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1.
BMC Psychiatry ; 22(1): 2, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983447

RESUMO

BACKGROUND: There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses' experiences of open and locked working spaces. RESULTS: A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be "invisible". The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople's crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users' abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as 'locked doors' in the community (limited or no care continuity and stigma). CONCLUSIONS: The impact of COVID-19 restrictions on people's crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.


Assuntos
COVID-19 , Transtornos Mentais , Grécia , Humanos , Transtornos Mentais/terapia , Psicoterapia , SARS-CoV-2
2.
J Int Med Res ; 50(1): 3000605211070766, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34994240

RESUMO

OBJECTIVE: To explore the relationship between temperament and character traits in Cloninger's psychobiological theory and mental disorders.Methods: A systematic literature search was conducted of five international databases for all articles published in English between January 1990 and April 2019 (PROSPERO-CRD42019133214). Owing to heterogeneity, pooled estimates of correlations for personality disorders and standardized mean differences for case-control studies related to other mental disorders were calculated using the random-effects method. RESULTS: The pooled effect sizes obtained from 149 studies showed that high harm avoidance (related to 22/24 diagnostic categories), low self-directedness (21/23), low cooperativeness (17/23), high self-transcendence (14/23), low reward dependence (11/24), high novelty-seeking (10/24), low novelty-seeking (7/24), high persistence (2/23), low persistence (2/23) and high reward dependence (2/24) were related to psychopathology. CONCLUSIONS: All traits provided unique psychobiological tools for differential diagnosis of mental disorders. However, high harm avoidance and low self-directedness played a canonical role in psychopathology. Despite the study limitations, additional studies are warranted to evaluate the differential diagnoses suggested by the present model.


Assuntos
Transtornos Mentais , Temperamento , Estudos de Casos e Controles , Caráter , Humanos , Transtornos Mentais/diagnóstico , Inventário de Personalidade
3.
BMC Health Serv Res ; 22(1): 27, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34983508

RESUMO

BACKGROUND: Several interventions have been developed to improve physical health and lifestyle behaviour of people with a severe mental illness (SMI). Recently, we conducted a pragmatic cluster-randomised controlled trial which evaluated the effects of the one-year Severe Mental Illness Lifestyle Evaluation (SMILE) lifestyle intervention compared with usual care in clients with SMI. The SMILE intervention is a 12-month group-based lifestyle intervention with a focus on increased physical activity and healthy food intake. The aim of the current study was to explore the experiences of people with SMI and healthcare professionals (HCPs) regarding implementation feasibility of the SMILE intervention and the fidelity to the SMILE intervention. METHODS: A process evaluation was conducted alongside the pragmatic randomized controlled trial. The experiences of clients and HCPs in the lifestyle intervention group were studied. First, descriptive data on the implementation of the intervention were collected. Next, semi-structured interviews with clients (n = 15) and HCPs (n = 13) were performed. Interviews were audiotaped and transcribed verbatim. A thematic analysis of the interview data was performed using MAXQDA software. In addition, observations of group sessions were performed to determine the fidelity to the SMILE intervention using a standardised form. RESULTS: Ten out of 26 HCPs who conducted the group sessions discontinued their involvement with the intervention, primarily due to changing jobs. 98% of all planned group sessions were performed. Four main themes emerged from the interviews: 1) Positive appraisal of the SMILE intervention, 2) Suggestions for improvement of the SMILE intervention 3) Facilitators of implementation and 4) Barriers of implementation. Both clients and HCPs had positive experiences regarding the SMILE intervention. Clients found the intervention useful and informative. The intervention was found suitable and interesting for all people with SMI, though HCPs sometimes had to tailor the intervention to individual characteristics of patients (e.g., with respect to cognitive functioning). The handbook of the SMILE intervention was perceived as user-friendly and helpful by HCPs. Combining SMILE with daily tasks, no support from other team members, and lack of staff and time were experienced as barriers for the delivery of the intervention. CONCLUSION: The SMILE intervention was feasible and well-perceived by clients and HCPs. However, we also identified some aspects that may have hindered effective implementation and needs to be considered when implementing the SMILE intervention in daily practice.


Assuntos
Transtornos Mentais , Pessoal de Saúde , Humanos , Estilo de Vida , Transtornos Mentais/terapia
4.
Med Clin North Am ; 106(1): 81-97, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823736

RESUMO

Extending from the triple wave epidemic of opioid-related overdose deaths, a fourth wave of high mortality involving methamphetamine and cocaine use has been gathering force. This article provides a review of the published literature on stimulants including epidemiology, pharmacology, neurobiology, medical and psychiatric consequences, withdrawal management, and medical and behavioral treatments.


