Orientador: Florindo Stella / Banca: Hanna Karen Antunes / Banca: Lilian Teresa Bucken Gobbi / Resumo: A doença de Parkinson (DP) é um processo neurodegenerativo crônico e progressivo que leva a um comprometimento físico refletindo os principais sinais e sintomas da DP. O comprometimento das funções motoras representa um comprometimento da execução das atividades da vida diária. O exercício físico (EF) tem um impacto positivo para os indivíduos com doenças neurodegenerativas, especificamente com DP. Dois estudos foram realizados. O estudo 1 teve como objetivo comparar a mobilidade funcional, distúrbios relatados do sono e os níveis séricos de homocisteína (Hcy) em pacientes com diferentes níveis de atividade física. 41 pacientes entre os estágios um a três da escala de estagiamento clínico de Hohen & Yahr foram distribuídos segundo a participação programas regulares de exercícios físicos. 17 pacientes eram sedentários e 18 mantinham uma prática regular de exercícios físicos. Os distúrbios relatados do sono foram avaliados por meio do Mini Questionário de Sono; as atividades instrumentais foram avaliadas por meio do questionário de Pfeffer; o estagiamento clínico da doença e a condição clínica dos pacientes foram mensurados, respectivamente, pela escala Hoehn e Yahr e pela Unified Parkinson's Disease Rating Scale - UPDRS. A escala de Schwab & England foi aplicada para medir o percentual de funcionalidade. O Mini-Exame do Estado Mental e Teste do Desenho do Relógio foram aplicados para avaliar o funcionamento cognitivo. Os níveis de Hcy foram medidos por meio de técnicas laboratoriais a partir de amostras de sangue. Para a análise dos dados foi realizada uma ANOVA one-way e um teste post hoc de Tuckey para verificar diferenças entre os grupos. A correlação de Pearson e análise de regressão múltipla foram usados para verificar a associação entre diversas variáveis, como a concentração sérica de Hcy... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Parkinson's disease (PD) is a chronic, progressive and neurodegenerative process. With progression of the disease, there are physical implicantions that reflects in physical symptoms. The motor impairment has a negative impact and compromise the execution of activities daily living. Physical exercise (PE) has a positive impact for individuals with neurodegenerative disabilities, specifically in PD. Two studies were conducted. The study 1 aimed to compare the functional mobility, sleep reported disorders and levels of homocysteine (Hcy) in PD patients with different levels of physical activity. Forty-one patients between stages one to three of Hohen & Yahr scale were distributed by participation in a program of regular physical exercises. 17 patients were sedentary and 18 had a regular practice of physical exercises. Sleep reported disorders were evaluated by Mini-Sleep Questionnaire; Instrumental activities were evaluated by Pfeffer Questionnaire; Clinical stages and motor condition of patients were respectively measured by the Hoehn and Yahr scale and by the Unified Parkinson's Disease Rating Scale - UPDRS. Schwab and England scale were applied to measure the daily functionality. The Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT) were applied to evaluate the cognitive background. Levels of Hcy were measured by collection of blood and laboratorial techniques. The one-way ANOVA and Tuckey's post hoc was applied to verify differences between groups. Pearson correlation and stepwise multiple regression analysis were used to consider the association between several variables, as serum concentration of Hcy, motor condition, cognitive status, and L-dopa dosages. Patients who practice PE presented significant less sleep reported disturbances and lower levels of Hcy when compared... (Complete abstract click electronic access below) / Mestre

Background: DISA (Depressive Symptoms In Swedish Adolescents) is a cognitive behavioral intervention aimed at preventing stress and depressive symptoms in adolescents. It is frequently used in Swedish schools for students aged 13-15 years. DISA is commonly offered to females, but at some schools, the intervention is also offered to males. In this study, the application of the intervention for both females and males is evaluated. Aim: The overarching aim of this thesis was to explore the experience, significance, and effectiveness of the school-based intervention DISA. The specific aims were to investigate the effectiveness of depressive symptoms and self-reporting health, and costs and cost-effectiveness as well as to elucidate the experiences of adolescents and tutors. Methods: The