This report presents an overview of the results of the US National Comorbidity Survey (NCS) (Kessler et al., 1994) and future directions based on these results. The NCS is a survey that was mandated by the US Congress to study the comorbidity of substance use disorders and nonsubstance psychiatric disorders in the general population of the US. (...)

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Psychiatric disorders are believed to result from the combination of genetic predisposition and many environmental triggers. While the large number of disease-associated genetic variations have been recognized by previous genome-wide association studies (GWAS), the role of epigenetic mechanisms that mediate the effects of environmental factors on CNS gene activity in the etiology of most mental illnesses is still largely unclear. A growing body of evidence suggested that the abnormalities (changes in gene expression, formation of neural circuits, and behavior) involved in most psychiatric syndromes are preserved by epigenetic modifications identified in several specific brain regions. In this thesis, we developed the second generation of one of our microfluidic technologies (MOWChIP-seq) and used it to profile genome-wide histone modifications in three mental illness-related biological studies: the effect of psychedelics in mice, schizophrenia, and the effect of maternal immune activation in mice offspring. The second generation of MOWChIP-seq was designed to generate histone modification profiles from as few as 100 cells per assay with a throughput as high as eight assays in each run. Then, we applied the new MOWChIP-seq and SMART-seq2 to profile the histone modification H3K27ac and transcriptome, respectively, using NeuN+ neuronal nuclei from the mouse frontal cortex after a single dose of psychedelic administration. The epigenomic and transcriptomic changes induced by 2,5-Dimethoxy-4-iodoamphetamine (DOI), a subtype of psychedelics, in mouse neuronal nuclei at various time points suggest that the long-lasting effects of the psychedelic are more closely related to epigenomic alterations than the changes in transcriptomic patterns. Next, we comprehensively characterized epigenomic and transcriptomic features from the frontal cortex of 29 individuals with schizophrenia and 29 individually matched controls (gender and age). We found that schizophrenia subjects exhibited thousands of neuronal vs. glial epigenetic differences at regions that included several susceptibility genetic loci, such as NRXN1, RGS4 and GRIN3A. Finally, we investigated the epigenetic and transcriptomic alterations induced by the maternal immune activation (MIA) in mice offspring's frontal cortex. Pregnant mice were injected with influenza virus at GD 9.5 and the frontal cortex from mice pups (10 weeks old) were examined later. The results offered us some insights into the contribution of MIA to the etiology of some mental disorders, like schizophrenia and autism. / Doctor of Philosophy / While this field is still in its early stage, the epigenetic studies of mental disorders present promise to expand our understanding about how environmental stimulates, interacting with genetic factors, contribute to the etiology of various psychiatric syndromes, like major depression and schizophrenia. Previous clinical trials suggested that psychedelics may represent a promising long-lasting treatment for patients with depression and other psychiatric conditions. These research presented the therapeutic potential of psychedelic compounds for treating major depression and demonstrated the capability of psychedelics in increasing dendritic density and stimulating synapse formation. However, the molecular mechanism mediating the clinical effectiveness of psychedelics remain largely unexplored. Our study revealed that epigenomic-driven changes in synaptic plasticity sustain psychedelics' long-lasting antidepressant action. Another serious mental illness is schizophrenia, which could affect how an individual feels, thinks, and behaves. Like most other mental disorders, schizophrenia results from a combination of genetic and environmental causes. Epigenetic marks allow a dynamic impact of environmental factors, including antipsychotic medications, on the access to genes and regulatory elements. Despite this, no study so far has profiled cell-type-specific genome-wide histone modifications in postmortem brain samples from schizophrenia subjects or the effect of antipsychotic treatment on such epigenetic marks. Here we show the first comprehensive epigenomic characterization of the frontal cortex of 29 individuals with schizophrenia and 29 matched controls. The process of brain development is surprisingly sensitive to a lot of environmental insults. Epidemiological studies have recognized maternal immune activation as a risk factor that may change the normal developmental trajectory of the fetal brain and increase the odds of developing a range of psychiatric disorders, including schizophrenia and autism, in its lifetime. Given the prevalence of the coronavirus, uncovering the molecular mechanism underlie the phenotypic alterations has become more urgent than before, for both prevention and treatment.

