Made available in DSpace on 2016-04-04T18:29:32Z (GMT). No. of bitstreams: 1 Jena Hanay Doutorado.pdf: 721081 bytes, checksum: 65f8d839cf686774d38170e56199f048 (MD5) Previous issue date: 2006-12-18 / Evaluates depression, anxiety, psychopathologic symptoms, alexithymia and defensive style of grade III obese patients, before and after bariatric surgery, as well as estimates the level of association among such variables. Methodological study design was correlational crosssectional type. 65 patients took part in the study (Group 1: surgical candidates vs. Group 2: postoperative patients), mainly females (92,3%), who answered the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Symptoms Assessment Scale (EAS- 40), and the version in Portuguese of The Toronto Alexithymia Scale (TAS-26) and of the Defensive Style Questionnaire (DSQ-40). Gr 1 showed mild anxiety and depression levels and Gr 2 minimum level (respectively, p< 0,001 e p< 0,01). The total average score for EAS- 40 and F2 and F3 (obesity-compulsion and somatization) were higher in Gr 1 when compared to Gr 2 (repetitively, p< 0,005, p< 0,005 e p< 0,001). On TAS, the total average score for F1 (ability to identify and describe feelings and distinguish them from bodily sensations) were higher in Gr 1 than in Gr 2 (respectively, p< 0,01 e p< 0,005). According to DSQ-40, there was a tendency for an immature defensive style in Gr 1 in comparison to Gr 2 (p< 0,02). In relation to the association between the variables and BMI, the correlations were negative for Gr 1 and F2 of TAS (daydreaming, p < 0,05) and for the mature factor of DSQ- 40 and Gr 2 (p < 0,05), which shows a trend towards a more mature and adaptive style in Gr 2. Correlations were positive and significant in relation to immature defenses - acting out (Gr 1: p<0,005 and Gr 2: p<0,05) and in the autistic fantasy in Gr 1 (p<0,05). The results show the psychological status of the participants, who are apt for bariatric surgery and point to a decrease in psychopathological symptoms proportional to weight loss after surgery. / Avalia depress?o, ansiedade, sintomas psicopatol?gicos, alexitimia e o estilo defensivo de pacientes obesos grau III, antes e depois de cirurgia bari?trica, e estima o grau de associa??o entre essas vari?veis. O delineamento metodol?gico foi correlacional de tipo cross-sectional. Participaram do estudo 65 pacientes (Gr 1: pr?-cir?rgico vs. Gr 2: p?scir?rgico), predominantemente do sexo feminino (92,3%), que responderam o Invent?rio de Depress?o de Beck (BDI), o Invent?rio de Ansiedade de Beck (BAI), a Escala de Avalia??o de Sintomas (EAS-40), a Vers?o em Portugu?s da Escala de Alexitimia de Toronto (TAS-26) e a Vers?o em Portugu?s da Defensive Style Questionnaire (DSQ-40). O Gr 1 apresentou n?vel de depress?o e ansiedade leve e o Gr 2 n?vel m?nimo (respectivamente, p< 0,001 e p< 0,01). O escore m?dio total da EAS-40 e de F2 e F3 (obsessividade-compulsividade e somatiza??o) foram mais elevados no Gr 1 quando comparados aos do Gr 2 (respectivamente, p< 0,005, p< 0,005 e p< 0,001). Na TAS, o escore m?dio total e de F1 (habilidade de identificar e descrever sentimentos e distingui-los de sensa??es corporais) foram maiores no Gr 1 do que no Gr 2 (respectivamente, p< 0,01 e p< 0,005). De acordo com o DSQ-40, houve tend?ncia a um estilo defensivo imaturo no Gr 1 quando comparado ao Gr 2 (p< 0,02). Em rela??o ? associa??o das vari?veis com o IMC, as correla??es foram negativas no Gr 1 e o F2 da TAS (sonhar acordado, p < 0,05) e no fator maduro do DSQ-40 e o Gr 2 (p < 0,05), apontando uma propens?o de estilo mais maduro e adaptativo no Gr 2. As correla??es foram positivas e significantes nas defesas imaturas acting out (Gr 1: p<0,005 e Gr 2: p<0,05) e na fantasia aut?stica no Gr 1 (p<0,05). Os resultados mostram o modo de funcionamento psicol?gico dos participantes aptos ? cirurgia bari?trica e assinalam uma diminui??o da sintomatologia psicopatol?gica na propor??o da perda de peso ap?s a cirurgia.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-12-01T10:18:04Z No. of bitstreams: 1 476506 - Texto Parcial.pdf: 2303755 bytes, checksum: e1461943f8a1798998634396936da36f (MD5) / Made available in DSpace on 2015-12-01T10:18:04Z (GMT). No. of bitstreams: 1 476506 - Texto Parcial.pdf: 2303755 bytes, checksum: e1461943f8a1798998634396936da36f (MD5) Previous issue date: 2014-05-26 / Population aging is particularly evident in developing countries. This fact modifies the health/disease profile in the population, with chronic diseases becoming more prevalent than the acute and infectious. Geriatric depression stands out among those diseases of a chronic nature, being highly prevalent in the world. The impact of the consequences of increased depression is still difficult to measure, although projections by the World Health Organization (WHO) place it, by 2030, as being the main disorder contributing to the global burden of disease. The WHO alert also indicates that the impact will be more intense in low- and middle-income countries, which is related to the underdiagnosis and undertreatment of this disorder at a primary care level. Furthermore, other factors increases the complexity of depression in the elderly, especially the comorbidity with anxiety disorders, contributing to the severity of the disease, which suggests a greater relevance for investigating both disorders. This cross-sectional study with prospective data collection aimed to examine factors related to depression in a random sample of the elderly, registered with the Family Health Strategy (FHS) program in the city of Porto Alegre. Data collection was conducted in two phases: 1) screening phase: measurement of sociodemographic and multidimensional health data and measurement of clinical significant depressive symptoms, using the 15-item Geriatric Depression Scale (GDS-15) accomplished in a home visit by Community Health Agents (CHA); and 2) specialist interview for the diagnostic assessment of psychiatric disorders, using the validated Brazilian version of the Mini International Neuropsychiatric Interview, 5.0.0 plus (M.I.N.I. 5.0.0 plus BR) - adopting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) as the gold standard. This study aimed to: examine the prevalence of clinical significant depressive symptoms and their associated characteristics, detected through data collection conducted by CHA; 2) identify associations between the diagnoses of depressive and anxiety disorders with the use of psychotropic medications. Two scientific articles were produced based on this research, with each investigating an objective outlined above. In the first, the sample consisted of 621 individuals aged 60+ years, who had completed the data screening phase performed by the CHA. The results showed that a high prevalence of depression (30.6%) was estimated via the screening assessment conducted by professionals without a high level of specialization. Depression was shown to be significantly more common in women than men (35.9% versus 20.9%; P<0.001). Independent associations were measured through robust analysis with Poisson regression to estimate the prevalence ratios (PR) of depression with the variables: female gender (PR: 1.4, CI: 1.1-1.8); low educational level, especially illiteracy (PR: 1.8, CI: 1.2-2.6); regular self-perceived health (PR: 2.2, CI: 1.6-3) and poor/very poor self-perceived health (PR: 4, CI: 2.9-5.5). These findings are consistent with the existing scientific literature. However, it should be emphasized that this replication of findings was carried out exclusively by CHA in the close to real-life situation of the Family Health Strategy program. In the second work, the sample consisted of 501 elderly people