Les donneurs de méthyles (B12 et folates) régulent le cycle des monocarbones qui joue un rôle primordial dans les régulations épigénétiques/épigénomiques par méthylation. Une carence en donneurs de méthyles produit un retard de croissance intra-utérine et favorise les anomalies du développement, principalement du système nerveux central. De plus, des taux élevés d'homocystéine associés à une telle carence constituent un facteur de risque pour diverses pathologies neurodégénératives. Nous avons étudié les conséquences d'une carence péri-conceptionnelle et gestationnelle sur le développement cérébral embryonnaire de rats Wistar. L'étude morphométrique a montré un retard de croissance des embryons carencés qui affectait également le cerveau, avec une atrophie de structures telles que l'hippocampe, le cortex et la zone subventriculaire. En raison de la forte sensibilité de l'hippocampe, les effets de la carence ont par ailleurs été étudiés sur un modèle cellulaire de progéniteurs neuronaux hippocampiques. L'utilisation de ces deux modèles a permis de montrer in vivo et in vitro la régulation négative par la carence de la voie Stat3, qui influence prolifération et survie, via une régulation épigénomique post-transcriptionnelle impliquant miR-124. La dérégulation du programme neurogénique impliquant les histones désacétylases affecte la différenciation cellulaire. Par ailleurs, nous avons démontré que la carence en donneurs de méthyles était associée à une modification post-traductionnelle correspondant à une N-homocystéinylation irreversible de protéines neuronales, en particulier associées au cytosquelette. Cette modification induit l'agrégation des protéines, phénomène impliqué dans de nombreuses maladies neurodégénératives. La combinaison de ces différents mécanismes apporte un éclairage nouveau sur les défauts de développement et les troubles cognitifs associés à une carence précoce en donneurs de méthyles, soulignant l'importance de la « programmation foetale » dans la survenue de certaines pathologies neurologiques / Methyl donors (B12 and folate) regulate the one-carbon cycle that plays an important role in the epigenetic/epigenomic regulations by methylation. Methyl donor deficiency (MDD) leads to intrauterine growth retardation and promotes neurodevelopmental abnormalities. Also, high levels of homocysteine associated with such a deficiency are a risk factor for various neurodegenerative diseases. We have studied the consequences of a periconceptional and gestational deficiency on the development of the embryonic brain of Wistar rats. Morphometric studies showed retardation in the development of deficient embryos which also affected the brain, with an atrophy of some structures including hippocampus, cortex and subventricular zone. Given the high sensitivity of the hippocampus, the effects of MDD have been additionally studied in a cellular model of hippocampal neuronal progenitors. Using these two models, we showed both in vivo and in vitro the downregulation of Stat3 pathway regulating cell proliferation and survival, through an epigenomic post-transcriptional process involving miR-124. Disruption of the neurogenic program implying histone deacetylases was shown to alter cell differentiation. Furthermore, we showed that methyl donor deficiency was associated with a post-translational modification corresponding to an irreversible N- homocysteinylation of neuronal proteins, especially those associated with the cytoskeleton. Such a process leads to protein aggregation, a phenomenon involved in many neurodegenerative diseases. The combination of these different mechanisms provides new insights into developmental defects and cognitive impairment associated with an early MDD, highlighting the importance of "fetal programming" in the occurrence of some neurological diseases

No description available.

