Atualmente os benzodiazepínicos constituem o grupo de fármacos de prescrição mais consumidas em todo o mundo. Além da utilização desta classe farmacológica como fármacos de abuso, mais recentemente seu uso está associado a uma nova cultura psicodélica emergente. O termo \"club drugs\" tem sido usado para descrever estes fármacos que levam a efeitos psicodélicos e euforizantes. Acresça-se a isto à preocupante utilização destas substâncias em situações de estupro e/ou assalto, as chamadas \"drug-facilitated sexual assault\", destacando-se o flunitrazepam. Devido às pequenas doses administradas e a extensiva metabolização, a identificação do flunitrazepam e seus metabólitos torna-se dificultada em relação a outros benzodiazepínicos. O presente trabalho constitui validação de metodologia analítica que permita a correta identificação e quantificação de flunitrazepam e seu principal produto de biotransformação, o 7-aminoflunitrazepam, em soro. O método desenvolvido mostrou boa linearidade, precisão, exatidão, rendimento e capacidade de detectar os analitos mesmo em baixas concentrações, permitindo desta forma a inferência sobre a realidade dos casos onde se utiliza este fármaco sem fins terapêuticos. / Currently the benzodiazepines are one of the most consumed groups among the prescripton drugs in the world. Beside this, they have been used as drugs of abuse and more recently their use is associated with the new emerging psychodelic culture. The term \"club drugs\" has been used to describe these drugs that cause psychodelic and euphoric effects. In addition to this, there is a growing concern with the use of these substances related to \"drug-facilitated sexual assault\", among of which Flunitrazepan is pointed out as one of the most important . Due to the small doses involved in the consumption for this purpose and also the extense biotransformation, the identification of this analyte and its metabolites become more difficult than that of other benzodiazeines. This study provides an analytical validation method that enables correct identification and quantification of Flunitrazepam and its main biotransformation product, the 7-aminoflunitrazepam, in serum. The method developed demonstrates good linearity, precision, accuracy, recovery and capacity of detect the analytes, even in low concentration. Thus making possible to makes inferences regarding the reality of cases where it is used as a drug without therapeutic use.

A importância de algumas abordagens psicoterápicas associadas à farmacoterapia no tratamento do Transtorno Depressivo Maior tem sido bastante destacada, no entanto, existem poucos dados sobre a Psicoterapia Psicodramática. O presente estudo comparou 20 pacientes com diagnóstico de TDM em uso de medicamentos antidepressivos e avaliados pela Escala de Depressão de HAM-D17 (escores entre 7 e 20), divididos em dois grupos: dez pacientes do Grupo Psicoterápico (GP) participaram de 4 sessões individuais de psicoterapia psicodramática e 24 de grupo. Dez pacientes do Grupo Controle (GC) não participaram de sessões psicoterápicas. Os dois grupos foram avaliados pela Escala de HAM-D17 e pela Escala de Adequação Social (EAS) no início e final do processo psicoterápico e o GP também foi avaliado pela Análise Sociométrica, fundamentada no método psicodramático. Em comparação ao GC, o GP apresentou uma melhora significativa quanto aos sintomas depressivos e ao funcionamento social, bem como uma expressiva mudança nos aspectos sociométricos investigados / The importance of several psychotherapic approaches associated to pharmacotherapy on the treatment of Major Depressive Disorder has been quite highlighted, although, there is little information as far as Psychodramatic Psychotherapy is concerned. The present study compared 20 patients diagnosed with MDD in use of antidepressant drugs and evaluated with the Hamilton Depression Scale (scores between 7 and 20), divided into two groups as follows: ten of the patients from the Psychotherapic Group (PG) took part in 4 individual psychodramatic psychotherapy sessions and 24 psychodramatic psychotherapy group sessions. Ten of the patients from the Control Group (CG) did not participate in the psychodramatic psychotherapy sessions. Both groups were evaluated with the HAM-D17 Scale and the Social Adjustment Scale - Self Report (SASSR) at the beginning and at the end of the psychotherapic process, and the PG was also evaluated through Sociometric Analysis, based on the psychodramatic method. In comparison to the CG, the PG presented a significant improvement regarding the symptoms of depression and social functioning, as well as an expressive change on the investigated sociometric aspects