Les objectifs de ce travail étaient d’évaluer la prévalence vie entière des traitements à visée psychotrope et les caractéristiques associées à cet usage dont l’adéquation avec l’existence de troubles psychiatriques. Les travaux ont été réalisés à partir des données issues de l’enquête Santé Mentale en Population Générale sur un échantillon de 36 785 adultes représentatifs de la population générale française. Un tiers des sujets a rapporté avoir fait usage d’au moins un traitement psychotrope au cours de la vie. L’inadéquation diagnostic-traitement est retrouvée dans le sens « usage en l’absence de trouble psychiatrique » aussi bien que dans le sens « absence d’usage en présence de trouble identifié ». Ainsi, seul un tiers des sujets avec un diagnostic de trouble dépressif récurrent a fait usage d’un traitement antidépresseur ou thymorégulateur. Concernant l’utilisation de traitements alternatifs, seuls 1,3 % des personnes rapportent un usage de traitement homéopathique à visée psychotrope. Ces traitements sont principalement utilisés par des personnes présentant un trouble anxieux en association avec un traitement psychotrope conventionnel. Des études ultérieures documentant l’ensemble des traitements à visée psychotrope utilisé dans le traitement des symptômes psychiques permettraient d’affiner les résultats sur l’adéquation diagnostic-traitement et d’estimer le nombre de sujets évitant le recours aux traitements conventionnels par l’utilisation d’alternatives thérapeutiques. / The aims of this work were to assess the lifetime prevalence of psychotropic drug use and the characteristics associated with use, particularly the congruence with psychiatric diagnoses. The studies were performed using the database from the survey Mental Health in the General Population including 36 785 persons representative of the French general population. One out of three subjects reported a lifetime use of psychotropic treatment. The non-congruence between diagnosis and psychotropic drug was observed in the pattern “use without psychiatric disorders” as well as in the pattern “no use with psychiatric disorders”. So, only one out of three persons with recurrent major depressive disorder reported having used an antidepressant or a mood stabilizer. Regarding complementary and alternative medicine use, only 1,3% of persons reported use of homeopathic treatment for psychiatric symptoms. These treatments were mainly used by persons with anxiety symptoms in association with conventional psychotropic drugs. Further studies assessing the all the treatments used for psychiatric symptoms would allow to refine the results on the congruence between diagnosis and psychotropic drug and to estimate the number of persons avoiding use of conventional psychotropic drugs by using complementary and alternative medicine.

Introdução: Evidências recentes indicam que situações de abandono, negligência e abusos são fatores de risco para desencadeamento de psicopatologias na vida adulta. Esta associação ocorre na medida em que eventos traumáticos, nas fases iniciais do desenvolvimento podem desencadear transtornos psiquiátricos graves e incapacitantes no adulto. Objetivo: O presente estudo objetivou avaliar a associação entre a ocorrência e a gravidade do Estresse Precoce (EP) e o desencadeamento de transtornos psiquiátricos em pacientes adultos em seguimento no Hospital Dia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Metodologia: A amostra foi composta por 81 pacientes psiquiátricos avaliados através de Entrevista Clínica, de acordo com os critérios do DSM-IV, para confirmação diagnóstica, divididos em 2 grupos: 58 pacientes com presença de EP e 23 com ausência de EP. A presença de EP foi confirmada através da aplicação do Questionário Sobre Traumas na Infância (QUESI). Os pacientes também foram avaliados quanto à gravidade da sintomatologia psiquiátrica através do Inventário de Depressão de Beck (BDI), Inventário de Ansiedade de Beck (BAI), Escala de Desesperança de Beck (BHS), Escala de Ideação Suicida de Beck (BSI), Escala Hospitalar de Ansiedade e Depressão (HAD) e da Escala de Impulsividade de Barratt (BIS-11). Resultados: Na amostra avaliada, 71.6% dos pacientes sofreram algum tipo grave de EP comparados a 28.4% dos pacientes que não sofreram. Considerando-se os subtipos de Estresse Precoce avaliados, os pacientes com história de trauma apresentaram escores maiores em todos os subtipos de Estresse Precoce em comparação aos pacientes sem história de abuso. A pontuação total do QUESI também foi significativamente diferente 66.05 vs. 34.78 (p<0.001) entre os grupos. A maioria dos pacientes avaliados (n=35; 60.4%) sofreu de 3 a 5 subtipos de Estresse Precoce. Os resultados indicam que o EP está associado principalmente com o desenvolvimento de transtornos de humor e também com o aumento da gravidade dos sintomas psiquiátricos, principalmente dos