effectiveness of DISA was investigated using method triangulation. The thesis is based on two quantitative and two qualitative studies. The quantitative studies were quasi-experimental trials with an intervention group (I, IV), and a control group (IV), with follow-up measurements obtained at 3 and 12 months after baseline. The qualitative studies were based on focus group interviews with adolescents (II) and tutors (III). The school-based cognitive behavioral prevention program DISA was presented by school health staff and teachers once per week for ten weeks. Students in grade 8 (median age: 14) participated in the intervention in study I (n=62, 52% females) and study IV (n=462, 79% females), and 486 students (46% females) were allocated to the control group (IV). Focus group interviews were conducted with 89 adolescents (II) and 22 tutors (III). The interviews were analyzed with qualitative content analysis. Findings: The intervention group decreased their self-reported depressive symptoms and improved their self-rated health more than the control group (p<0.05) at the 12-month follow-up. The majority of the adolescents rated the cognitive behavioral program as a positive experience, and the attendance rate was high. The incremental cost-effectiveness ratio was approximately USD 6,300 per quality-adjusted life year (QALY). The focus group interviews with the adolescents revealed that the students found that they developed intrapersonal strategies through DISA, such as directed thinking, improved self-confidence, stress management, and positive activities. They also gained an increased interpersonal awareness regarding trusting the group and considering others. However, structural constraints of the DISA program, such as negative framing and an emphasis on performance, were also noted. The focus group interviews with the tutors identified an overall theme of striking a balance between strictly following the manual and meeting student needs. Conclusions: The DISA program appears to be a feasible, cost-effective school-based cognitive behavioral program with high levels of student adherence and satisfaction, as well as positive mental health benefits. However, a desire for a more health-promoting approach was expressed.

A proposta desta dissertaÃÃo à compreender o cÃncer infantil entrelaÃado ao processo de constituiÃÃo subjetiva, tomando como referÃncia o estudo psicanalÃtico dos sintomas somÃticos em bebÃs e crianÃas pequenas a partir dos lugares simbÃlicos e imaginÃrios que os filhos ocupam no desejo dos pais. Abordamos esse tema articulando a constituiÃÃo do sujeito com o trabalho da pulsÃo, em que a mÃe â enquanto Outro â assume grande importÃncia por sua funÃÃo de para-excitaÃÃo e, portanto, na qualidade de organizadora do circuito pulsional. Ã, portanto, no tempo de constituiÃÃo subjetiva que acreditamos poder encontrar a chave para a compreensÃo do sintoma somÃtico, visto que à na pequena infÃncia que o corpo simbÃlico e imaginÃrio se forma nesse duplo com o corpo anatÃmico. Neste estudo, utilizamos como referenciais teÃricos a PsicossomÃtica psicanalÃtica e os textos de Assoun, ambos fundamentados na metapsicologia freudiana. O primeiro oferece compreensÃo acerca da constituiÃÃo dos sintomas somÃticos nas relaÃÃes primordiais que a crianÃa estabelece com seus pais. O segundo aborda o sintoma somÃtico com base em uma desfusÃo pulsional localizada na origem do eu-corporal, constituÃdo no laÃo com o Outro. Trata-se de uma pesquisa qualitativa, com realizaÃÃo de entrevistas semi-estruturadas com seis pais que estavam acompanhando os filhos durante o perÃodo de internaÃÃo num hospital pÃblico de referencia em Fortaleza/CE. Os dados foram submetidos ao mÃtodo de anÃlise de conteÃdo, cujas categorias temÃticas centrais foram a funÃÃo materna e o sintoma somÃtico. A anÃlise desses temas mostrou que a qualidade do laÃo pais/filhos recebe a influÃncia do desejo materno que, por sua vez, traz a marca da ambivalÃncia inerente a esta relaÃÃo, mediante o conflito psÃquico que, nÃo sendo resolvido em termos de uma elaboraÃÃo simbÃlica, recai sobre o corpo (da crianÃa) como inscriÃÃo, marca do poder do desejo do Outro. As elaboraÃÃes fantasmÃticas dos pais sobre a causa do cÃncer dos filhos foram outro dado relevante, possibilitando melhor compreensÃo do laÃo pais/filhos e do lugar que o filho ocupa na economia libidinal materna. Dessa forma, a compreensÃo dos sintomas somÃticos em bebÃs e crianÃas pequenas deve levar em consideraÃÃo nÃo apenas a realidade somÃtica desse corpo fÃsico, como tambÃm as vicissitudes do desejo materno, que operam por meio da corporizaÃÃo do