Made available in DSpace on 2014-06-11T19:32:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T19:02:41Z : No. of bitstreams: 1 goncalves_ab_dr_sjrp.pdf: 1056631 bytes, checksum: 8c6e50d96980a2c8a0252cd8afe2e9ab (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / As Doenças do Espectro Autístico (DEA) são afecções do neurodesenvolvimento que ocorrem em um contínuo de gravidade e comprometem a interação social, a comunicação e o comportamento dos afetados. A prevalência é muito alta na população e o esclarecimento das causas, ainda desconhecidas na maioria dos casos, tem implicações na prática clínica. A complexidade etiológica tem fomentado muitas investigações, que têm revelado loci de susceptibilidade, alterações cromossômicas e associação com outras condições médicas, além da ação de componentes ambientais. Entre as alterações genéticas propostas estão as deleções em 2q37 e 22q13.3. Este trabalho teve como objetivos a investigação genético-clínica, cariótipica por bandamento GTG, das regiões subteloméricas 2q37 e 22q13.3 por Hibridização in situ Fluorescente (FISH), com as sondas D2S447 e N85A3, e de mutação no gene FMR1 por técnicas moleculares, em 71 indivíduos com estas doenças. Entre eles, oito (11.3%) apresentaram outras condições médicas associadas, de etiologia cromossômica em um (1.4%) (Síndrome do 5q-), gênica em três (4.22%) (Síndrome do Cromossomo X Frágil, Síndrome de Sotos e Sindrome de Van der Woude) e ambiental em quatro (5.63%) [Síndrome da Rubéola Fetal, Síndrome do Álcool Fetal (dois casos) e Anóxia Neonatal]. Nenhum indivíduo apresentou alterações em 2q37 e em 22q13.3. Trata-se da primeira descrição da associação entre Síndrome do 5q- e Sindrome de Van der Woude com DEA. Os resultados mostram a importância do screening destes indivíduos quanto a presença de doenças genéticas ou fatores ambientais associados, pela variedade de mecanismos biológicos envolvidos, que devem ser elucidados, e pelas implicações no prognóstico, terapêutica e no Aconselhamento Genético das famílias. A introdução... / Autism Spectrum Disorders (ASD) are neurodevelopment disorders that vary in severity and impair the social interaction, communication and behavior of sufferers. The prevalence is very high in the population and an elucidation of the causes, which are still not well understood in most cases, has implications in the clinical practice. This etiological complexity has encouraged many investigations that have identified loci related to susceptibility, chromosomal alterations and associations with other medical conditions, as well as the action of environmental aspects. Among proposed genetic alterations are deletions in the chromosome regions 2q37 and 22q13.3. The aims of this study were to perform a genetic-clinical investigation of 71 individuals with ASD as well as studies using karyotyping by GTG banding, Fluorescent in situ hybridization (FISH), probes D2S447 and N85A3, of the 2q37 and 22q13.3 subtelomeric regions and of the FMR1 gene mutation using molecular techniques. Of the participating individuals, eight (11.3%) presented with other associated medical conditions: one (1.4%) had a chromosomal aberration (syndrome do 5q-), three (4.22%) had associated genetic conditions (Fragile X syndrome, Soto’s syndrome and Van der Woude syndrome) and four (5.63%) had environmental-related anomalies [congenital rubella syndrome, fetal alcohol syndrome – 2 cases and neonatal anoxia]. None of the individuals presented with alterations in the 2q37 and 22q13.3 regions. This is the first description of associations of ASD with 5q- syndrome and also ASD with Van der Woude syndrome. The results demonstrate the importance of screening in these individuals to identify the presence of associated genetic diseases or environmental factors due to the variety of biological mechanisms involved that can be elucidated and because of the implications on the prognosis, therapy and on genetic... (Complete abstract click electronic access below)

In this study the phenomenon of persistent physical symptoms (PPS) has been examined by realist evaluation of research and practice. Nimnuan et al., (2001) have shown that up to 35% of patients in primary care and 66% in specialist out-patient clinics have presented with such ‘medically unexplained’ symptoms. The cost in medical investigation to reach diagnosis for PPS is an estimated 10% of the annual UK National Health Service budget (Bermingham et al., 2010) but poor patient outcomes prevail (Dwamena et al., 2009). Currently, PPS is linked to high comorbidity with anxiety and depression (DH 2011b) and Cognitive Behavioural Therapy (CBT) is advised as the evidence based treatment for PPS (IAPT, 2014). However, a shortfall in clinical skills to address PPS is also demonstrated and engagement could be improved (De Lusignan et al., 2014). Moreover, the pragmatic study of alternative therapy modalities and processes for PPS is recommended (Leichsenring, 2005). To obtain a broader knowledge of process for patients with or without co-morbidity, practice based experience suggests that one such alternative is a brief psychodynamic intervention (STPP) for PPS. A Realist Literature Synthesis (Wong et al. 2013) highlights effective psychotherapeutic STPP interventions in real world circumstances in 5 comparison with CBT interventions for heterogenous PPS. STPP for PPS is found at least as effective as CBT, with improved engagement rates. Additionally, common factors were discovered between ‘third generation’ STPP and CBT for effective PPS interventions and these were developed into a preliminary cross-modality theoretical analytical framework. In the realist contextual evaluation (Pawson and Tilley, 1997) of a psychosexual service delivery, the majority of PPS sufferers were found only moderately co-morbid with anxiety and depression. For complete investigative study, clinical tools are developed providing integrative CBT/STPP principles for engagement with PPS for teaching, training and practice. In conclusion, the findings suggest that the reflexive insider position of the realist Therapist-Evaluator facilitates systematically derived Practice-Based Evidence of PPS process, meeting recommendations of Deary et al., (2007) to explore and define process and outcomes with PPS. The findings contribute to development of a conceptual platform to support health professionals in overcoming physical/mental health barriers to addressing PPS and wider patient access to effective care (NHSE, 2014, 2015).