Uma série de estudos na literatura vêm demonstrando a necessidade de intervenções voltadas para adultos portadores do transtorno do espectro do autismo, cuja situação de exclusão social somadas às necessidades crescentes do mundo atual de flexibilidade e engajamento podem levar a problemas emocionais, como ansiedade e depressão. O foco deste estudo foi baseado em funções executivas (FEs) real-world, isto é, focado no funcionamento diário bemsucedido e adaptativo. Este estudo pretendeu: 1) apresentar uma revisão bibliográfica para melhor compreensão do desenvolvimento das FEs em indivíduos com TEA; 2) apresentar uma intervenção neurodesenvolvimental global, o método Ramain; 3) apresentar como ilustração um estudo longitudinal de caso de 4 anos e 6 meses de intervenção (1 sessão semanal de 2 hr e 30 min) e de follow-up de 2 e 5 anos, relativo a um jovem adulto portador de TEA atendido por meio desse método. O método buscou ativar as FEs e mobilizar simultaneamente as funções cognitivas, motoras, emocionais e sociais. Concluiu-se através de observação de duas escalas e de marcadores de ganho de autonomia tanto em espaço terapêutico, como na vida cotidiana (por meio dos relatos de pais e profissionais), que houve aprimoramento das FEs e uma evolução significativa na adaptabilidade, no desenvolvimento das habilidades psicossociais, da autonomia e na qualidade de vida desse adulto, o que abre a possibilidade do uso de intervenções globais em casos de indivíduos com TEA / Several studies in literature have indicated the need for interventions targeting adults with autism spectrum disorder, whose social exclusion, coupled with today\'s increasing needs for flexibility and engagement, may lead to emotional problems such as anxiety and depression. The focus of this study was based on real-world (EFs) executive functions, that is, focused on successful and adaptive daily functioning. The purpose of this study was to: 1) present a bibliographical review for better comprehension of the development of EFs in individuals with ASD; 2) present a global neurodevelopmental intervention, i.e., the Ramain method; 3) present, as an illustration, a longitudinal case study of 4 years and 6 months of intervention (1 weekly session of 2 hr and 30 min) and 2- and 5-year follow-up of a young adult ASD patient, through this method. The method sought to activate EFs and simultaneously mobilize cognitive, motor, emotional and social functions. It was concluded through the observation of two scales and markers of autonomy gain both in therapeutic space and in daily life (through reports of parents and professionals) that there was an improvement of EFs and significant evolution in adaptability, in the development of psychosocial skills, autonomy and quality of life of this adult, which opens the possibility of using global interventions in cases of individuals with ASD

Doctor of Philosophy (PhD) / Schizophrenia is a severe mental illness that affects approximately 1% of the population worldwide, and which typically has a devastating effect on the lives of its sufferers. The characteristic symptoms of the disease include hallucinations, delusions, disorganized thought and reduced emotional expression. While many of the early theories of schizophrenia focused on its psychosocial foundations, more recent theories have focused on the neurobiological underpinnings of the disease. This thesis has four primary aims: 1) to use magnetic resonance imaging (MRI) to identify the structural brain abnormalities present in patients suffering from their first episode of schizophrenia (FES), 2) to elucidate whether these abnormalities were static or progressive over the first 2-3 years of patients’ illness, 3) to identify the relationship between these neuroanatomical abnormalities and patients’ clinical profile, and 4) to identify the normative relationship between longitudinal changes in neuroanatomy and electrophysiology in healthy participants, and to compare this to the relationship observed between these two indices in patients with FES. The aim of Chapter 2 was to use MRI to identify the neuroanatomical changes that occur over adolescence in healthy participants, and to identify the normative relationship between the neuroanatomical changes and electrophysiological changes associated with healthy periadolescent brain maturation. MRI and electroencephalographic (EEG) scans were acquired from 138 healthy participants between the ages of 10 and 30 years. The MRI scans were segmented into grey matter (GM) and white matter (WM) images, before being parcellated into the frontal, temporal, parietal and occipital lobes. Absolute EEG power was calculated for the slow-wave, alpha and beta frequency bands, for the corresponding cortical regions. The age-related changes in regional tissue volumes and regional EEG power were inferred with a regression model. The results indicated that the healthy participants experienced accelerated GM loss, EEG power loss and WM gain in the frontal and parietal lobes between the ages of 10 and 20 years, which decelerated between the ages of 20 and 30 years. A linear relationship was also observed between the maturational changes in regional GM volumes and EEG power in the frontal and parietal lobes. These results indicate that the periadolescent period is a time of great structural and electrophysiological change in the healthy human brain. The aim of Chapter 3 was to identify the GM abnormalities present in patients with FES, both at the time of their first presentation to mental health services (baseline), and over the first 2-3 years of their illness (follow-up). MRI scans were acquired from 41 patients with FES at baseline, and 47 matched healthy control subjects. Of these participants, 25 FES patients and 26 controls returned 2-3 years later for a follow-up scan. The analysis technique of voxel-based morphometry (VBM) was used in conjunction with the Statistical Parametric Mapping (SPM) software package in order to identify the regions of GM difference between the groups at baseline. The related analysis technique of tensor-based morphometry (TBM) was used to identify subjects’ longitudinal GM change over the follow-up interval. Relative to the healthy controls, the FES patients were observed to exhibit widespread GM reductions in the frontal, parietal and temporal cortices and cerebellum at