Orientadora: Telma Gonçalves Carneiro Spera de Andrade / Banca: Camila Marroni Roncon / Banca: Lucinéia dos Santos / Resumo: Fármacos antidepressivos como os inibidores seletivos de recaptação de serotonina são utilizados no tratamento da ansiedade, pânico e outros transtornos mentais. Os efeitos desejados ocorrem somente após administração crônica, em torno de 3 a 4 semanas após o início do tratamento, com aumento dos sintomas de ansiedade no início da terapia farmacológica, ocasionando a descontinuidade do uso desses fármacos. Além disso, há relatos de resistência a esse tipo de tratamento. Visando encontrar soluções para tais problemas, fundamentados em estudos que mostraram que mecanismos opioides favorecem a atividade inibitória da serotonina em neurônios da Substância Cinzenta Periaquedutal Dorsal que modulam a fuga/pânico, o presente estudo teve por objetivo investigar o efeito da Buprenorfina, um agonista parcial de receptores μ-opioide e antagonista de receptores κ-opioide, como agente ansiolítico e anti-pânico, como também avaliar se o efeito ansiolítico e antipânico da Fluoxetina seriam antecipados pela associação com a Buprenorfina. Foram realizados 3 experimentos utilizando ratos machos Wistar com peso médio de 200g no início das sessões experimentais: 1. Tratamento agudo com Buprenorfina IP nas doses (0,015mg/Kg, 0,03mg/Kg e 0,3mg/Kg), tendo como controle positivo o Alprazolam IP (4mg/Kg); 2. Tratamento subcrônico 3 dias com Buprenorfina IP (0,3mg/Kg); 3. Tratamento agudo com Buprenorfina (0,3mg/Kg) - associado ao tratamento subcrônico com Fluoxetina 3 dias IP (10mg/Kg)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Antidepressant drugs such as selective serotonin reuptake inhibitors are used in the treatment of anxiety, panic and other mental disorders. The desired effects occur only after chronic administration, around 3 to 4 weeks after starting treatment, with increased anxiety symptoms at the beginning of pharmacological therapy, causing the discontinuation of the use of these drugs. In addition, there are reports of resistance to this type of treatment. Aiming to find solutions for such problems, based on studies that showed that opioid mechanisms favor the serotonin inhibitory activity in SCPD neurons that modulate scape/panic, the present study aimed to investigate the effect of Buprenorphine, a partial agonist of μ receptors-opioid and antagonist κ receptor-opioid as anxiolytic and anti-panic agents as well as assessing whether the anxiolytic and antipanic effect of Fluoxetine would be antecipated by association with Buprenorphine.Three experiments were performed using male Wistar rats weighing 200g at the beginning of the experimental sessions: 1. Acute treatment with Buprenorphine IP at doses (0,015mg/kg, 0,03mg /kg and 0,3mg/kg) or Alprazolan IP (4mg/kg); 2. Subchronic treatment 3 days with Buprenorphine IP (0,3mg/kg); 3. Acute treatment with Buprenorphine (0,3mg/kg) - associated to the subchronic treatment with Fluoxetine 3 days IP (10mg/kg). After the treatments, the animals were submitted to behavioral evaluation in the Elevated T Maze (ETM) and subsequently to the Open Field and the Light-Dark Transition Test. In experiment 1 the behavioral test was repeated 24 hours after the first behavioral evaluation. The results showed that Buprenorphine in the larger doses decreased the manifestation of the avoidances, without alterations of the scapes in the ETM, differently from what was (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2015-06-17T19:34:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-08-26. Added 1 bitstream(s) on 2015-06-18T12:46:58Z : No. of bitstreams: 1 000830348.pdf: 3391927 bytes, checksum: 3ca79e0cf7b3d78dffe919001e95a392 (MD5) / Introdução: Várias são as razões pelas quais familiares de portadores de transtornos mentais podem sentir sobrecarga e sofrimento. Os pacientes podem apresentar comportamentos problemáticos e incapacidades, que geram dependência e impacto negativo na vida dos familiares, principalmente os cuidadores. Foram realizados vários estudos para medir esse impacto, mas principalmente em transtornos mentais mais graves, como esquizofrenia e demências. Já foi encontrada também sobrecarga relevante em familiares de pacientes com transtorno obsessivo-compulsivo, mas não há na literatura estudos sobre sobrecarga e sofrimento psíquico em familiares cuidadores de pacientes com transtorno de pânico e agorafobia (TPA). O TPA se caracteriza por crises intensas, inesperadas e recorrentes de ansiedade, associadas à ansiedade antecipatória e vários comportamentos de esquiva, por medo de ter novas crises em diversos locais e situações. Assim, em geral essas pessoas se tornam dependentes de algum familiar