enrolled in the FHS, who had completed both screening and specialist evaluations. The paper examined associations between diagnosis of depressive and anxiety disorders with the use of psychotropic drugs. Clinical variables were analyzed in a dichotomous manner by grouping the diagnoses of unipolar depression and anxiety with consistent psychopharmacotherapeutic indications: 1) unipolar depression: current major depressive episode, recurrent major depressive disorder or dysthymia; 2) anxiety: generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder, panic disorder, social phobia or agoraphobia. The psychotropic drugs were grouped into antidepressants, benzodiazepines, mood stabilizers, antipsychotics, anticonvulsants, and other psychotropic drugs. The results showed high frequencies of unipolar depression (11.4%), anxiety (9.0%), and depression and anxiety comorbidity (8.6%), observed in the total sample. Female gender was more associated with both the unipolar depression group (26.4% versus 9.5%, P <0.001) and the anxiety group (21.9% versus 10.5%, P<0.001). Antidepressants are considered the pharmacological treatment of choice for the disease groups analyzed and were the most frequently used (13.2%), followed by benzodiazepines (6.8%), and antipsychotics (2.2%). In depression, the elderly received antidepressants (40.4%) more frequently than benzodiazepines (19.3%), antipsychotics (7.0%), mood stabilizers (1.8%), and other psychotropic drugs (24.6%). However, the chance of receiving benzodiazepines rather than antidepressants was considerably higher (PR: 6.6 vs 4.2); a tendency towards antipsychotic drug use was also observed (PR: 6.8). As such, the findings of this study indicate that elderly individuals with unipolar depressive disorders have a greater risk of receiving psychosedative drugs like benzodiazepines and antipsychotics, than antidepressants. The frequency of antidepressant use in anxiety disorders is considered low (11.1%), with the risk of benzodiazepine use in this diagnostic group being approximately 3.5 times greater than the use of antidepressants (PR 4.3 versus 1.2). The findings in the elderly group with a comorbidity diagnosis of at least one depressive and one anxiety disorder are of even greater concern. Although these are particularly severe cases with a tendency of chronification, the chances of their using an antidepressant is reduced by almost half, in comparison to the group diagnosed with depression alone (PR: 4.2 versus 2.2). An aging population and the growth of depressive disorders in the world increasingly indicate the importance of expanding our knowledge regarding this disease in older age groups. While results such as those shown by the outlined studies are worrying, they shed light on the significant problems of public health. Findings generated by a strategic model that include the local family health teams provide hope for the implementation of action plans in elderly mental health, by indicating that lay professionals can play a fundamental role in the early detection and prevention of depression at a community and primary care level. In summary, the research has allowed important health issues to be examined and produced data showing a high prevalence of geriatric depression, as well as indicators that appropriate pharmacological therapy for this disease is not being achieved. Therefore, the implementation of an active strategic model of action is necessary for a preventive approach to elderly mental health care. This would allow the use of low-cost tools (screening scales) that make it possible to detect cases of depression at an early stage and more severe cases, as well as helping in the identification of those elderly individuals at risk or receiving inadequate treatment. / O envelhecimento populacional ocorre de sobremaneira nos pa?ses em desenvolvimento. Tal fato modifica o perfil de sa?de e doen?a na popula??o, prevalecendo as doen?as cr?nico-degenerativas sobre as agudas e infecciosas. Dentre as doen?as de caracter?sticas cr?nicas destaca-se a depress?o geri?trica, altamente prevalente no mundo. O impacto das repercuss?es do aumento da depress?o ainda ? dif?cil de mensurar, embora proje??es da Organiza??o Mundial da Sa?de (OMS) para 2030 a coloquem como a principal patologia a contribuir para a carga global de doen?as no mundo. O alerta da OMS ainda destaca que o impacto ser? mais intenso em pa?ses de baixa e m?dia renda, o que est? relacionado ao subdiagn?stico e subtratamento ao n?vel da aten??o b?sica (AB). Al?m disso, outros fatores contribuem para a complexidade da depress?o na faixa idosa dentre os quais destaca-se a comorbidade com transtornos de ansiedade contribuindo para a severidade do quadro psiqui?trico o que aponta para uma maior relev?ncia ? investiga??o de ambos transtornos. Este ? um estudo transversal com coleta prospectiva que objetivou examinar fatores relacionados ? depress?o em uma amostra aleat?ria estratificada de idosos cadastrados pelo programa Estrat?gia Sa?de da Fam?lia (ESF) do Munic?pio de Porto Alegre. Para o desenvolvimento do trabalho, os dados utilizados s?o provenientes de duas etapas de coleta: 1) etapa de rastreamento: com coleta de dados sociodemogr?ficos, multidimensionais de sa?de e de Sintomas Depressivos Clinicamente Significativos (SDCS) com a Escala de Depress?o Geri?trica de 15 itens (EDG-15) em visita domiciliar por Agentes Comunit?rios de Sa?de (ACS); e 2) entrevista especializada com a avalia??o diagn?stica de transtornos psiqui?tricos, utilizando-se a vers?o brasileira validada do Mini International Neuropsychiatric Interview 5.0.0 plus (M.I.N.I. 5.0.0 plus BR) ? admitindo-se os crit?rios da 4? edi??o revisada do Manual Diagn?stico e Estat?stico de Transtornos Mentais (DSM-IV) como padr?o ouro. O presente trabalho objetivou: examinar a preval?ncia SDCS e suas caracter?sticas associadas, detectadas atrav?s da coleta realizada pelos ACS; 2) identificar associa??es entre os diagn?sticos de transtornos depressivos e de ansiedade com os medicamentos psicotr?picos em uso. Como produto deste trabalho, dois artigos cient?ficos foram produzidos; cada qual investigando um dos objetivos acima descritos. No primeiro trabalho, a amostra foi composta por 621 indiv?duos de 60 anos ou mais que completaram a etapa de coleta de rastreamento realizada pelos ACS. Os resultados mostraram que uma preval?ncia alta de depress?o (30,6%) foi estimada atrav?s da avalia??o de rastreamento realizada por profissionais sem alta especializa??o. A depress?o mostrou-se significativamente mais frequente em mulheres do que em homens (35.9% versus 20.9%; P<0.001). A partir de uma an?lise robusta pelo m?todo de Poisson foram medidas associa??es independentes atrav?s da estimativa de Raz?es de Preval?ncias (RP) da depress?o com as vari?veis: g?nero feminino (RP: 1.4, IC: 1.1-1.8); baixa escolaridade, destacando-se analfabetismo (RP:1.8, IC:1.2-2.6); autopercep??o de sa?de regular (RP: 2.2, IC: 1.6-3.0) e m?