sintomas depressivos, sintomas de desesperança, de ideação suicida e de impulsividade. Com relação ao diagnóstico de eixo II, o EP está associado com o desenvolvimento de transtorno de personalidade (p=0.03). Pacientes com história de abuso emocional (OR: 5.2; 95% IC, 1.9-13.5), negligência emocional (OR: 4.02; 95% IC, 1.6-10.2) e negligência física (OR: 4.0; 95% IC, 1.6-10.1) apresentam um risco de 4 a 5 vezes maior de desenvolver transtorno de personalidade. Além disso, indivíduos que sofreram abuso físico (OR: 2.46; 95% IC; 0.89-6.78), abuso sexual (OR: 2.87; 95% IC; 0.86-9.57) e negligência física (OR: 2.50; 95% IC; 0.95-6.55) possuem de 2 a 3 vezes mais chances de cometer tentativas de suicídio. Nossos dados também demonstram que entre os subtipos de EP, o abuso emocional foi associado ao desencadeamento de psicopatologias na vida adulta, principalmente com os transtornos depressivos. Além disso, pacientes com presença de abuso emocional, tiveram maior gravidade em todos os sintomas psiquiátricos, tais como: sintomas de depressão, desesperança, ideação suicida, ansiedade e impulsividade. Também foram encontradas correlações positivas entre impulsividade, ideação suicida e desesperança com os escores totais do QUESI. Conclusões: Os dados apontam para a importância do Estresse Precoce como fator desencadeante de transtornos psiquiátricos, bem como indicam que a gravidade do Estresse Precoce está associada com a gravidade dos sintomas psiquiátricos.Dessa forma, há necessidade de mais estudos que avaliem a importância dos subtipos de Estresse Precoce como fator de risco para desencadeamento de psicopatologias graves no adulto. / Introduction: Recent evidences suggest that situations of abandonment, neglect and abuse are risk factors for onset of psychopathology on adulthood. This association occurs in that traumatic events in the early stages of development and may trigger severe and disabling psychiatric disorders in adults. Objective: The present study aimed to evaluate the association between the occurrence and severity of early life stress (ELS) and the development of psychiatric disorders in adult patients of the Day Hospital Unit of the Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto University of São Paulo (HCFMRP- USP). Methodology: The sample was consisted of 81 psychiatric patients evaluated by Clinical Interview according to the DSM-IV criteria for the diagnosis, divided into two groups: 58 patients with presence of ELS and 23 with absence of ELS. The presence of ELS was confirmed by the Childhood Trauma Questionnaire (CTQ). Patients also were evaluated for severity of psychiatric symptoms by the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Beck Hopelessness Scale (BHS), the Beck Scale for Suicide Ideation (BSI), the Hospital Anxiety and Depression Scale (HAD) and the Barratt Impulsiveness Scale (BIS-11). Results: In the sample studied, 71.6% of patients with some type of severe ELS compared to 28.4% of patients without ELS. Considering the subtypes of ELS evaluated, patients with a history of trauma showed higher scores in all subtypes of ELS compared to patients without a history of abuse. The total score of QUESI was also significantly different 66.05 vs. 34.78 (p<0.001) between groups. Most patients (n = 35, 60.4%) suffered 3-5 subtypes of ELS. The results indicate that ELS is associated mainly with the development of mood disorders and also with increasing severity of psychiatric symptoms, especially the depressive symptoms, hopelessness, suicidal ideation and impulsivity. Regarding the diagnosis of axis II, ELS is associated with personality disorder (p=0.03). Patients with emotional abuse (OR: 5.2, 95% CI, 1.9-13.5), emotional neglect (OR: 2.4, 95% CI, 1.6-10.2) and physical neglect (OR: 4.0, 95% CI, 1.6-10.1) at 4-5 fold higher risk of personality disorder. In addition, individuals who suffered physical abuse (OR: 2.46, 95% CI, 0.89-6.78), sexual abuse (OR: 2.87, 95% CI, 0.86-9.57) and physical neglect (OR: 2.50; 95% CI, 0.95-6.55) at 2-3 fold higher to commit suicide attempts. Our data also showed that among the subtypes of ELS, emotional abuse was associated with the onset of psychopathology in adulthood, especially in depressive disorders. Furthermore, patients with presence of emotional abuse, had more severe psychiatric symptoms at all, such as depressive symptoms, hopelessness, suicidal ideation, anxiety and impulsivity. We also found positive correlations between impulsivity, suicide ideation and hopelessness with the total scores of the QUESI. Conclusions: These data demonstrate the importance of ELS as a trigger for psychiatric disorders, and indicate that the severity of ELS is associated with the severity of psychiatric symptoms. Therefore, further studies are needed to assess the importance of subtypes of ELS as a risk factor for onset of severe psychopathology in adults.

