Made available in DSpace on 2017-06-01T18:08:54Z (GMT). No. of bitstreams: 1 raquel_carvalho_queiroz.pdf: 803013 bytes, checksum: c364f4d8c3ab66e929f3eef6a8d135e8 (MD5) Previous issue date: 2014-04-30 / In the current context of the treatment of psychosis, there is an emphasis in favor of use, almost exclusively, of psychotropic drugs. In this way, we have pointed out the importance of considering the impact of this abusive use in the ripening process of this subject. For both, the present research used the bibliographic data bases of the Scielo, NCBI, Fiocruz, Anvisa and WHO; in addition to online libraries of universities and psychoanalytic´s institutions. For the searches, we used descriptors such as: treatment of psychosis, ripening process of Winnicott and excessive use of psychotropic drugs. We depart from the constitution and evolution of psychiatric knowledge and psychoanalytic about insanity. Then, based on the theory of the maturation process of the subject of Winnicott, is presented the panorama of this theory, in order to substantiate that form the medication´s can interfere in this process. Finally, are discussed the proposals of psychoanalytic and psychiatric treatment of psychosis, highlighting the consequences of improper use of medicines. In this regard, the present study points to the importance for an ethical practice of professionals who works with this clinical specificity. In addition, we emphasize the fundamental aspect of cautious use of psychotropic drugs for which he may assist the subject in the resumption of the process. / No contexto atual do tratamento da psicose, há uma ênfase em prol da utilização, quase exclusiva, de psicofármacos. Desse modo, apontamos para a importância de se considerar as repercussões desse uso de forma abusiva no processo de amadurecimento desse sujeito. Para tanto, a presente pesquisa bibliográfica utilizou as bases de dados do Scielo, NCBI, Fiocruz, Anvisa e OMS; além de bibliotecas online de universidades e de instituições psicanalíticas. Para as buscas, utilizamos descritores como: tratamento da psicose, processo de amadurecimento de Winnicott e uso excessivo de psicofármacos. Partimos da constituição e evolução do saber psiquiátrico e psicanalítico acerca da loucura. Em seguida, baseada na teoria do processo de amadurecimento do sujeito de Winnicott, é apresentado o panorama dessa teoria, de modo a fundamentar de que forma a medicação pode interferir nesse processo. Por fim, são discutidas as propostas de tratamento psicanalítico e psiquiátrico da psicose, dando destaque às consequências do uso abusivo dos medicamentos. Nesse sentido, o presente estudo aponta para a importância para uma prática ética dos profissionais que atuam com essa especificidade clínica. Além disso, ressaltamos o aspecto fundamental do uso comedido do psicofármaco para que ele possa auxiliar o sujeito na retomada desse processo.

Psychotropic drugs are commonly used group of pharmaceuticals, their main effect is to alter psychic condition, including mental diseases treatment. Symptoms of mental illnesses are more and more common, theref orenumber of patients diagnosed with mental illnes, and thus using psychotropics, is growing stronger. But using psychotropics during gestation is not without risks for mother and embryo itself. However, thanks to the absence of controlled human studies, the knowledge of emrbyotoxic effects of pschotropics is limited to casuistics, reported side effects and animal experimental studies. Many of those studies suggests emrbyotoxic potential of psychotropic drugs, on the other hand, others claim their safety. The goal of this thesis is to test at least some of them, using CHEST method, that allows us to observe direct effect of unmetabolized substance on chick embryo. In this thesis we tested selected psychotropics, very common antidepressant fluoxetine (prozac) and antipsychotic drug olanzapine, for embryotoxicity, using in ovo method CHEST with chick embryos as model organism. By bypassing the maternal organism and his metabolism, this method allows to observe direct effect of unmetabolized substance on chick embryo. Results revealed embryotoxic effect of fluoxetin in dosage 10-2 and 10-3 on 3rd and...