baseline, as well as more circumscribed regions of GM increase, particularly in the occipital lobe. Furthermore, the FES patients lost considerably more GM over the follow-up interval than the controls, particularly in the parietal and temporal cortices. These results indicate that patients with FES exhibit significant structural brain abnormalities very early in the course of their illness, and that these abnormalities progress over the first few years of their illness. Chapter 4 employed the same methodology to investigate the white matter abnormalities exhibited by the FES subjects relative to the controls, both at baseline and over the follow-up interval. Compared to controls, the FES patients exhibited volumetric WM deficits in the frontal and temporal lobes at baseline, as well as volumetric increases at the fronto-parietal junction bilaterally. Furthermore, the FES patients lost considerably more WM over the follow-up interval than did the controls in the middle and inferior temporal cortex bilaterally. While there is substantial evidence indicating that abnormalities in the maturational processes of myelination play a significant role in the development of WM abnormalities in FES, the observed longitudinal reductions in WM were consistent with the death of a select population of temporal lobe neurons over the follow-up interval. The aim of Chapter 5 was to investigate the clinical correlates of the GM abnormalities exhibited by the FES patients at baseline. The volumes of four distinct cerebral regions where 31 patients with FES exhibited reduced GM volumes relative to 30 matched controls were calculated and correlated with patients’ scores on three primary symptom dimensions: Disorganization, Reality Distortion and Psychomotor Poverty. The results indicated that the greater the degree of atrophy exhibited by the FES patients in three of these four ‘regions-of-reduction’, the less severe their degree of Reality Distortion. These results suggest that an excessive amount of GM atrophy may in fact preclude the formation of hallucinations or highly systematized delusions in patients with FES. The aim of Chapter 6 was to identify the relationship between the longitudinal changes in brain structure and brain electrophysiology exhibited by 19 FES patients over the first 2-3 years of their illness, and to compare it to the normative relationship between the two indices reported in Chapter 2. The methodology employed for the parcellation of the MRI and EEG data was identical to Chapter 2. The results indicated that, in contrast to the healthy controls, the longitudinal reduction in GM volume exhibited by the FES patients was not associated with a corresponding reduction in EEG power in any brain lobe. In contrast, EEG power was observed to be maintained or even to increase over the follow-up interval in these patients. These results were consistent with the FES patients experiencing an abnormal elevation of neural synchrony. Such an abnormality in neural synchrony could potentially form the basis of the dysfunctional neural connectivity that has been widely proposed to underlie the functional deficits present in patients with schizophrenia. The primary aim of Chapter 7 was to assimilate the findings from the preceding empirical chapters with the theoretical framework provided in the literature, into an integrated and testable model of schizophrenia. The model emphasized dysfunctions in brain maturation, specifically in the normative processes of synaptic ‘pruning’ and axonal myelination, as playing a key role in the development of disintegrated neural activity and the subsequent onset of schizophrenic symptoms. The model concluded with the novel proposal that disintegrated neural activity arises from abnormal elevations in the synchrony of synaptic activity in patients with first-episode schizophrenia.

Nearly 80% of children treated for cancer are expected to survive, but not without cost. Survivors face unprecedented challenges associated with long-term consequences of treatment, also called late effects. Approximately half of children treated for cancer are at risk for experiencing cognitive late effects, which typically emerge several years post diagnosis. The nature and extent of cognitive late effects appear to be developmental and related to patient, disease, and treatment variables. However, the relationships between these variables is not well understood because there have been few prospective and longitudinal studies that report on the contributions of these variables over time. This dissertation examined the effects of patient, disease, and treatment variables, as well as their interactions over time on neurocognitive functioning in childhood cancer survivors. It comprises part of a large prospective, randomized clinical trial designed to examine changes in cognitive function over three years as a function of different levels of monitoring of school-based intervention based on individual educational plans (IEPs). This dissertation uniquely contributed a new measure (the Treatment Intensity Rating Scale) that was used to systematically classify treatment severity across different types of cancer and cancer treatments. Participants included 61 children ages 7 to 12 years at enrollment who were two to five years from completion of treatment for a brain tumor, leukemia, or lymphoma. Participants received yearly neuropsychological evaluations for a follow-up period of 3 years. Results of these evaluations were used to develop IEPs. Participants were randomized to have their IEPs monitored on a quarterly or annual basis for the duration of the study. Contrary to the progressive decline in neurocognitive functioning that is typically anticipated in pediatric cancer survivors, analyses revealed relative stability of performance on neurocognitive measures over time. Higher neurocognitive performance was noted in children whose IEPs were monitored more frequently versus less frequently. Results also supported gender-specific risk for late effects, with lower performance on select neurocognitive measures in females compared to males. Results of this study provide encouraging evidence of the positive effects of school-based interventions and their close monitoring. This has important implications for quality of life as these children survive well beyond childhood into adulthood.