Die vorliegende Habilitationsschrift zu „Computer-based diagnostic and prognostic approaches in medical research using brain MRI“ ist in zwei Abschnitte gegliedert. Konkret wird im ersten Abschnitt eine Übersicht über verschiedene Aspekte des Computer- und MRT-basierten Vorhersageansatzes gegeben. Im zweiten Abschnitt werden die Artikel aus diesem Feld beschrieben, die ich für die Habilitation eingereicht habe. Konkret beginnt der erste Abschnitt der Habilitationsschrift damit, das grundlegende methodische Konzept des Vorhersageansatzes zu beschreiben. Danach werden die drei prozeduralen Stadien beschrieben, die seine Anwendung charakterisieren, d.h. die Phase der Feature-Bestimmung, des Trainings von Regressionsalgorithmen und schließlich des Tests dieser Algorithmen mit Daten unbekannter Genese. Daran schließt sich eine Beschreibung der Entwicklung des Ansatzes in Form von drei Epochen an, die charakterisiert sind durch die Entdeckung diagnostischer Information in Signalen der Magnetresonanz, die erste Nutzung statistischer Regressionsverfahren zu deren Analyse, und die massenhaften Anwendung des Ansatzes. Schließlich werden zum Ende des ersten Abschnittes die Forschungsfragen skizziert, die mit dem Ansatz adressiert werden, d.h. die automatisierte Diagnostik, die Verfeinerung bestehender diagnostischer Richtlinien und die Identifikation neuer Biomarker. Im zweiten Abschnitt beschreibe ich im Detail die Forschungsartikel, die ich im Rahmen der Habilitation eingereicht habe. Über diese Artikel oder Studien hinweg wurden alle oben genannten Forschungsfragen adressiert, die mit dem Verfahren in der Literatur untersucht werden. Darüber hinaus wurden vielfältige technische Herausforderungen des Ansatzes in unterschiedlicher Weise bearbeitet. Zusammenfassend lässt sich daher sagen, dass die vorliegende Habilitationsschrift und die darin beschriebenen Fachartikel einen umfassenden Überblick über die konzeptionelle und methodische Vielfalt des Ansatzes geben. / This habilitation thesis on ‘Computer-based diagnostic and prognostic approaches in medical research using brain MRI’ is divided in two parts – an introductory first part that gives an overview on various aspects of the computer- and MRI-based disease prediction approach and a second part describing the research articles from this field that I submitted for habilitation. In particular, in the first part the habilitation synopsis starts by outlining the basic methodological concept of the disease prediction approach and by describing the three fundamental procedural stages characterizing it, i.e. the feature determination, training and test stages. Then, it continues by delineating the development of the approach in terms of three epochs that are characterized by the discovery of diagnostic information in MR signals, the first use of statistical regression techniques to analyze this information, and the mass use of the approach. Finally, it outlines the research aims pursued with the approach, i.e. automated diagnosis, refinement of diagnostic guidelines, and identification of novel diagnostic biomarkers. In the second part, I describe the peer-reviewed research articles that I submitted for habilitation. Across these articles or studies respectively, all of the three research aims pursued with the approach were addressed. Furthermore, technical challenges connected to the approach were addressed in various different fashions. Thus together, these studies and this habilitation thesis provide a substantial overview on the methodological and conceptual diversity of the field.