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The presence of pharmaceuticals in the aquatic environment has long been reported for some years in various studies. However, the impact of drugs on organisms present in aquatic ecosystems is still poorly known. Thus, we investigated the effects of acute exposure to diazepam or fluoxetine on the response to acute stress in zebrafish (Danio rerio). Fish were exposed to drugs for 15 minutes and, after this period, the group designated time 0 was collected; the other groups were subjected to a stimulus of stress, which consisted in persecution of fish with a net for two minutes, and after that, were collected at the times of 15, 60 and 240 minutes. Three concentrations of diazepam 0.88 μg/L (environmental concentration) were used; 16 μg/L; and 160 μg/L, concentrations that cause behavioral effects in zebrafish. Regarding fluoxetine at concentrations of 1 μg/L, 25 μg/L and 50 μg/L (25 to 50 times the concentration of the environment, respectively) were used. Our results show that diazepam and fluoxetine inhibit the axis of stress in the zebrafish. The intermediate concentration of diazepam is able to suppress the stress response, as measured by levels of cortisol whereas the fluoxetine is able to inhibit the stress response at concentrations similar to those found in the environment. Fish with an impaired stress response loses the ability to maintain homeostasis against stress factors, since it reduces the ability to promote ionic, metabolic and behavioral adjustments necessary for such response. Thus, these data suggest that the presence of psychoactive drugs in aquatic ecosystems may cause neuroendocrine dysfunction in fish. / A presença de produtos farmacêuticos no ambiente aquático tem sido relatada há alguns anos em vários estudos. No entanto, o impacto de medicamentos sobre os organismos presentes nesses ecossistemas ainda é pouco conhecido. Assim, investigamos os efeitos da exposição aguda ao diazepam e à fluoxetina sobre a resposta ao estresse agudo em zebrafish (Danio rerio). Os peixes foram expostos aos fármacos por 15 minutos e, após esse período, o grupo denominado tempo 0 foi coletado; os demais grupos foram submetidos a um estímulo de estresse, com perseguição dos peixes com uma rede durante dois minutos, e, após, foram coletados nos tempos de 15, 60 e 240 minutos. Foram utilizadas três concentrações de diazepam a 0,88 μg/L (concentração ambiental); 16 μg/L; e 160 μg/L, concentração com efeitos comportamentais relatados em zebrafish. Em relação à fluoxetina, foram utilizadas as concentrações de 1 μg/L, 25 μg/L e 50 μg/L (25 a 50 vezes a concentração do ambiente, respectivamente). Nossos resultados demonstram que o diazepam e a fluoxetina inibem o eixo de estresse no zebrafish. A concentração intermediária de diazepam é capaz de suprimir a resposta de estresse, conforme se mediu pelos níveis de cortisol, ao passo que a fluoxetina é capaz de inibir a resposta ao estresse em concentrações semelhantes às encontradas no ambiente. Peixes com resposta de estresse prejudicada perdem a capacidade de manter a homeostase contra fatores de estresse, uma vez que reduz a capacidade de promover ajustes iônicos, metabólicos e comportamentais necessários para tal resposta. Assim, esses dados sugerem que a presença de fármacos psicoativos em ecossistemas aquáticos pode causar disfunção neuroendócrina em peixes.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The medicalization has long been constituted as a social phenomenon, based on the principles of biomedical rationality. Given this context, the present research sought to investigate the conception of users, family members and health professionals regarding the use of the psychotropic medication in the therapeutic process, in the setting of Primary Care. The study had as a scenario the family health unit (USF), in the city of Aracaju, classified as a reference in mental health. The method used runs through the presuppositions of qualitative research, having as an instrument of investigation and data collection the narrative. It counted with the collaboration of 18 interlocutors, among them 10 professionals, 6 users and 2 family members. The data collection took place from the insertion of the researcher in the field, through the productions of field diaries and narrative of the participants. Data analysis was performed by reading / re-reading these productions, interpreting and highlighting data relevant to the research question. With this, it was possible to know a little of the observed reality, having as highlight the presence of the medical practices. It was perceived that the USF currently constitutes a device that contributes to the strengthening of the medicalization process. Regarding conceptions about the psychotropic drug: users perceive this use ambivalently, considering that it is good and bad to use it as a strategy of care, good in the sense of redeeming symptoms, and bad for the appearance of undesirable effects; family members see the medicine as very good because it helps them deal with problems presented by their relatives; and finally, the professionals, who despite highlighting the undesirable effects caused by the use, see the medication as necessary in the containment and control of the symptoms that the users present. Thus, the study brought a discussion about these aspects, concluding on the importance