Aim: The aim of the study is to gain deeper understanding into the lived experiences of parents at a stimulation centre in KwaZulu-Natal, South Africa, and the coping strategies they employ in caring for their children with Autism Spectrum Disorder (ASD). Significance: As literature has focused on international studies this study has provided deeper understanding of the lived experiences and coping strategies of parents of children with ASD in a local setting within South Africa. Experiences across the age spectrum of children, gendered differences in coping and the meaning behind having a child with ASD provides a unique outlook on ASD as opposed to literature that focuses on other areas. Methods: Eleven parents participated in semi-structured interviews. These interviews were triad, dyad or one-on-one interviews. Interviews were audiotaped and transcribed verbatim once completed. Thematic analysis was used to analyze the data and extract themes. Findings: The lived experiences of parents included stressful and devastating experiences as well as positive meaning. Daily challenges were navigated by positive and negative coping strategies with gendered differences in coping being evident. Parents expressed mixed feelings about the benefits of support groups and provided a road map of advice for other parents of children with ASD. Conclusion: Parents of children with ASD undergo enormous stress and emotional upheaval in caring for their children. However in addition to negative experiences, they gain some positive meaning and see it as character building. Their experiences provide useful information for other parents undergoing the same journey. / Thesis (M.O.T.)-University of KwaZulu-Natal, Durban, 2013.

Doctor of Philosophy (PhD) / Schizophrenia is a severe mental illness that affects approximately 1% of the population worldwide, and which typically has a devastating effect on the lives of its sufferers. The characteristic symptoms of the disease include hallucinations, delusions, disorganized thought and reduced emotional expression. While many of the early theories of schizophrenia focused on its psychosocial foundations, more recent theories have focused on the neurobiological underpinnings of the disease. This thesis has four primary aims: 1) to use magnetic resonance imaging (MRI) to identify the structural brain abnormalities present in patients suffering from their first episode of schizophrenia (FES), 2) to elucidate whether these abnormalities were static or progressive over the first 2-3 years of patients’ illness, 3) to identify the relationship between these neuroanatomical abnormalities and patients’ clinical profile, and 4) to identify the normative relationship between longitudinal changes in neuroanatomy and electrophysiology in healthy participants, and to compare this to the relationship observed between these two indices in patients with FES. The aim of Chapter 2 was to use MRI to identify the neuroanatomical changes that occur over adolescence in healthy participants, and to identify the normative relationship between the neuroanatomical changes and electrophysiological changes associated with healthy periadolescent brain maturation. MRI and electroencephalographic (EEG) scans were acquired from 138 healthy participants between the ages of 10 and 30 years. The MRI scans were segmented into grey matter (GM) and white matter (WM) images, before being parcellated into the frontal, temporal, parietal and occipital lobes. Absolute EEG power was calculated for the slow-wave, alpha and beta frequency bands, for the corresponding cortical regions. The age-related changes in regional tissue volumes and regional EEG power were inferred with a regression model. The results indicated that the healthy participants experienced accelerated GM loss, EEG power loss and WM gain in the frontal and parietal lobes between the ages of 10 and 20 years, which decelerated between the ages of 20 and 30 years. A linear relationship was also observed between the maturational changes in regional GM volumes and EEG power in the frontal and parietal lobes. These results indicate that the periadolescent period is a time of great structural and electrophysiological change in the healthy human brain. The aim of Chapter 3 was to identify the GM abnormalities present in patients with FES, both at the time of their first presentation to mental health services (baseline), and over the first 2-3 years of their illness (follow-up). MRI scans were acquired from 41 patients with FES at baseline, and 47 