Exclusive breastfeeding for at least 6 months provides numerous infant and maternal benefits. Yet mothers with risk factors, such as lower education, lower socioeconomic status, younger maternal age, planned cesarean birth, and anxiety and depression, are more likely to stop breastfeeding in the early postpartum period. Few studies have focused on perinatal depression as a risk factor for breastfeeding cessation. To tailor effective interventions, nurses must first understand the lived experience of breastfeeding for mothers at risk for perinatal depression. A descriptive phenomenological study was conducted to elucidate the experience of breastfeeding for mothers with perinatal depression. The study was grounded in Swanson’s middle-range theory of caring. After university Institutional Review Board approval, a purposive sample of 10 women was recruited from various organizations. Participants completed a demographic questionnaire and the Edinburgh Postnatal Depression Scale, and semistructured, audiorecorded face-to-face or telephonic interviews were conducted. The researcher transcribed the data which was transformed into constituents of the mothers’ lived experience by utilizing Giorgi’s descriptive phenomenological method. Five constituents emerged: choosing selflessness, harboring inadequacy, deliberate persevering, discerning meaning, and cherishing intimacy. The constituents embodied the essence of the mothers’ thoughts and feelings connected to breastfeeding. By daily choosing selflessness, mothers consciously decided to breastfeed despite physical or psychological struggles. They often were harboring inadequacy due to ongoing struggles which led to incessant thoughts of maternal incompetence. Yet they successfully breastfed for at least 2 weeks after birth by deliberate persevering. Through breastfeeding, they were discerning meaning to realize their value as mothers. Finally, they reveled in purposeful moments of togetherness with their babies through cherishing intimacy. The study findings inform recommendations for nursing education, practice, research, and policy. Nursing education must include basic breastfeeding and perinatal mental health knowledge in prelicensure curricula and up-to-date lactation management techniques and perinatal mental health awareness training in continuing education. Practicing maternal-child nurses must provide education and support to mothers about advantages and difficulties of breastfeeding throughout the perinatal period. Future research includes determination of support needs for women with perinatal depression with subsequent development and evaluation of therapeutic actions to promote breastfeeding success. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

INTRODUÇÃO: O cuidado nutricional é parte essencial para o acompanhamento integral da crescente população idosa, principalmente quando na presença de doenças crônicas e neurodegenerativas e morbidades psiquiátricas. A Mini Avaliação Nutricional (MAN®), tem sido utilizada para este fim, e em algumas situações, informações adicionais a essa ferramenta são necessárias. OBJETIVOS: Caracterizar o estado nutricional de idosos acompanhados em ambulatório de neuropsiquiatria geriátrica. MÉTODOS: Foi obtida uma amostra de conveniência selecionada aleatoriamente entre pacientes idosos com diagnóstico de depressão (DEP), doença de Alzheimer (DA) e outros transtornos psiquiátricos (OTP). O estado nutricional foi avaliados através da MAN®, pelo índice de massa corporal (IMC= peso/altura2) e pelas circunferências do braço (CB) e panturrilha (CP). Os dados referentes ao consumo de medicamentos também foram obtidos, considerando-se como polifarmácia o consumo de mais de três medicamentos/dia. Os dados de diagnóstico médico e exames laboratoriais foram obtidos do prontuário médico. Foram avaliados 217 indivíduos no total, distribuídos conforme o diagnóstico clínico: grupo DEP= 107 (49,3%); grupo DA=59 (27,2%) e grupo OTP=51 (23,5%). RESULTADOS: O escore da MAN® identificou risco nutricional em 67,3%, 69,5% e 54,9%, e desnutrição em 14,0%, 13,6% e 27,5% dos pacientes em DEP, DA e OTP respectivamente. O baixo peso, avaliado pelo IMC foi observado