fantasma, denunciando o efeito plÃstico ativo do processo inconsciente, ou seja, a corporizaÃÃo (no filho) do fantasma (materno). / We propose in this dissertation to understand the childhood cancer linked to the subjective constitution process, taking as a reference the psychoanalytic study of somatic symptoms in babies and small children from the symbolic and imaginary places that children have on parentâs desire. We address this issue articulating the process of the subject construction with the drive work, where the mother â as the Other - is of great importance for its function of excitement-shielding and, therefore, as an organizer of the drive circuit. It is, therefore, on the time of subjective constitution that we believe we can find the key to understanding the somatic symptoms, since it is in early childhood that the imaginary and symbolic body is formed in this double with the anatomical body. In this study, we used as the theoretical framework the psychoanalytic psychosomatic and AssounÂs texts, both based in Freudian metapsychology. The first one gives us an understanding about the formation of somatic symptoms from the primary relationships the child has with his parents. The second one, deals with somatic symptoms from a drive unmerge located in the origin of the I-body, forming the link with the Other. This is a qualitative research, with semi-structured interviews with six parents who were accompanying their children during hospitalization time in a known public hospital in Fortaleza-CE. The data were submitted to the method of content analysis, which center themes were maternal function and somatic symptoms. The analysis of these issues has shown us that the quality of the parents/children link suffer the effects of maternal desire that brings, itself, the mark of the inherent ambivalence in this relationship, through the psychic conflict, that when is not resolved in terms of symbolic development, falls on the body (of the child) as an affiliation, the mark of the Otherâs desire power. The parentâs phantasmagoric constructions about the cause of cancer of their children were another relevant thing, enabling us to have a better understanding of the parents / children link, and of the childâs place in maternal libidinal economy. Thus, the understanding of somatic symptoms in babies and small children should take into account not only the somatic reality of this physical body, but also the vicissitudes of maternal desire that act through the embodiment of the ghost, denouncing the plastic effect that is active in unconscious process, that is, the embodiment (in the son) of the ghost (maternal).

Este trabalho versa sobre o problema do desencadeamento para a psicanálise e toma por fio condutor alguns casos freudianos. O tema sublinhado foi concebido como um ponto clínico fundamental, que remete o psicanalista tanto à questão diagnóstica quanto à investigação etiológica. Neste sentido, destacamos que o surgimento de sintomas e do surto psicótico mereceu particular atenção ao longo de nossas linhas. Verificamos que, depois de Freud, a presença de uma conversão histérica ou de um delírio paranóico logo indicava uma direção para o tratamento e também indagava a psicanálise acerca das causas precipitadoras de tais quadros. Pois bem, sobretudo nos intrigou a pesquisa sobre as dimensões causais de um desencadeamento. Para realizá-la seguimos primeiro Freud e sua complexa teoria da causalidade psíquica e depois Jacques Lacan, que, de maneira peculiar, soube destacar o inédito freudiano e postular uma noção de causalidade que designamos como própria à psicanálise e pertinente ao desencadeamento. / This work seeks to explore the question of triggering off in psychoanalytic theory by examining some Freudian cases. The theme was conceived as a key clinical aspect which poses for the psychoanalyst the questions of diagnosis and of etiological investigation. In this sense, we highlight that the emergence of symptoms and of psychotic breakdown were particularly important to this work. We verified that since Freud, either the hysterical conversion or the paranoid delirium indicated the direction of the treatment; and raised concerns about the emerging causes of these conditions. In this study the causal dimensions of triggering off was particularly intriguing. To accomplish this investigation, we first drew upon Freuds theories of the psychic causality and proceeded to the study of Jacques Lacan who in a particular manner highlighted Freudians findings and postulated a notion of causality that is central to psychoanalysis and strongly related to the idea of triggering off.