matched healthy control subjects. Of these participants, 25 FES patients and 26 controls returned 2-3 years later for a follow-up scan. The analysis technique of voxel-based morphometry (VBM) was used in conjunction with the Statistical Parametric Mapping (SPM) software package in order to identify the regions of GM difference between the groups at baseline. The related analysis technique of tensor-based morphometry (TBM) was used to identify subjects’ longitudinal GM change over the follow-up interval. Relative to the healthy controls, the FES patients were observed to exhibit widespread GM reductions in the frontal, parietal and temporal cortices and cerebellum at baseline, as well as more circumscribed regions of GM increase, particularly in the occipital lobe. Furthermore, the FES patients lost considerably more GM over the follow-up interval than the controls, particularly in the parietal and temporal cortices. These results indicate that patients with FES exhibit significant structural brain abnormalities very early in the course of their illness, and that these abnormalities progress over the first few years of their illness. Chapter 4 employed the same methodology to investigate the white matter abnormalities exhibited by the FES subjects relative to the controls, both at baseline and over the follow-up interval. Compared to controls, the FES patients exhibited volumetric WM deficits in the frontal and temporal lobes at baseline, as well as volumetric increases at the fronto-parietal junction bilaterally. Furthermore, the FES patients lost considerably more WM over the follow-up interval than did the controls in the middle and inferior temporal cortex bilaterally. While there is substantial evidence indicating that abnormalities in the maturational processes of myelination play a significant role in the development of WM abnormalities in FES, the observed longitudinal reductions in WM were consistent with the death of a select population of temporal lobe neurons over the follow-up interval. The aim of Chapter 5 was to investigate the clinical correlates of the GM abnormalities exhibited by the FES patients at baseline. The volumes of four distinct cerebral regions where 31 patients with FES exhibited reduced GM volumes relative to 30 matched controls were calculated and correlated with patients’ scores on three primary symptom dimensions: Disorganization, Reality Distortion and Psychomotor Poverty. The results indicated that the greater the degree of atrophy exhibited by the FES patients in three of these four ‘regions-of-reduction’, the less severe their degree of Reality Distortion. These results suggest that an excessive amount of GM atrophy may in fact preclude the formation of hallucinations or highly systematized delusions in patients with FES. The aim of Chapter 6 was to identify the relationship between the longitudinal changes in brain structure and brain electrophysiology exhibited by 19 FES patients over the first 2-3 years of their illness, and to compare it to the normative relationship between the two indices reported in Chapter 2. The methodology employed for the parcellation of the MRI and EEG data was identical to Chapter 2. The results indicated that, in contrast to the healthy controls, the longitudinal reduction in GM volume exhibited by the FES patients was not associated with a corresponding reduction in EEG power in any brain lobe. In contrast, EEG power was observed to be maintained or even to increase over the follow-up interval in these patients. These results were consistent with the FES patients experiencing an abnormal elevation of neural synchrony. Such an abnormality in neural synchrony could potentially form the basis of the dysfunctional neural connectivity that has been widely proposed to underlie the functional deficits present in patients with schizophrenia. The primary aim of Chapter 7 was to assimilate the findings from the preceding empirical chapters with the theoretical framework provided in the literature, into an integrated and testable model of schizophrenia. The model emphasized dysfunctions in brain maturation, specifically in the normative processes of synaptic ‘pruning’ and axonal myelination, as playing a key role in the development of disintegrated neural activity and the subsequent onset of schizophrenic symptoms. The model concluded with the novel proposal that disintegrated neural activity arises from abnormal elevations in the synchrony of synaptic activity in patients with first-episode schizophrenia.

No description available.