/p?ssima (RP: 4.0, IC: 2.9-5.5). Esses achados s?o compat?veis com a literatura pr?via existente. Entretanto, deve-se destacar que essa replica??o de achados neste formato ? in?dita, j? que foi realizada exclusivamente por ACS em uma situa??o pr?xima da real da Aten??o B?sica (AB). O segundo trabalho foi realizado a partir de uma amostra de 501 idosos que completaram as fases de rastreamento e de avalia??o especializada. O estudo examinou associa??es entre diagn?sticos de transtornos depressivos e de ansiedade com o uso de psicotr?picos em idosos cadastrados na ESF. As vari?veis cl?nicas foram analisadas de forma dicot?mica agrupando-se os diagn?sticos de depress?o unipolar e ansiedade com indica??es psicofarmacoterap?uticas consistentes: 1) depress?o unipolar: epis?dio depressivo maior atual, transtorno depressivo maior recorrente ou distimia; 2) ansiedade: transtorno de ansiedade generalizada, transtorno obsessivo compulsivo, transtorno de estresse p?s-traum?tico, transtorno do p?nico, fobia social ou agorafobia. As medica??es psicotr?picas foram agrupadas em antidepressivos, benzodiazep?nicos, estabilizadores de humor, antipsic?ticos, anticonvulsivantes e outros medicamentos psicotr?picos. Como resultado, altas frequencias de depress?o unipolar (11,4%), de ansiedade (9,0%) e da comorbidade de depress?o e ansiedade (8,6%) foram observadas na amostra total. O g?nero feminino esteve mais associado tanto com o grupo de depress?o unipolar (26,4% versus 9,5%; P<0,001) quanto com o grupo de ansiedade (21,9% versus 10,5%, P<0,001). Os antidepressivos s?o considerados o tratamento farmacol?gico de elei??o para o grupo de patologias analisadas e foram os mais utilizados (13.2%), seguido pelos benzodiazep?nicos (6.8%) e antipsic?ticos (2.2%). Na depress?o, os idosos recebem mais frequentemente antidepressivos (40,4%) do que benzodiazepinicos (19,3%), antipsic?ticos (7,0%), estabilizadores de humor (1,8%) e outros psicotr?picos (24,6%). Entretanto, a analise controlada pelo m?todo de Poisson mostrou que o risco de receber benzodiazep?nicos, ao inv?s de antidepressivos ? consideravelmente maior na depress?o geri?trica (PR: 6,6 vs 4,2); tamb?m observou-se a tend?ncia para risco de uso de antipsic?ticos (RP: 6,8) nesses casos. Ou seja, os achados deste estudo indicam que idosos portadores de transtornos depressivos unipolares t?m maior risco de receber medicamentos psicosedativos como benzodiazep?nicos e antipsic?ticos do que antidepressivos. No grupo dos transtornos de ansiedade a frequ?ncia do uso de antidepressivos ? considerada baixa (11,1%) sendo que a risco de uso de benzodiazep?nicos nesse grupo diagn?stico ? aproximadamente 3,5 vezes maior do que o uso de antidepressivos (RP de 4.3 versus 1.2). Os achados no grupo de idosos que possuem diagn?stico com?rbido de, ao menos, um transtorno depressivo e de um transtorno de ansiedade ? ainda mais preocupante, j? que ? embora sejam casos particularmente graves e associados ? cronicidade ? a chance de usar um antidepressivo ? reduzida para quase a metade se comparada com o grupo diagnosticado com depress?o isolada (RP: 4.2 versus 2.2). Com o envelhecimento populacional e o aumento dos transtornos depressivos no mundo, cada vez mais torna-se importante a amplia??o do conhecimento acerca desta patologia em faixas de idade cada vez mais avan?adas. Embora os resultados evidenciados nestes estudos sejam preocupantes, os mesmos lan?am luz para importantes problemas de sa?de p?blica. Al?m disso, achados a partir da operacionaliza??o de equipes de sa?de locais trazem esperan?a para um modelo de implementa??o estrat?gica de a??es em sa?de mental do idoso, j? que apontam que ?profissionais leigos? podem ter um papel fundamental na detec??o precoce e na preven??o da depress?o ao n?vel da comunidade e da AB, assim como na identifica??o de indiv?duos deprimidos sem tratamento ou em uso de medica??es psicotr?picas inadequadas. Enfim, os estudos permitiram examinar problemas importantes de sa?de trazendo dados de alta preval?ncia de depress?o geri?trica, assim como indicadores de que sua terap?utica farmacol?gica adequada, muitas vezes, n?o ? alcan?ada. Assim, faz-se necess?rio a implementa??o de um modelo estrat?gico e ativo de a??o para abordagem preventiva na sa?de mental de idosos, pois utilizando ferramentas de baixo custo (escalas de rastreamento) ? poss?vel a identifica??o de casos de depress?o incidente, em fase inicial, de casos severos, bem como auxiliar na identifica??o daqueles idosos que recebem tratamento inadequado.

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-04-07T20:43:48Z No. of bitstreams: 1 FabioBarretoRodriguesDissertacao2015.pdf: 3967415 bytes, checksum: f7cf99ba46734ee5644ff6b6f3b44749 (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-04-07T20:44:08Z (GMT) No. of bitstreams: 1 FabioBarretoRodriguesDissertacao2015.pdf: 3967415 bytes, checksum: f7cf99ba46734ee5644ff6b6f3b44749 (MD5) / Made available in DSpace on 2017-04-07T20:44:08Z (GMT). No. of bitstreams: 1 FabioBarretoRodriguesDissertacao2015.pdf: 3967415 bytes, checksum: f7cf99ba46734ee5644ff6b6f3b44749 (MD5) Previous issue date: 2015-07-16 / The reduced dopamine production in Parkinson's disease (PD) substantially affects the motor skills and other primary bodily functions, including mood, cognition and functional performance. At the same time, losses occur in the autonomic nervous system. It is unknown how the autonomic function is related to these losses and whether a walking program can modify the heart rate variability (HRV) in this population. The aim of this study was to assess HRV in patients with PD and its relationship with anxiety and depression symptons, functional performance and severity of disease, and also the effect of a walking program in autonomic modulation and functional capacity. In cross- sectional phase were evaluated 26 patients (16 men / 10 women, 57.4 ?? 9.2 years) using the scales of anxiety, depression (HADS-A and HADS-D) and disease severity (UPDRS motorexamination and Hoehn and Yahrd scales). Functional performance was evaluated by the Timed Up and Go test (TUG) and three tests from the Senior Fitness Tests. These results were correlated with HRV indexes of time (RMSSD, SDNN) and frequency domain (HF, LF, LF / HF, TP, HF / TP, LF / TP) and nonlinear analysis (SampEn and DFA1) measured in sitting and standing position. The HRV variation from sitting to standing position (??? analysis) was also considered. In longitudinal phase a walking group (WG, n = 13) and a control group (CG n = 6) were formed through a randomized controlled trial. The home-based walking program had a duration of six weeks. The patients in the WG group were reassessed after 12 weeks of training. Were observed high levels of anxiety (30.7%) and depression (34.6%) in the patients evaluated. Depressive symptoms were associated to the parasympathetic activity: RMSSD (r = - 0.382; p ??? 0.05), as the activity in the both sympathetic and parasympathetic branches: LFseated (r = -0383; p ??? 0.05), LFstanding (r = -0.411; p ??? 0.05), TPstanding (r = -0, 504, p ??? 0.05) and ??? SampEn (r = -0384, p ??? 0.05). The severity and duration of illness also were negatively associated with autonomic function. RMSSDseated (r = -0.438; p ??? 0.05), SDNNseated (r = -0.452; p ??? 0.05) SDNNstanding (r = -0.602, p ??? 0.01); LFstanding (r = -0.603; p ??? 0.01); TPstanding (r = -0.504; p ??? 0.05) and LF/ TPstanding (r = -0.504; p ??? 0.05) were negatively associated with time to perform the TUG test. Other significant correlations (p ??? 0.05) of physical and functional tests and age HRV were observed . The six-weeks walking program have promoted significant changes in SampEn index (which measures the irregularity of HR data) in WG group compared to the CG group (20.47 vs -22.81%; CA and CO, respectively; p = 0.033) as well as ???SampEn measure (-22.83% vs. 18.46; WG and CG, respectively; p = 0.022), suggesting positive changes in autonomic function. At week 12, the WG group patients exhibited increased ratios of HF/TPstanding (7.0%; p = 0.017) and SampEn-standing (20.5%; p = 0.008; respectively), and reduction of the LF/HFstanding index (-10.65%; p = 0.012 ) compared to the first week, suggesting improvements in autonomic balance. There was an increase in sit-to-stand repetitions (10.50 ?? 1.93 to 13.25 ?? 1.58 repetitions; p = 0.021) and reduced time to perform the TUG test (7.34"?? 0.67 to 6.91" ?? 