para realizar suas atividades da vida diária. Objetivos: Estimar a prevalência e a gravidade de sobrecarga e sofrimento psíquico (transtorno mental comum - TMC) em familiares de pacientes com TPA, assim como avaliar a associação de fatores demográficos e clínicos com estes dois desfechos. Método: Estudo transversal, com amostra clínica de adultos portadores de TPA (critérios do DSM-IV), em tratamento numa clínica privada de Bauru e no Ambulatório de Transtornos Ansiosos e Obsessivo-Compulsivos (ATAOC) do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP de janeiro de 2011 a outubro de 2013. Os instrumentos de avaliação do cuidador foram: um questionário sobre dados sociodemográficos, a Carer Burden Interview (CBI), a Escala de Avaliação da Sobrecarga dos Familiares (FIBS-BR) e o Self-Reporting Questionnaire (SRQ). Os instrumentos de avaliação dos pacientes foram: um questionário para avaliar características ... / Introduction: There are many reasons for family members of patients with mental disorders to suffer and feel burdened. Psychiatric patients may present inappropriate behaviors and functional impairments, becoming dependent on others. This situation can have a negative impact on the lives of family members, especially the caregivers. There are several studies to measure this impact on caregivers, but they are mainly about major mental disorders, such as schizophrenia and dementia. High levels of family burden were also observed among Obsessive-Compulsive Disorder (OCD) caregivers, but there are no studies on family burden and distress among Panic-Agoraphobic Disorder (PAD) caregivers. The main PAD features are: intense, unexpected and recurrent panic attacks in association with anticipatory anxiety and avoidance of places and/or situations due to fear of having another panic attack. So, in general, the patients become dependent upon family members for assistance in daily life activities. Objective: To estimate the prevalence and severity of the burden and psychological suffering (common mental disorder - CMD) in family members of patients with PAD. Method: It is a cross-sectional study, with a clinical sample of adults with PAD diagnosis (DSM-IV criteria), receiving treatment from a private clinic in Bauru and also at an outpatient service (Ambulatório de Transtornos Ansiosos e Obsessivo-Compulsivos- ATAOC) of the Botucatu Medical School (UNESP), State of São Paulo -Brazil, between January 2011 and October 2013. The assessment instruments used to evaluate the caregivers were: a questionnaire with sociodemographic data, the Carer Burden Interview (CBI), the Brazilian version of the Family Burden Interview Scale (FIBS-BR) and the Self-Reporting Questionnaire (SRQ). The instruments to assess the patients were: a questionnaire with sociodemographic and clinical data, the Panic and Agoraphobia Scale (PAS) to evaluate the severity of ...

O contexto atual apresenta mudanças nos modos de organização subjetiva. Em meio a isso, as redefinições dos papéis do homem e da mulher, as novas formas de filiação, assim como as novas configurações familiares têm levado a uma crise de referências que atinge diferentes setores da vida humana. Dentre outros aspectos, isso tem implicado o redimensionamento do lugar do pai, tradicionalmente concebido como representante da lei simbólica. O papel social do pai passou a ser questionado e, muitas vezes, confundido com o declínio da função paterna, porém, se há um declínio, é do poder do patriarcado, e não de sua função, que permanece como estrutural. Fundamental à estruturação do humano e à convivência social, a lei se apresenta como um modo de amparo simbólico. Diante de tal quadro, questionamos como fica a referência à lei simbólica, que, no panorama atual, parece deixar lacunas importantes em seu exercício. Ineficiente na função de interdição e limite, a lei falha, como falham também as vantagens que ela deveria assegurar. Não mais interditado, o sujeito se vê convocado ao excesso e, paradoxalmente, sem referências, desamparado. A condição humana de desamparo constituinte do sujeito , em razão das circunstâncias de vida das pessoas, vem sendo exacerbada, o que revela a constante situação de desamparo na qual vivem os sujeitos atuais. Isso os leva a novas formas de desorganização psíquica e faz emergir novas configurações sintomatológicas, cujas formas de expressão estão vinculadas a contextos específicos. Dentre elas, o transtorno de pânico se destaca como uma ilustração do desamparo mais freqüentemente evocado na contemporaneidade, promovido pela fragilidade com que a lei se apresenta / The current context presents changes in the subjectives organization ways. Inside this, the redefinitions from the man and woman roles, the new