INTRODUÇÃO: Os critérios diagnósticos atuais para as síndromes depressivas não identificam uma parcela dos idosos com sintomatologia depressiva clinicamente significativa. Instrumentos psicométricos específicos para esta população, que sejam rápidos e fáceis de aplicar tornam-se necessários. A partir de instrumentos previamente validados como as escalas GDS e CES-D, e de um consenso de especialistas foi desenvolvida uma escala de 10 itens para avaliar o construto clínico de depressão em pacientes idosos. OBJETIVO: Validação interna de uma nova escala de rastreio de sintomas depressivos em idosos (D10) desenvolvida no Programa Terceira Idade (PROTER), Instituto de Psiquiatria HC FMUSP. MÉTODOS: Uma amostra de conveniência composta por 62 sujeitos foi utilizada para o estudo de validade de critério (validade concorrente). Destes, 44 foram incluídos nos estudos de confiabilidade (consistência interna, estabilidade e equivalência) e de validade de construto (validades convergente e divergente). Todos os participantes incluídos tinham idade 60 anos, não apresentavam doenças médicas graves ou descompensadas, déficits cognitivo e funcional significativos (avaliados, respectivamente, pela M-CIRS, MMSE e B-ADL) e não apresentavam histórico passado ou atual sugestivo de síndrome psicótica. Os diagnósticos foram obtidos pela entrevista estruturada MINI-Plus (seções A, B, D, E, F e P) e a intensidade dos sintomas depressivos mensurados pela MADRS. Outros instrumentos foram utilizados (CAMCOG, IQCODE, CAGE, DUSI-R) no desenho da pesquisa, para reduzir a possibilidade de vieses sistemáticos. A distribuição da amostra foi avaliada pelo Teste Kolgomorov-Smirnov, e os índices de correlação de Pearson e Spearman foram utilizados para aferir a relação entre a D10 e as escalas MADRS e CAGE. A correlação entre os itens da D10 foram analisados pelos coeficientes de Correlação Intraclasse (CCI) e alfa de Cronbach. A acurácia do teste foi investigada pela análise das áreas sob as curvas ROC. RESULTADOS: A amostra (idade média de 72,35; SD=7,05) não apresentou diferenças significativas entre as variáveis sócio-demográficas, econômicas, clínicas, cognitivas e funcionais estudadas (p>0,05). O valor de alfa (consistência interna) manteve-se estável e elevado (=0,84±0,02) e os itens da D10 apresentaram boa equivalência (inter-rater) (rs=0,95, p0,01) e boa estabilidade (intra-rater) (rs=0,95, p0,01). A escala MADRS correlacionou-se significativamente com a D10 (rp=0,86, e rs=081, p0,01), não tendo se correlacionado com a CAGE (p>0,05). Esse achado foi reforçado pela correlação entre a CAGE e a DUSI-R (rp=0,31, p=0,005; e rs=0,29 p=0,01). A nota de corte de 6 pontos na D10 apresentou elevados níveis de sensibilidade (96,2%), especificidade (88,9%), valor preditivo positivo (86,2%), valor preditivo negativo (97%) e acurácia (91,9%). O tempo médio de aplicação do novo instrumento foi de 42±4 segundos. CONCLUSÕES: Os resultados obtidos indicaram que a escala D10 apresentou confiabilidade, validade interna, e acurácia adequadas para ser utilizada como um instrumento de aplicação rápida para o rastreio de sintomatologia depressiva clinicamente significativa em idosos / identify a portion of elderly people with clinically significant depressive symptoms. Specific psychometric instruments for this population with quick and easy application properties are of the essence. Based on previously validated instruments, such as GDS and CES-D scales, and on consensus among specialists, a 10-item scale was developed to assess the clinical depression construct in elderly patients. OBJECTIVES: Internal validation of a scale to screen depressive symptoms in elderly people (D10) developed in the Senior Citizens Program (locally, PROTER), at the Institute of Psychiatry of the HCFMUSP. METHODS: A convenience sample of 62 subjects was used for the criterion validity study (concurrent validity). Of these, 44 were included