A investigação da fisiopatologia do transtorno bipolar em pacientes no início da doença é uma estratégia para evitar um potencial efeito de confusão associado à duração da doença, presença de múltiplos episódios de alteração do humor e tratamento medicamentoso. Nosso objetivo foi investigar, in vivo, metabólitos neuronais do hipocampo de portadores de transtorno afetivo bipolar (TAB) usando a espectroscopia por ressonância magnética de próton (1H-ERM) logo após o seu primeiro episódio de mania. Para isso, foram estudados cinqüenta e oito pacientes com TAB tipo I, classificados de acordo com os critérios do DSM-IV (APA, 2000), após o primeiro episódio de mania e 27 indivíduos saudáveis utilizando a 1H-ERM com um aparelho Philips Achieva de 3T. Voxels com 30X15X15 mm foram posicionados no hipocampo em ambos os lados do cérebro e o sinal foi adquirido utilizando uma sequência PRESS com TE = 35ms e TR = 2000ms. A análise dos dados foi realizada utilizando o programa LC Model. Os níveis de N-acetil-aspartato, compostos de colina, mio-inositol, creatina e glutamina + glutamato (Glx) foram comparados entre os grupos e não foram encontradas diferenças estatisticamente significativas entre eles. Esses achados sugerem que no início do curso do TAB não há alterações no metabolismo neuronal ou vulnerabilidade no hipocampo após o primeiro episódio maníaco / The investigation of the pathophysiology of bipolar disorder in patients at disease onset is a strategy to avoid a potential confounding effect associated with disease duration, presence of multiples mood episodes and pharmacological treatment. Our purpose was to investigate, in vivo, neuronal metabolites in the hippocampus of bipolar disorder (BD) patients using proton magnetic resonance spectroscopy (1H-MRS) soon after their first manic episode. We studied fifty-eight BD I patients meeting DSM-IV (APA, 2000) criteria following their first episode of mania and 27 healthy subjects using 1H-MRS with a 3.0 T Philips Achieva scanner. Voxels with 30X15X15 mm were placed in the hippocampus on both sides of the brain and the signal was collected using a PRESS sequence with TE = 35ms and TR = 2000ms. Data analysis was performed using the LC Model software. N- Acetyl-Aspartate, choline compounds, myo-inositol, creatine and glutamine + glutamate (Glx) levels were compared between the groups and no statistically significant differences were found. These results suggest that early in the course of BD there are no alterations in neuronal metabolism or vulnerability in the hippocampus after the first manic episode

A investigação da fisiopatologia do transtorno bipolar em pacientes no início da doença é uma estratégia para evitar um potencial efeito de confusão associado à duração da doença, presença de múltiplos episódios de alteração do humor e tratamento medicamentoso. Nosso objetivo foi investigar, in vivo, metabólitos neuronais do hipocampo de portadores de transtorno afetivo bipolar (TAB) usando a espectroscopia por ressonância magnética de próton (1H-ERM) logo após o seu primeiro episódio de mania. Para isso, foram estudados cinqüenta e oito pacientes com TAB tipo I, classificados de acordo com os critérios do DSM-IV (APA, 2000), após o primeiro episódio de mania e 27 indivíduos saudáveis utilizando a 1H-ERM com um aparelho Philips Achieva de 3T. Voxels com 30X15X15 mm foram posicionados no hipocampo em ambos os lados do cérebro e o sinal foi adquirido utilizando uma sequência PRESS com TE = 35ms e TR = 2000ms. A análise dos dados foi realizada utilizando o programa LC Model. Os níveis de N-acetil-aspartato, compostos de colina, mio-inositol, creatina e glutamina + glutamato (Glx) foram comparados entre os grupos e não foram encontradas diferenças estatisticamente significativas entre eles. Esses achados sugerem que no início do curso do TAB não há alterações no metabolismo neuronal ou vulnerabilidade no hipocampo após o primeiro episódio maníaco / The investigation of the pathophysiology of bipolar disorder in patients at disease onset is a strategy to avoid a potential confounding effect associated with disease duration, presence of multiples mood episodes and pharmacological treatment. Our purpose was to investigate, in vivo, neuronal metabolites in the hippocampus of bipolar disorder (BD) patients using proton magnetic resonance spectroscopy (1H-MRS) soon after their first manic episode. We studied fifty-eight BD I patients meeting DSM-IV (APA, 2000) criteria following their first episode of mania and 27 healthy subjects using 1H-MRS with a 3.0 T Philips Achieva scanner. Voxels with 30X15X15 mm were placed in the hippocampus on both sides of the brain and the signal was collected using a PRESS sequence with TE = 35ms and TR = 2000ms. Data analysis was performed using the LC Model software. N- Acetyl-Aspartate, choline compounds, myo-inositol, creatine and glutamine + glutamate (Glx) levels were compared between the groups and no statistically significant differences were found. These results suggest that early in the course of BD there are no alterations in neuronal metabolism or vulnerability in the hippocampus after the first manic episode

A disease has consequences not only for the afflicted person but also for those who interact with him or her. A low-grade glioma is a brain tumour whose regarding its psychosocial implications for adult patients and their next of kin has received little attention in the literature. In the light of this the overall aim of the present thesis was to provide increased knowledge about how patients with low-grade glioma and their next of kin experience and deal with everyday life. The methods of the studies were mainly qualitative. Thirty-nine patients and 28 next of kin were interviewed and all except one next of kin completed a quality of life questionnaire. The onset of low-grade glioma was described from the patients’ perspective as a process, either rapid (up to a few months) or prolonged over several years. This phase of low-grade glioma encompassed repeated visits to physicians and care institutions. The onset of low-grade glioma was accompanied by stress, anxiety and uncertainty in the case of both the patients and those nearest. The symptoms and problems the patients experienced covered a broad range of consequences, physical, psychological and social. The patients presented a wide range of ways to cope with illness-related problems. The next of kin were often deeply involved in the patients’ situation and many of them experienced extremely stressful emotions mainly in the early period of the illness. They had experience of positive encounters in health care but more often they had had a sense both of powerlessness and of being invisible and neglected. Relations and roles changed in ways that mostly were experienced as negative. Enabling strength in everyday life had to do with alleviation of strain and having a positive outlook upon life. By means of the questionnaire Subjective estimation of Quality of Life (SQoL) the patients and those nearest estimated their quality of life as being comparatively high. Only one variable, among the patients the absence of work/meaningful occupation and among the next of kin the absence of own children, being estimated at below 60% of the maximum score.