evaluate effectiveness) include measurable variables such as functional capacity, CAD risk factors (blood pressure, waist circumference, glycemic, cholesterol levels, depressive symptoms, and the level of physical activity), the patient's quality of life, the disease knowledge, and the morbidity rate. Parameters such as the program cost and the usability will also be evaluated. The programs will last 12 weeks, with a total of 60 rehabilitation and 6 educational sessions. Patients of the CenterRehab program will participate in 24 supervised sessions and 36 home sessions, while the patients of the Home-Based program will participate in 2 supervised sessions and 58 home sessions, guided by telephone. After the 12-week period all participants will be recommended to continue practicing physical exercises at home or at a community center, and they will be invited for re-evaluation after 3 months. The outcomes will be evaluated at baseline, and after 3 and 6 months. RESULTS: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by October 2019. CONCLUSIONS: This is the first study in Brazil comparing the traditional cardiac rehabilitation approach with a novel, home-based protocol that uses an accessible and low-cost technology. If positive results are obtained, the study will contribute to establish a new and viable model of cardiac rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03605992; https://clinicaltrials.gov/ct2/show/NCT03605992. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13901.

Clinical stability, diagnosis and catchment area: the patients of a university-based psychiatric outpatient clinic / Estabilidade clínica, diagnóstico e território: os pacientes de um ambulatório psiquiátrico universitário

ABSTRACT Objective This study aimed to characterize the patients assisted at the general outpatient clinic of the Psychiatry Institute of Universidade Federal do Rio de Janeiro (IPUB-UFRJ) and to assess these patients' clinical stability. Methods This cross-sectional study collected information using a structured questionnaire filled in by the patient's physician. The questionnaire, specifically developed for this purpose, included sociodemographic data; the dwelling area; psychiatric diagnosis according to ICD-10; clinical stability assessment by means of five psychiatric instability criteria and the physician's global clinical impression over the six previous months. Clinical stability was defined as a negative answer to all five pre-defined instability criteria. Results Overall, 1,447 questionnaires were filled in. The sample was composed of 824 (57%) women; with an average age of 49 years; 1,104 (76.3%) patients lived in the city of Rio de Janeiro and 343 (23.7%) lived outside the city; 983 (67.9%) patients had a severe mental disorder (SMD) diagnosis and 946 (65.3%) patients were considered stable. Statistically, the clinical stability by dwelling area did not differ. The most frequent clinical instability criterion was "exacerbation or emergence of acute manifestations of the disease". Conclusion The major part of the patients displayed a SMD and was considered clinically stable.

RESUMO Objetivo Este trabalho buscou caracterizar os pacientes atendidos no ambulatório geral do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) e avaliar sua estabilidade clínica. Métodos Este estudo descritivo, transversal, coletou informações utilizando um questionário estruturado preenchido pelo médico assistente. O questionário, especificamente desenvolvido para esse propósito, continha dados sociodemográficos, área de moradia, diagnóstico psiquiátrico de acordo com a CID-10, avaliação da estabilidade clínica por meio de cinco critérios de instabilidade psiquiátrica e a impressão clínica global do médico, nos últimos seis meses. A estabilidade clínica foi definida como uma resposta negativa a todos os cinco critérios de instabilidade predefinidos. Resultados No total, 1.447 questionários foram preenchidos. A amostra foi composta por 824 (57%) mulheres, com média de idade de 49 anos; 1.104 (76,3%) pacientes residentes na cidade do Rio de Janeiro e 343 (23,7%) residentes fora da cidade; 983 (67,9%) pacientes com diagnóstico de transtorno mental grave (TMG) e 946 (65,3%) pacientes foram considerados estáveis. Estatisticamente, a estabilidade clínica por área de moradia não apresentou diferenças. O critério de instabilidade mais frequente foi "recrudescimento ou o surgimento de manifestações agudas da doença". Conclusão A maioria dos pacientes apresentava um TMG e foi considerada clinicamente estável.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability.

BACKGROUND: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. OBJECTIVES: To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). METHOD: The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC ≥ 0.92) for test-retest. CONCLUSION: The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability / Versão brasileira do instrumento de avaliação ambiental Craig Hospital Inventory of Environmental Factors (CHIEF): tradução, adaptação cultural e confiabilidade

Background: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. Objectives : To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). Method : The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC≥0.92) for test-retest. Conclusion : The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP. .