of the planning of actions that can contribute to the establishment of strategies of care, besides the medical practices, that bring benefits to the users, their relatives and to the network of health care; Of the articulation of the care network and, in particular, sought to contribute to the expansion of empirical studies that involve the theme. / A medicalização há muito vem se constituindo como um fenômeno social, tendo como base os princípios da racionalidade biomédica. Diante desse contexto, a presente pesquisa buscou investigar a concepção de usuários, familiares e profissionais de saúde a respeito do uso do medicamento psicotrópico, no processo terapêutico, no cenário da Atenção Básica. O estudo teve como cenário uma unidade de saúde da família (USF), da cidade de Aracaju, classificada como referência em saúde mental. O método utilizado perpassa pelos pressupostos da pesquisa qualitativa, tendo como instrumento de investigação e coleta de dados a narrativa. Contou com a colaboração de 18 interlocutores, entre eles 10 profissionais, 6 usuários e 2 familiares. A coleta de dados aconteceu a partir da inserção da pesquisadora no campo, através das produções de diários de campo e narrativa dos participantes. A análise de dados foi realizada através da leitura/releitura dessas produções, interpretação e destaque de dados relevantes à questão de pesquisa. Com isso, pôde-se conhecer um pouco da realidade observada, tendo como destaque a presença das práticas medicalizantes. Percebeu-se que a USF, atualmente, se constitui como um dispositivo que contribui para o fortalecimento do processo da medicalização. No tange às concepções sobre o medicamento psicotrópico: os usuários percebem esse uso de modo ambivalente, considerando ser bom e ruim utilizá-lo como estratégia de cuidado, bom no sentido de redimir os sintomas, e ruim pelo aparecimento dos efeitos indesejáveis; os familiares veem o medicamento como algo muito bom, pois os ajudam a lidar com os problemas apresentados por seus parentes; e por fim, os profissionais, que apesar de ressaltarem os efeitos indesejáveis provocados pelo uso, veem o medicamento como necessário na contenção e controle dos sintomas que os usuários apresentam. Desse modo, o estudo trouxe uma discussão sobre esses aspectos, concluindo sobre a importância do planejamento de ações que possam contribuir para o estabelecimento de estratégias de cuidado, para além das práticas medicalizantes, que tragam benefícios aos usuários, seus familiares e para a rede de atenção à saúde; da articulação da rede de cuidado e, em especial, buscou contribui para a ampliação de estudos empíricos que envolvem o tema. / São Cristóvão, SE

L’objectif de ce mémoire de recherche était double, soit de mesurer l’effet des conditions de l’organisation du travail sur la consommation de médicaments psychotropes ainsi que de mesurer l’effet modérateur de la famille sur cette relation dans la population de travailleurs canadiens. Les données utilisées pour mener à terme cette recherche sont des données secondaires provenant de l’Enquête sur la Santé dans les Collectivités Canadiennes (ESCC cycle 2.1) de Statistique Canada. La consommation de médicaments psychotropes fut mesurée sur une période d’un mois. La prévalence de consommation chez les travailleurs canadiens s’élève à 8.8%, plus particulièrement 6.3% pour les hommes et 11.7% en ce qui concerne les femmes. À l’égard des conditions de l’organisation du travail, le nombre d’heures travaillées est associé de manière négative à la consommation de médicaments psychotropes. Ainsi, plus le nombre d’heures travaillées augmente, plus le risque de consommer des médicaments psychotropes est faible. Quant à la situation familiale, le fait de vivre seul, ainsi que le fait d’avoir un revenu économique élevé sont tous deux associés à la consommation de médicaments psychotropes. Les résultats de cette étude suggèrent une influence de la part des conditions de l’organisation du travail et de la famille sur la consommation de médicaments psychotropes. Toutefois, il nous est impossible à cette étape de montrer un effet modérateur de la famille sur la relation entre les conditions de l’organisation du travail et la consommation de médicaments psychotropes. MOTS CLÉS : Conditions de l’organisation du travail, médicaments psychotropes, famille, population active canadienne / The aims of this study were two-fold : first to examine whether there exists a significant relation between work organization conditions and drug use among members of the Canadian workforce; and secondly, to analyze the moderating effect of family situation status on the relation between work organization conditions and drug use. Analysis of data from a sample of Canadian workers, through the Canadian Community Health Survey of Statistics Canada (ESCC 2.1), determined that prevalence of consumption was 8.8%. More specifically, prevalence for women (11.7%) was higher that of men (6.3%). The findings of this research support one possible negative relation between the amount of working hours and drug use. We also found a positive association between celibacy and drug use. The same connection was found in regards to the total household income, more specifically to a higher household income. Finally, these results demonstrated a lack of the family’s moderating effect on the relation between work organization conditions and drug use.