filiation forms, as the new familiar configurations, have brought to a references crisis that reaches different sections from the human life. Among others aspects, this has been implied on redimensionment of the fathers place, traditionally conceived as representing from the symbolic law. The father social role is so questioned and, many times, confused with the decline from the paternal function, but, is there is a decline, it is from the patriarchal power, and not of its function, that stays as structural. Fundamental to the structuring of human being and to the social coexistence, the law presents itself like a way of symbolic support. In front of this, we question how stays the reference from the symbolic law, that in the current panorama, it seems leave important blanks in its duties. Inefficient in the limit and interdiction function, the law fails, as well the advantages that should assure of her. No more interdicted, the subject sees himself summoned to the excess and, paradoxally, without references, unsupported. The human condition of unssuporting constituent of the subject due to the life circumstances of people have been exacerbated, what reveals a constant unssuporting situation in which live the nowadays subjects. This leave them to new psychic disorganization forms and makes emerge new symptomatologic configurations, in which expression forms are linked to specific contexts. Among them, the panic disorder highlights as a illustration of the unssuporting more often evocated in the contemporary times, due to the fragility which the law presents itself

O presente estudo se propõe analisar os sintomas físicos manifestados na Síndrome de Pânico, enfocando-os não como reações fisiológicas, mas como eles se organizaram, psiquicamente, ou seja, como acontecimento corporal no sentido tomado por Czermak, ao referir-se à clínica do real em Lacan, que privilegia o corpo e suas intensidades. Trata-se de uma pesquisa psicanalítica, na qual utilizaremos fragmentos de um caso clínico de um jovem de vinte e nove anos, do sexo masculino, casado, cujo diagnóstico psiquiátrico é de Síndrome de Pânico. Nosso objetivo é buscar as significações metapsicológicas dos sintomas físicos manifestados. Para tanto, apresentaremos as significações dadas pelo paciente aos seus sintomas corporais, distinguindo-as das manifestações fisiológicas desencadeadas pelo pânico, descritas na síndrome. As representações corporais serão entendidas como uma memória corporal que se manifesta na transferência. Nosso propósito é compreender, a partir da análise dos fragmentos deste caso, como se organiza psiquicamente o acontecimento corporal, utilizando o método de interpretação proposto pela psicanálise. Como referencial teórico para discussão de tais questões, tomaremos as contribuições freudianas, pela ótica de Bastos, e também de autores contemporâneos que tratam do corpo na clínica, como Paul-Laurent Assoun, Piera Aulagnier, Ivanise Fontes e Maria Helena Fernandes. A análise dos fragmentos mostrou que é possível identificar, por intermédio do acontecimento de corpo manifesto nos sintomas físicos do pânico, a organização da subjetividade nascente. / This study aims at analysing the physical symptoms triggered by panic disorder not only its merely physiological reactions but also the way they are psychologically organized, that is to say, the corporal demeanour as viewed by Czermak, When referring to real clinic in Lacan, who privileges the body and its intensities. It is a psychoanalytic research, on which we will use fragments of a clinical case of a 29 year-old young man, married, whose psychiatric diagnosis is Panic Disorder. Our purpose is to search for metapsychological meanings of the revealed physical symptoms. To accomplish this, we will present the meanings expressed by the patient in relation to his corporal symptoms, by means of distinction between such meanings and the physiological manifestations caused by panic, described on the disorder. The corporal representations will be taken as a corporal memory that is revealed oh the transfer. Our aim is to comprehend, with the analysis of the fragments of the studied case, how the corporal demeanour organizes it self psychologically, by means of the interpretation method suggested by psychoanalysis. As theoretical basis for discussion of such issues, we will consider Freud's ideas, according to Basto's view as well as contemporary authors who treat the body in clinic, like Paul Laurent Assoun, Piera Aulagnier, Ivanise Fontes and Maria Helena Fernandes. The analysis of the fragments has indicated that it is possible to identify the organization of the rising subjectiveness throuem body demeanour present in the physical symptoms of panic.