0.83, p = 0.002). Several HRV indices measured before walking program (SDNN, RMSSD, LF, HF, LF / TP) have shown correlations with the functional gain (r2 ranging from 0.62 to 0.81), suggesting a role of autonomic function in neuromuscular adaptation to training. It follows that HRV may work as an integrative measure and also as a peripheral marker of body's adaptability and its self-regulatory capacity, besides a practical and sensitive tool e to the disease progression. The home-based walking program have improved autonomic function of participants, often hampered by the disease. This is particularly interesting in that many bodily functions impaired in PD are mediated by autonomic function. / A redu????o da produ????o de dopamina na Doen??a de Parkinson (DP) afeta substancialmente a motricidade e outras fun????es org??nicas primordiais, como humor e a cogni????o, bem como o desempenho funcional. Paralelamente, ocorrem preju??zos no sistema nervoso aut??nomo. N??o se sabe como a fun????o auton??mica se relaciona com estes preju??zos e se um programa de caminhada pode modificar a variabilidade da frequ??ncia card??aca (VFC) desta popula????o. O objetivo deste estudo foi avaliar a VFC de pacientes com DP e a sua rela????o com os sintomas de ansiedade, depress??o, desempenho funcional e gravidade da doen??a, e tamb??m o efeito de um programa de caminhada na modula????o auton??mica e na capacidade funcional. Na etapa transversal foram avaliados 26 pacientes (16 homens/ 10 mulheres; 57,4 ?? 9,2 anos) pelas escalas de ansiedade, depress??o (HADS-A e HADS-D) e gravidade da doen??a (UPDRSexame motor e Hoehn e Yahrd). O desempenho funcional foi avaliado pelos testes Timed up and Go (TUG) e tr??s testes da bateria Senior Fitness Test. Estes resultados foram correlacionados com ??ndices da VFC no dom??nio do tempo (RMSSD, SDNN) e da frequ??ncia (HF, LF, LF/HF, TP, HF/TP, LF/TP), e an??lise n??o linear (SampEn e DFA1) aferidos na posi????o sentado e em p??. A varia????o da VFC da posi????o sentada para em p?? (valores em ??) tamb??m foi considerada. Na etapa longitudinal foram formados um grupo de caminhada (CA; n=13) e um grupo controle (CO; n=6), a partir de um ensaio cl??nico randomizado. O programa de caminhada home-based teve dura????o de seis semanas. Os pacientes do grupo CA foram reavaliados ap??s 12 semanas de treinamento. Foram observados elevados n??veis de ansiedade (30,7%) e depress??o (34,6%) nos pacientes avaliados. Os sintomas depressivos associaram-se tanto ?? atividade parassimp??tica: RMSSD (r= - 0,382; p ??? 0,05), quanto ?? atividade conjunta nos ramos simp??tico e parassimp??tico: LFsent (r= -0.383; p ??? 0,05), LFem p?? (r= -0,411; p ??? 0,05), TPemp?? (r= -0, 504; p ??? 0,05) e ?? SampEn (r= -0.384; p ??? 0,05). A gravidade e tempo da doen??a tamb??m se associaram negativamente ?? fun????o auton??mica. RMSSDsentado (r= -0,438; p ??? 0,05), SDNNsentado (r= -0,452; p ??? 0,05) e SDNNemp?? (r= -0,602; p ??? 0,01); LFemp?? (r= -0,603; p ??? 0,01); TPemp?? (r= -0,504; p ??? 0,05) e LF/TPemp?? (r= -0,504; p ??? 0,05) foram negativamente associados ao tempo no teste TUG. Outras correla????es significativas dos testes f??sico-funcionais e da idade com a VFC foram observadas. O programa de seis semanas de caminhada promoveu varia????es significativas do ??ndice SampEn (que mede a irregularidade dos dados de FC) no grupo CA em rela????o ao grupo CO (20,47 vs ???22,81%; CA e CO, respectivamente; p=0,033), assim como o ??ndice ??SampEn (-22,83 vs 18,46%; CA e CO, respectivamente; p=0,022), sugerindo mudan??as positivas na fun????o auton??mica. Na 12?? semana, os pacientes do grupo CA exibiram aumento dos ??ndices HF/TPemp?? (7,0%; p=0,017) e SampEn-em p?? (20,5%, p= 0,008), respectivamente) e redu????o do ??ndice LF/HFemp?? (-10,65 %; p=0,012) em rela????o ?? 1?? semana, sugerindo melhoras no equil??brio auton??mico. Houve aumento no n??mero de agachamentos (de 10,50 ?? 1,93 para 13,25 ?? 1,58 repeti????es; p= 0,021) e redu????o no tempo para realizar o TUG ( de 7,34??? ?? 0,67 para 6,91 ?? 0,83, p=0,002). V??rios ??ndices de VFC aferidos na tes do programa de caminhada (SDNN, RMSSD, LF, HF, LF/TP) mostraram correla????es com o ganho funcional (r2 variando de 0,62 a 0,81), sugerindo papel da fun????o auton??mica na adapta????o neuromuscular ao treinamento. Conclui-se que a VFC pode funcionar como medida integrativa e marcador perif??rico da adaptabilidade do organismo e da sua capacidade autoregulat??ria, al??m de recurso de avalia????o pr??tico e sens??vel ?? progress??o da doen??a. O programa de caminhada home-based melhorou a fun????o auton??mica dos participantes, frequentemente prejudicada pela doen??a. Isto ?? particularmente interessante na medida em que v??rias fun????es org??nicas debilitadas na DP s??o mediadas pela fun????o auton??mica.

Made available in DSpace on 2014-12-17T14:46:45Z (GMT). No. of bitstreams: 1 TarcianaSC_DISSERT.pdf: 2117561 bytes, checksum: a2f9349c2f46dbd6ce80b38d80f3068e (MD5) Previous issue date: 2010-10-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Brazilian health public assistance is going through two Reforms, Sanitary and Psychiatric, and through these the assistance is guaranteed in the three levels: primary, secondary and tertiary. Thus, mental health assistance should be offered since preventive cares until the ones that demand larger technological apparatus. Programs like Health Community Agent's Program (HCAP) and Family Health Strategy (FHS), besides increasing the services coverage, have been making possible the system reorientation in the meaning of integrality, universalization and equity. Thus, united intervention of mental health team and FHS can offer several benefits to the population, providing assistance and follow-up to patients with mental disorder. It was aimed to assess health community agents facing the user of Family Health Strategy in depressive state. This quanti-qualitative study took place in the municipal district of Abaiara-CE. Semi-structured interview was applied with health community agents and Beck Depression Inventory with the users registered in Family Health Strategy. It was verified that among the 64 users interviewed, 12.5% didn't present symptoms of depression, 10.9% presented symptoms of light depression, 14.1% symptoms of moderate depression and 62.5% symptoms of serious depression. For the 22 health community agents interviewed, they all reported the existence of people with symptoms of depression in their personal micro-areas, being difficult to work with them, once the FHS team is not qualified to work with mental health problems. It was verified that the Municipal district doesn't have specialized professionals, making difficult the routing and treatment. Based on these results, it was concluded that in spite of the articulation of mental health with FHS is necessary and benefactor to the population, it still doesn't exist, worsening the situation, mainly in small Municipal districts, once they don't have mental health services. Thus, the population is exposed and without follow-up, which allows the identification of installed diseases and with gravity, like depression, because there are no prevention and control activities. It is recommended, due the extreme need, the elaboration and implantation of a mental health program in these municipal districts, articulated with FHS / A assist?ncia p?blica ? sa?de brasileira perpassa por duas Reformas, a Sanit?ria e a Psiqui?trica, e trav?s destas garante-se a assist?ncia nos tr?s n?veis: prim?ria, secund?ria e terci?ria. Neste sentido, a assist?ncia ? sa?de mental deve ser prestada desde os cuidados preventivos at? os que exigem maior aparato tecnol?gico. Programas como o Programa de Agentes