O desenvolvimento de síndrome metabólica como decorrência do uso de psicofármacos vem recebendo grande atenção da literatura nos últimos anos. O uso de antipsicóticos atípicos foi fortemente associado a ganho de peso, desenvolvimento de diabetes tipo 2 e aumento da mortalidade em pacientes esquizofrênicos. Já o uso de antidepressivos, embora associado a alterações de peso, não foi suficientemente estudado quanto ao risco de desenvolvimento de síndrome metabólica. Este estudo objetivou investigar alterações do peso corporal e de parâmetros relacionados à síndrome metabólica em pacientes com transtorno de pânico tratados com clomipramina, fluoxetina ou placebo. Foi realizado um estudo randomizado, duplo-cego e controlado com 83 pacientes seguidos ao longo de 24 semanas. Foram obtidas medidas de peso, relação cintura-quadril, glicemia, e níveis séricos de colesterol total, HDL e LDL colesteróis e triglicérides. Os resultados deste estudo permitiram concluir que, no tratamento do transtorno de pânico, não foram observadas alterações significativas de peso ou dos parâmetros bioquímicos associados à síndrome metabólica / The development of metabolic syndrome as a result of psychopharmacological treatment has been a highlight in medical literature on recent years. Atypical antipsychotics have been strongly associated with weight gain, type 2 diabetes and elevated mortality rates in schizophrenic patients. Although related to weight gain, antidepressants have not been as well studied concerning the risk of metabolic syndrome development. The objective of this study was to investigate changes in weight and in parameters associated with the metabolic syndrome in patients with panic disorder treated with clomipramine, fluoxetine or placebo. We conducted a randomized, double-blind, controlled study with 83 patients during 24 weeks. Measures were obtained for weight, waist-hip rate, glicemia and serum levels of total, HDL and LDL cholesterols, and triglycerides. The results of this study allowed the conclusion that, in the treatment of panic disorder, changes on weight or on the biochemical parameters related to metabolic syndrome were not significant

Esta pesquisa investiga a multiplicação dos diagnósticos de doenças mentais junto aos Wajãpi do Amapari e, concomitantemente, o aumento gradativo e discreto de prescrições de medicamentos psicotrópicos. A fim de compreender este fenômeno, são analisadas as explicações fornecidas pelas famílias acerca dos estados alterados de seus parentes, bem como os vários caminhos trilhados na tentativa de reversão dos mesmos. Nestes, as famílias estabelecem relações com os mais diversos agentes: pajés, médicos, psicólogos, missionários, pastores e curandeiros. Todas as relações abordadas nesse trabalho reforçam que, para os Wajãpi, só é possível viver realizando composições. / This research investigates the multiplication of mental illness diagnosis among the Wajãpi of Amapari and in parallel the gradual and discrete rise in prescriptions of psychotropical medications. In order to understand this phenomenon, the study analyzes both the family explanations about the altered states of their relatives and also the different paths taken to try to reverse such states. In doing so, these families establish relations with very different agents, such as: shamans, doctors, psychologists, missionaries, pastors and healers. All the relations described in this study reinforce the idea that, to Wajãpi, it is only possible to live realizing different compositions.