in the studies of reliability (internal consistency, stability and equivalence) and of the construct validity (convergent and divergent validity). All the participants included in the study were 60 years old, did not present any serious or uncontrolled medical conditions, significant cognitive or functional deficits (evaluated, respectively, through M-CIRS, MMSE and B-ADL), nor past or present history suggestive of psychotic syndrome. Diagnostics were obtained through the MINI-Plus structured interview (sections A, B, D, E, F and P), and the intensity of depressive symptoms through the MADRS. In the research design, other instruments were used (CAMCOG, IQCODE, CAGE, DUSI-R), aimed at reducing the possibility of systematic bias. The sample distribution was evaluated through the Kolgomorov- Smirnov Test, and the Pearson and Spearman correlation indexes were used to verify the relation between the D10 and the MADRS and CAGE scales. The correlation of the D10 items were analyzed through the Intraclass Correlation (ICC) and Cronbach\'s alpha. The test accuracy was investigated through the analysis of the areas under ROC curves. RESULTS: The sample (mean age of 72,35; SD=7,05) did not evidence significant differences in the socio-demographic, economic, clinical, cognitive and functional variables studied (p>0,05). The alpha value (internal consistency) remained stable and elevated (=0,84±0,02), D10 items presented good equivalence (inter-rater) (rs=0,95, p0,01) and good stability (intra-rater) (rs=0,95 p0,01). The MADRS scale correlated significantly with CAGE (p>0,05). This finding was reinforced by the correlation between CAGE and DUSI-R (rp=0,31 p=0,005; and rs=0,29 p=0,01). A cut-off score of 6 points in D10 presented high levels of sensitivity (96,2%), specificity (88,9%), positive predictive value (86,2%), negative predictive value (97%) and accuracy (91,9%). The average application time of the new instrument was 42±4 seconds. CONCLUSIONS: The results obtained indicate that the D10 scale presented adequate reliability, internal validity and accuracy for use as a quick application instrument to screen clinically significant depressive symptoms in the elderly

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-06-07T11:58:41Z No. of bitstreams: 1 CAROLINE ZECHLINSKI XAVIER DE FREITAS.pdf: 1044165 bytes, checksum: 3aafdb545d282654c4bdaefdb37a4ec3 (MD5) / Made available in DSpace on 2018-06-07T11:58:41Z (GMT). No. of bitstreams: 1 CAROLINE ZECHLINSKI XAVIER DE FREITAS.pdf: 1044165 bytes, checksum: 3aafdb545d282654c4bdaefdb37a4ec3 (MD5) Previous issue date: 2016-10-25 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq# / #-2555911436985713659# / #600 / Introduction: Due to immune reconstitution, provided by antiretroviral therapy (HART), the articular manifestations that were mainly of septic origin in the pre-HAART era have changed its spectrum and giving rise to chronic joint diseases. The aim of this study is to evaluate the prevalence of joint symptoms and arthritis in patients living with HIV / AIDS in a reference center in the city of Pelotas. Methods: Cross-sectional study in the outpatient clinic specializing in HIV / AIDS in the city of Pelotas, where about 3200 patients are monitoring. Participants answered a questionnaire that assessed the presence of joint symptoms and arthritis (the two dependent variables in this study). In addition, socio-demographic variables were collected (gender, age, marital status, education, employment status), lifestyle factors (smoking and nutritional status) and health (tuberculosis, hepatitis B, hepatitis C, current CD4, use of antiretroviral therapy, use of protease inhibitor). To verify differences in the proportion of joint symptoms and arthritis in relation to the categories of the independent variables we used the chi-square test. The analysis adjusted for potential confounders was performed by Poisson regression. Results: From a total of 413 participants, 55% (n=227) were women and 45% (n=186) men. The overall prevalence of joint symptoms found was 65% (n=271) was higher in women (p=0.012), people with overweight (p= 0.000) and individuals aged between 40 and 49 (p=0.028). The overall prevalence of arthritis was 14% (n=58), being higher in women (p=0.002) and those with overweight (p=0.047). In adjusted analysis as having outcome joint symptoms, only the association with age was lost. In analysis adjusted for arthritis, the association with overweight was lost, however, the association with tuberculosis became significant (p=0.038). Among the individuals with joint pain, 67.6% used medication for pain relief and all respondents only 5.8% (n=24) had a previous diagnosis of rheumatism. Conclusion: The studies that address joint conditions in patients living with HIV aims overwhelmingly investigate the occurrence of rheumatic diseases as a whole and not the prevalence of joint symptoms in this population, as done here. The findings reinforce the idea that patients living with HIV due to antiretroviral therapy and immune reconstitution, are now chronically ill and deserve greater attention to conditions that reduce their quality of life, such as joint pain and its implications. / Introdução: Devido a reconstituição imune, proporcionada pela terapia anti-retroviral (TARV), as manifestações articulares que eram principalmente de origem séptica na era pré-TARV vêm mudando seu espectro e dando espaço a doenças articulares crônicas.O objetivo deste estudo é avaliar a prevalência de sintomas articulares e artrite em pacientes vivendo com HIV/AIDS atendidos em centro de referência na cidade de Pelotas-RS. Métodos: Estudo transversal realizado no ambulatório especializado em HIV/AIDS da cidade de Pelotas-RS, onde cerca de 3200 pacientes fazem acompanhamento. Os participantes responderam a questionário que avaliou a presença de sintomas articulares e artrite (as duas variáveis dependentes deste estudo). Além disso, foram coletadas variáveis sociodemográficas (sexo, idade, estado civil, escolaridade, situação laboral), variáveis comportamentais (tabagismo e estado nutricional) e de saúde (tuberculose, hepatite B, hepatite C, CD4 atual, uso de TARV, uso de inibidor de protease). Para verificar diferenças de proporção de sintomas articulares e artrite em relação às categorias das variáveis independentes foi utilizado o teste qui-quadrado. A análise ajustada para potenciais fatores de confusão foi feita através da regressão de Poisson. Resultados: De um total de 413 participantes, 55% (n=227) eram mulheres e 45% (n=186) homens. A prevalência geral de sintomas articulares encontrada foi de 65% (n=271) sendo maior em mulheres (p=0,012), pessoas com excesso de peso (p=0,000) e indivíduos com idade entre 40 e 49 anos (p=0,028). A prevalência geral de artrite foi de 14% (n=58), sendo maior em mulheres (p=0,002) e pessoas com excesso de peso (p=0,047). Na análise ajustada tendo como desfecho sintomas articulares, apenas a associação com idade foi perdida. Na análise ajustada para artrite, a associação com excesso de peso foi perdida, entretanto, a associação com tuberculose tornou-se significativa (p=0,038). Dentre os indivíduos que apresentavam dor articular, 67,6% usava medicação para alívio da dor e de todos entrevistados apenas 5,8% (n=24) tinham algum diagnóstico prévio de reumatismo. Conclusão: Os estudos que abordam condições articulares em pacientes vivendo com HIV tem como objetivo em sua imensa maioria investigar a ocorrência de doenças reumatológicas como um todo e não a prevalência de sintomas articulares nesta população, como o realizado aqui. Os achados deste estudo reforçam a idéia de que os pacientes vivendo com HIV, devido a TARV e a reconstituição imune, hoje são doentes crônicos e merecem maior atenção a condições que diminuam sua qualidade de vida, como a dor articular e suas implicações.