em 29,0% (DEP), 24,1% (DA) e 45,1% (OTP) dos avaliados. A prevalência de anemia foi de 11,2% (DEP), 10,2% (DA) e 19,6% (OTP); sendo mais frequente em mulheres em DEP e OTP e em homens em DA. A média para vitamina D em todos os grupos encontrava-se na insuficiência. A presença de colesterol total acima dos intervalos de normalidade foi de 47,0% (DEP), 36,3% (DA) e 31,8% (OTP). Foi observada hiperglicemia em 52,9% (DEP), 48,1% (DA) e 41,6% (OTP) dos pacientes. A polifarmácia foi observada em 18,7% (DEP), 15,2% (DA) e 19,6% (OTP). Não houve associação significativa entre o uso de medicamentos e o estado nutricional, embora tenha sido apontado um direcionamento ao risco de desnutrição com o uso de medicamentos para o tratamento da depressão (inibidores seletivos de receptação de serotonina), demências (inibidores de colinesterase), cloridrato de omeprazol e indutores do sono. CONCLUSÕES: o risco nutricional e a desnutrição são prevalentes na população estudada, independente do grupo específico de doença neuropsiquiátrica ou demência. Esses achados demandam e justificam um monitoramento nutricional permanente para esses indivíduos, uma vez que vem acompanhados de outras deficiências específicas que comprometem a saúde de forma geral, como a anemia e insuficiência de vitamina D. A elaboração de planos educativos envolvendo os pacientes, cuidadores e a equipe médica, poderá contribuir para a melhora dessas condições. / INTRODUCTION: Nutritional care is an essential part for the integral follow - up of the growing elderly population, especially in the presence of chronic and neurodegenerative diseases and psychiatric morbidities. The Mini Nutrition Assessment (MAN®) has been used for this purpose, and in some situations, additional information to this tool is necessary. OBJECTIVES: To characterize the nutritional status of elderly patients in a geriatric neuropsychiatry clinic. METHODS: A randomly selected convenience sample was obtained among elderly patients diagnosed with depression (DEP), Alzheimer\'s disease (AD) and other psychiatric disorders (OTP). The nutritional status was evaluated through MAN®, body mass index (BMI = weight / height2) and circumference of arm (CB) and calf (CP). The data referring to the consumption of medicines were also obtained, considering as polypharmacy the consumption of more than three medications/day. The data of medical diagnosis and laboratory tests were obtained from the medical record. A total of 217 individuals were evaluated, distributed according to the clinical diagnosis: DEP = 107 (49.3%); Group DA = 59 (27.2%) and OTP group = 51 (23.5%). RESULTS: The MAN® score identified nutritional risk in 67.3%, 69.5% and 54.9%, and malnutrition in 14.0%, 13.6% and 27.5% of the patients in DEP, DA and OTP respectively. Low weight, evaluated by BMI, was observed in 29.0% (DEP), 24.1% (AD) and 45.1% (BTP) of the evaluated patients. The prevalence of anemia was 11.2% (DEP), 10.2% (AD) and 19.6% (OTP); Being more frequent in women in DEP and OTP and in men in AD. The mean for vitamin D in all groups was in the insufficiency. The presence of total cholesterol above the normality intervals was 47.0% (DEP), 36.3% (DA) and 31.8% (OTP). Hyperglycemia was observed in 52,9% (DEP), 48,1% (AD) and 41,6% (OTP) of the patients. Polypharmacy was observed in 18.7% (DEP), 15.2% (DA) and 19.6% (OTP). There was no significant association between drug use and nutritional status, although there was a trend towards malnutrition with the use of drugs to treat depression (selective serotonin reuptake inhibitors), dementias (cholinesterase inhibitors), Omeprazole hydrochloride and sleep inducers. CONCLUSIONS: nutritional risk and malnutrition are prevalent in the population studied, regardless of the specific group of neuropsychiatric disease or dementia. These findings demand and justify a permanent nutritional monitoring for these individuals, since they are accompanied by other specific deficiencies that compromise health in general, such as anemia and insufficiency of vitamin D. The elaboration of educational plans involving patients, caregivers and The medical team, could contribute to the improvement of these conditions.

