Attrition in Interpersonal Psychotherapy Among Women With Post-traumatic Stress Disorder Following Sexual Assault.

BACKGROUND: An estimated 16.9% of adult Brazilian women experience sexual assault in their lifetime. Almost half of women who suffer such trauma develop post-traumatic stress disorder (PTSD). Markowitz et al. (2015) found that an affect-focused non-exposure therapy, Interpersonal Psychotherapy (IPT), adapted to treat PTSD (IPT-PTSD) had similar efficacy to and lower dropout rates than Prolonged Exposure (PE), the "gold standard," most studied exposure therapy for PTSD. OBJECTIVE: To assess attrition rates in IPT of sexually assaulted women recently diagnosed with PTSD. METHODS: The current study derives from a two-arm, randomized controlled clinical trial of sexually assaulted women with PTSD who received 14 weeks of standardized treatment with either IPT-PTSD or sertraline. Sample: The 32 patients in the IPT treatment arm were analyzed. RESULTS: Overall attrition was 29%. One patient was withdrawn because of suicidal risk; four dropped out pre-treatment, and five dropped out during IPT-PTSD. If the excluded patient is considered a dropout, the rate increases to 31%. DISCUSSION: This is the first formal study of IPT for PTSD specifically due to sexual assault. IPT attrition approximated dropout rates in PE studies, which are often around 30%, and to the sertraline group in our study (34.5%). Further research should compare IPT and PE among sexually assaulted women to clarify our hypothesis that IPT could be an attractive alternative approach for this patient group.

Special Phenomena in Rorschach Protocols in Patients Diagnosed with Schizophrenia.

The Rorschach method has been proved as an effective tool for personality dynamics assessment, as well as for identify psychopathological patterns, especially with regard to the dissociation of consciousness, which makes it relevant in the context of schizophrenia. The aim of this study was to contribute to the evaluation of the so-called special phenomena in Rorschach protocols in patients diagnosed with schizophrenia. The sample consisted of ten patients previously diagnosed with ICD-10 F20 who were hospitalised in the Federal District, Brazil, in the Centre for Living and Psychosocial Care (Life Mansion). The participants were chosen in the free choice form by the lead researcher. All were under regular psychiatric care and used medication continuously to treat the illness. Data were analysed according to the interpretative principles of Bruno Klopfer's theoretical and clinical approach. It was found eight fixed special phenomena in the schizophrenic patients' responses to Rorschach tests. All patients responses showed the following special phenomena: confabulation; contamination; named colour; self-referential ideation; referential ideation; looking at the back of the card; perseveration and position response. Normal patients did not present high frequency and intensity of special phenomena in their respective protocols. Taken together, this clinical study supports the conclusion that the Rorschach technique is an important tool for the evaluation of schizophrenic patients.

A utilização do Método de Rorschach no diagnóstico diferencial da Esquizofrenia e Transtorno Dissociativo de Identidade / Using the Rorschach Method in The Differential Diagnosis of Schizophrenia and Dissociative Identity Disorder

RESUMO O objetivo deste artigo foi investigar a prevalência do Transtorno Dissociativo de Identidade (TDI) em dez pacientes diagnosticados com esquizofrenia com característica paranóide, com base no Método de Rorschach. Foram registrados indicadores ou sintomas psicológicos que caracterizaram o diagnóstico diferencial desses pacientes, analisadas diferenças clínicas específicas e verificado o enquadramento dos dados obtidos, com a aplicação da Técnica de Rorschach. Para fins de diagnóstico diferencial, observou-se que dois pacientes apresentaram sintomas diferenciais aos da esquizofrenia, sendo que um deles apresentou sintomas dissociativos, não sendo confirmada a prevalência do TDI entre os esquizofrênicos. No caso da esquizofrenia e do TDI, devido às características similares que apresentam, avaliações multidisciplinares são indicadas para se fazer o diagnóstico diferencial entre eles.