A exposição da gestante a drogas de abuso tem sido motivo de preocupação mundial com relação à saúde do binômio mãe-filho. A exposição fetal ao álcool constitui-se em um dos principais fatores de risco para retardo mental, defeitos congênitos e desordens do desenvolvimento neuropsicomotor, sendo a Síndrome Fetal do Álcool e os Efeitos Fetais do Álcool um conjunto de complicações clínicas resultantes desta exposição. Vários autores encontraram associação entre exposição fetal ao álcool e sintomas psiquiátricos na infância. Este é um estudo transversal tendo como objetivo principal investigar as relações entre consumo de álcool na gestação e sintomas psiquiátricos em escolares. A amostra foi constituída de 59 pares mãe-filho. As mães responderam a um instrumento de avaliação psicopatológica na infância (CBCL), uma entrevista diagnóstica semi-estruturada (KSADS- PL) e um questionário de dados sociodemográficos e dados sobre a saúde atual e pregressa da criança. Dados referentes ao consumo de álcool na gestação foram obtidos de um estudo pregresso com os mesmos indivíduos. Foram encontradas maiores prevalências de sintomas isolados do CBCL em filhos de mães com padrão de consumo semanal de álcool na gestação, mas não maior pontuação total ou de sintomas internalizáveis ou externalizáveis. Foi encontrada maior prevalência de diagnóstico psiquiátrico atual (K-SADS-PL) nos filhos de mães com padrão de consumo semanal de álcool na gestação. Ressalta-se que novos estudos são necessários para esclarecer como outros fatores - ambientais, genéticos e psicológicos - contribuem para a gênese da psicopatologia infantil. Além disso, este estudo reforça a importância da implementação de programas nacionais de prevenção de consumo de álcool por mulheres gestantes. / Prenatal exposure to drugs of abuse has been a concern worldwide regarding mother and child health. Prenatal alcohol exposure is one of the main risk factors for mental retardation, congenital defects and neurodevelopmental disorders, namely Fetal Alcohol Syndrome and Fetal Alcohol Effects. Many authors found associations between prenatal exposure to alcohol and psychiatric symptoms in childhood. This study has a cross-sectional design and is aimed to investigate the relationships between prenatal alcohol exposure and psychiatric symptoms in school-age children Fifty-nine mothers and their children were enrolled. The mothers answered to the Child Behaviour Checklist (CBCL), a semi-structured interview (K-SADS-PL) and a general social, demographic and health questionnaire. Prenatal alcohol consumption information was obtained from a previous study on the same individuals. We found a higher prevalence of isolated CBCL symptoms among children born from mothers with prenatal weekly alcohol consumption pattern. Additionally, we found a higher prevalence of psychiatric diagnoses (K-SADS-PL) among children born from mothers with prenatal weekly alcohol consumption pattern. Those results emphasize the need for new studies to clarify how environmental, genetical and psychological factos may contribute to the genesis of childhood psychopathology. Besides, this study reinforces the importance of developing a national alcohol prevention program for pregnant women.

Doyenne de la thérapeutique antiparkinsonienne, puissant outil pharmacologique au profil singulier, l’apomorphine est aujourd’hui indiquée comme thérapeutique de deuxième intention, au stade où les fluctuations liées au traitement oral handicapent le quotidien des patients. Si ses effets sur la triade parkinsonienne et les fluctuations motrices sont connus et objectivés depuis le milieu du XXème siècle, son spectre d’action sur les troubles non moteurs a, quant à lui, été encore peu exploré. Ce travail de thèse avait deux objectifs : (1) établir un état de l’art quant aux connaissances actuelles sur l’apomorphine et (2) étudier les effets d’un traitement par pompe à apomorphine sur la symptomatologie non motrice parkinsonienne, en particulier aux plans cognitifs et émotionnels, sur une période de six mois. Pour ce faire, deux études ont été menées. La première, intitulée APO-TEP, s’intéressait à l’évolution de l’état cognitif et de la qualité de vie de patients présentant la maladie à un stade avancé, mais ne pouvant bénéficier de la chirurgie de stimulation cérébrale profonde du noyau subthalamique. Une exploration du métabolisme cérébral était associée à l’évaluation clinique. Ce travail a permis de mettre en évidence une amélioration significative des fonctions motrices, cognitivo-psychiatriques (fonctions exécutives et apathie) et de la qualité de vie après six mois de traitement. Des modifications d’activité cérébrale dans les réseaux fonctionnels cognitifs, moteurs et limbiques ont par ailleurs été observées, soutenant l’idée d’un substratum anatomo-fonctionnel diffus. La seconde étude, intitulée APO-EMO, évalue les effets du traitement par pompe à apomorphine sur la sphère émotionnelle, souvent altérée dans la maladie de Parkinson. Cette dernière étude est toujours en cours ; les résultats préliminaires ne mettent pour l’heure pas en évidence d’effets sur la perception individuelle des émotions (intelligence émotionnelle et expressivité). Les analyses visant à explorer les effets du traitement sur le mimétisme facial et la reconnaissance des expressions faciales