Orientadores: Giovanni Battista Cassano, Evandro Gomes de Matos, Luis Alberto Magna / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T19:45:50Z (GMT). No. of bitstreams: 1 Sardelli_LionelaRavera_M.pdf: 5978329 bytes, checksum: 971b584cbbbf0036bf7a9e97f8c70921 (MD5) Previous issue date: 2005 / Resumo: Objetivo ¿ A presente investigação é parte integrante do ¿Spectrum Project¿, projeto internacional de pesquisa desenvolvido na Europa e nos Estados Unidos, o qual propõe uma metodologia para avaliar características psicopatológicas e clínicas de sintomas relacionados aos transtornos de ansiedade (TA), com enfoque especial no Transtorno do Pânico (TP). Tem como objetivo principal detectar a prevalência de aspectos subclínicos do TP em uma amostra representativa da Região Metropolitana de Campinas (RMC), Brasil. Casuística e Método ¿ Realizou-se um estudo epidemiológico de corte transversal. A amostra de estudo constituiu-se de 405 sujeitos, equilibrada segundo sexo, idade e cidade de moradia da população da Região Metropolitana de Campinas (RMC), São Paulo. Utilizou-se o questionário de auto-avaliação ¿Panic Agoraphobic Spectrum-Self Report¿ (PAS-SR) que contém 114 perguntas divididas em 8 Domínios e 13 subdomínios. O total escore do PAS-SR (total de respostas positivas de cada questionário) permite uma avaliação quantitativa dos sintomas correlacionados ao transtorno do pânico (TP) em cada sujeito entrevistado. Resultados- A idade dos sujeitos da amostra variou entre 16 e 89 anos, com média de 36,82 anos e desvio padrão de 14,74. Em relação ao escore total obteve-se uma média de 31,61 e um desvio-padrão de 19,63. Não foram encontradas diferenças significativas quanto aos valores médios do escore total do PAS-SR em relação a: faixa etária (p=0,21), raça (p=0,59), grau de instrução (p=0,20), estado civil (p=0,21) e região (p=0,13). A diferença mais significativa foi encontrada entre os sexos (p=0,001), onde as mulheres apresentaram em média um valor de escore total de 37,45, enquanto os homens de 25,74. A análise fatorial, utilizada como método de validação de construto, indicou que o questionário possui adequadas características psicométricas. Conclusões: Os dados obtidos neste estudo corroboram os da literatura quanto aos fatores mais freqüentemente associados no TP. O instrumento PAS-SR, traduzido e validado para uso no Brasil foi bem compreendido e teve boa aceitação pelos sujeitos da pesquisa. Isso permitiu a individualização de uma faixa da população geral com maior freqüência de sintomas relacionados ao TP. Revelando-se um instrumento útil para avaliação em nosso meio / Abstract: Objective ¿ The current investigation is part of ¿Spectrum Project¿, an international research project already developed in Europe and in the United States, which proposes a methodology for the evaluation of psychopathologic and clinical characteristics of symptoms related to Anxiety Disorder (AD), with a special focus on Panic Disorder (PD). It aims mainly at detecting the prevalence of sub-clinical PD symptms in a representative sample in the Metropolitan Region of Campinas (RMC), Brazil. Method ¿ An epidemiological study of transversal cut was carried out. The sample for this study consisted of 405 subjects and was balanced according to sex, age and city where they live in the Metropolitan Region of Campinas (RMC), São Paulo. The Panic Agoraphobic Spectrum-Self Report (PAS-SR) questionnaire containing 114 questions divided into 8 fields and 13 sub-fields was applied. The total PAS-SR score (total of positive answers of each questionnaire) allows a quantitative evaluation of the symptoms associated with the Panic Disorder (PD) in each interviewed subject. Results ¿ The age of the subjects ranged from 16 to 89 years, mean 36.82 (±14.74) and the total 31.61 ( ±19.63). There were no significant differences in the median values of the PAS-SR total score in relation to age range (p=0.21), race (p=0.77), education level (p=0.20), marital status (p=0.21) and location (p=0.14). The most significant difference was the one found between both sexes (p=0.001). Females presented a mean value of total score of 37.45, while males presented the average of 25.74. Conclusion ¿ The findings agreed substantially with those found in the literature concerning the most frequent factors associated with PD. The PAS-SR instrument, which was translated and validated for use in Brazil, had a good acceptance and was well understood by the subjects who underwent the research. It allowed the individualization of a sample of general population with greater frequency of symptoms related to PD. Thus, it was revealed as a useful instrument for evaluation in our environment / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

The objective of this study is to see if nonclinical panickers with unexpected panic attacks (NCPs-U) may be a more useful panic disorder (PD) analogue than nonclinical panickers with expected panic attacks (NCPs-E).

The effects of physiological arousal and panic expectancy on anxiety and agoraphobic avoidance were evaluated on thirty-six Ss diagnosed with panic disorder. It was hypothesized that there would be main effects of increased physiological arousal and increased panic expectancy on anxiety and avoidance, as well as an interaction of these two factors, in a behavioral avoidance test containing agoraphobic situations. Physiological arousal induced through hyperventilation raised anxiety immediately following induction, but did not affect anxiety or avoidance on the subsequent walk. Although panic expectancy did not change as a result of the manipulations, initial panic expectancy was the strongest predictor of anxiety on the walk, and the best predictor of general agoraphobia measured by the Chambless Mobility Inventory. Absence of reliable changes in panic expectancy and significant results are discussed in terms of possible pretest sensitization, nature of the sample and subject selection, floor and ceiling effects, experimental demand characteristics, a relatively weak expectancy manipulation, and statistical issues such as large pre-group differences and large within-group variability. This research does however support previous studies which have found a strong correlational relationship between panic expectancy and agoraphobia. / Ph. D.