Contextualização: Fatores ambientais são essenciais para a caracterização dos processos de funcionalidade e incapacidade, no entanto a escassez de instrumentação padronizada sobre tais elementos restringe a investigação científica de barreiras e facilitadores associados à participação social de pessoas com deficiência. Objetivos : Traduzir para o Português do Brasil, adaptar culturalmente e verificar a confiabilidade do questionário de avaliação ambiental denominado Craig Hospital Inventory of Environmental Factors (CHIEF). Método : O questionário foi traduzido para o Português, analisado, retrotraduzido para o Inglês e comparado com a versão original. A versão final (CHIEF-BR) foi administrada em 47 cuidadores de crianças e adolescentes com paralisa cerebral (PC), e a confiabilidade teste-reteste foi analisada pelo Kappa quadrático e índice de consistência (CCI) a partir de entrevista com 23 cuidadores dessa amostra, em dois momentos, com intervalo de dez dias. Resultados : Durante a administração, foi necessário o fornecimento de exemplos para facilitar a compreensão das questões relacionadas à subescala política. Kappa quadrático evidenciou que a confiabilidade teste-reteste de cada questão variou de 0,28 a 1,0 no escore de frequência e de 0,38 a 0,98 no escore de magnitude. Os coeficientes de correlação intraclasse dos escores totais apresentaram um alto índice de consistência (CCI≥0,92). Conclusão: O CHIEF-BR mostrou-se reprodutível e aplicável à amostra do estudo, podendo ser utilizado para documentar os efeitos de intervenções que visem a minimizar o impacto das barreiras ambientais na participação de crianças e jovens com PC. .

Homicide by a forensic female sample in Brazil: a preliminary study.

The objective of the study was to evaluate the mental status of all women (n = 14) who were acquitted by reason of insanity of charges of murder or attempted murder and committed to a forensic psychiatric hospital in the state of Rio de Janeiro, Brazil. All cases were retrospectively examined, including medical files, technical records, and forensic experts' official reports. A conclusive psychiatric diagnosis was established using the Structured Clinical Interview for DSM-IV Axis I and II Disorders and clinical and forensic records. The most common diagnosis was schizophrenia/schizoaffective disorders (n = 8; 57.3%). Most victims (n = 12; 75%) were close relatives of the patients. We found that 43% (n = 6) of the patients had a previous history of violent behavior. According to the initial psychiatric forensic evaluation, 5 patients (35.7%) had psychotic symptoms. It is expected that a growing understanding of motivational factors underlying homicidal behavior in mentally disturbed female offenders may further the implementation of effective preventive and therapeutic interventions.

The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype.

OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype

OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

Relação entre crimes sexuais e transtornos mentais e do desenvolvimento: uma revisão / Relationship between sexual offences and mental and developmental disorders: a review

CONTEXTO: A violência sexual é um grave problema de saúde pública que preocupa e confronta nossa sociedade. A prevalência, a magnitude e as consequências desse problema têm merecido atenção crescente por parte de estudiosos e pesquisadores da saúde e dos direitos humanos. OBJETIVO: Realizar uma revisão bibliográfica sobre a relação entre crimes sexuais e transtornos mentais e do desenvolvimento. MÉTODOS: Foi realizada uma pesquisa bibliográfica nas bases de dados do PubMed, Scientific Eletronic Library Online (SciELO) e Lilacs, utilizando os descritores "sexual crime", "sexual offense", "mental disorder", "mental retardation", "developmental disability" e suas combinações. RESULTADOS: Os transtornos mentais e do desenvolvimento mais frequentemente relacionados à perpetração de crimes sexuais foram esquizofrenia, transtorno bipolar e retardo mental. CONCLUSÃO: São importantes a detecção e o tratamento da morbidade psiquiátrica entre ofensores sexuais nos sistemas de saúde e de justiça criminal, o que pode contribuir para menor risco de reincidência desse comportamento sexual.

BACKGROUND: Sexual violence is a serious public health problem that concerns and faces our society. The prevalence, magnitude and consequences of this problem have merited growing attention by health researchers and human rights scholars. OBJECTIVE: To conduct a review of the literature regarding the relationship between mental disorders, sexual offences and those of development. METHODS: A bibliographic research was performed in PubMed, Scientific Electronic Library Online (SciELO) and Lilacs, employing the terms "sexual crime", "sexual offence", "mental disorder", "mental retardation", "developmental disability" and its combinations. RESULTS: The mental disorders and developmental disorders more frequently related to the perpetration of sexual offences were schizophrenia, bipolar disorder and mental retardation. DISCUSSION: The detection and treatment of psychiatric morbidity among sexual offenders in health and criminal justice systems, which may contribute to a lower risk of recidivism of this sexual behaviour, is important.

A randomized, naturalistic, parallel-group study for the long-term treatment of panic disorder with clonazepam or paroxetine.

This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.