Introdução: Epilepsia é uma desordem cerebral caracterizada predominantemente pela interrupção paroxística do funcionamento normal do cérebro causada por crises epilépticas que ocorrem de maneira recorrente e imprevisível. Aproximadamente 50% dos adultos com epilepsia têm ao menos uma comorbidade médica associada, e algumas condições apresentam uma prevalência maior quando comparados à população em geral. Entre elas podemos citar as comorbidades psiquiátricas e as alterações nutricionais. Objetivos: O presente estudo avaliou o consumo alimentar de pacientes portadores de epilepsia, e de forma mais específica, o consumo dos ácidos graxos poli-insaturados (PUFAS), e a sua relação com a presença de transtornos neuropsiquiátricos. Métodos: Foi realizado um estudo transversal onde o consumo alimentar de paciente com epilepsia do lobo temporal foi avaliado por um questionário de frequência alimentar (QFA) validado para a população de Porto Alegre –RS. Também foi avaliado a presença de transtornos psiquiátricos e sintomas de ansiedade através dos questionários estruturados, SCID, BAI e Escala de Hamilton. Resultados: Pacientes com diagnóstico de transtornos psiquiátricos avaliado por SCID apresentaram menor consumo de ácidos graxos omega-3, (0,53 ± 0,34g vs 0,84 ± 0,58g; p=0,047) e (0,21g ± 0,13g/1000kcal vs 0,32±0,21g/1000kcal; p=0,049). Pacientes com maiores níveis de ansiedade avaliados pelo BAI também apresentaram menor ingestão de PUFAS n-3 (9,14 ± 3,65g vs 12,82 ± 4,84g; p=0,011 e 3,41 ± 1,21% vs 4,14 ± 1,05% do VET; p=0,04). A Escala de Hamilton apresentou correlação inversa ao consumo de PUFAS n-3 (-0,306; p=0,041). Conclusão: Foi identificada uma associação entre o consumo de PUFAS n-3 e a presença de transtornos psiquiátricos e níveis mais altos de ansiedade em pacientes com epilepsia do lobo temporal. Ainda que o nosso estudo não pode determinar uma relação de cause efeito entre alterações neuropsiquiátricas e consumo de PUFAS é possível que um consumo de alimentos ricos em Omega-3 possa ser uma estratégica terapêutica a fim de melhorar anormalidades neuropsiquiátricas nesses pacientes. Essa é uma interessante questão que necessita ser melhor avaliada no futuro. / Background: Epilepsy is a brain disorder characterized by recurrent and unpredictable interruptions of normal brain function. About 50% of the adults patients with epilepsy have one or more coexisting medical conditions. Among the comorbidities, we highlight nutritional problems as well psychiatric disorders, which have a significant impact in the life quality of this patient. Aims: The aim of this study is to evaluate the nutritional intake of lobe temporal epilepsy patients and investigate its relation with psychiatric disorders diagnosis. Patients and Methods: we performed a cross-sectional study with 45 temporal lobe epilepsy patients and applied a food frequency questionary (FFQ), comparing the results with psychiatric diagnosis assessed by SCID to any disorders and depression by BAI and Hamilton Scale for anxiety. Results: All patients had a higher consumption of calories (38,89 ± 15,44). than the preconized for people in general and a lower intake of PUFAS than the recommended for cardiovascular protection. Patients identified with any psychiatric disorder by SCID had a lower intake of PUFAS n-3 (0,53 ± 0,34g vs 0,84 ± 0,58g; p=0,047 and 0,21g ± 0,13g/1000kcal vs 0,32±0,21g/1000kcal; p=0,049 than those free of diagnosis. Patients with high levels of anxiety also had also had a lower consumption of PUFAS n-3 (9.14 ± 3.65g vs 12.82 ± 4,84g; p=0.011). The Hamilton Scale had a negative correlation with PUFAS n-3 intake (0,306; p=0,041). Conclusion: We found a negative relation between the diagnosis of psychitric disorders and anxiety as assessed by SCID and BAI respectively. It’s not possible to determine a cause and effect relationship in this association, but we can consider the omega-3 fat acid and PUFAS n-3 rich food might be potentially therapeutic in patients with temporal lobe epilepsy. This question might deserve further studies.