RESUMO
Bipolar disorder (BD) is a severe chronic psychiatric disorder that has been associated with cellular dysfunctions related to mitochondria, neurotrophin levels, and oxidative stress. Evidence has shown that endoplasmic reticulum (ER) stress may be a common pathway of the cellular changes described in BD. In the present study we assessed unfolded protein response (UPR) and the effects of this cellular process on lymphocytes from patients with BD. We also evaluated whether the stage of chronicity of BD was associated with changes in UPR parameters. Cultured lymphocytes from 30 patients with BD and 32 age- and sex-matched controls were treated with tunicamycin, an ER stressor, for 12 or 24 h to measure levels of UPR-related proteins (GRP78, eIF2α-P, and CHOP) using flow cytometry, and for 48 h to analyse ER stress-induced cell death. In healthy controls but not in patients we found an increase in levels of GRP78, eIF2α-P, and CHOP after ER stress induction. In addition, tunicamycin-induced cell death was significantly higher in patients compared to controls. More importantly, early-stage patients did not differ from controls while the late-stage patients showed an impaired ER stress response. Thus, dysfunction in ER-related stress response may be associated with decreased cellular resilience in BD and illness progression.
Assuntos
Transtorno Bipolar/patologia , Estresse do Retículo Endoplasmático/fisiologia , Linfócitos/fisiologia , Adulto , Transtorno Bipolar/tratamento farmacológico , Estudos de Casos e Controles , Sobrevivência Celular , Progressão da Doença , Chaperona BiP do Retículo Endoplasmático , Feminino , Citometria de Fluxo , Proteínas de Choque Térmico/metabolismo , Humanos , Linfócitos/ultraestrutura , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fator de Transcrição CHOP/metabolismo , Fatores de Transcrição/metabolismo , Tunicamicina , Resposta a Proteínas não Dobradas/fisiologiaRESUMO
There is evidence that the brain-derived neurotrophic factor (BDNF) has implications for the pathophysiology of major depressive disorders (MDD). Measures of BDNF levels are highly dependent on the methodologies used and these vary among different studies. Therefore, the aim of this study was to carry out a descriptive analysis of the methodologies used to measure BDNF in clinical trials (CT) in patients with the diagnosis of major depression. We conducted a qualitative systematic review of CT that included samples of subjects diagnosed with major depression and evaluated the BDNF levels as an outcome. The search was performed on Pubmed, Scielo, Psychinfo and Lilacs. The selected articles were analyzed according to the CONSORT Statement and their methods of BDNF collection and analysis were described. Twenty-eight studies were included in the final analysis. Of those, 6 trials (21.4%) involved non-pharmacological interventions and only half had the MDD diagnosis based on structured interview. Trials used different methods to evaluate BDNF levels: most of them verified serum BDNF levels, 17 (60.7%) trials mentioned that measured BDNF levels in duplicate and 9 (32.1%) collected blood in fasting. A variety of methods for BDNF collection and analysis was used in the different studies, making it difficult to compare results. However, despite of the methodology, BDNF seems to increase after treatment for major depression.
Assuntos
Fator Neurotrófico Derivado do Encéfalo/análise , Ensaios Clínicos como Assunto , Transtorno Depressivo Maior/metabolismo , Antidepressivos/uso terapêutico , Biomarcadores/análise , Fator Neurotrófico Derivado do Encéfalo/sangue , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Pesquisa Qualitativa , Kit de Reagentes para Diagnóstico , Manejo de Espécimes/métodos , Resultado do TratamentoRESUMO
Randomized clinical trial (RCT) is the best study design for treatment-related issues, yet these studies may present a number of biases and limitations. The objective of this study is to carry out a qualitative analysis of RCT methodology in the treatment of bipolar depression (BD). A systematic review covering the last 20 years was performed on PubMed selecting double-blind RCTs for BD. The identification items of the articles, their design, methodology, outcome and grant-related issues were all analyzed. Thirty articles were included, all of which had been published in journals with an impact factor >3. While almost half studies (46.7%) used less than 50 patients as a sample, 70% did not describe or did not perform sample size calculation. The Last Observation Carried Forward (LOCF) method was used in 2/3 of the articles and 53.4% of the studies had high sample losses (>20%). Almost half the items were sponsored by the pharmaceutical industry and 33.3% were sponsored by institutions or research foundations. Articles on the pharmacological treatment of BD have several limitations which hinder the extrapolation of the data to clinical practice. Methodological errors and biases are common and statistical simplifications compromise the consistency of the findings.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Apoio à Pesquisa como Assunto , Viés , Transtorno Bipolar/epidemiologia , Interpretação Estatística de Dados , Método Duplo-Cego , Humanos , Fator de Impacto de Revistas , Resultado do TratamentoRESUMO
BACKGROUND: Cocaine and amphetamine-regulated transcript (CART) is an endogenous antioxidant present since the embryonic period. CART is activated by high levels of dopamine and might be of interested in understanding the changes in the REDOX system associated with crack/cocaine intake. The goal of this study was to determine whether exposure to crack in utero is associated with increased CART levels. METHODS: In this cross-sectional study with consecutive sampling, we compared the umbilical cord blood (UCB) CART levels (µg/mL) of newborns exposed to crack/cocaine in utero (EN, n = 57) to levels in non-exposed newborns (NEN, n = 99). In addition, we compared serum CART levels between EN and NEN mothers, in the immediate postpartum period. Potential confounders, such as perinatal data (e.g., weight, Apgar, etc.), psychopathology (DSM-IV), and use of drugs other than crack (ASSIST) were assessed. RESULTS: According to general linear model analysis, the adjusted mean CART was significantly higher in EN (0.180, 95% CI 0.088-0.272) than in NEN (0.048, 95% CI 0.020-0.076; p < 0.002; d = 0.68). The difference in CART levels between EN and NEN mothers was not significant (p ≥ 0.05). CONCLUSION: The increase in CART levels in EN UBC suggests a response to crack/cocaine-induced oxidative stress during gestational period, as a potential attempt of neuroprotection. In adult women in puerperium, however, this endogenous antioxidant recruitment does not seem to operate.