ABSTRACT The aim of this article was to investigate the prevalence of the Dissociative Identity Disorder (DID) in ten patients diagnosed with schizophrenia with paranoid characteristic, based on the Rorschach approach. Psychological symptoms that characterize the differential diagnosis of these patients were registered, specific clinical differences were analyzed and the framework of the data obtained with the application of the Rorschach approach. For purposes of differential diagnosis, it was observed that two patients had differential symptoms to schizophrenia, one of which showed dissociative symptoms, not confirmed the prevalence of DID among schizophrenics. In the case of schizophrenia and DID due to exhibit similar characteristics, multidisciplinary evaluations are set to make a differential diagnosis between them.

Evaluation of periodontitis in hospital outpatients with major depressive disorder. A focus on gingival and circulating cytokines.

An imbalance in stimulated cytokine production is associated with the etiopathogenesis of numerous diseases such as major depressive disorder (MDD) and periodontal disease. Increased cytokine levels have been reported in the gingival crevicular fluid (GCF) of patients with MDD. Thirty-six outpatients with MDD participated in this study. Each outpatient was age-matched (± 3 years) with a healthy control (n=36). The patients were controlled for race and smoking habits. Unstimulated and stimulated interleukin 6 (IL-6), interleukin 1ß (IL-1ß), and interferon-γ (INF-γ) production in whole blood culture (WBC) and IL-6 and IL-1ß levels in the GCF were evaluated. Circulating levels of IL-6 and IL-1ß (unstimulated) as well as GCF IL-1ß were modestly lower in MDD patients, compared to the levels in age-matched controls (Mann-Whitney, p=0.002, 0.0075, ANCOVA, p=0.025, respectively). In the unstimulated group, there was no correlation between the levels of circulating IL-6 and GCF IL-6 (r=0.07, p=0.67), and between the levels of circulating IL-1ß and the IL-1ß level in the CGF (r=-0.08, p=0.63). In the LPS stimulation group, there was no correlation between the levels of circulating levels of IL-6 and GCF IL-6 (r=0. 02, p=0.91) or between the circulating IL-1ß and GCF IL-1ß (r=0.13, p=0.42). We observed modest immunosuppression in MDD patients (evaluated by no stimulation whole blood culture [WBC]), especially in patients with melancholic depression, chronic depression, and severe depression.

Cuidado integral em saúde mental

Esse módulo visa capacitar os profissionais de saúde para atuarem na mobilização da rede interna e externa do território com foco na atenção integral à saúde mental. É constituído por 9 lições com os seguintes conteúdos: rede de atenção à saúde mental; núcleo de apoio a saúde da família (NASF); transtornos mentais comuns; transtorno de ansiedade generalizada; transtorno depressivo; transtorno do pânico; transtorno obsessivo-compulsivo; psicoses; uso, abuso e dependência de substancias psicoativas.

Panic disorder patients have reduced cyclic AMP in platelets.

Little is known about the intracellular mechanisms involved in the pathophysiology of panic disorder (PD). Abnormalities in the cyclic AMP system have been described in several psychiatric disorders but there are no studies in panic patients. We evaluated not only the levels of platelet cyclic AMP, but also cyclic GMP and nitric oxide synthase (NOS) activity in patients with PD at baseline and after treatment with clomipramine and in healthy volunteers. Platelet cyclic AMP was determined by enzymeimmunoassay, cyclic GMP by radioimmunoassay and NOS activity by the conversion of (3)H-arginine to (3)H-citruline in 17 PD patients before treatment with clomipramine, after remission of panic attacks and in 22 healthy volunteers. Average baseline cyclic AMP of PD patients was lower than after remission of panic attacks (P<0.005) and lower than in healthy volunteers (P<0.005). Average cyclic AMP after remission of panic attacks was not significantly different than in healthy volunteers. There were no significant differences in cyclic GMP and NOS analysis. Our results suggest that PD patients without treatment have lower platelets cyclic AMP levels than healthy volunteers and that this decrease may be corrected by clomipramine.