Assuntos
Estimulantes do Sistema Nervoso Central/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Metanfetamina/efeitos adversos , Overdose de Opiáceos/epidemiologia , Síndrome de Abstinência a Substâncias/terapia , Antagonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Terapia Comportamental/métodos , Bupropiona/uso terapêutico , Estimulantes do Sistema Nervoso Central/farmacologia , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/mortalidade , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/epidemiologia , Comorbidade , Inibidores da Captação de Dopamina/uso terapêutico , Feminino , Humanos , Drogas Ilícitas/efeitos adversos , Drogas Ilícitas/farmacologia , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/epidemiologia , Metanfetamina/farmacologia , Mirtazapina/uso terapêutico , Neurobiologia , Doenças Neurodegenerativas/induzido quimicamente , Doenças Neurodegenerativas/epidemiologia , Overdose de Opiáceos/mortalidade , Topiramato/uso terapêutico , Pessoas Transgênero , Estados Unidos/epidemiologia
7.
Lancet Psychiatry ; 9(1): 59-71, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34921796

RESUMO

BACKGROUND: There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS: In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FINDINGS: We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION: WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING: US National Institute of Mental Health.


Assuntos
Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Análise Custo-Benefício , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , População Rural , Método Simples-Cego , Organização Mundial da Saúde
12.
Med Care ; 60(1): 56-65, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882109

RESUMO

BACKGROUND: Given the wide range of uses for antidepressants, understanding indication-specific patterns of prescription filling for antidepressants provide valuable insights into how patients use these medications in real-world settings. OBJECTIVE: The objective of this study was to determine the association of antidepressant prescription filling with treatment indication, as well as prior prescription filling behaviors and medication experiences. DESIGN: This retrospective cohort study took place in Quebec, Canada. PARTICIPANTS: Adults with public drug insurance prescribed antidepressants using MOXXI (Medical Office of the XXIst Century)-an electronic prescribing system requiring primary care physicians to document treatment indications and reasons for prescription stops or changes. MEASURES: MOXXI provided information on treatment indications, past prescriptions, and prior medication experiences (treatment ineffectiveness and adverse drug reactions). Linked claims data provided information on dispensed medications and other patient-related factors. Multivariable logistic regression models estimated the independent association of not filling an antidepressant prescription (within 90 d) with treatment indication and patients' prior prescription filling behaviors and medication experiences. RESULTS: Among 38,751 prescriptions, the prevalence of unfilled prescriptions for new and ongoing antidepressant therapy was 34.2% and 4.1%, respectively. Compared with depression, odds of not filling an antidepressant prescription varied from 0.74 to 1.57 by indication and therapy status. The odds of not filling an antidepressant prescription was higher among adults filling < 50% of their medication prescriptions in the past year and adults with an antidepressant prescription stopped or changed in the past year due to treatment ineffectiveness. CONCLUSION: Antidepressant prescription filling behaviors differed by treatment indication and were lower among patients with a history of poor prescription filling or ineffective treatment with antidepressants.


Assuntos
Antidepressivos/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Cooperação e Adesão ao Tratamento/psicologia , Antidepressivos/farmacologia , Estudos de Coortes , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Prevalência , Quebeque , Estudos Retrospectivos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos
13.
J Affect Disord ; 296: 59-66, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34592657

RESUMO

BACKGROUND: Severe psychological and psychosocial consequences of the COVID-19 pandemic are expected, especially for people already vulnerable to biological or psychosocial stressors, including those with mental health problems. The study aimed to investigate factors associated with the loss of jobs and unemployment during the COVID-19 pandemic. In particular, we investigated whether mental illness was associated with a higher risk of losing one's job because of the COVID-19 pandemic. METHODS: Nineteen thousand four hundred ninety-six adults living in Italy were administered an online protocol including a sociodemographic checklist and questionnaires investigating suicide ideation and risk, mental health status and general distress (stress, anxiety, and depression), resilience, and perceived support. RESULTS: One thousand two hundred seventy-four reported having lost their job because of the COVID-19 pandemic, and 5.4% of the sample reported a mental illness (mostly a depressive disorder). Unemployment was independently associated with mental illness, poor mental health, and depression. Mental illness was associated with the risk of losing one's job because of the COVID-19 pandemic, but not at the multivariate analyses. Those who lost their job because of the COVID-19 pandemic (compared to others) reported worse mental health and depression. LIMITATIONS: The presence of mental illness was self-reported by respondents and the administered measures were self-reported questionnaires affected by social desirability and other response bias. CONCLUSIONS: The COVID-19 pandemic and social isolation measures and lockdown used to contain its spread among the Italian population were associated with occupational insecurity, especially among the more vulnerable social categories.