Assuntos
Cocaína Crack/farmacologia , Sangue Fetal/metabolismo , Proteínas do Tecido Nervoso/sangue , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Período Pós-Parto , GravidezRESUMO
INTRODUCTION: The objective of this study was to compare patients with bipolar disorder (BD), their first-degree relatives and a group of healthy controls in terms of use of adaptive and maladaptive coping strategies, exploring differences between specific types of strategies and their correlations with clinical variables. METHODS: This was a cross-sectional study enrolling 36 euthymic patients with BD, 39 of their first-degree relatives and 44 controls. Coping strategies were assessed using the Brief COPE scale. RESULTS: Significant differences were detected in the use of adaptive and maladaptive strategies by patients, their first-degree relatives and controls. Patients used adaptive strategies less often than the patients' relatives (p<0.001) and controls (p = 0.003). There was no significant difference between first-degree relatives and controls (p=0.707). In contrast, patients (p<0.001) and their relatives (p=0.004) both exhibited higher scores for maladaptive coping than controls. There was no significant difference regarding the use of maladaptive strategies between patients and their relatives (p=0.517). CONCLUSIONS: First-degree relatives were at an intermediate level between patients with BD and controls regarding the use of coping skills. This finding supports the development of psychosocial interventions to encourage use of adaptive strategies rather than maladaptive strategies in this population.
Assuntos
Adaptação Psicológica , Transtorno Bipolar/psicologia , Família , Estudos Transversais , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Childhood trauma (CT) is a modifiable risk factor for lifetime suicide attempts (SA). However, the extent to which each type of CT increases SA risk is unclear. This study aimed to conduct a meta-analysis of longitudinal studies published in the last 10 years about the relationship between CT and lifetime SA risk. The PUBMED, PsycINFO, ISI, and EMBASE databases were searched for cohort studies that reported AS during follow-up and included an assessment of CT. A meta-analysis was conducted to identify potential effects of each type of CT on SA. Seven unique studies were included for review. Sexual (n=6, OR=3.73, 95%CI 2.94-4.75, p<0.001), physical (n=6, OR=4.11, 95%CI 2.30-7.33, p<0.001), and emotional abuse (n=3, OR=3.98, 95%CI 2.89-5.64, p<0.001), as well as physical neglect (n=2, OR=3.42, 95%CI 2.09-5.59, p<0.001), were associated with SA. Emotional neglect and a broken home were not significantly associated with further SA. The modes of CT that most contribute to SA in later life are physical, emotional, and sexual abuse and physical neglect, in descending order.
Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Maus-Tratos Infantis/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Adulto JovemRESUMO
INTRODUCTION: Acute stress disorder (ASD) encompasses a set of symptoms that can arise in individuals after exposure to a traumatic event. This study assessed the defense mechanisms used by victims of physical trauma who developed ASD. METHOD: This was a controlled cross-sectional study of 146 patients who suffered physical trauma and required hospitalization. A structured questionnaire was used to evaluate ASD symptoms based on DSM-5 diagnostic criteria, in addition to the Defense Style Questionnaire (DSQ). RESULTS: Ten participants (6.85%) received a positive diagnosis of ASD, and 136, (93.15%) a negative diagnosis. The majority of the sample consisted of men with median age ranging from 33.50 to 35.50. The most prevalent defense mechanisms among the 10 patients with ASD were cancellation and devaluation, which belong to the neurotic and immature factors, respectively. Positive associations between the presence of symptoms from criterion B of the DSM-5 and defense mechanisms from the DSQ were found. These included the mechanisms of undoing, projection, passive aggression, acting out, autistic fantasy, displacement, and somatization. CONCLUSION: Patients with ASD employed different defense mechanisms such as undoing and devaluation when compared to patients not diagnosed with ASD. These results mark the importance of early detection of ASD symptoms at a preventative level, thereby creating new possibilities for avoiding exacerbations related to the trauma, which represents an important advance in terms of public health.