Comunit?rios de Sa?de (PACS)/ Estrat?gia Sa?de da Fam?lia (ESF), al?m de ampliarem a cobertura de servi?os, t?m possibilitado reorienta??es do sistema no sentido da integralidade, universaliza??o e equidade. Assim, a interven??o conjunta da equipe em sa?de mental e a ESF podem oferecer diversos benef?cios ? popula??o, proporcionando assist?ncia e acompanhamento aos portadores de transtorno mental. Desse modo, objetivou-se avaliar as a??es dos agentes comunit?rios de sa?de diante do usu?rio da Estrat?gia Sa?de da Fam?lia com estados depressivos. Este estudo do tipo quantiqualitativo, realizou-se no munic?pio de Abaiara-CE. Aplicou-se a entrevista semiestruturada com os agentes comunit?rios de sa?de e o Inqu?rito de Beck aos usu?rios cadastrados na Estrat?gia Sa?de da Fam?lia. Verificou-se que dentre os 64 usu?rios entrevistados, 12,5% n?o apresentaram sintomas depressivos, 10,9% sintomas de depress?o leve, 14,1% sintomas de depress?o moderada e 62,5% sintomas de depress?o grave. Os 22 agentes comunit?rios de sa?de entrevistados relataram a exist?ncia de pessoas com sintomas depressivos em suas micro ?reas e destacaram a dificuldade em atuar junto a esta clientela, pois para eles a equipe da ESF n?o se encontrava capacitada para lidar com problemas de sa?de mental. Constatou-se que o Munic?pio n?o dispunha de profissional especializado, o que dificultava o encaminhamento e tratamento. Com base nestes resultados, concluiu-se que apesar da articula??o da sa?de mental com a ESF ser necess?ria e benfeitora ? popula??o, esta ainda ? inexistente, agravando a situa??o, principalmente em munic?pios de pequeno porte, uma vez que estes n?o disp?em de servi?os de sa?de mental. Assim, a popula??o permanece exposta e sem acompanhamento, o que permite a identifica??o de doen?as instaladas e com gravidade, como a depress?o, por n?o haver atividades de preven??o e controle. Recomenda-se a elabora??o e implanta??o de um programa de sa?de mental nestes munic?pios, de forma articulada com a ESF

Made available in DSpace on 2014-12-17T15:36:42Z (GMT). No. of bitstreams: 1 RodrigoPAF_TESE.pdf: 1146990 bytes, checksum: e87dcca3a2082ed00e0523d76a6a9042 (MD5) Previous issue date: 2013-09-20 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome of unknown etiology, with symptoms of diffuse musculoskeletal pain and presence of specific anatomic sites called tender points. The symptoms are often associated with fatigue, sleep disturbances, morning stiffness, alterations in pain perception, anxiety and depression. Fibromyalgia exhibits a correlation between physical and behavioral symptoms, which have a negative influence on the quality of life of patients. Emotional skills are important factors since they are related to subjective well-being, personal productivity, social interaction and interpersonal relationships. We aim to describe the physical and psychosocial interactions in women with FM, showing the association between perceived social support and affect with symptoms of pain, functionality and mood. We will also describe a body representation of pain in women with FM. Data were collected over 3 years and the sample size ranged between studies. This is an exploratory cross-sectional study conducted with a convenience sample of 63 women with FM and 42 healthy women as a control group (CT), aged 20-76 years, recruited through spontaneous demand at Onofre Lopes University Hospital (HUOL) and the Clinical School of Physiotherapy of Universidade Potiguar (UNP). The Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Social Support Scale (MOS), Hamilton Anxiety Scale and Scale of Positive and Negative Affect Schedule (PANAS), in addition to pressure algometry were used. For data analysis, we used parametric and non-parametric tests and a general linear model with adjustment variables and analysis of variance. A significant difference was found between pain threshold and tolerance, functionality, depression, anxiety, social support, and positive and negative affect between the groups. Affective states and social support were associated with anxiety, depression and functionality. A body was drawn representing pain with higher incidences in trapeze, supraspinatus and second ribs. The reason for studying sensory aspects, affective behavior and social support in FM patients opens perspectives for scientific and clinical research of this syndrome. Women with chronic pain such as FM appear to have altered mood states, less social support and affective dysfunctions, influencing the other symptoms of the syndrome / A fibromialgia (FM) ? uma s?ndrome reum?tica n?o inflamat?ria, de etiologia desconhecida, apresentando sintomas de dor musculoesquel?tica difusa e presen?a de s?tios anat?micos espec?ficos dolorosos ? palpa??o, denominados tender points. Dentre os sintomas frequentemente associados est?o a fadiga, dist?rbios do sono, rigidez matinal, altera??es na percep??o da dor, ansiedade e depress?o. Existe na FM uma correla??o entre os sintomas f?sicos e comportamentais que influenciam negativamente na qualidade de vida dos pacientes. As habilidades emocionais aparecem como fatores importantes por estarem relacionadas com o mecanismo de bem estar subjetivo pessoal, produtividade, intera??o social e de relacionamento interpessoal. Objetivou-se descrever as intera??es f?sicas e psicossociais em mulheres com FM apresentando poss?veis associa??es entre a percep??o de apoio social e afetividade com os sintomas de dor, funcionalidade e estado de humor. Objetivo-se tamb?m, descrever um tipo de representa??o corporal da dor em mulheres com FM. Os dados foram coletados ao longo de 3 anos e o n?mero amostral variou entre os estudos. A partir de um estudo explorat?rio descritivo transversal, foi composta uma amostra por conveni?ncia de 63 mulheres com FM e 42 mulheres saud?veis como grupo controle (CT), com faixa et?ria de 20 a 76 anos, recrutadas mediante demanda espont?nea no setor de Fisioterapia do Hospital Universit?rio Onofre Lopes (HUOL) e na Cl?nica Escola de Fisioterapia da Universidade Potiguar (UNP). Foi aplicado o Question?rio de Impacto da Fibromialgia (FIQ), Invent?rio de Depress?o de Beck (IDB), Escala de Apoio Social (MOS), Escala de Ansiedade de Hamilton e Escala de Afeto Positivo e Negativo (PANAS). A seguir foi realizada a avalia??o da dor atrav?s da algometria de press?o. Para a an?lise dos dados, foram utilizados testes param?tricos e n?o param?tricos e de an?lise de vari?ncia. Foi encontrada diferen?a significativa quanto ao limiar e toler?ncia ? dor, funcionalidade, depress?o, ansiedade, apoio social e afetividade positiva e negativa. Os estados afetivos e o apoio social apresentaram associa??o com ansiedade, depress?o e funcionalidade. Foi elaborada uma representa??o corporal da dor que apresentou maiores incid?ncias em trap?zio, supraespinhal e segunda costela. A raz?o de se estudar a FM integrando os aspectos sensoriais, afetivo-comportamentais e sociais amplia os horizontes para investiga??o cient?fica e cl?nica dessa s?ndrome. Mulheres com FM apresentam estados de humor alterados, menor apoio social e express?o disfun??es de afetividade que influenciam os demais sintomas da s?ndrome