Assuntos
COVID-19 , Transtornos Mentais , Adulto , Ansiedade , Controle de Doenças Transmissíveis , Depressão , Humanos , Itália/epidemiologia , Transtornos Mentais/epidemiologia , Pandemias , SARS-CoV-2 , Desemprego
15.
Artigo em Inglês | MEDLINE | ID: mdl-34848503

RESUMO

BACKGROUND AND OBJECTIVES: To understand the course of recovery from coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) and to determine its predictors, including patients' pre-COVID-19 physical and mental health status. METHODS: This prospective and longitudinal cohort study recruited patients with MS who reported COVID-19 from March 17, 2020, to March 19, 2021, as part of the United Kingdom MS Register (UKMSR) COVID-19 study. Participants used online questionnaires to regularly update their COVID-19 symptoms, recovery status, and duration of symptoms for those who fully recovered. Questionnaires were date stamped for estimation of COVID-19 symptom duration for those who had not recovered at their last follow-up. The UKMSR holds demographic and up-to-date clinical data on participants as well as their web-based Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) scores. The association between these factors and recovery from COVID-19 was assessed using multivariable Cox regression analysis. RESULTS: Of the 7,977 patients with MS who participated in the UKMSR COVID-19 study, 599 reported COVID-19 and prospectively updated their recovery status. Twenty-eight hospitalized participants were excluded. At least 165 participants (29.7%) had long-standing COVID-19 symptoms for ≥4 weeks and 69 (12.4%) for ≥12 weeks. Participants with pre-COVID-19 web-EDSS scores ≥7, participants with probable anxiety and/or depression (HADS scores ≥11) before COVID-19 onset, and women were less likely to report recovery from COVID-19. DISCUSSION: Patients with MS are affected by postacute sequelae of COVID-19. Preexisting severe neurologic impairment or mental health problems appear to increase this risk. These findings can have implications in tailoring their post-COVID-19 rehabilitation.


Assuntos
COVID-19/complicações , COVID-19/epidemiologia , Esclerose Múltipla/epidemiologia , Sistema de Registros , Adulto , COVID-19/terapia , Comorbidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Risco , Fatores de Tempo , Reino Unido/epidemiologia
16.
Maturitas ; 155: 63-69, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34876250

RESUMO

BACKGROUND: Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the main causes of disability. Yet, their comorbidity has not received the deserved attention. OBJECTIVE: To investigate the extent of the comorbidity between MDs and MSDs in ageing women using national registries on prescription medications and work disability pensions (DPs). METHODS: The study included 7,809 Finnish women, born during 1932-41, from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort, established in 1989. Lifetime permanent DPs due to: 1) 'MDs only' (n = 359), 2) 'MSDs only' (n = 954), 3) 'MDs + MSDs' (n = 227), were recorded till 2003. The reference group was 'no DP' (n = 6,269). Data from the OSTPRE questionnaires was obtained in 1994. Use of medications was recorded in 1995 and 2003. The use of musculoskeletal or psychotropic medications by women having a DP or medication due to MD, or MSD diagnoses, respectively, was considered as an indicator of comorbidity. RESULTS: In 1995, all DP groups had used psychotropic and musculoskeletal medications more often than the referents. Use of musculoskeletal medications was associated with a higher use of psychotropic medications, and vice versa (OR=2.45; 95% CI 2.17-2.77), compared with non-use. The 'MSDs only' group was more likely to use psychotropic (OR=1.79; 95% CI 1.50-2.12), and the 'MDs only' group musculoskeletal medications (OR=1.38; 95% CI 1.09-1.74), compared with those without DPs. The proportions of medication users were similar in 1995 and 2003; however, the amounts used increased. CONCLUSIONS: There was strong evidence for comorbidity between MDs and MSDs in ageing women. Further research concerning their longitudinal relationships is warranted.


Assuntos
Transtornos Mentais , Doenças Musculoesqueléticas , Envelhecimento , Comorbidade , Feminino , Humanos , Armazenamento e Recuperação da Informação , Transtornos Mentais/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Sistema de Registros , Fatores de Risco
17.
Int J Offender Ther Comp Criminol ; 66(1): 70-83, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33463395

RESUMO

Every year, more children and youths are sent to Secure Children's Homes while moving through the criminal justice system. Aggressive and violent incidents in these settings are common, and staff are often required to intervene and restrain violent individuals. The research literature has many examples of aggression and violence questionnaires and measures; however, for staff in communal areas it is the observable behaviors that they react to most. The current research, therefore, analyzed observable behaviors leading-up to violent episodes, and used Behavior Sequence Analysis to highlight the typical chains of behaviors that tend toward violence. The outcomes of this research show pathways to violence that staff can use to highlight potential spirals of aggression and violence. The current results show the links between non-confrontational behaviors (e.g., talking) through to more confrontational (staring, approaching, and pushing others). Overall, the research forms the foundation for future investigation into these and similar settings and outlines a novel approach to understanding violence escalation in a way that can be interpreted and used by service staff.