Introdução: Os neuropeptídeos regulam uma variedade de aspectos da função nervosa e neuroendócrina, atuando através da ativação de receptores específicos da membrana celular. No sistemana nervoso central (SNC) os receptores do pepetídeo liberador de gastrina (GRPR) são amplamente expressos, e numerosos efeitos centrais têm sido descritos com a sua ativação, incluindo efeitos sobre a saciedade, regulação do ritmo circadiano, termorregulação, modulação do stress, resposta ao medo, ansiedade e memória. Pesquisas mostram que o bloqueio farmacológico do GRPR em modelos animais leva ao aparecimento de deficits na interação social, padrões restritivos de comportamento e estereotipias motoras, sintomas semelhantes ao comportamento autista em humanos, sugerindo a possibilidade de que o complexo GRP/GRPR possa ter um papel na patogênese do transtorno do espectro autista (TEA). Recentemente, dois estudos não controlados com administração do peptídeo liberador de gastrina (GRP) a 13 crianças com autismo sugeriram que ele é seguro e que possa melhorar alguns sintomas do transtorno, principalmente interação social e sintomas associados à irritabilidade. Objetivos: Comparar a eficácia, segurança, tolerabilidade do GRP em relação ao placebo em sintomas do TEA. Metodologia: Ensaio clínico crossover, randomizado, duplo-cego, controlado por placebo, com uso de GRP 160 picomol/kg por 4 dias consecutivos, em 10 crianças com autismo. Os desfechos foram medidos através da escala Aberrant Behavior Checklist (ABC). Resultados: Todos os participantes eram do sexo masculino, com idade entre 4 e 9 anos. Houve uma redução nos escores da escala ABC e suas subescalas após o uso de GRP e de placebo. Apesar dessa redução ser mais proeminente com o GRP, principalmente nas subescalas Irritabilidade, Comportamento estereotipado e Hiperatividade, não houve diferença estatística entre os resultados (p 0,334). Após uma semana da infusão, 5 crianças apresentavam melhora maior que 25% no escore total da escala ABC com uso de GRP e 2 com uso de placebo, não apresentando diferença estatística (p 0,375). Não houve efeitos adversos, alterações dos sinais vitais ou variações laboratoriais associados ao uso de GRP em nenhum paciente. Conclusões: Os resultados deste estudo, apesar do tamanho reduzido da amostra, reforçam os dados anteriores sobre a segurança do GRP no uso a curto prazo. Apesar de ter ocorrido redução dos escores da escala ABC após uso de GRP, não houve diferença estatística em relação ao placebo. Devido ao desenho crossover e tamanho pequeno da amostra do estudo atual, não foi possível esclarecer a real eficácia do GRP na redução dos sintomas do TEA na infância. Existe a necessidade de novas pesquisas com outros delineamentos e tamanho amostral maior para confirmar a eficácia e segurança do GRP em crianças com autismo. / Introduction: The neuropeptides regulate a variety of aspects of the nervous and neuroendocrine function, acting through activation of specific receptors of the cellular membrane. In system central nervous (CNS) the gastrin-releasing peptide recptors (GRPR) are widely expressed, and numerous central effects have been reported with their activation, including effects on satiety, regulating the circadian rhythm, thermoregulation, stress modulation, response to fear, anxiety and memory. Research has shown that pharmacological blockade of GRPR in animal models leads to the deficits in social interaction, restrictive patterns of behavior and motor stereotypies, autistic symptoms similar to human behavior, suggesting the possibility that the complex GRP/GRPR may have a role in the pathogenesis of autism spectrum disorder (ASD). Recently, two studies are not controlled with the administration of gastrin releasing peptide (GRP) to 13 children with autism suggest that it is safe and can improve some symptoms of the disorder, especially social interaction and symptoms associated with irritability. Objectives: To compare the efficacy, safety, tolerability GRP compared to placebo in ASD symptoms. Methodology: crossover clinical trial, randomized, double-blind, placebo-controlled, using GRP 160 picomol/kg for 4 consecutive days in 10 children with autism. Outcomes were measured by the Aberrant Behavior Checklist scale (ABC). Results: All participants were male, aged between 4 and 9 years. There was a reduction in the scores of the ABC range and its subscales after use GRP and placebo. Despite this reduction be more prominent with the GRP, particularly in subscales Irritability, Stereotypic behavior and Hyperactivity and noncompliance, there was no statistical difference between the results (p 0.334). After a week of infusion, 5 children showed improvement greater than 25% in the total score of the ABC scale in GRP use and 2 with placebo use, however there was no statistical difference (p 0.375). No adverse effects, changes in vital signs or laboratory abnormalities associated with use of GRP in any patient. Conclusions: The results of this study, despite the small sample size, reinforce previous data on the safety of the GRP in the short-term use. Although there was a reduction in ABC scale scores after use of GRP, there was no statistical difference from placebo. Due to the small sample size and design of the current study, it was not possible to clarify the real effectiveness of GRP in reducing the symptoms of ASD in childhood. There is a need for further research with other designs and larger sample size to confirm the efficacy and safety of GRP in children with autism.