Orientador: Agnes Cristina Fett Conte / Banca: Andréa Borduchi Franco Salles / Banca: Flávia Lisoni / Banca: João Monteiro de Pina Neto / Banca: Luiz Carlos de Matos / Resumo: As Doenças do Espectro Autístico (DEA) são afecções do neurodesenvolvimento que ocorrem em um contínuo de gravidade e comprometem a interação social, a comunicação e o comportamento dos afetados. A prevalência é muito alta na população e o esclarecimento das causas, ainda desconhecidas na maioria dos casos, tem implicações na prática clínica. A complexidade etiológica tem fomentado muitas investigações, que têm revelado loci de susceptibilidade, alterações cromossômicas e associação com outras condições médicas, além da ação de componentes ambientais. Entre as alterações genéticas propostas estão as deleções em 2q37 e 22q13.3. Este trabalho teve como objetivos a investigação genético-clínica, cariótipica por bandamento GTG, das regiões subteloméricas 2q37 e 22q13.3 por Hibridização in situ Fluorescente (FISH), com as sondas D2S447 e N85A3, e de mutação no gene FMR1 por técnicas moleculares, em 71 indivíduos com estas doenças. Entre eles, oito (11.3%) apresentaram outras condições médicas associadas, de etiologia cromossômica em um (1.4%) (Síndrome do 5q-), gênica em três (4.22%) (Síndrome do Cromossomo X Frágil, Síndrome de Sotos e Sindrome de Van der Woude) e ambiental em quatro (5.63%) [Síndrome da Rubéola Fetal, Síndrome do Álcool Fetal (dois casos) e Anóxia Neonatal]. Nenhum indivíduo apresentou alterações em 2q37 e em 22q13.3. Trata-se da primeira descrição da associação entre Síndrome do 5q- e Sindrome de Van der Woude com DEA. Os resultados mostram a importância do screening destes indivíduos quanto a presença de doenças genéticas ou fatores ambientais associados, pela variedade de mecanismos biológicos envolvidos, que devem ser elucidados, e pelas implicações no prognóstico, terapêutica e no Aconselhamento Genético das famílias. A introdução... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Autism Spectrum Disorders (ASD) are neurodevelopment disorders that vary in severity and impair the social interaction, communication and behavior of sufferers. The prevalence is very high in the population and an elucidation of the causes, which are still not well understood in most cases, has implications in the clinical practice. This etiological complexity has encouraged many investigations that have identified loci related to susceptibility, chromosomal alterations and associations with other medical conditions, as well as the action of environmental aspects. Among proposed genetic alterations are deletions in the chromosome regions 2q37 and 22q13.3. The aims of this study were to perform a genetic-clinical investigation of 71 individuals with ASD as well as studies using karyotyping by GTG banding, Fluorescent in situ hybridization (FISH), probes D2S447 and N85A3, of the 2q37 and 22q13.3 subtelomeric regions and of the FMR1 gene mutation using molecular techniques. Of the participating individuals, eight (11.3%) presented with other associated medical conditions: one (1.4%) had a chromosomal aberration (syndrome do 5q-), three (4.22%) had associated genetic conditions (Fragile X syndrome, Soto's syndrome and Van der Woude syndrome) and four (5.63%) had environmental-related anomalies [congenital rubella syndrome, fetal alcohol syndrome - 2 cases and neonatal anoxia]. None of the individuals presented with alterations in the 2q37 and 22q13.3 regions. This is the first description of associations of ASD with 5q- syndrome and also ASD with Van der Woude syndrome. The results demonstrate the importance of screening in these individuals to identify the presence of associated genetic diseases or environmental factors due to the variety of biological mechanisms involved that can be elucidated and because of the implications on the prognosis, therapy and on genetic... (Complete abstract click electronic access below) / Doutor

The objective of this thesis was the description of the work of the Child and Adolescent Detoxification Centre in Prague, its importance in the treatment drug addiction among children and adolescents. Another objective was to find out about the interrelationship of the work of regional coordinators for the prevention of risk behaviour and forms of follow-up therapy according to individual needs and nature of Child and Adolescent Detoxification Centre in Prague. The research conducted in the period from January to March 2010. Mapping the variants of follow-up therapy of the clients using habit-forming drugs in different regions of the Czech Republic and the forms of prevention are other objectives. The theoretical part of the thesis contains the description of the establishment of the Hospital of Sisters of Mercy of St. Charles Borromeo, in the premises of which the Child and Adolescent Detoxification Centre (CaADC) in Prague is located, as well as the description of the CaADC, and its medical and other personnel. The thesis describes the process of hospitalization, tests which preceded it and the necessary procedures to ensure successful completion