Schizophrenia and violent behavior / Esquizofrenia e comportamento violento / Schizophrénie et comportement violent / La esquizofrenia y el comportamiento violento

The aim of this study is to report the case of a woman who killed a child. After a forensic psychiatric appraisal to evaluate penal responsibility, she was considered not guilty by reason of insanity and mandatorily committed to the central forensic psychiatric hospital in the State of Rio de Janeiro, Brazil. The patient received a diagnosis of paranoid schizophrenia, based on DSM-IV-TR. She was not in psychiatric treatment and showed psychotic symptoms before the violent behavior became manifest. The study of motivational factors in homicidal behavior may provide further knowledge for understanding, preventing and treating it in such cases.(AU)

O objetivo deste estudo é relatar o caso de uma mulher que assassinou uma criança. Após uma avaliação psiquiátrico-forense para avaliação da responsabilidade penal, ela foi considerada inimputável por insanidade mental e involuntariamente internada em hospital psiquiátrico forense do estado do Rio de Janeiro, Brasil. A paciente recebeu diagnóstico de esquizofrenia paranoide de acordo com os critérios do DSM-IV-TR. Ela não estava em tratamento psiquiátrico e apresentava sintomas psicóticos antes da manifestação do comportamento violento. O estudo de fatores motivadores do comportamento homicida pode fornecer conhecimentos para a sua compreensão, prevenção e tratamento, em casos como esse.(AU)

Cette étude analyse le cas d'une femme qui a tué son enfant. Après l'évaluation psychiatrique médico-légale sur la responsabilité pénale, cette femme a été déclarée irresponsable en raison de son trouble mental et hospitalisée dans un hôpital de psychiatrie légale à Rio de Janeiro, Brésil. Cette patiente a été diagnostiquée comme schizophrène paranoïde selon la DSM-IV-TR. Au moment du crime, la patiente ne suivait pas de traitement psychiatrique et présentait plusieurs symptômes psychotiques. L'étude des facteurs de motivation du comportement meurtrier peut fournir des indications importantes pour la compréhension, la prévention et le traitement de ce genre de cas.(AU)

Este estudio relata el caso de una mujer que asesinó a un niño. Después de una evaluación psiquiátrica-forense para determinar la responsabilidad penal, se la consideró inimputable por razones de insanidad mental e fue compulsoriamente internada en el hospital psiquiátrico-forense de Río de Janeiro, Brasil. El cuadro de la paciente fue diagnosticado como esquizofrenia paranoide, según el DSM-IV-TR. La misma no estaba en tratamiento psiquiátrico y presentaba síntomas psicóticos antes de la manifestación de la conducta violenta. El estudio de los factores determinantes para el comportamiento homicida podría ofrecer pistas para la comprensión, prevención y tratamiento en casos similares.(AU)

Schizophrenia and violent behavior / Esquizofrenia e comportamento violento / Schizophrénie et comportement violent / La esquizofrenia y el comportamiento violento

The aim of this study is to report the case of a woman who killed a child. After a forensic psychiatric appraisal to evaluate penal responsibility, she was considered not guilty by reason of insanity and mandatorily committed to the central forensic psychiatric hospital in the State of Rio de Janeiro, Brazil. The patient received a diagnosis of paranoid schizophrenia, based on DSM-IV-TR. She was not in psychiatric treatment and showed psychotic symptoms before the violent behavior became manifest. The study of motivational factors in homicidal behavior may provide further knowledge for understanding, preventing and treating it in such cases.

O objetivo deste estudo é relatar o caso de uma mulher que assassinou uma criança. Após uma avaliação psiquiátrico-forense para avaliação da responsabilidade penal, ela foi considerada inimputável por insanidade mental e involuntariamente internada em hospital psiquiátrico forense do estado do Rio de Janeiro, Brasil. A paciente recebeu diagnóstico de esquizofrenia paranoide de acordo com os critérios do DSM-IV-TR. Ela não estava em tratamento psiquiátrico e apresentava sintomas psicóticos antes da manifestação do comportamento violento. O estudo de fatores motivadores do comportamento homicida pode fornecer conhecimentos para a sua compreensão, prevenção e tratamento, em casos como esse.

Cette étude analyse le cas d'une femme qui a tué son enfant. Après l'évaluation psychiatrique médico-légale sur la responsabilité pénale, cette femme a été déclarée irresponsable en raison de son trouble mental et hospitalisée dans un hôpital de psychiatrie légale à Rio de Janeiro, Brésil. Cette patiente a été diagnostiquée comme schizophrène paranoïde selon la DSM-IV-TR. Au moment du crime, la patiente ne suivait pas de traitement psychiatrique et présentait plusieurs symptômes psychotiques. L'étude des facteurs de motivation du comportement meurtrier peut fournir des indications importantes pour la compréhension, la prévention et le traitement de ce genre de cas.

Este estudio relata el caso de una mujer que asesinó a un niño. Después de una evaluación psiquiátrica-forense para determinar la responsabilidad penal, se la consideró inimputable por razones de insanidad mental e fue compulsoriamente internada en el hospital psiquiátrico-forense de Río de Janeiro, Brasil. El cuadro de la paciente fue diagnosticado como esquizofrenia paranoide, según el DSM-IV-TR. La misma no estaba en tratamiento psiquiátrico y presentaba síntomas psicóticos antes de la manifestación de la conducta violenta. El estudio de los factores determinantes para el comportamiento homicida podría ofrecer pistas para la comprensión, prevención y tratamiento en casos similares.