Enhanced glomerular permeability to macromolecules in the Nagase analbuminemic rat.

Plasma albumin restricts capillary water filtration. Accordingly, the glomerular ultrafiltration coefficient is higher in Nagase analbuminemic rats (NAR) than in Sprague-Dawley controls. We investigated whether the glomerular permeability to macromolecules is also enhanced in NAR. SDS-PAGE fractionation of urine proteins showed several bands with molecular masses between 60 and 90 kDa in NAR only. Acute administration of BSA to NAR led to nearly complete disappearance of these proteins from urine, an effect partially reversed when most of the exogenous albumin was cleared from circulation. The fractional clearance of 70-kDa dextran was increased in NAR, indicating a size defect. Binding of cationized ferritin to the glomerular basement membrane was decreased in NAR, suggesting associated depletion of fixed anions. The magnitude of cationic ferritin binding correlated negatively with the fractional clearance of 70-kDa dextran, suggesting that the two abnormalities may share a common pathogenic mechanism. Collectively, these results suggest enhanced glomerular permeability to macromolecules in NAR. Albumin may be necessary to maintain the normal glomerular permselectivity properties.

Nephrotoxicity of Bence-Jones Proteins: correlation with endocytosis by BHK cells and intracellular movement

O objetivo deste trabalho foi avaliar a endocitose de duas proteínas de Bence Jones por células renais, com a finalidade de elucidar a interferência de características físico-químicas na nefrotoxicidade. As proteínas de Bence Jones (denominadas AK e GL) forma purificadas e isoladas da urina de dois pacientes com mieloma múltiplo. Isótopos de ambas as proteínas foram caracterizados como sendo cadeias leves lambda monoclonais humanas. AK, apresentou principalmente pI>7,0, alto conteúdo de galactose e baixo teor de moléculas de ácido siálico. Por outro lado, GL apresentou uma única banda com pI 4,3, maior teor de ácido siálico e baixo teor de galactose, em comparaçäo co AK. Células renais de hamster, BHK(Baby Hamster Kidney) foram mantidas em cultura à temperatura de 37§C, utilizando meio de cultura DMEM suplementado com 10 por cento de sooro fetal bovino, em pH 7,4. Quando confluentes, as células BHK foram incubadas com as duas proteínas dissolvidas em meio isento de soro, durante 1, 5, 15, 30, 60 minutos e 24 horas. Foi omitida a incubaçäo com proteínas de Bence Jones em células usadas como controle. Com o término da incubaçäo, as células foram lavadas, tripsinizadas, centrifugadas e fixadas em soluçäo de paraformaldeído 4, 0 por cento e glutaraldeído 0,5 por cento em tampäp fosfato 0,1M pH 7,4. A seguir, os pellets obtidos foram processados para microscopia e incluídos em LRWhite. Cortes semi-finos foram colhidos e submetidos a reaçöes imunocitoqumícas, utilizando proteína acoplada a ouro coloidal e intensificaçäo pela prata. A detecçäo da amrcaçäo foi avaliada em microscopia de luz. Os resultados mostraram q1ue a proteóna GL tendeu a ser direcionada para localizaçäo pewri-nuclear. Por outro lado, AK demonstrou um comportamento diferente. Os dados indicaram que houve uma contribuiçäo direta das características físico-químicas das proteínas no direcionamento intracelular

Estresse, depressao, alteracoes imunologicas e doenca periodontal / Stress, depression, immune system abnormalities and periodontal disease

Fatores estressores psicossociais e depressao tem sido associados com diminuicao da funcao imunologica e aumento da susceptibilidade a infeccoes e neoplasias. Alguns autores tem encontrado uma relacao importante entrea doenca periodontal e os fatores estressores que pode ser explicada pelas alteracoes em ...