Assuntos
Agressão , Transtornos Mentais , Adolescente , Criança , Humanos , Análise de Sequência , Inquéritos e Questionários , Violência
18.
Sci Total Environ ; 804: 150222, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34520928

RESUMO

Using one-night sleep recordings from 852 subjects all living in Uppsala, Sweden, the present study represents one of the largest polysomnography investigations into the association of the 29.53-day long lunar cycle with sleep among men and women and across a wide age range (22-81 years). Following the day after the new moon until the day of the full moon (also named the waxing period), the moon's illumination increases, and the timing of the meridian of the moon is gradually shifted from noontime toward midnight. In contrast, from the day after the full moon until the day of the new moon (also named the waning period), the moon's illumination decreases, and the timing of the meridian of the moon is gradually shifted from early night hours toward noontime. Thus, we focused on the contrast between the waxing and waning periods. Sleep duration was shorter on nights during the waxing period as compared to waning period (P < 0.001). In addition, a significant interaction effect of participants' sex with the lunar period on sleep was noted (P < 0.05). Men, but not women, exhibited lower sleep efficiency (P < 0.001 and P = 0.748, respectively) and were longer awake after sleep onset (P = 0.010 and P = 0.890, respectively) on nights during the waxing period. All associations were robust to adjustment for confounders (including regular sleep disturbances). Our findings suggest that the effects of the lunar cycle on human sleep are more pronounced among men. Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations.


Assuntos
Transtornos Mentais , Lua , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sono , Suécia , Adulto Jovem
19.
J Palliat Care ; 37(1): 13-14, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34154461

RESUMO

There are a small number of articles in the literature discussing palliative and end-of-life care in the SMI population. Most tackle the questions relating to competency to refuse care in end-stage anorexia or terminal medical conditions. This is a case review of a 55 year old patient with a complex psychiatric and medical history, who despite extensive treatment and long hospitalizations has failed to regain any ability to care for her basic needs. She has exhausted all available treatment options and her prognosis is extremely poor. The mental health community is resistant to discussing and/ or confronting the fact that such a patient faces with the need for end-of-life care directly related to chronic psychiatric illness.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Transtornos Mentais , Assistência Terminal , Doença Crônica , Feminino , Humanos , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Cuidados Paliativos
20.
Chem Biol Interact ; 352: 109794, 2022 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-34963564

RESUMO

Noscapine is a phthalide isoquinoline alkaloid with antitussive activity. Noscapine protects oligodendroglia from ischemic and chemical injury, binds to bitter taste receptors, antagonizes the bradykinin and histaminergic systems, which may be of benefit in treatment of multiple sclerosis. Noscapine normalizes axonal transport and exerts significant therapeutic efficacy in animal models of Parkinson's Disease and Amyotrophic Lateral Sclerosis. Noscapine exerts neuroprotective effects on oxygen- and glucose-deprived fetal cortical neuronal cells and reduces ischemic brain damage in neonatal rat pups. Pilot clinical studies indicated some beneficial effects of noscapine in stroke. Noscapine harbours anxiolytic activity and methyl-noscapine blocks small conductance SK channels, which is beneficial in alleviating anxiety and depression. Noscapine exerts anticholinesterase activity and acts inhibitory on the inflammatory transcription factor NF-κB, which may be harnessed in treatment of Alzheimer's Disease. With its blood-brain barrier traversing features and versatile actions, noscapine may be a promising agent in the armamentarium against neurodegenerative and psychiatric diseases.


Assuntos
/farmacologia , Fármacos Neuroprotetores/farmacologia , Noscapina/farmacologia , Doença de Alzheimer/tratamento farmacológico , Esclerose Amiotrófica Lateral/tratamento farmacológico , Animais , Bradicinina/metabolismo , Antagonistas dos Receptores Histamínicos/farmacologia , Humanos , Canais Iônicos/efeitos dos fármacos , Transtornos Mentais/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Doenças Neurodegenerativas/tratamento farmacológico , Noscapina/administração & dosagem , Noscapina/sangue , Oligodendroglia/efeitos dos fármacos , Transtornos Parkinsonianos/tratamento farmacológico , Receptores Acoplados a Proteínas G/metabolismo , Transdução de Sinais/efeitos dos fármacos , Acidente Vascular Cerebral/tratamento farmacológico
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