Several studies targeting individuals with panic disorder have demonstrated that Cognitive-behavioral treatment (CST) is the psychological treatment of choice. CST interventions that include exposure to panic symptoms, along with cognitive restructuring. breathing retraining, and relaxation training are more effective than any of these components administered alone. Past studies have demonstrated the efficacy of imparting the above CBT components in the form of bibliotherapy (BT) in the treatment of panic disorder. The present study examined the differential effectiveness of BT and self-regulatory treatments in the treatment of individuals with panic attacks. The present study examined a much purer version of a self-help bibliotherapy intervention by reducing therapist contact much more than prior studies had done. In addition, the present study examined the additive effectiveness of self-regulatory components-self-monitoring (SM) and feedback (FB)--to BT. Sixty-three participants who experienced a DSM-IV full-blown or limited symptom attack in the two weeks prior to beginning the Self-help Project were assigned via stratified randomization to 1 of 4 experimental conditions: 1) BT alone (N = 17); 2) ST plus DML (daily self-monitoring plus feedback; (N = 15); 3) DML (N = 13); or 4) WL (N = 18). The present study utilized a pre - post treatment assessment design with pre-treatment assessment occurring two weeks prior to treatment and post-treatment assessment occurring approximately two weeks after the end of treatment. Treatment was 8 weeks in duration. Participants were sent pre-treatment assessment and treatment materials via mail in order to minimize therapist contact. At post-treatment assessment, participants were assessed either in-person or via mail/phone depending upon their geographic location. It was expected that participants in all treatment conditions would experience less full-blown panic attacks, limited-symptom attacks, avoidance, fear of having a panic attack, panic cognitions. panic symptoms, state anxiety and depressive symptoms and increases in coping strategies and coping self-efficacy than participants in the WL condition. Furthermore, it was expected that participants in the BT plus DML condition would experience more change on the above dependent variables than participants in the BT alone and DML alone conditions from pre- to post-treatment assessment. A 4 X 2 repeated measures MANOVA revealep no Condition by Time interaction or Condition effect. However, a main effect for time across conditions emerged. Univariate tests revealed significant reductions from pre- to post-treatment assessment for full blown panic attacks, avoidance. fear of having a panic attack. panic cognitions, panic symptoms, depressive symptoms, and state anxiety. In addition, an exploratory 4 X 2 repeated measures ANOVA revealed a Condition by Time interaction with partiCipants in the BT and BT plus DML conditions increasing in coping self-efficacy from pre- to post-treatment. Partial correlations revealed that change in coping self-efficacy was related to lower scores on the Panic Attack Symptoms Questionnaire (PASQ) at post-treatment assessment for participants in the BT and BT plus DML conditions. The results of this study are discussed in terms of motivational issues and the effectiveness of such "pure" self-help interventions with individuals experiencing panic attacks. / Ph. D.

A recent study suggested that bibliotherapy may be an effective intervention for panic disordered individuals with agoraphobia. The present study attempted to enhance this bibliotherapy intervention by adding audio- and videotape self-help supplements. Thirty subjects suffering panic disorder with mild to moderate agoraphobia were matched on level of avoidance and then randomly assigned to 1) a Wait-list control condition (WL). or 2) a Self-help condition (SH). The intervention lasted four weeks followed by an eight week post treatment phase. and follow-up measures at the end of this phase. Results indicated that, from pre-treatment to follow-up, SH subjects improved significantly on 11 of the 12 dependent measures used in this study. while WL subjects did not. Furthermore. SH subjects were significantly more improved than WL subjects at follow-up with regard to agoraphobic avoidance, coping with panic attacks, self efficacy for mild, moderate and severe attacks, and for two critical measures of distress: frequency of panic attacks. and total severity of each attack. Clinical outcome measures also supported the effectiveness of the self-help approach. More than two-thirds of SH subjects met the criteria for clinical improvement. While only one-quarter of WL subjects met these criteria. Implications for the treatment of panic disordered individuals are discussed, as is the role of self-efficacy in mediating clinical change. / Ph. D.

Thesis (Ph.D.) in Psychology--University of Maine, 2004. / Includes bibliographical references (leaves 136-169).