of the hospitalization. Part of the theoretical block is dedicated to the care provided by a social worker, psychologist and therapists. Related legislation that forms the basis of prevention methods of individual regional drug coordinators and the centre itself is an integral part of the work. Prevention is a critical form of struggle against the abuse of psychotropic substances by children and adolescents. It is described in detail here, as well as the factors involved in the development of addiction. Other related terms only complement the mosaic of the studied issue. Within quantitative research, a content analysis of the data from the statistics of the Child and Adolescent Detoxification Centre in Prague was used to verify set hypotheses. The responses of regional drug coordinators to a set of open and semi-open questions, which were formulated for this purpose, were also used. Another source was the results of standardized interviews with three doctors at the Child and Adolescent Detoxification Centre in Prague. Hypotheses 1, 3 and 5 have not been confirmed. On the contrary, hypotheses 2 and 4 have been confirmed. The set objectives have been met. Unfortunately, our country still lacks a sufficient number of facilities that provide follow-up care of child drug addicts, as is clear from the research.

abstract: Monitoring complex diseases and their comorbidities requires accurate and convenient measurements of multiple biomarkers. However, many state-of-the-art bioassays not only require complicated and time-consuming procedures, but also measure only one biomarker at a time. This noncomprehensive single-biomarker monitoring, as well as the cost and complexity of these bioassays advocate for a simple, rapid multi-marker sensing platform suitable for point-of-care or self-monitoring settings. To address this need, diabetes mellitus was selected as the example complex disease, with dry eye disease and cardiovascular disease as the example comorbidities. Seven vital biomarkers from these diseases were selected to investigate the platform technology: lactoferrin (Lfn), immunoglobulin E (IgE), insulin, glucose, lactate, low density lipoprotein (LDL), and high density lipoprotein (HDL). Using electrochemical techniques such as amperometry and electrochemical impedance spectroscopy (EIS), various single- and dual-marker sensing prototypes were studied. First, by focusing on the imaginary impedance of EIS, an analytical algorithm for the determination of optimal frequency and signal deconvolution was first developed. This algorithm helped overcome the challenge of signal overlapping in EIS multi-marker sensors, while providing a means to study the optimal frequency of a biomarker. The algorithm was then applied to develop various single- and dual-marker prototypes by exploring different kinds of molecular recognition elements (MRE) while studying the optimal frequencies of various biomarkers with respect to their biological properties. Throughout the exploration, 5 single-marker biosensors (glucose, lactate, insulin, IgE, and Lfn) and one dual-marker (LDL and HDL) biosensor were successfully developed. With the aid of nanoparticles and the engineering design of experiments, the zeta potential, conductivity, and molecular weight of a biomarker were found to be three example factors that contribute to a biomarker’s optimal frequency. The study platforms used in the study did not achieve dual-enzymatic marker biosensors (glucose and lactate) due to signal contamination from localized accumulation of reduced electron mediators on self-assembled monolayer. However, amperometric biosensors for glucose and lactate with disposable test strips and integrated samplers were successfully developed as a back-up solution to the multi-marker sensing platform. This work has resulted in twelve publications, five patents, and one submitted manuscripts at the time of submission. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2018

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Obstructive sleep apnea (OSA) is a common sleep disorder that has serious repercussions for health and everyday life. Sleep changes, such as insomnia and daytime sleepiness, depressive symptoms, hypertension, gastroesophageal reflux and other comorbidities have been associated with OSA. However, the etiology of these symptoms remains unclear. Particularly, the use of medications and habits such as alcohol consumption, coffee drinking and smoking may influence sleep and other clinical values. Sleep apnea severity, obesity, age, use of alcohol, nicotine and associated comorbid diseases are some of the factors that may be integrated in a complex pattern as determinants of depressive symptoms and EDS in OSA. The aim of this study was to evaluate about depressive symptoms, excessive daytime sleepiness (EDS), comorbidity severity, morning-evening preference and pharmacotherapy in OSA. This was a cross-sectional study of 140 consecutive patients referred for polysomnography with clinical suspicion of OSA syndrome. After full night polyssomnography, they were diagnosed as snorers (N=14;<5/h), mild OSA (N=41; from 5 to 15/h), moderate OSA (N=37; from 15 to 30/h) and severe OSA (N=48; >de 30/h). Clinical data, alcohol consumption, coffee drinking, smoking, pharmacotherapy, polyssomnography data and results from behavior scales evaluated by the Epworth sleepiness scale, Hamilton depressive symptoms scale, Horne Osberg scale of chronotype and the cumulative comorbidity severity index (CCSI) were analyzed. Most cases were of male gender and diagnosed as moderate or severe OSA. OSA severity was directly related to body mass index (BMI) and to age. Daytime sleepiness, depressive symptoms and the chronotype was not different between groups. Excessive daytime sleepiness was found in 40% of cases and was not related to any of the studied variables. Most common medications on use were sedatives and beta-blockers. Patients with depressive symptoms used more sedatives (P=0,003) and selective serotonin reuptake inhibitor (SSRI) (P=0,001). Smoking was more frequent in younger patients and in those with an evening preference (P=0,003). Apnea-hypopnea index (AHI) was correlated to the use of platelet inhibitors (P=0,02). Minimal oxygen saturation was lower in those on use of beta-blockers (P= 0,04). In general, patients tended to be evening types and cases with depressive symptoms also had an evening preference (P=0,03). Older patients showed greater CCSI (P=0,000), greater AHI (P=0,005), lower oxygen saturation (P=0,001), increased sleep latency (P= 0,003), lower sleep efficiency (P=0,000) and greater amount of periodic leg movements (PLM) (P=0,039). AHI was inversely related to oxygen saturation (P=0,000) and to sleep efficiency (P=0,003) and was directly related to PLM (P=0,003). Depressive symptoms and hypertension were frequent and related to a greater CCSI scores. Alcohol consumption was also related to a greater CCSI. Female gender, BMI, chronotype, and the presence of PLM were associated with depressive symptoms. A trend of association between alcohol consumption (P=0,08), smoking (P= 0,05) and depressive symptoms was observed. In conclusion, depressive symptoms and arterial hypertension were common and influenced the comorbidity severity in these OSA patients. Obesity and EDS were common and in general, patients showed an evening preference. Female gender, greater BMI, evening preference, and periodic leg movements influenced the presence of depressive symptoms and these patients used more used more sedatives and SSRI. / A sÃndrome da apnÃia/hipopnÃia do sono obstrutiva (SAHSO) à um dos problemas noturnos mais comuns em seres humanos e tem sÃrias repercussÃes sobre o dia a dia do indivÃduo. AlteraÃÃes do ciclo-sono vigÃlia, transtornos do humor, hipertensÃo arterial, refluxo gastroesofÃgico e outras comorbidades tÃm sido associados à SAHSO. Os fatores que influenciam a presenÃa de sintomas depressivos, alteraÃÃes do cronotipo, co-morbidades associadas e o uso de agentes medicamentosos nÃo sÃo, ainda, bem conhecidos. Em um estudo transversal, nÃs avaliamos 140 pacientes encaminhados com distÃrbio respiratÃrio do sono que apÃs a polissonografia foram diagnosticados como ronco primÃrio (N=14; <5 eventos/hora), SAHSO leve (N=41; entre 5 e 15 eventos/hora), SAHSO moderada (N=37; entre 15 e 30 eventos/hora) e SAHSO grave (N=48; >de 30 eventos/hora). Os resultados dos dados clÃnicos, dos resultados obtidos atravÃs das escalas de sonolÃncia de Epworth, cronotipo de Horne e Ostberg, depressÃo de Hamilton (17 itens), o Ãndice cumulativo de co-morbidades (ICC), o consumo de cafÃ, Ãlcool, tabagismo e o uso de medicamentos, alÃm dos achados na polissonografia foram analisados. A maior parte dos pacientes apresentaram SAHSO moderada e grave e eram do sexo masculino. A gravidade da SAHSO foi diretamente proporcional ao IMC e a idade. O grau de sonolÃncia, os sintomas depressivos e o cronotipo nÃo foram diferentes entre os grupos classificados pelo diagnÃstico. SonolÃncia diurna foi encontrada em 40% dos casos e nÃo se relacionou aos fatores estudados. Os medicamentos mais usados foram os benzodiazepÃnicos, seguidos dos beta-bloqueadores. Os pacientes com sintomas depressivos usavam mais benzodiazepÃnicos (P=0,003) e inibidores seletivos da recaptaÃÃo de serotonina (ISRS) (P=0,001). Os fumantes eram mais jovens e apresentavam cronotipo mais vespertino (P=0,003). O Ãndice de apnÃia-hipopnÃia (IAH) foi mais elevado em pacientes em uso de anti-agregantes plaquetÃrios (P=0,02). A saturaÃÃo arterial mÃnima de oxigÃnio foi menor em indivÃduos que estavam em uso de beta-bloqueadores (P= 0,04). De maneira geral, observou-se uma maior preferÃncia vespertina nos pacientes com SAHSO. Os casos com sintomas depressivos apresentavam uma maior preferÃncia vespertina (P=0,03). Pacientes mais idosos tinham maior ICC (P=0,000), maior IAH (P=0,005), menor saturaÃÃo arterial de oxigÃnio (P=0,001), maior latÃncia de sono (P= 0,003), menor eficiÃncia do sono (P=0,000) e maior quantidade de movimentos periÃdicos de extremidades (MPE) (P=0,039). O IAH relacionou-se inversamente com a saturaÃÃo arterial de oxigÃnio (P=0,000) e com a eficiÃncia do sono (P=0,003) e diretamente