RÉSUMÉ: L’objectif de ce mémoire de recherche était double, soit de mesurer l’effet des conditions de l’organisation du travail sur la consommation de médicaments psychotropes ainsi que de mesurer l’effet modérateur de la famille sur cette relation dans la population de travailleurs canadiens. Les données utilisées pour mener à terme cette recherche sont des données secondaires provenant de l’Enquête sur la Santé dans les Collectivités Canadiennes (ESCC cycle 2.1) de Statistique Canada. La consommation de médicaments psychotropes fut mesurée sur une période d’un mois. La prévalence de consommation chez les travailleurs canadiens s’élève à 8.8%, plus particulièrement 6.3% pour les hommes et 11.7% en ce qui concerne les femmes. À l’égard des conditions de l’organisation du travail, le nombre d’heures travaillées est associé de manière négative à la consommation de médicaments psychotropes. Ainsi, plus le nombre d’heures travaillées augmente, plus le risque de consommer des médicaments psychotropes est faible. Quant à la situation familiale, le fait de vivre seul, ainsi que le fait d’avoir un revenu économique élevé sont tous deux associés à la consommation de médicaments psychotropes. Les résultats de cette étude suggèrent une influence de la part des conditions de l’organisation du travail et de la famille sur la consommation de médicaments psychotropes. Toutefois, il nous est impossible à cette étape de montrer un effet modérateur de la famille sur la relation entre les conditions de l’organisation du travail et la consommation de médicaments psychotropes. MOTS CLÉS : Conditions de l’organisation du travail, médicaments psychotropes, famille, population active canadienne / ABSTRACT: The aims of this study were two-fold : first to examine whether there exists a significant relation between work organization conditions and drug use among members of the Canadian workforce; and secondly, to analyze the moderating effect of family situation status on the relation between work organization conditions and drug use. Analysis of data from a sample of Canadian workers, through the Canadian Community Health Survey of Statistics Canada (ESCC 2.1), determined that prevalence of consumption was 8.8%. More specifically, prevalence for women (11.7%) was higher that of men (6.3%). The findings of this research support one possible negative relation between the amount of working hours and drug use. We also found a positive association between celibacy and drug use. The same connection was found in regards to the total household income, more specifically to a higher household income. Finally, these results demonstrated a lack of the family’s moderating effect on the relation between work organization conditions and drug use. KEYWORDS: work organization conditions, psychotropics, drug use, family, active Canadian population

O desenvolvimento de síndrome metabólica como decorrência do uso de psicofármacos vem recebendo grande atenção da literatura nos últimos anos. O uso de antipsicóticos atípicos foi fortemente associado a ganho de peso, desenvolvimento de diabetes tipo 2 e aumento da mortalidade em pacientes esquizofrênicos. Já o uso de antidepressivos, embora associado a alterações de peso, não foi suficientemente estudado quanto ao risco de desenvolvimento de síndrome metabólica. Este estudo objetivou investigar alterações do peso corporal e de parâmetros relacionados à síndrome metabólica em pacientes com transtorno de pânico tratados com clomipramina, fluoxetina ou placebo. Foi realizado um estudo randomizado, duplo-cego e controlado com 83 pacientes seguidos ao longo de 24 semanas. Foram obtidas medidas de peso, relação cintura-quadril, glicemia, e níveis séricos de colesterol total, HDL e LDL colesteróis e triglicérides. Os resultados deste estudo permitiram concluir que, no tratamento do transtorno de pânico, não foram observadas alterações significativas de peso ou dos parâmetros bioquímicos associados à síndrome metabólica / The development of metabolic syndrome as a result of psychopharmacological treatment has been a highlight in medical literature on recent years. Atypical antipsychotics have been strongly associated with weight gain, type 2 diabetes and elevated mortality rates in schizophrenic patients. Although related to weight gain, antidepressants have not been as well studied concerning the risk of metabolic syndrome development. The objective of this study was to investigate changes in weight and in parameters associated with the metabolic syndrome in patients with panic disorder treated with clomipramine, fluoxetine or placebo. We conducted a randomized, double-blind, controlled study with 83 patients during 24 weeks. Measures were obtained for weight, waist-hip rate, glicemia and serum levels of total, HDL and LDL cholesterols, and triglycerides. The results of this study allowed the conclusion that, in the treatment of panic disorder, changes on weight or on the biochemical parameters related to metabolic syndrome were not significant