Assuntos
Mecanismos de Defesa , Transtornos de Estresse Traumático Agudo/psicologia , Adulto , Estudos Transversais , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Traumático Agudo/diagnóstico , Transtornos de Estresse Traumático Agudo/epidemiologia , Transtornos de Estresse Traumático Agudo/terapia , Inquéritos e Questionários , Adulto JovemRESUMO
AIMS: To measure the variation in Brain-Derived Neurotrophic Factor (BDNF), Thiobarbituric Acid Reactive Substances (TBARS) and interleukin (IL) levels in crack-cocaine dependent adolescents after 21days of abstinence, comparing to levels found in a group of healthy controls. DESIGN: Cross-sectional nested on a short follow-up study. SETTING: Two inpatient treatment units for adolescents, and a low-income neighborhood. PARTICIPANTS: 90 adolescents, of both genders, with diagnosis of crack cocaine dependence, and 81 healthy adolescents. MEASUREMENTS: Serum levels of IL-6, IL-10, TBARS and BDNF were assessed on admission and discharge. Drug addiction severity was assessed by the Addiction Severity Index - Teen Version (T-ASI) and Cocaine Craving Questionnaire - Brief version (CCQ-b). Psychiatric comorbidities were assessed by the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Generalized Estimating Equations (GEE) were used to estimate the IL-6, IL-10, TBARS and BDNF levels, adjusted for confounders. Hedges' g was used to estimate effect size. FINDINGS: TBARS (p=0.005, d=0.04), IL-6 (p=0.027, d=0.40) and IL-10 (p=0.025, d=0.41) were elevated and BDNF (p<0.001, d=0.62) was reduced (p<0.001), in patients, in comparison to controls, at admission time. Variation in those levels between admission and discharge were not significant. CONCLUSIONS: Crack-cocaine use seems to be associated with inflammatory and oxidative imbalances in adolescents.
Assuntos
Comportamento do Adolescente , Transtornos Relacionados ao Uso de Cocaína/sangue , Transtornos Relacionados ao Uso de Cocaína/terapia , Cocaína Crack/administração & dosagem , Adolescente , Comportamento do Adolescente/psicologia , Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/sangue , Criança , Transtornos Relacionados ao Uso de Cocaína/psicologia , Comorbidade , Estudos Transversais , Feminino , Seguimentos , Humanos , Interleucina-10/sangue , Interleucina-6/sangue , MasculinoRESUMO
INTRODUCTION: Prenatal cocaine exposure (PCE) is associated with neurobehavioral problems during childhood and adolescence. Early activation of the inflammatory response may contribute to such changes. Our aim was to compare inflammatory markers (IL-6 and IL-10) both in umbilical cord blood and in maternal peripheral blood at delivery between newborns with history of crack/cocaine exposure in utero and non-exposed newborns. METHODS: In this cross-sectional study, 57 newborns with a history of crack/cocaine exposure in utero (EN) and 99 non-exposed newborns (NEN) were compared for IL-6 and IL-10 levels. Sociodemographic and perinatal data, maternal psychopathology, consumption of nicotine and other substances were systematically collected in cases and controls. RESULTS: After adjusting for potential confounders, mean IL-6 was significantly higher in EN than in NEN (10,208.54, 95% confidence interval [95%CI] 1,328.54-19,088.55 vs. 2,323.03, 95%CI 1,484.64-3,161.21; p = 0.007; generalized linear model [GLM]). Mean IL-10 was also significantly higher in EN than in NEN (432.22, 95%CI 51.44-812.88 vs. 75.52, 95%CI 5.64-145.39, p = 0.014; GLM). Adjusted postpartum measures of IL-6 were significantly higher in mothers with a history of crack/cocaine use (25,160.05, 95%CI 10,958.15-39,361.99 vs. 8,902.14, 95%CI 5,774.97-12,029.32; p = 0.007; GLM), with no significant differences for IL-10. There was no correlation between maternal and neonatal cytokine levels (Spearman test, p ≥ 0.28 for all measures). CONCLUSIONS: IL-6 and IL-10 might be early biomarkers of PCE in newborns. These findings could help to elucidate neurobiological pathways underlying neurodevelopmental changes and broaden the range of possibilities for early intervention.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína Crack , Sangue Fetal/metabolismo , Interleucina-10/sangue , Interleucina-6/sangue , Complicações na Gravidez/sangue , Adulto , Biomarcadores/sangue , Transtornos Relacionados ao Uso de Cocaína/sangue , Cordocentese , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Período Pós-Parto , GravidezRESUMO
OBJECTIVE: To describe the clinical characteristics of adolescents with crack cocaine dependence and possible predictors of transition from drug experimentation to crack cocaine dependence. METHODS: This cross-sectional study enrolled a consecutive sample of 90 adolescents admitted to a psychiatric inpatient unit in the city of Porto Alegre in southern Brazil for crack cocaine detoxification between May 2011 and November 2012. Comorbid psychological conditions were assessed using the Kiddie-SADS-Present and Lifetime Version, and severity of drug use was assessed using the Teen Addiction Severity Index (T-ASI). Comorbidities were compared with those in a community sample of non-drug using controls (n = 81). RESULTS: Patients' mean age was 15.6 years (85.6% boys, 14.4% girls). Seventy-nine (93.2%) met criteria for cocaine dependence (DSM-IV-TR), while 78 (91.8%) had symptoms consistent with cocaine abuse. All patients had experimented with at least 1 other addictive substance before crack cocaine: 61.4%, tobacco (mean age at first use = 11.61 years); 44.3%, alcohol (age at first use = 12.43 years); and 54.5%, cannabis (age at first use = 12.15 years). Patients had used crack cocaine 23.2 days in the last month, and the mean age at first use of crack cocaine was 13.38 years. The most common psychiatric comorbidity was conduct disorder (81.8%), followed by oppositional defiant disorder (52.3%) and attention-deficit/hyperactivity disorder (44.3%), all of which were more prevalent in the patient population