com a quantidade de MPE (P=0,003). Sintomas depressivos e hipertensÃo arterial foram freqÃentes nesse estudo e tiveram relaÃÃo com o ICC que tambÃm se relacionou ao consumo freqÃente de Ãlcool. Os fatores que se associaram à presenÃa de sintomas depressivos foram o sexo feminino, o IMC, o cronotipo e a presenÃa de MPE. Observou-se uma tendÃncia de associaÃÃo entre o uso de Ãlcool (P=0,08) e o tabagismo (P= 0,05) com a presenÃa de sintomas depressivos. Em conclusÃo, sintomas depressivos e hipertensÃo arterial foram freqÃentes nesse estudo e tiveram relaÃÃo com o Ãndice cumulativo de co-morbidades. O sexo feminino, maior IMC, cronotipo vespertino e MPE associaram-se a presenÃa de sintomas depressivos e esses pacientes utilizavam mais benzodiazepÃnicos e ISRS. SonolÃncia e obesidade foram comuns.

O ciúme romântico é um complexo de pensamentos, emoções e ações que visam proteger o relacionamento diante de uma ameaça percebida real ou imaginária e tem como objetivo eliminar os riscos da perda do objeto de amor. O ciúme excessivo (patológico) é uma preocupação infundada, irracional e irreal, composto de diversas emoções e pensamentos que provocam prejuízos significativos no funcionamento pessoal e relacional. O objetivo deste trabalho foi explorar a presença de transtornos psiquiátricos, características sócio-demográficas, aspectos emocionais (tais como impulsividade, personalidade, depressão, ansiedade e agressividade), comportamentos excessivos, adequação social, intensidade do ciúme e características do relacionamento amoroso (tais como qualidade, tipo de apego e estilo de amor) em três amostras distintas: 32 sujeitos com ciúme excessivo, 33 sujeitos com amor patológico e 31 sujeitos saudáveis. Os resultados mostraram que os indivíduos com ciúme excessivo comparativamente aos indivíduos saudáveis, apresentam elevada sintomatologia depressiva e elevada impulsividade e maior agressividade, elevada busca de novidades e esquiva ao dano e menor autodirecionamento e cooperatividade. São mais submissos no relacionamento e trabalham excessivamente. Apresentam pior adequação social e mais história de abuso infantil. Além disso, são mais insatisfeitos com o relacionamento, apresentam mais frequentemente o tipo apego ansioso-ambivalente e o estilo de amor Mania. Diferentemente dos sujeitos com amor patológico, a maior parte dos indivíduos com ciúme excessivo mora com o parceiro. Já o estilo de amor Ágape é mais presente nos sujeitos com amor patológico, que apresentam maior autodirecionamento, estão mais insatisfeitos no relacionamento e são menos agressivos comparativamente aos sujeitos com ciúme excessivo. Conclui-se que pessoas com ciúme excessivo apresentam uma série de características emocionais e psicossociais que necessitam ser levadas em consideração no desenvolvimento de estratégias terapêuticas / Romantic jealousy is a complex of thoughts, emotions and actions aimed to protect the relationship in face of a perceived threat - real or imaginary - and to eliminating the risks of loss of the love object. Excessive (pathological) jealousy is an unfounded, unreasonable and unrealistic concern, composed of various emotions and thoughts that cause significant losses in personal and relational functioning. The aim of this study was to explore psychiatric disorders, socio-demographic characteristics, emotional aspects (such as impulsivity, personality, depression, anxiety and aggression), excessive behaviors, social adjustment, jealousy intensity and romantic relationship characteristics (such as quality, type of attachment and love style) in three different samples: 32 subjects with excessive jealousy, 33 subjects with pathological love and 31 healthy subjects. The results showed that individuals with excessive jealousy display intense depressivce symptomatology and compared to healthy individuals, show high impulsivity and increased aggressiveness, higher novelty seeking and harm avoidance and lower self-directedness and cooperativity. They are workaholic and more submissive in the relationship. They have worse social adjustment and more history of childhood abuse. Moreover, they are more jealous and dissatisfied with the love relationship, often show the ambivalent-anxious attachment type and Mania love style. Unlike subjects with pathological love, most individuals with excessive jealousy live with their partner. Agape love style is more present in subjects with pathological love. Pathological love subjects have higher self-directedness, are more dissatisfied in their relationship and are less aggressive compared to subjects with excessive jealousy. We conclude that people with excessive jealousy present a series of emotional and psychosocial characteristics that need to be taken into account in the development of therapeutic strategies