Assim como a medicina, a psiquiatria não consiste em uma disciplina teórica, mas sim, em uma práxis, um projeto teórico que somente se justifica pelo projeto prático. Trata-se, portanto, de um campo de intervenção. A psiquiatria utiliza diversas abordagens teóricas e científicas com uma finalidade prática. O objeto de estudo do campo, entretanto, não se confunde com o objeto destas abordagens. O objeto da psiquiatria pode ser definido em vertentes reducionistas e não-reducionistas. No contexto atual, há uma tendência a uma polarização. Por um lado, o objeto da psiquiatria é concebido como o objeto das demais especialidades médicas, enquanto doença mental, localizado no cérebro e resultando em práticas que privilegiam as abordagens biológicas. Por outro, em vertentes mais amplas de definição, ele consiste no sofrimento psíquico e social ou em disfunções internas socialmente inapropriadas, o que envolve múltiplos níveis e dimensões biológico, fenomenológico, cultural. Esta concepção do objeto da psiquiatria demanda uma multiplicidade e pluralidade de abordagens tanto no plano teórico quanto no plano prático. A presente tese afirma que uma perspectiva multinível e plural é imperiosa à práxis psiquiátrica. A tese está dividida em duas partes. Na primeira, realiza-se uma discussão filosófica na psiquiatria, mediante o método da investigação conceitual, visando um refinamento teórico do campo, que tende a gerar práticas mais efetivas. Três problemas filosóficos que perpassam a psiquiatria são discutidos: a distinção explicação-compreensão; o problema mente-cérebro e a distinção fato-valor. Aponta-se uma solução pragmatista para cada um destes problemas. Na segunda parte, realiza-se um estudo de caso com o exemplar esquizofrenia, analisando os múltiplos níveis do fenômeno mediante a apresentação das abordagens biológicas, fenomenológicas e antropológicas da esquizofrenia na contemporaneidade, enfocando, respectivamente, as hipóteses neurodesenvolvimentais, as alterações na consciência pré-reflexiva de si e as concepções do fenômeno em contextos não-ocidentais. A esquizofrenia corresponde a uma categoria de alta validade, tendo uma importante participação de fatores genético-biológicos. Ainda assim, o modelo biomédico se mostra insuficiente para dar conta da complexidade da experiência do adoecimento nesta condição. Portanto, uma perspectiva multinível e plural se faz mandatória. E se esta perspectiva se aplica à esquizofrenia, aplicar-se-á também a todos os transtornos mentais, com importantes implicações para a práxis psiquiátrica, seja no âmbito da teoria e pesquisa, seja no âmbito da clínica e da elaboração de políticas públicas de saúde mental, ajustando-se melhor, por exemplo, aos propósitos do Global Mental Health. / Just as medicine, psychiatry does not consist in a theoretical discipline, but in praxis, a theoretical project that is only justified by practical project. Therefore, it is a field of intervention. Psychiatry uses various theoretical and scientific approaches with a practical purpose. However, the subject of this field cannot to be confused with the subject of these approaches. The subject of psychiatry can be defined in reductionist and non-reductionist strands. In the current context, there is a tendency to polarization. On the one hand, the subject of psychiatry is conceived as the subject of other medical specialities, as a mental disease, located in the brain and resulting in practices that favor biological approaches. On the other hand, in broader strands of definition, it consists on psychic and social suffering or socially inappropriate internal dysfunctions, which involves multiple levels and dimensions - biological, phenomenological, cultural. This conception of the subject of psychiatry demands a multiplicity and plurality of approaches in both theoretical and practical plans. This thesis affirms that a multilevel and plural perspective is imperative to psychiatric praxis. The thesis is divided into two parts. In the first part, there is a philosophical discussion in psychiatry, by the method of conceptual investigation, aiming a theoretical refinement of the field, which tends to generate more effective practices. Three philosophical problems that pass through psychiatry are discussed: the explanation-understanding distinction, the mind-brain problem and the fact-value distinction. A pragmatist solution for each of these problems is pointed. In the second part, there is a case study of schizophrenia as exemplar, analyzing the multiple levels of the phenomenon upon presentation of biological, phenomenological and anthropological approaches to schizophrenia in contemporary times. This case study is focusing on neurodevelopmental hypothesis, changes in pre-reflective self-consciousness and conceptions of the phenomenon in non-Western contexts, respectively. Schizophrenia represents a category of high validity, with an important contribution of genetic-biological factors. Still, the biomedical model is insufficient to account for the complexity of the experience of suffering this condition. Therefore, a multilevel and plural perspective becomes mandatory. And if this perspective applies to schizophrenia, also will apply to all mental disorders, with important implications for psychiatric praxis, either within the theory and research, either within the clinical and mental health policy development, adjusting better, for example, to the purposes of the Global Mental Health.