than in controls (P < .001). The T-ASI questionnaire showed severe consequences of drug use in most areas of life assessed. The mean time between onset of drug experimentation and crack cocaine dependence was 2.53 (SD = 1.96) years. When Cox regression models were applied, we found that predictors of earlier progression to using crack cocaine were age at first use of any drug (hazard ratio [HR] = 0.79 [95% CI, 0.71-0.88]; P < .001) and age at admission (HR = 0.7 [95% CI, 0.57-0.87]; P = .001). CONCLUSIONS: Patients were found to have a multitude of comorbid conditions, which supports the idea of treatment by a multidisciplinary health care team. For each year of delay in the age at first drug use, the chance of crack cocaine initiation is reduced by 18%. Prevention programs aimed at delaying experimentation with addictive substances, especially "gateway" drugs, could delay the progression to crack cocaine dependence.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Cocaína Crack , Adolescente , Idade de Início , Brasil , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Transtornos Relacionados ao Uso de Cocaína/reabilitação , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Fatores de Risco , Fumar/epidemiologia , Fumar/psicologia , Meio Social , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Abstract Introduction: The objective of this study was to compare patients with bipolar disorder (BD), their first-degree relatives and a group of healthy controls in terms of use of adaptive and maladaptive coping strategies, exploring differences between specific types of strategies and their correlations with clinical variables. Methods: This was a cross-sectional study enrolling 36 euthymic patients with BD, 39 of their first-degree relatives and 44 controls. Coping strategies were assessed using the Brief COPE scale. Results: Significant differences were detected in the use of adaptive and maladaptive strategies by patients, their first-degree relatives and controls. Patients used adaptive strategies less often than the patients' relatives (p<0.001) and controls (p = 0.003). There was no significant difference between first-degree relatives and controls (p=0.707). In contrast, patients (p<0.001) and their relatives (p=0.004) both exhibited higher scores for maladaptive coping than controls. There was no significant difference regarding the use of maladaptive strategies between patients and their relatives (p=0.517). Conclusions: First-degree relatives were at an intermediate level between patients with BD and controls regarding the use of coping skills. This finding supports the development of psychosocial interventions to encourage use of adaptive strategies rather than maladaptive strategies in this population.
Resumo Introdução: O objetivo deste estudo foi comparar os pacientes com transtorno bipolar (TB), seus familiares de primeiro grau e um grupo de controles saudáveis em termos de uso de estratégias adaptativas e não adaptativas, explorando diferenças entre tipos específicos de estratégias e suas correlações com variáveis clínicas. Métodos: Estudo transversal, envolvendo 36 pacientes com TB eutímicos, 39 familiares de primeiro grau e 44 controles. As estratégias de enfrentamento foram avaliadas usando a escala Brief COPE. Resultados: Foram detectadas diferenças significativas no uso de estratégias adaptativas e não adaptativas por pacientes, seus familiares e controles. Os pacientes usaram estratégias adaptativas com menos frequência do que os familiares (p<0,001) e controles (p=0,003). Não houve diferença significativa entre familiares dos pacientes e controles (p=0,707). Por outro lado, os pacientes (p<0,001) e seus familiares (p=0,004) exibiram pontuações mais elevadas para coping não adaptativo em relação aos controles. Não houve diferença significativa quando os pacientes foram comparados com seus familiares (p=0,517). Conclusões: Familiares de primeiro grau estavam em um nível intermediário entre pacientes com TB e controles no que diz respeito ao uso de habilidades de enfrentamento. Esta descoberta apoia o desenvolvimento de intervenções psicossociais para incentivar o uso de estratégias adaptativas em vez de estratégias inadequadas nessa população.
Assuntos
Humanos , Masculino , Feminino , Transtorno Bipolar/psicologia , Adaptação Psicológica , Família/psicologia , Estudos Transversais , Pessoa de Meia-IdadeRESUMO
INTRODUÇÃO: No Brasil, o uso de crack permanece um desafio à saúde pública devido à facilidade de aquisição da droga e sua elevada capacidade de induzir dependência. A exposição intrauterina (EIU) à cocaína está associada a alterações neurocomportamentais durante a infância e adolescência. Em estudo prévio do nosso grupo, achou-se menor nível de estresse oxidativo (EO) em recém-nascidos (RN) com EIU. Uma possível explicação pode ser a Cocaine and Amphetamine Regulated Transcript (CART), um antioxidante endógeno presente desde o período embrionário e ativado por maiores níveis de dopamina. OBJETIVO: Verificar a correlação entre os níveis de CART no sangue de cordão umbilical (SCU) e sangue periférico de 57 gestantes com exposição ao crack. MÉTODOS: Trata-se de um estudo transversal, com amostragem consecutiva, em que o desfecho primário foi a correlação entre os níveis de CART no SCU e sangue periférico materno no pós-parto imediato. Dados gestacionais e perinatais foram sistematicamente coletados. RESULTADOS: Houve correlação significativa entre os níveis de CART no sangue de cordão umbilical e sangue periférico materno (rs= 0,350 e p<0,05). CONCLUSÕES: Estes achados demonstram que os níveis de CART no sangue materno e no SCU se correlacionam. Todavia, não se pode afirmar de quem é a produção, ou se é produzida por ambos. O presente trabalho pode ajudar a elucidar os caminhos neurobiológicos responsáveis pelas alterações de neurodesenvolvimento, contribuindo para a ampliação das possibilidades de intervenções precoces.