Pacientes com transtornos alimentares freqüentemente apresentam comorbidades com outros transtornos psiquiátricos, em especial com os transtornos de humor. Apesar de estudos recentes sugerirem uma íntima relação com o transtorno bipolar, o estudo do espectro bipolar em suas formas abrangentes ainda não foi realizado nesta população. O presente trabalho estudou, em pacientes com transtornos alimentares atendidos em serviço terciário, a ocorrência do espectro bipolar e os correlatos de impulsividade, imagem corporal, sintomas de humor ao longo da vida, adequação social e qualidade de vida. Avaliou sessenta e nove pacientes com diagnóstico de anorexia nervosa, bulimia nervosa ou transtorno alimentar sem outra especificação e, como grupo comparativo, sessenta e nove mulheres sem diagnóstico de transtornos alimentares ou transtorno bipolar. A avaliação foi constituída pela Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM IV, avaliação clínica dos critérios de Zurich para diagnóstico do espectro bipolar, a Escala de Impulsividade de Barrat, o Questionário de Imagem Corporal, a Escala de Auto-avaliação de Hipomania, a Entrevista Clínica Estruturada para o Espectro do Humor, Escala de Hamilton para Avaliação de Depressão, Escala de Young para Avaliação de Mania, a Escala de Adequação Social e a Escala de Avaliação da Qualidade de Vida. As comparações das médias das variáveis contínuas foram realizadas por meio dos testes de Kruskal- Wallis e Mann-Whitney. A associação entre as variáveis categóricas e os grupos foi descrita através de tabelas de contingência e analisadas através do teste Chi- Quadrado de Pearson ou Exato de Fisher. A análise multivariada pelo método de stepwise foi realizada para verificar o efeito das variáveis sobre a imagem corporal, adequação social e qualidade de vida. O nível de significância alfa foi estabelecido em 5%. Os resultados mostraram que 68,1% das pacientes apresentaram comorbidade com espectro bipolar e isto esteve associado à maior renda familiar, proporção de pessoas casadas, comorbidade com uso de substâncias e mais sintomas maníacos/hipomaníacos ao longo da vida. Tanto o grupo com e sem comorbidade com espectro bipolar apresentaram maiores níveis de gravidade em todos os desfechos avaliados em relação ao grupo comparativo. No grupo de pacientes com comorbidade com espectro bipolar a qualidade de vida, impulsividade e comportamento suicida influenciaram a imagem corporal. Estes resultados mostraram que o espectro bipolar é uma comorbidade comum em pacientes com transtornos alimentares e está associado a correlatos de importância clínica, notadamente a comorbidade com uso de substâncias. Devido ao padrão de semelhança entre os grupos com e sem comorbidade com o espectro bipolar em relação a diversos desfechos avaliados a identificação da comorbidade pode ser difícil. Entretanto, o diagnóstico preciso e a identificação criteriosa de correlatos clínicos pode contribuir para futuros avanços no tratamento destas condições / Eating disorder patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship with bipolar disorder, the study of bipolar spectrum broader definition has not been done in this population. This work studied the occurrence of bipolar spectrum and correlates of impulsivity, body image, mood symptoms throughout life, social adjustment and quality of life in eating disorders patients of a tertiary service. Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified and, as a comparative group, sixty-nine women without a diagnosis of eating disorder or bipolar disorder were evaluated. The evaluation comprised the Structured Clinical Interview for DSM IV Axis I Disorders, clinical criteria for diagnosis of Zurich bipolar spectrum, Barratt Impulsiveness Scale, the Body Shape Questionnaire, the Hypomania Checklist-32, the Structured Clinical Interview for Mood Spectrum, Hamilton Depression Rating Scale, Young Mania Rating Scale, Social Adjustment Scale and the World Health Organizations Quality of Life Questionnaire. Kruskall-Wallis and Mann-Whitney tests compared means of continuous variables. The association between categorical variables and the groups were described using contingency tables and analyzed using the chi-squared or Fisher exact test. Multivariate analysis using the stepwise method was performed to verify the effect of variables on body image, social adjustment and quality of life. The level of significance alpha was set at 5%. The results showed that 68,1% of patients had comorbidity with bipolar spectrum and this was associated with higher family income, proportion of married people, comorbidity with substance use and more manic/hypomanic symptoms throughout life. The groups with or without comorbidity with bipolar spectrum showed more severity in all outcomes compared with the comparison group. In patients with comorbid bipolar spectrum, quality of life, impulsivity and suicidal behavior influenced the body image. These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions

A literatura científica biomédica tem apontado que pessoas em intenso sofrimento psíquico encontram no consumo de drogas um modo de lidar com esse sofrimento. Assim, o consumo de drogas tem alta prevalência entre pessoas que apresentam algum quadro clínico psiquiátrico e este aparece muitas vezes como uma estratégia de lidar com os sintomas. Em contrapartida, este consumo aparece descrito como causador de pior prognóstico, colocando o usuário em situações de maior vulnerabilidade. Esta pesquisa teve como objetivo compreender a perspectiva de profissionais de um serviço de saúde mental sobre o consumo de drogas por pessoas em tratamento psiquiátrico. O estudo tem caráter qualitativo, descritivo e exploratório e foi aprovado por Comitê de Ética em Pesquisa. Foram realizadas entrevistas semi-estruturadas com 16 profissionais de um Centro de Atenção Psicossocial III (CAPS) do interior de São Paulo. Para a análise dos dados, considerou-se o papel da linguagem como construtora da realidade. Foi realizada análise de conteúdo temática, sendo construídas quatro categorias: Especificidades do contexto; O fenômeno da droga; O uso de drogas durante o tratamento psiquiátrico; e Fronteira entre a saúde mental e o uso de drogas. Os profissionais destacaram a presença do uso de drogas em pacientes do serviço, apesar da disposição da rede local em dividir o cuidado às duas demandas. Os participantes compreendiam que o sofrimento era o principal motivador para o uso de drogas nesta população. A identificação do consumo foi tema relevante para os profissionais não havendo, porém, protocolo específico para isto. O vínculo estabelecido com o paciente foi apontado como principal estratégia para identificação. O uso de drogas em pacientes do CAPS foi relatado como fomentando preconceito por parte de alguns profissionais, influenciados pelo discurso moral na construção de sentidos sobre os usuários de drogas. O tabaco não era descrito como uma droga, sendo algumas vezes compreendido inclusive como parte do tratamento no CAPS. Os discursos moral e biomédico construindo sentidos sobre o uso de drogas concorrem nas falas dos profissionais para explicar o fenômeno da droga. Da mesma forma, estratégias de cuidado dividem-se entre aquelas voltadas à redução de danos ou em busca da abstinência, sendo mais prevalentes as voltadas à abstinência. O papel central atribuído ao medicamento no tratamento suscitou questionamentos a respeito do lugar ocupado por este como droga ou como tratamento. Ações que proporcionem aos profissionais mais espaços para construção de sentidos a respeito do tema, seja de mais ajuda do que apenas uma divisão arbitrária (e aparentemente impossível de ser implementada na prática) entre as duas demandas. O momento das entrevistas foi uma oportunidade para a construção destes sentidos. / Biomedical scientific literature has showed that people under severe mental suffering conditions usually consume drugs as a coping strategy. Therefore, the drug consumption has high prevalence in psychiatric patients and is frequently described as a coping strategy to deal with theirs symptoms. On the other hand, this drug consumption is described as causing poorer prognosis, including putting the users in vulnerable situations. This research aimed to understand the perspective of professionals from a mental health service about the patients drug use during psychiatric treatment. This study is qualitative, descriptive and exploratory and was approved by the Research Ethics Committee. Sixteen semi-structured interviews were conducted with professionals of a Psychosocial Care Center (CAPS- 3) in a medium city in the countryside of São Paulo state. For data analysis, we consider the role of language as a constructor of reality. A thematic content analysis was performed, resulting in four categories: Particularities of the context; the drug phenomena; drug use during psychiatric treatment; and the boundaries between mental health and drug use. The professionals highlighted a perceived presence of drug use in patients, despite of the local network willingness in offering care for both demands. Participants understood that suffering was the main motivator for the use of drugs in this population. Identifying the drug consumption was a relevant issue for professionals, however, there was no specific protocol to address this issue. Establishing bonding with the patient was pointed out as the main strategy for drug use identification. The drug use in CAPS patients was reported as contributing to the stigma by some professionals, mostly influenced by the moral discourse on meaning making attributed to drug users. Tobacco was not described as a drug, and sometimes was even understood as part of treatment in CAPS. Both moral and biomedical discourses constructed meanings about the use of drugs compete in the professionals´ speeches to explain the drug phenomena. Similarly, care strategies were divided between those aiming to reduce damage or seeking withdrawal, and the most prevalent ones were those focused on drug abstinence. The central role assigned to medication in the treatment raised questions about the place occupied by the medication as drug or as a treatment tool. Actions providing professionals more opportunities for meaning making about this subject can be more helpful than the currently arbitrary division (and seemingly impossible to implement in practice) for addressing both demands. The interviews offered the professionals an opportunity for the construction of these meanings and senses.