Made available in DSpace on 2014-12-17T15:37:03Z (GMT). No. of bitstreams: 1 ThiezaGASGM_DISSERT.pdf: 786174 bytes, checksum: fd475af7fc805fbc9f6633c6413d9035 (MD5) Previous issue date: 2011-05-16 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Treatment of major depression, posttraumatic stress disorder and other psychopathologies with antidepressants can be associated with improvement of the cognitive deficits related to these disorders. Although the mechanisms of these effects are not completely elucidated, alterations in extinction of aversive memories are believed to be present in these psychopathologies. Moreover, researches with laboratory animals usually focus on male subjects, and we have recently verified that extinction of an aversive task is reduced in female rats when compared to males. In the present study, female rats were long-term treated with clinically used antidepressants (fluoxetine, nortriptyline or mirtazapine) and tested in the plus-maze discriminative avoidance and forced swimming tests in order to evaluate learning, memory, extinction, anxiety and depression-related behaviors. All groups learned the task, but learning was somewhat faster in nortriptyline and mirtazapine-treated animals . Task retrieval was also showed by all experimental groups. Chronic treatment with fluoxetine, but not with the other antidepressants, increased extinction of the discriminative task. In the forced swimming test, animals treated with fluoxetine and mirtazapine showed decreased immobility duration. In conclusion, antidepressants interfere with learning and female rats treated with fluoxetine presented increased extinction of the aversive memory task. On the other hand, both fluoxetine and mirtazapine were effective in the forced swimming test, suggesting dissociation between the antidepressant effects and the extinction of aversive memories / Os tratamentos de depress?o, transtorno de estresse p?s-traum?tico e outras psicopatologias que se utilizam de antidepressivos podem estar associados ? melhora de d?ficits cognitivos relacionados a esses transtornos. Embora os mecanismos pelos quais a melhora nos d?ficits cognitivos ocorre n?o estejam totalmente esclarecidos, altera??es na extin??o de mem?rias aversivas podem estar presentes nestas psicopatologias. Al?m disso, pesquisas com animais de laborat?rio geralmente s?o realizadas com indiv?duos do sexo masculino, e recentemente verificamos que a extin??o de uma tarefa aversiva ? diminu?da em ratas quando comparada ao desempenho de ratos. No presente estudo, ratas Wistar foram tratadas prolongadamente com antidepressivos utilizados na cl?nica (nortriptilina, fluoxetina ou mirtazapina) e testadas na esquiva discriminativa em labirinto em cruz elevado e no teste do nado for?ado, a fim de avaliar a aprendizagem, a mem?ria, a extin??o, a ansiedade e comportamentos relacionados ? depress?o. A explora??o do bra?o aversivo na sess?o de treino foi semelhante em todos os grupos, mostrando que todos os grupos aprenderam a tarefa, havendo, por?m, uma melhora no desempenho dos grupos tratados com nortriptilina e mirtazapina. Na sess?o teste todos os animais evocaram a tarefa. O tratamento prolongado com a fluoxetina, mas n?o com os outros antidepressivos, promoveu uma melhora na extin??o da mem?ria aversiva da EDLC. No teste de nado for?ado, os animais tratados com fluoxetina e mirtazapina apresentaram diminui??o na dura??o da imobilidade, comparados ao ve?culo. Em conclus?o, os antidepressivos podem interferir no aprendizado, mas n?o na evoca??o de mem?rias aversivas. Al?m disso, ratas tratadas com fluoxetina apresentam um aumento da extin??o da tarefa aversiva, em compara??o ao ve?culo, enquanto os demais tratamentos impediram a extin??o dessa tarefa. Al?m disso, tanto a fluoxetina como a mirtazapina foram eficazes no teste de nado for?ado, sugerindo dissocia??o entre os efeitos antidepressivos e extin??o de mem?rias aversivas

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:49:32Z No. of bitstreams: 1 DanielGermanoMaciel_DISSERT.pdf: 1593169 bytes, checksum: 5afe86923f3e38d947bd98013d678865 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-11T21:40:36Z (GMT) No. of bitstreams: 1 DanielGermanoMaciel_DISSERT.pdf: 1593169 bytes, checksum: 5afe86923f3e38d947bd98013d678865 (MD5) / Made available in DSpace on 2017-04-11T21:40:36Z (GMT). No. of bitstreams: 1 DanielGermanoMaciel_DISSERT.pdf: 1593169 bytes, checksum: 5afe86923f3e38d947bd98013d678865 (MD5) Previous issue date: 2017-03-02 / A fibromialgia ? uma doen?a que apresenta dor musculoesquel?tica cr?nica e difusa associada a fadiga, dist?rbio do sono, problemas cognitivos e baixos n?veis de condicionamento f?sico. Trabalhos recentes mostram bons resultados tanto com a pr?tica de exerc?cios funcionais quanto com a utiliza??o da terapia laser de baixa intensidade (TLBI) para reduzir os sintomas dessa popula??o. Por?m, n?o foram encontradas evid?ncias que associem as duas formas de terapia no tratamento da fibromialgia. Objetivo: Investigar os efeitos de um programa de exerc?cios funcionais associado ? TLBI na dor, desempenho funcional e qualidade de vida de indiv?duos com fibromialgia. M?todos: Trata-se de um ensaio cl?nico randomizado e duplo-cego composto por 22 mulheres divididas em dois grupos de forma aleat?ria em blocos: grupo placebo (n=11) que foi submetido a um programa de exerc?cios funcionais associado a TLBI placebo; e o grupo laser (n=11) que foi submetido ao mesmo programa de exerc?cios associado a TLBI ativa. O programa de exerc?cio teve dura??o de dois meses e frequ?ncia de tr?s vezes semanais. A TLBI (808nm; 100mW; 4J e 142,85 J/cm2 por ponto) foi aplicada imediatamente ap?s cada sess?o de exerc?cio em diferentes pontos dos m?sculos quadr?ceps (8), isquiotibiais (6) e tr?ceps sural (3), bilateralmente. Todos os indiv?duos foram submetidos a avalia??es pr? e p?s interven??o quanto a: dor (locais, intensidade e limiar), desempenho funcional (equil?brio, testes funcionais), desempenho muscular (flexibilidade e vari?veis isocin?ticas), depress?o e qualidade de vida. A an?lise estat?stica foi realizada por meio do SPSS 20.0 adotando um intervalo de confian?a de 95%. Resultados: Pode-se observar que houve uma redu??o da dor e melhora do desempenho funcional e muscular, da depress?o e qualidade de vida em ambos os grupos (p<0,05), por?m, sem diferen?as significativas entre eles (p>0,05). Conclus?o: O programa de exerc?cio funcional foi eficaz na melhora da dor, desempenho funcional e qualidade de vida de indiv?duos com fibromialgia. No entanto, a TLBI n?o promoveu um incremento nos efeitos positivos proporcionados pelo exerc?cio. / Background: Fibromyalgia is a disease that presents chronic and diffuse musculoskeletal pain associated with fatigue, sleep disturbance, cognitive problems and low levels of physical conditioning. Recent studies have shown good results both with the practice of functional exercises or with the use of low-level laser therapy (LLLT) to reduce the symptoms of this population. However, no evidence was found associating both forms of therapy in the treatment of fibromyalgia. Objective: To investigate the effects of a LLLT associated with an exercise program on pain, functional capacity and quality of life of individuals with fibromyalgia. Methods: It was performed a randomized, double-blind clinical trial with 22 women randomly divided into two blocked groups: placebo group (n = 11) who went through a functional exercise program associated with placebo LLLT and the laser group (n = 11), who underwent the same functional exercise program associated with active TLBI. The exercise program occurred in two months and three times a week. The LLLT (808nm; 100mW; 4J e 142,85 J/cm2 per point) was applied right after each exercise program session in different points of quadriceps (8), hamstrings (6) and sural tr?ceps (3), bilaterally. Both groups were submitted to an evaluation of pain (sites, intensity and threshold), functional capacity (balance, functional tests), muscle performance (flexibility and isokinetic variables), depression and quality of life, before and after the intervention. Statistical analysis was performed using SPSS 20.0 adopting a 95% confidence interval. Results: It was observed that there was a reduction of pain and depression levels and an improvement of functional capacity, muscular performance and quality of life in both groups (p<0.05), but with no significant differences among them (p>0.05). Conclusion: The functional exercise program was effective on pain relief, better functional capacity and quality of life of individuals with fibromyalgia. However, LLLT did not promote an increase on the positive effects caused by the exercise.