INTRODUCTION: The use of crack cocaine remains a public health challenge in Brazil, due to easy drug acquisition and its high ability to induce dependence. Intrauterine exposure (IUE) to crack cocaine is associated with neurobehavioral changes during childhood and adolescence. In a previous study of our group, lower levels of oxidative stress (OS) were found in newborns with IUE. One possible explanation may be the Cocaine and Amphetamine Regulator Transcript (CART), an endogenous antioxidant present since the embryonic period activated by higher levels of dopamine. OBJECTIVE: The aim of this study is to investigate the correlation of CART levels between umbilical cord blood (UCB) and peripheral blood samples of 57 pregnant women exposed to crack. METHODS: This is a cross-sectional study with a consecutive sampling, in which the primary outcome was the correlation between CART levels in UCB and peripheral blood of their mothers in immediate postpartum. Gestational and perinatal data were systematically collected. Spearman correlation test was performed after checking the pattern of distribution, being considered a 0.05 significance level. RESULTS: There was a significant correlation between CART levels in umbilical cord blood and peripheral blood (rs = 0.350 and p <0.05). CONCLUSIONS: These findings suggest a correlation between CART levels at UCB and mother's blood. However, it remains unclear whether it is produced by the mother, the fetus, or both. This study may help to elucidate the neurobiological pathways responsible for neurodevelopmental changes, providing a rationale for early interventions.
Assuntos
Cocaína Crack , Sangue Fetal , Estresse Oxidativo , GravidezRESUMO
Abstract Introduction: Acute stress disorder (ASD) encompasses a set of symptoms that can arise in individuals after exposure to a traumatic event. This study assessed the defense mechanisms used by victims of physical trauma who developed ASD. Method: This was a controlled cross-sectional study of 146 patients who suffered physical trauma and required hospitalization. A structured questionnaire was used to evaluate ASD symptoms based on DSM-5 diagnostic criteria, in addition to the Defense Style Questionnaire (DSQ). Results: Ten participants (6.85%) received a positive diagnosis of ASD, and 136, (93.15%) a negative diagnosis. The majority of the sample consisted of men with median age ranging from 33.50 to 35.50. The most prevalent defense mechanisms among the 10 patients with ASD were cancellation and devaluation, which belong to the neurotic and immature factors, respectively. Positive associations between the presence of symptoms from criterion B of the DSM-5 and defense mechanisms from the DSQ were found. These included the mechanisms of undoing, projection, passive aggression, acting out, autistic fantasy, displacement, and somatization. Conclusion: Patients with ASD employed different defense mechanisms such as undoing and devaluation when compared to patients not diagnosed with ASD. These results mark the importance of early detection of ASD symptoms at a preventative level, thereby creating new possibilities for avoiding exacerbations related to the trauma, which represents an important advance in terms of public health.
Resumo Introdução: O transtorno de estresse agudo (TEA) reúne um conjunto de sintomas que pode surgir nos indivíduos após exposição a um evento traumático. Este estudo verificou a relação entre o estilo defensivo e o desenvolvimento de TEA e seus sintomas em uma amostra de pacientes que sofreram trauma físico. Métodos: Este estudo transversal controlado envolveu 146 pacientes que sofreram trauma físico e necessitaram hospitalização. Um questionário estruturado foi utilizado para avaliar sintomas de TEA, baseado nos critérios diagnósticos do DSM-5, além do Questionário de Estilo Defensivo (Defense Style Questionnaire - DSQ). Resultados: Dez (6,85%) pacientes tiveram diagnóstico positivo para TEA, e 136 (93,15%), diagnóstico negativo. A maioria da amostra foi composta por homens com idade mediana variando de 33,50 a 35,50. Nos 10 pacientes positivos para TEA, destacou-se a maior utilização de mecanismos de defesa de anulação e desvalorização, pertencentes ao fator neurótico e ao fator imaturo, respectivamente. Foram observadas associações positivas entre presença de sintomas de TEA do critério B do DSM-5 e os mecanismos de defesa do DSQ, sobretudo nos mecanismos de anulação, projeção, agressão passiva, acting out, fantasia autística, deslocamento e somatização. Conclusão: Pacientes com TEA utilizaram mais mecanismos de defesa do tipo anulação e desvalorização quando comparados aos pacientes sem diagnóstico de TEA. Ressalta-se a importância da detecção precoce de sintomas de TEA a fim de evitar outros agravos relacionados ao trauma, o que representa uma importante evolução em termos de saúde pública.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Mecanismos de Defesa , Transtornos de Estresse Traumático Agudo/psicologia , Estudos Transversais , Inquéritos e Questionários , Transtornos de Estresse Traumático Agudo/diagnóstico , Transtornos de Estresse Traumático Agudo/terapia , Transtornos de Estresse Traumático Agudo/epidemiologia , Serviços Médicos de Emergência , Pessoa de Meia-IdadeRESUMO