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-03-29T13:18:00Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Carlos_Alberto_dos_Santos_Treichel.pdf: 4138762 bytes, checksum: 1071a774bc33b0f53d5548686e5fdafb (MD5) / Made available in DSpace on 2018-04-03T18:38:32Z (GMT). No. of bitstreams: 2 Dissertacao_Carlos_Alberto_dos_Santos_Treichel.pdf: 4138762 bytes, checksum: 1071a774bc33b0f53d5548686e5fdafb (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-02-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / A partir dos movimentos de reforma psiquiátrica e do estabelecimento dos serviços comunitários de saúde mental, a família que antes se mantinha como observadora do processo do cuidado é olhada em uma nova perspectiva, passando a ser incorporada no processo terapêutico e contribuindo com a reabilitação psicossocial do indivíduo. Nesse sentido, dentro do contexto de cuidado comunitário, a família passa a ser considerada como um objeto de estudo deste campo de atuação. Diversos estudos têm enfatizado sua abordagem como necessária e documentado diferentes repercussões desse cenário entre esses sujeitos, dentre as quais àquelas relacionadas a aspectos psicossomáticos como a manifestação de transtornos psiquiátricos menores. Levando em conta que identificar quais características influem na ocorrência desses transtornos possa ser um passo importante para o estabelecimento de práticas que previnam ou interfiram nesse desfecho este estudo buscou identificar a prevalência e os fatores associados à manifestação de transtornos psiquiátricos menores entre 537 cuidadores familiares de pessoas em sofrimento psíquico atendidas em 16 Centros de Atenção Psicossocial (CAPS) localizados na 21ª região de saúde do estado do Rio Grande do Sul. Para análise, munindo-se de um modelo teórico hierarquizado, utilizou-se regressão de Poisson com o cálculo das razões de prevalência ajustadas. A prevalência de Transtornos Psiquiátricos Menores encontrada na população estudada foi de 42,1%. Os fatores associados à esses transtornos foram: sexo feminino (RP: 1,54); vínculo próximo com o usuário, em especial pais/mães (RP: 2,00); baixa escolaridade, apresentando risco de RP: 1,85 no estrato mais baixo; possuir problemas de saúde (RP: 1,24); referir problemas de nervos (RP: 3,02); baixo desempenho de avaliação da qualidade de vida nos âmbitos físico (RP:1,84) e de meio ambiente (RP:1,95); insatisfação com as relações familiares (RP: 1,56); falta de apoio familiar (RP: 1,25) e sentimento de sobrecarga, para qual foi encontrado um risco de RP: 2,61 entre os indivíduos com maior nível de sobrecarga. Levando em conta que na análise multivariada os aspectos que efetivamente exerceram influência sobre o desfecho na amostra estudada estão relacionados às condições situacionais e de apoio e organização familiar, sugere-se a implementação por parte dos serviços de medidas que favoreçam a melhoria no suporte social e inclusão de todos os membros do grupo familiar de seus usuários nos processos de cuidado. / With the psychiatric reform movements and the establishment of community mental health services, the family that before were considered as an observator of the health care process is seen in a new perspective, becoming incorporated into the therapeutic process and contributing to patient rehabilitation. In this sense, in the context of communitary health care, the family is considered as an object of study in this field. Several studies have emphasized their approach as a need and have documented different repercussions of this scenario among the relatives. These repercussions include those related to psychosomatics aspects as the manifestation of minor psychiatric disorders. Taking into account that identifying characteristics that contribute to occurrence of these disorders may be an important step towards establishing practices that prevent or interfere in this outcome, this study sought to identify the prevalence and the associated factors with the manifestation of minor psychiatric disorders among 537 family caregivers of In psychic suffering attended at 16 Psychosocial Care Centers (CAPS) located in the 21st health region of the state of Rio Grande do Sul. Using a hierarchical theoretical model, Poisson regression was used to track the Prevalence ratio. The prevalence of Minor Psychiatric Disorders found in the study was 42.1%. The associated factors with these disorders were: female gender (PR: 1.54); strong bond with the user, especially fathers / mothers (PR: 2.00); low educational level, especially in the lowest stratum (PR: 1.85); Have health problems (PR: 1.24); Refer problems of nerves (PR: 3.02); low performance of evaluation in the quality of life in the physical aspect (RP: 1.84) and environment aspect (PR: 1.95); dissatisfaction with family relationships (PR: 1.56); lack of family support (PR: 1.25) and feelings of burden, especially when intense (PR: 2,61). Taking into account that in the multivariate analysis the aspects that effectively influenced the outcome in the studied sample are related to situational conditions, family support and organization, it is suggested the implementation by the services of measures that favor the improvement in social support and inclusion of all members of the family group of its users in the processes of care.