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-10-18T21:17:41Z No. of bitstreams: 1 FernandaPalhanoXavierDeFontes_TESE.pdf: 13181222 bytes, checksum: 0ecabee11e1314b4530f44422a85a1bd (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-10-30T19:36:31Z (GMT) No. of bitstreams: 1 FernandaPalhanoXavierDeFontes_TESE.pdf: 13181222 bytes, checksum: 0ecabee11e1314b4530f44422a85a1bd (MD5) / Made available in DSpace on 2017-10-30T19:36:31Z (GMT). No. of bitstreams: 1 FernandaPalhanoXavierDeFontes_TESE.pdf: 13181222 bytes, checksum: 0ecabee11e1314b4530f44422a85a1bd (MD5) Previous issue date: 2017-07-28 / Ensaios cl?nicos recentes t?m sugerido o potencial antidepressivo de alguns psicod?licos seroton?rgicos, como a ayahuasca e a psilocibina. A ayahuasca ? uma subst?ncia utilizada h? centenas de anos por povos ind?genas da bacia amaz?nica. Essa bebida ? geralmente preparada a partir de duas plantas, uma contendo a triptamina psicod?lica N,Ndimetiltriptamina, um agonista de receptores seroton?rgicos e sigma-1. A outra planta cont?m potentes inibidores revers?veis da monoamina oxidase A, como a harmina, harmalina e tetrahidroharmina. Em um ensaio cl?nico recente, 17 pacientes com depress?o resistente ao tratamento foram submetidos a uma ?nica sess?o com a ayahuasca, e a severidade dos sintomas avaliados por escalas cl?nicas para a depress?o, nesse caso a Escala de Avalia??o de Depress?o de Montgomery-?sberg (MADRS) e a escala de Hamilton (HAM-D). Os resultados sugerem melhora significativa j? nas primeiras horas ap?s a ingest?o, efeito esse mantido por 21 dias. Apesar de promissor, esse estudo n?o controlou o efeito placebo, que ? alto, chegando a alcan?ar 40%, em ensaios cl?nicos para depress?o. Esta tese faz parte de um ensaio cl?nico duplo-cego randomizado placebo-controlado em 35 pacientes com depress?o unipolar resistente ao tratamento. Um grupo de volunt?rios controles saud?veis tamb?m foi avaliado. Os pacientes receberam uma ?nica dose de ayahuasca ou placebo. Um dia antes e um dia depois da administra??o da subst?ncia, os pacientes participaram de uma s?rie de testes e avalia??es, incluindo escalas psicom?tricas e imagem por resson?ncia magn?tica funcional (fMRI), realizados no decurso de uma sess?o experimental de quatro dias. A severidade da depress?o foi aferida por duas escalas cl?nicas: MADRS e HAM-D. As avalia??es foram realizadas um dia antes (linha de base), e um, dois e sete dias ap?s a sess?o de tratamento. Observamos efeitos antidepressivos significativos da ayahuasca quando comparados ao placebo em todos os instantes de tempo avaliados (D1, D2 e D7). Os escores da MADRS foram significativamente menores no grupo da ayahuasca, em compara??o com o placebo. Da mesma forma, as pontua??es da HAM-D foram significativamente diferentes entre os grupos no D7. Os tamanhos do efeito entre os grupos aumentaram de D1 para D7. As taxas de resposta (redu??o de 50% nos sintomas) foram elevadas para ambos os grupos nos dias D1 e D2. J? sete dias ap?s a sess?o, a taxa de resposta foi significativamente maior no grupo ayahuasca que no placebo (64% ayahuasca x 27% placebo). Nesse mesmo ponto de avalia??o, a taxa de remiss?o foi marginalmente maior no grupo ayahuasca que no placebo (p<0.056, 36% ayahuasca x 7% placebo). Al?m disso, investigamos a rela??o entre os efeitos antidepressivos e os efeitos psicod?licos agudos da ayahuasca, avaliados pela Escala de Avalia??o Alucin?gena (HRS, Hallucinogenic Rating Scale) e o Question?rio de Experi?ncia M?stica (MEQ30, Mystical Experience Questionnaire). Os resultados sugerem que efeitos psicod?licos mais intensos est?o correlacionados a taxas de resposta maiores no D7. Por fim, para investigar as bases neurais dos efeitos antidepressivos da ayahuasca, utilizamos dados de fMRI adquiridos durante a realiza??o de um protocolo de regula??o emocional um dia antes e um dia ap?s a sess?o de tratamento. Observamos mudan?as na am?gdala, ?nsula anterior, c?rtex pr?-frontal ventrolateral e na por??o subgenual do giro do c?ngulo. Este ? o primeiro ensaio cl?nico, duplocego, controlado, a testar o uso de uma subst?ncia psicod?lica para a depress?o resistente ao tratamento. Em conjunto, nossos resultados trazem novas evid?ncias que apoiam a seguran?a e o valor terap?utico da ayahuasca, administrada dentro de um cen?rio apropriado, para ajudar a tratar a depress?o. / Recent open label trials show that psychedelics hold promise as fast-onset antidepressants in treatment resistant depression. In Brazil, a psychedelic substance worth mentioning is the ayahuasca. This brew composed by the psychedelic N,N-dimethyltryptamine (N,NDMT), a serotonin and sigma-1 receptors agonist, and reversible monoamine oxidase A inhibitors, such as harmine, harmaline, and tetrahydroharmine, causes changes in perception, emotion and cognition. Preliminary results from our group suggest its antidepressant potential, in addition to demonstrating its safety and tolerability. Although promising, none of these studies have controlled for the placebo effect, which is high in clinical trials for depression. To address this issue, we conducted a parallel-arm, double-blind randomized placebocontrolled trial in 35 patients with treatment-resistant depression. A healthy control group of 50 volunteers was also examined. Patients received a single dose of either ayahuasca or placebo. One day before dosing, and one day after dosing patients were enrolled in a series of tests and assessments, including psychometric scales and fMRI, conducted in the course of a four-day experimental session, to assess changes in different markers of depression. Two clinical scales for depression assessed changes in depression severity: the Montgomery??sberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating scale (HAM-D). Assessments were made at baseline, and at 1, 2 and 7 days after dosing. We observed significant antidepressant effects of ayahuasca when compared to placebo at all endpoints. MADRS scores were significantly lower in the ayahuasca group, compared to placebo. Likewise, HAMD scores were significantly different at D7. Between-group effect sizes increased from D1 to D7. Response rates were high for both groups at D1 and D2, and were significantly higher in the ayahuasca group at D7. Remission rate was marginally significant at D7. In addition, we examined the relationship between the antidepressant and acute psychedelic effects of ayahuasca. The psychedelic effects were assessed using the Hallucinogen Rating Scale (HRS) and the Mystical Experience Questionnaire (MEQ30) after the dosing session. We found that higher psychedelic effects measured by both HRS and MEQ30 correlated with improvements in clinical outcome at D7. Finally, to investigate the neural bases of the antidepressant effects of ayahuasca, we used fMRI data through an emotional task at baseline, and one day after dosing. We observed changes in key limbic regions, such as amygdala, anterior insula, ventrolateral prefrontal cortex, and subgenual cingulate cortex in ayahuasca group when compared to placebo. To our knowledge this is the first controlled trial to test a psychedelic substance in treatment resistant depression. Overall, this study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression.