Introduction Prenatal cocaine exposure (PCE) is associated with neurobehavioral problems during childhood and adolescence. Early activation of the inflammatory response may contribute to such changes. Our aim was to compare inflammatory markers (IL-6 and IL-10) both in umbilical cord blood and in maternal peripheral blood at delivery between newborns with history of crack/cocaine exposure in utero and non-exposed newborns. Methods In this cross-sectional study, 57 newborns with a history of crack/cocaine exposure in utero (EN) and 99 non-exposed newborns (NEN) were compared for IL-6 and IL-10 levels. Sociodemographic and perinatal data, maternal psychopathology, consumption of nicotine and other substances were systematically collected in cases and controls. Results After adjusting for potential confounders, mean IL-6 was significantly higher in EN than in NEN (10,208.54, 95% confidence interval [95%CI] 1,328.54-19,088.55 vs. 2,323.03, 95%CI 1,484.64-3,161.21; p = 0.007; generalized linear model [GLM]). Mean IL-10 was also significantly higher in EN than in NEN (432.22, 95%CI 51.44-812.88 vs. 75.52, 95%CI 5.64-145.39, p = 0.014; GLM). Adjusted postpartum measures of IL-6 were significantly higher in mothers with a history of crack/cocaine use (25,160.05, 95%CI 10,958.15-39,361.99 vs. 8,902.14, 95%CI 5,774.97-12,029.32; p = 0.007; GLM), with no significant differences for IL-10. There was no correlation between maternal and neonatal cytokine levels (Spearman test, p ≥ 0.28 for all measures). Conclusions IL-6 and IL-10 might be early biomarkers of PCE in newborns. These findings could help to elucidate neurobiological pathways underlying neurodevelopmental changes and broaden the range of possibilities for early intervention.
Introdução A exposição pré-natal à cocaína está associada a problemas neurocomportamentais durante a infância e adolescência. A ativação precoce da resposta inflamatória pode contribuir para tais alterações. Nosso objetivo foi comparar marcadores inflamatórios (IL-6 e IL-10) no sangue do cordão umbilical e no sangue periférico materno na hora do parto, entre recém-nascidos expostos ao crack intraútero e recém-nascidos não expostos. Métodos Neste estudo transversal, 57 recém-nascidos expostos ao crack intraútero (RNE) e 99 recém-nascidos não expostos (RNNE) foram comparados quanto aos níveis de IL-6 e IL-10. Dados sociodemográficos e perinatais, psicopatologia materna, consumo de nicotina e outras substâncias foram sistematicamente coletados em casos e controles. Resultados Após o ajuste para potenciais confundidores, a média de IL-6 foi significativamente maior nos RNE em comparação aos RNNE [10.208,54, intervalo de confiança (IC95%) 1.328,54-19.088,55 versus2.323,03, IC95% 1.484,64-3.161,21; p = 0,007; modelo linear generalizado (MLG)]. A média ajustada de IL-10 foi significativamente maior nos RNE do que nos RNNE (432,2189, IC95% 51,44-812,88 versus 75,52, IC95% 5,64-145,39, p = 0,014; MLG). Medidas pós-parto ajustadas de IL-6 foram significativamente maiores nas mães que usaram de crack/cocaína (25.160,05, IC95% 10.958,15-39.361,99 versus 8.902,14, IC95% 5.774,97-12.029,32; p = 0,007; MLG), sem diferenças significativas para IL-10. Não houve correlação entre níveis maternos e neonatais de citocinas (teste de Spearman, p ≥ 0,28 para todas as medidas). Conclusões IL-6 e IL-10 podem ser biomarcadores precoces da exposição pré-natal a cocaína em recém-nascidos. Esses resultados podem ajudar a elucidar as vias neurobiológicas subjacentes a alterações do desenvolvimento e aumentar a gama de possibilidades para intervenção precoce.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Complicações na Gravidez/sangue , Interleucina-6/sangue , Interleucina-10/sangue , Cocaína Crack , Transtornos Relacionados ao Uso de Cocaína/complicações , Sangue Fetal/metabolismo , Biomarcadores/sangue , Modelos Lineares , Estudos Transversais , Cordocentese , Transtornos Relacionados ao Uso de Cocaína/sangue , Período Pós-PartoRESUMO
O objetivo deste estudo é reunir os ensaios clínicos que envolveram alguma modalidade de Psicoterapia Psicanalítica publicados no período compreendido entre julho de 2008 e julho de 2013. Pretendemos identificar quais as modalidades contempladas, qual a população mais estudada, quais os fatores de interesse mais estudados, que localidades apresentam maior produção e quais os principais resultados encontrados. A revisão foi realizada em julho de 2013, através das bases de dados PsycINFO, Embase e Pubmed. Foram selecionados 27 estudos. O número de ECRs em PP encontrado nesta revisão pode ser considerado pequeno, o que possivelmente reflete uma preferência por outros delineamentos de pesquisa na avaliação dos resultados das técnicas psicanalíticas. A pesquisa em PP parece ser veiculada predominantemente através de periódicos acessados muitas vezes apenas por outros pesquisadores. Porém, o difícil acesso pode não ser a única razão por trás da reconhecida dissociação entre academia e prática clínica: a linguagem utilizada nos artigos encontrados nesta revisão pressupõe amplo conhecimento de termos de uso restrito de pesquisadores. Acreditamos que esta revisão pode ser útil para uma geração de terapeutas e pesquisadores que desejam trabalhar em sincronia com o avanço do conhecimento científico.(AU)
This systematic review aims at gathering all the psychoanalytic psychotherapy clinical trials published in the period between July 2008 and July 2013. We intend to identify which modalities were contemplated, the most studied population, the most studied factors of interest, the locations with higher production and the main results. The search was conducted in July 2013 on the following databases: Embase, Pubmed, and PsycINFO. Twenty-seven studies were selected. The number of RCTs in PP found in this review can be considered small, which may reflect a preference for other research designs in evaluating the results of psychoanalytic techniques. Research in PP seems to be conveyed predominantly through journals which are often only accessed by other researchers. However, the difficult access may not be the only reason behind the recognized dissociation between academia and clinical practice: the language used in the articles found in this review requires extensive knowledge of terms of restricted use by researchers. We believe that this review may be useful for a generation of therapists and researchers who wish to work in synchrony with the advancement of scientific knowledge.(AU)