émotionnelles seront menées dans un second temps. L’ensemble de ces résultats expérimentaux est discuté à la lumière des données de la littérature et plusieurs perspectives cliniques et de recherche sont développées. De nouveaux travaux, visant à mieux comprendre les réseaux neuronaux et les voies neurochimiques activées par l’apomorphine en perfusion continue, sont à mener. Longtemps cantonnée au rang de curiosité pharmacologique, l’apomorphine semble enfin trouver sa place dans l’arsenal thérapeutique. / Apomorphine is a peculiar drug, currently used as a second-line therapy in Parkinson’s disease (PD). If its motor efficacy has been amply established, questions remain about its effect on non motor symptoms, a common burden in PD. This thesis address these questions by (1) reviewing the state of the art of the current knowledge about apomorphine (history, pharmacology and current interest in neurological disorders) and (2) exploring the effect of continuous subcutaneous apomorphine infusion (CSAI) on cognitive and emotional symptoms in PD, while studying brain metabolism. Two studies were conducted: APO-TEP and APO-EMO. Well-tolerated, CSAI appears to be an interesting option in advanced PD. Changes in brain metabolism (motor, cognitive and limbic networks) were observed at 6 months and correlated to clinical improvement (executive functions, apathy and motricity) in patients with advanced PD and contra-indications for subthalamic nucleus deep brain stimulation. Preliminary results of the ongoing APO-EMO study suggest that CSAI does not seem to improve emotional self-perception in patients; however we will further explore its effect on facial mimicry and facial emotion recognition. If further research is still needed, apomorphine seems to be destined to become a key feature of future therapeutic strategies, in PD (nonmotor symptoms, advanced PD, withdrawal of oral medications) but also in other dopaminergic disorders, and rightly so.

Although approximately one-fourth of adolescents have a mental health disorder only half of them receive treatment. The goal of this study was to determine if Strong Kids, a social and emotional learning curriculum, implemented over a 4-week period could help decrease internalizing symptoms and increase resilience in middle school students, something not previously investigated. This study also measured social and emotional knowledge as measured by the Strong Kids questionnaire. Additionally, treatment fidelity and social validity were measured. The study used a non-equivalent, control group design. The sample consisted of 148 students: 70 in the treatment group and 78 in the control group. This study was completed using existing data from a title one middle school that implemented Strong Kids. The school had a relatively diverse population and was relatively low SES, with 66% of students receiving free or reduced price school lunch. The Strong Kids curriculum was taught by the school's health teacher to half of the eighth grade students, while the other half received normal state curriculum. Pre and post rating scales were completed by teachers and students on measures of resilience, internalizing symptoms, and social-emotional knowledge. Since there were some differences at pre-test, a 2-by-2 mixed-design analysis of variance and an analysis of covariance were used to analyze results. Results suggested that teacher was able to implement the curriculum with fidelity, with moderate social validity among students and the teacher, and some benefit for at-risk students. While the differences only approached statistical significance, it was likely due to the small sample size of at-risk students. The lack of significant differences between treatment and control classrooms were likely due to confounds. Further, this study suggests that the state curriculum implemented may be effective for general education students. SEL programs like Strong Kids could be used as a targeted approach for students who are at-risk or struggling with internalizing symptoms. Future studies should include randomly assigned students, parent and student ratings, different measures for resilience, a longer intervention period, and follow up data points if implemented over a shorter time frame.

Hope, optimism, and several markers of religiosity and spirituality were examined as potential moderators of the association between negative life events and depressive symptoms in a secondary data analysis of an ethnically diverse sample. Participants (267 female, 119 male) were college students enrolled at an urban Northeastern university. It was hypothesized that negative life events would be associated with increased depressive symptoms and that higher levels of hope, optimism, and religious and spiritual variables would attenuate this relationship. Ethnically-stratified moderation analyses were conducted to assess for differences in moderation between Blacks, Hispanics, Whites, and Asians. Hypotheses were generally supported, with some ethnic variation in findings. Although hope and optimism predicted decreased depressive symptoms in Blacks, Hispanics, and Whites, optimism was a significant moderator in Whites only. Measures of religiosity were significant moderators among Blacks as well as Whites. Clinical and research implications are explored based on the extant literature.