Made available in DSpace on 2016-04-04T18:29:26Z (GMT). No. of bitstreams: 1 Rosemarie Elizabeth.pdf: 975117 bytes, checksum: b92177ce882a77c11884e90b9344d9f0 (MD5) Previous issue date: 2006-03-03 / The present study analyzed several causes of psychosocial and environment issues (DSM IV revised axis) affecting the incidence of the major depression (axis I) in young women between 16 and 25 years old assisted at the psychiatric ambulatory unit of the State University of Londrina, UEL. At the first phase of this research, it was studied medical records in a descriptive manner. In the second phase, 32 depressive patients of this ambulatory, who were previously submitted to a structured clinical interview (clinical version Scid-I) and DSM-IV axis (psychosocial and environment issues), were selected for inclusion in the study. In the final phase, it was done a therapeutic group attendance composed only by four patients. The results emphasized the significance of the union in a collaborative research, as much as the presence of a holding environment, through the transitional space, which offered perspectives of continuity of the group therapy, with their expectative the cure of depression / O presente estudo investigou a determina??o de v?rios problemas pssicossociais e ambientais (eixo DSM-IV revisado) na incid?ncia da depress?o maior (eixo I), em mulheres jovens com idades entre 16 e 25 anos, atendidas no ambulat?rio de psiquiatria da Universidade Estadual de Londrina, UEL. Na primeira etapa desta pesquisa, foram analisados prontu?rios m?dicos de modo descritivo. Na segunda etapa, foram selecionadas 32 pacientes com depress?o maior, e que foram previamente submetidas ? entrevista cl?nica estruturada (Scid-I vers?o cl?nica) e eixo IV do DSM-IV (problemas pssicossociais e ambientais), para inclus?o no estudo. Na etapa final, foi realizada a consulta terap?utica em grupo, realizada somente em 04 pacientes. Os resultados enfatizaram a import?ncia da integra??o em uma pesquisa colaborativa, bem como a exist?ncia de um ambiente de holding , atrav?s do espa?o transicional oferecido com perspectivas de continuidade deste atendimento em grupo, tendo como expectativa a cura da depress?o

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-08-09T23:58:08Z No. of bitstreams: 1 AdrianaSoeiroDeFariasSilvaJunqueiraAyres_TESE.pdf: 4492005 bytes, checksum: 363e585cddc1b3b004eb5170356b575b (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-08-15T23:16:31Z (GMT) No. of bitstreams: 1 AdrianaSoeiroDeFariasSilvaJunqueiraAyres_TESE.pdf: 4492005 bytes, checksum: 363e585cddc1b3b004eb5170356b575b (MD5) / Made available in DSpace on 2016-08-15T23:16:31Z (GMT). No. of bitstreams: 1 AdrianaSoeiroDeFariasSilvaJunqueiraAyres_TESE.pdf: 4492005 bytes, checksum: 363e585cddc1b3b004eb5170356b575b (MD5) Previous issue date: 2015-12-11 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / As plantas medicinais constituem uma rica fonte de compostos biologicamente ativos com seu potencial terap?utico para o tratamento de diversos transtornos psiqui?tricos, como os transtornos de ansiedade e depress?o. O transtorno de ansiedade generalizada tem aumentado de forma significativa, sendo o segundo transtorno mais prevalente em locais de assist?ncia ? sa?de p?blica. A depress?o ? considerada um transtorno psiqui?trico cr?nico e comum que afeta 350 milh?es de indiv?duos de todas as idades ao redor do mundo. Neste contexto as condutas de interven??o farmacol?gica que v?m sendo empregadas, embora eficazes, deixam a desejar, quando observados seus efeitos adversos. A Passiflora ? uma variedade comumente conhecida comercialmente, mas tamb?m ? usada na medicina tradicional brasileira. A Passiflora edulis exibe consider?vel variabilidade morfol?gica. Esta planta produz dois tipos de fruto: o roxo (P. edulis var. edulis) e o amarelo (P. edulis var. flavicarpa). O presente estudo investigou os efeitos centrais do extrato aquoso das folhas de duas variedades da esp?cie Passiflora edulis em testes comportamentais utilizados para avaliar comportamentos relacionados ? ansiedade e depress?o, bem como investigou o potencial efeito do tipo antidepressivo das subfra??es da Passiflora edulis var. edulis e os mecanismos neurofarmacol?gicos respons?veis por essa a??o. Para a realiza??o desse estudo foram utilizados camundongos Swiss machos (2 meses de idade, pesando 30-35 g). Os animais receberam o extrato aquoso das folhas das duas esp?cies de Passiflora: Passiflora edulis Sims var. edulis (PEE - 100, 300, 1000 mg/Kg) e subfra??es AcOet, BuOH e residual (25, 50, 75, 100 mg/Kg), e a P. edulis var. flavicarpa (PEF - 30, 100, 300, 1000 mg/Kg) ou solu??o salina, por gavagem, 60 minutos antes dos testes do labirinto em cruz elevado (LCE), teste de campo aberto (TCA), teste de nata??o for?ada (TNF) e teste de seda??o induzido por tiopental. Para investigar o mecanismo de a??o da atividade do tipo antidepressiva das subfra??es foram utilizadas as seguintes drogas: PCPA (inibidor da s?ntese de 5-HT), AMPT (inibidor da s?ntese de catecolaminas), DSP-4 (neurotoxina noradren?rgica) e Sulpiride (antagonista seletivo de receptor dopamin?rgico D2). Foram utilizados como controle positivo padr?o, a fluoxetina e a nortriptilina. Os resultados do perfil fitoqu?mico demonstram caracter?sticas bem distintas para o extrato aquoso das variedades de P. edulis ?flavicarpa? e ?edulis?. Os extratos aquosos de ambas as variedades de P. edulis compartilham atividade do tipo ansiol?tica (PEE 300 mg/Kg; PEF 300 e 1000 mg/Kg) e antidepressiva (PEE 300 mg/Kg; PEF 1000 mg/Kg), enquanto o efeito hipolocomotor/sedativo s? foi visto para a PEE (1000 mg/Kg). Ambas subfra??es AcOet e BuOH do extrato aquoso da PEE apresentaram atividade do tipo antidepressiva na dose de 50 mg/Kg no TNF. Os dados sugerem que o efeito do tipo antidepressivo das subfra??es da P. edulis envolve a neurotransmiss?o serotonin?rgica e catecolamin?rgica, principalmente dopamin?rgica, haja visto que o pr?-tratamento com DSP-4 n?o afetou a a??o antidepressiva das subfra??es, enquanto que mostrou ser dependente da ativa??o de receptores dopamin?rgicos D2. / The medicinal plants constitute a rich source of biologically active compounds used for the treatment of many psychiatric disorders, such as anxiety disorders and depression. Generalized anxiety disorder has increased significantly, being the second most prevalent disorder in care facilities to public health. Depression is considered a chronic and common psychiatric disorder that affects 350 million people of all ages around the world. In this context, the pharmacological intervention conduits have been employed, effective, although leave to be desired when observed adverse effects. The genus Passiflora is commonly commercially known by its fruit, but is also widely used in traditional Brazilian medicine. Passiflora edulis displays considerable morphological variability. This plant produces two types of fruit: Purple (Passiflora edulis Sims fo. edulis) and yellow (Passiflora edulis fo. flavicarpa Degener). This study investigated the central effects of aqueous extract of the leaves of the two varieties of the species Passiflora edulis in tests used to assess behavior related to anxiety and depression, as well as investigating the potential effect of the antidepressant-like fractions of edulis fo. edulis and neuropharmacological mechanisms responsible for this action. To conduct this study used male Swiss mice (2 months old, weighing 30-35 g). The animals received the aqueous extract of the leaves of the two species of Passiflora: edulis fo. edulis (100, 300, 1000 mg / kg) and fractions ethyl acetate, butanol and aqueous waste (25, 50, 75, 100 mg / kg) and edulis fo. flavicarpa (30, 100, 300, 1000 mg / kg) or saline by gavage 60 minutes prior to the maze tests at high cross the open field test, test forced swim test and sedation induced by thiopental. To investigate the mechanism of action of the activity of antidepressant type of fractions the following drugs were used: PCPA (inhibitor of 5-HT synthesis) AMPT (inhibitor of catecholamine synthesis), DSP-4 (noradrenergic neurotoxin) and Sulpiride (antagonist selective dopamine D2 receptor). They were used as a standard positive control, fluoxetine and nortriptyline. The results of the phytochemical profile show very different characteristics to the aqueous extract of the varieties of Passiflora edulis "flavicarpa" and "edulis". The aqueous extracts of both varieties of Passiflora edulis share anxiolytic activity type (edulis fo. edulis 300 mg/kg; edulis fo. flavicarpa 300 and 1000 mg/kg) and antidepressant (edulis fo. edulis 300 mg/kg; edulis fo flavicarpa 1000 mg/kg), while the effect hipolocomotor/sedative was only seen for edulis fo. edulis (1000 mg/kg). Both fractions ethyl acetate, butanol aqueous extract edulis fo. edulis showed activity type antidepressant at a dose of 50 mg/kg in the forced swim test. The data suggest that the effect of antidepressant-like fractions edulis fo. edulis involves catecholaminergic and serotonergic neurotransmission, particularly dopaminergic, there is seen that pre-treatment DSP-4 is not affected antidepressant action of fractions as was dependent activation of dopamine D2 receptors.