Assuntos
Adulto , Terapia Psicanalítica , PsicoterapiaRESUMO
Introdução: Alterações nos ritmos circadianos tem sido frequentemente observadas entre pacientes com Transtorno do Humor Bipolar (THB). No entanto, existem poucos instrumentos para medi-las e a maioria deles mede exclusivamente distúrbios do sono. A escala BRIAN, validada para adultos com THB, avalia a regularidade dos ritmos biológicos em quatro diferentes aspectos: sono, atividades, social e padrão de alimentação. O objetivo deste estudo-piloto foi adaptar a escala BRIAN para uma população de crianças e adolescentes (BRIAN-K) e avaliar se o novo instrumento é capaz de detectar diferenças entre pacientes e controles saudáveis. Métodos: Foram avaliados 20 pacientes com THB entre 8-16 anos e 32 controles pareados por sexo e idade. Os sujeitos foram avaliados por meio de entrevista clínica, K-SADS-PL e testagem cognitiva. A BRIAN-K foi aplicada em ambos os grupos. Resultados: O grupo de pacientes com THB apresentou escores mais altos de alterações em seus ritmos circadianos pelo escore total da BRIAN-K, quando comparados com o grupo controle (p=0,022). Particularmente, maior irregularidade foi observada no domínio atividades no grupo de pacientes (p=0,001). Nossos resultados também mostraram uma correlação positiva entre a idade de diagnóstico e o domínio sono da BRIAN-K (r=0,485; p=0,03). Conclusões: Estes dados preliminares sugerem que a versão BRIAN-K, recentemente adaptada para crianças e adolescentes, é capaz de discriminar pacientes com THB e controles. Futuros estudos com maior tamanho amostral são necessários para determinar a confiabilidade, a validade interna e externa do presente instrumento.
Background: Alterations in the circadian rhythms have been frequently observed in patients with Bipolar Disorder (BD). However, there are few instruments to measure these changes, and most of them only assess sleep disorders. The BRIAN scale validated for adults with BD, evaluates the regularity of the biological rhythms in four different aspects: sleep, activities, social rhythm, and eating pattern. The objective of this pilot study was to adapt the BRIAN scale to a sample of children and adolescents (BRIAN-K) and to evaluate if the new instrument is capable of detecting differences among patients and healthy controls. Methods: Twenty patients with BD, aged between 8 and 16 years, and 32 controls matched for gender and age were included. Participants were assessed using the clinical interview Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS-PL) and cognitive testing. The BRIAN-K was administered to both groups. Results: The group of patients with BD had higher scores of alterations in the circadian rhythms according to the BRIAN-K total score when compared to the control group (p=0.022). Particularly, more irregularity was found in the activitiesdomain in the group of patients (p=0.001). Our results have also showed a positive correlation between the age at diagnosis and the sleep domain of the BRIAN-K(r=0.485; p=0.03). Conclusions: These preliminary data suggest that the BRIAN-K version, recently adapted for children and adolescents, can differentiate patients and controls. Future studies with a larger sample size are necessary to determine the reliability, as well as the internal and external validity of the present instrument.
Assuntos
Criança , Adolescente , Transtorno Bipolar , Ritmo Circadiano , Transtornos do Humor , SonoRESUMO
The Bipolar Mood Disorder is characterized by the alternation of depressive crises with episodes of mania or euphoria, having these patients 15 to 35 times more chances of suicide, as compared with people without this disorder. The pharmacotherapy is fundamental for this disease, aiming to decrease the frequency of episodes and disease severity. In these patients, the polypharmacy has recently increased and one of the main difficulties is the adherence to treatment. The objective of this study was to contribute for the improvement of bipolar patients health conditions, developing their respective pharmacotherapeutic follow-up. Twenty eight adult bipolar patients who were participants of a specialized clinic within a tertiary hospital in Porto Alegre have been randomly selected, and the Dader Method of pharmacotherapeutic follow-up has been applied. The more common clinical comorbidities were: hypertension (50 percent), obesity (46.43 percent), and hypothyroidism (36.29 percent). The bipolar patients are more susceptible to clinical comorbidities, and many of them could be due to pharmacotherapy. Only 1.43 percent of patients presented Drug Related Problems, being all of them resolved along the study. It was also observed that 32.14 percent of evaluated patients presented low adherence to treatment, and between these patients, 55.56 percent passed to have good adherence after pharmacotherapeutic follow-up. The pharmacotherapeutic follow-up is fundamental for the improvement of patient's health. New studies, with higher number of patients and longer duration, are necessary to evaluate the percentage of patients that could be beneficiary of Pharmaceutical Care.