O diagnóstico de câncer é uma experiência traumática que pode precipitar sintomas do Transtorno de Estresse Pós Traumático TEPT. São poucos os estudos que avaliaram a prevalência e o impacto do TEPT na qualidade de vida de mulheres com câncer de mama, antes do início dos tratamentos. Este trabalho teve como objetivos estimar a prevalência e o impacto dos sintomas do TEPT Agudo na qualidade de vida de mulheres recém diagnosticadas com câncer de mama, investigando as variáveis sócio-demográficas e clínicas associadas ao TEPT. Foi realizado um estudo do tipo corte transversal no Centro de Referência da Saúde da Mulher Hospital Pérola Byington. Os sintomas de TEPT foram avaliados com a Post-Traumatic Stress Disorder Checklist- Civilian Version, os sintomas de Ansiedade e Depressão com a Escala Hospitalar de Ansiedade e Depressão, e a Qualidade de Vida com o SF-36. Comparamos as variáveis sócio-demográficas e clínicas nas mulheres com TEPT, TEPT Subsindrômico e sem TEPT. Foi feita uma análise de co-variância, com comparação pos-hoc pelo método de Tukey, para avaliar o impacto do TEPT sobre a qualidade de vida. Identificamos que 81% das mulheres apresentaram ao menos um sintoma de estresse pós-traumático clinicamente significativo, 17,9% tinham sintomas de TEPT e 24,5% de TEPT subsindrômico. As características sóciodemográficas e estadiamento do câncer não estavam associadas ao TEPT. História de tratamentos psiquiátricos mostrou uma tendência de associação (p<0,056), enquanto os escores das escalas de ansiedade e depressão estavam significativamente associados ao TEPT (p<0,001). Pacientes com TEPT tinham prevalência de Ansiedade seis vezes maior (Razão de Prevalência - RP = 6,56), e de Depressão quatorze vezes maior (RP = 14,41), do que as pacientes sem TEPT. As mulheres com TEPT e TEPT subsindrômico apresentaram os piores escores em todos os domínios da qualidade de vida, comparadas àquelas sem TEPT, mesmo controlando para a influência das variáveis sócio-demográficas e clínicas. Os domínios Capacidade Funcional e Aspecto Social estavam significativamente reduzidos nas mulheres com TEPT e com TEPT subsindrômico comparados ao grupo sem TEPT (p < 0,05) quando adicionamos no modelo os sintomas de ansiedade e depressão. Os sintomas de TEPT foram prevalentes e repercutiram negativamente na qualidade de vidas das mulheres recém diagnosticadas com câncer de mama, sugerindo que a avaliação destes sintomas nessa fase da doença é importante, pelas possibilidades de intervenção precoce. / Receiving a diagnosis of cancer is a traumatic experience which may trigger Post Traumatic Stress Disorder PTSD. To date, few studies have assessed the prevalence and impact of PTSD on the quality of life in women with breast cancer prior to commencement of treatment. The present study aimed to estimate the prevalence and impact of Acute PTSD symptoms on the quality of life in women recently diagnosed with breast cancer, while investigating the socio-demographic and clinical variables associated to PTSD. A transversal, cross-sectional type study was conducted at a Reference Center for Womens Health Byington Pérola Hospital. The PTSD symptoms were assessed using the Post-Traumatic Stress Disorder Checklist - Civilian Version, the Anxiety and Depression symptoms were evaluated with the Hospital Anxiety and Depression Scale, while Quality of Life was evaluated by the SF-36 questionnaire. The socio-demographic and clinical variables of the women with PTSD, Subsyndromal PTSD, and without PTSD were compared. Co-variance analysis was performed to assess the impact of the symptoms of PTSD on quality of life, independently from the potential effects of socio-demographic and clinical variables or psychiatric comorbidities, followed by Tukeys post-hoc comparison. We found a high prevalence of clinically significant post-traumatic stress symptoms. A total of 81% of women presented at least one symptom, 17.9% were diagnosed with PTSD, and 24.5% with subsyndromal PTSD. The sociodemographic characteristics and clinical staging of cancer were not associated with PTSD. Prior history of treatment and consultations for psychiatric problems presented a tendency toward association (p<0.056), while scores on the anxiety and depression scales were significantly associated with PTSD (p<0.001). We identified high comorbidity among PTSD, Anxiety and Depression. Patients with PTSD had a six-fold higher prevalence of Anxiety (Prevalence Ratio PR = 6.56), and a fourteen-fold higher rate of Depression (PR = 14.41) compared to patients without PTSD. Scores on domains of the quality of life scale were significantly lower in women with PTSD and subsyndromal PTSD. After controlling for influence of socio-demographic variables, cancer staging and psychiatric history, scores across all domains of the quality of life scale remained significantly lower in PTSD and subsyndromal PTSD groups. In the final step of the co-variance analysis, when anxiety and depression symptoms were included, the scores on the Functional Capacity and Social Aspect domains remained significantly lower in PTSD and subsyndromal PTSD groups than in the group without PTSD (p < 0.05). PTSD symptoms were prevalent and had a negative impact on the quality of life of women recently diagnosed with breast cancer, suggesting that the assessment of these symptoms during this stage of the disease is important to enable early intervention.