O Transtorno do Humor Bipolar é caracterizando pela alternância de crises depressivas com episódios de mania ou euforia, tendo estes pacientes 15-35 vezes mais chances de suicídio em comparação com pessoas sem este transtorno. A farmacoterapia é fundamental, visando diminuir a freqüência dos episódios e a gravidade da doença. Nestes pacientes, a polifarmácia tem aumentado ultimamente e uma das maiores dificuldades é a adesão ao tratamento. O objetivo do estudo foi contribuir para a melhoria das condições de saúde de pacientes bipolares, realizando o acompanhamento farmacoterapêutico dos mesmos. Foram selecionados aleatoriamente 28 pacientes bipolares adultos, participantes de um ambulatório especializado de um hospital terciário em Porto Alegre e aplicado o Método Dáder de acompanhamento farmacoterapêutico. As co-morbidades clínicas mais comuns foram: hipertensão (50 por cento), obesidade (46,43 por cento) e hipotiroidismo (39,29 por cento). Os pacientes bipolares são mais suscetíveis a co-morbidades clínicas e muitas destas podem ser devidas a farmacoterapia. Apenas 1,43 por cento dos pacientes apresentavam Problemas Relacionados a Medicamentos, sendo todos solucionados no decorrer do estudo. Também se observou que 32,14 por cento dos pacientes avaliados apresentavam baixa adesão ao tratamento e entre estes, 55,56 por cento passaram a ter boa adesão após o acompanhamento farmacoterapêutico. É fundamental para a melhoria da saúde do paciente o acompanhamento farmacoterapêutico. Novos estudos, com maior número de pacientes e maior duração, são necessários para avaliar o percentual de pacientes que poderão ser beneficiados pela Atenção Farmacêutica.
Assuntos
Humanos , Masculino , Feminino , Adulto , Assistência Farmacêutica/organização & administração , Projetos Piloto , Transtorno Bipolar/tratamento farmacológico , Continuidade da Assistência ao Paciente , Nível de SaúdeRESUMO
O Transtorno do Humor Bipolar (THB) caracteriza-se por oscilações do humor que causam prejuízos significativos no âmbito biopsicossocial. O interesse da comunidade científica por este transtorno vem aumentando nos últimos cinco anos em função de sua crescente prevalência associada ao refinamento diagnóstico, à ampliação do arsenal terapêutico e ao conhecimento dos avanços nas pesquisas da neurobiologia do transtorno. A presente revisão aborda questões diagnosticas e terapêuticas aplicadas à neurobiologia dos THB, relacionando-as diretamente à terapêutica dos quadros de mania, hipomania, estados mistos, depressão bipolar e ciclagem rápida, da infância à idade adulta. São revisados criticamente importantes estudos realizados com diferentes fármacos potencialmente eficazes como estabilizadores do humor, nos diversos subdiagnósticos do THB. São analisados fármacos, tais como o lítio, anticonvulsivantes, antipsicóticos, benzodiazepínicos, bloqueadores dos canais de cálcio e hormônio tireoideo, bem como as possíveis bases biológicas para seus efeitos terapêuticos. Em síntese, este trabalho aborda os avanços da psicofarmacologia cuja eficácia é comprovada nos subtipos do THB, procurando relacioná-los com a neurobiologia deste transtorno.
Assuntos
Humanos , Masculino , Feminino , Neurobiologia , Psicofarmacologia , Transtorno Bipolar , Neuroendocrinologia , Psicotrópicos , Transtornos do Humor/diagnóstico , Transtornos do Humor/fisiopatologia , Transtornos do Humor/induzido quimicamente , Transtornos do Humor/patologia , Transtornos do Humor/psicologia , Transtornos do Humor/terapiaRESUMO
Os tranplantes hepáticos säo atualmente considerados como a melhor terapia para certas patologias do fígado. O maior problema que aparece após o transplante de fígado ainda é a rejeiçäo ao órgäo transplantado; para se contornar esse problema Säo usados fármacos imunossupressores. Nos Estados Unidos e Europa o tacrolimus, um potente agente imunossupressor, estásendo utilizado. este trrabalho se realizou um estudo químico farmaceutico do tacrolimus, abordando ítens como química, farmacologia, mecanissmo de açäo, contra-indicaçöes, reaçöes adversas, precauçöes, interaçöes medicamentosas, a relaçäo com a ciclosporina, que também é um agente imunossupressor semelhante ao abordado, e sua aplicaçäo terapêutica após transplantes hepáticos.(au)