Le système nerveux central est un organe privilégié et protégé, notamment grâce à l’existence des barrières histologiques entre le sang et les tissus nerveux. La barrière-hémato encéphalique (BHE) et la barrière hémato-rétinienne (BHR) séparent respectivement le parenchyme cérébral et la rétine des composés contenus dans l’espace vasculaire, grâce à l’expression de jonctions serrées et de transporteurs membranaires permettant une régulation spécifique des échanges entre le sang et le parenchyme nerveux. Ce travail a porté sur l’étude d’un nouveau transporteur de cations organiques mis en évidence fonctionnellement à la BHE de la souris. Ce transporteur appartenant très probablement à la superfamille des solute carrier (SLC), fonctionne comme un antiport proton. Actuellement, sa présence ne peut être démontrée que de façon fonctionnelle car son identité moléculaire est encore inconnue. Cet antiport proton constitue un nouvel acteur de la perméabilité cérébrale et ouvre une nouvelle voie d’accès au cerveau. Nous nous sommes tout d’abord attachés à approfondir les connaissances fonctionnelles de ce transporteur en étudiant de nouveaux substrats et tissus d’expression. Le transport cérébral de psychotropes a été étudié in vivo par la technique de perfusion carotidienne in situ chez la souris et in vitro grâce à une lignée de cellules endothéliales cérébrales humaines immortalisées (hCMEC/D3). Nous avons démontré que la haute perméabilité cérébrale de la cocaïne fait intervenir à la fois une diffusion passive et surtout une diffusion médiée par un antiport proton. La vitesse d’entrée des substances d’abus dans le cerveau est associée à un plus fort risque d’addiction et fait de ce transporteur un nouvel acteur critique de la régulation du passage cérébral. En effet, d’autres substances comme la nicotine et certaines amphétamines comme le MDPV et l'ecstasy sont également des substrats de cet antiport. Ce transporteur apparaît comme une cible pharmacologique potentielle dans la prise en charge de toxicomanies. Malgré la diversité chimique et pharmacologique d’interactions des composés avec cet antiport, les concentrations nécessaires pour l’inhiber dépassent celles retrouvées dans le sang. Pour aider l’identification d’inhibiteurs sélectifs et efficaces nous avons développé un modèle pharmacophorique d’inhibiteurs du transporteur à partir de données générées in vitro et de l’approche FLAPpharm. Ce modèle semble prédictif de nouveaux composés pouvant constituer de meilleurs inhibiteurs de ce transporteur. L’étude des échanges in vivo au niveau du tissu nerveux nous a menés à étudier l’impact de transporteurs ABC et de l’antiport-proton au niveau cérébral et rétinien à l’aide de substances spécifiques ou de substrats mixtes comme le vérapamil. L’antiport proton est fonctionnel au niveau de la BHR et transporte notamment la clonidine, le DPH et le vérapamil. Cependant, dans le cas d’un substrat mixte P-gp et SLC (ex : vérapamil), ce transport d’influx n’est visible à la BHE que lorsque la P-gp est neutralisée. Au contraire, à la BHR l’influx lié à cet SLC est visible naturellement. L’impact de la P-gp à la BHR étant 6.3-fois plus faible ce processus est probablement moins masqué. Cette étude illustre la difficulté actuelle de prédire l’impact fonctionnel d’un transporteur pour des substrats multi-spécifiques et l’existence d’une priorisation du transport. Enfin, nous avons essayé d’identifier l’antiport proton au niveau moléculaire par une méthode de photo-activation à l’aide d’un composé adapté. Cette méthode s’est avérée efficace pour fixer une molécule sur le transporteur, permettant par la suite de l’isoler plus facilement. En conclusion, ce travail a permis de mettre en évidence l’importance de l’antiport proton dans la distribution cérébrale de psychotropes et d’ouvrir de nouvelles perspectives dans l’addiction et la compréhension du transport de substrats multi-spécifiques. / The central nervous system is a privilege organ protected by histological barriers between the blood and the nervous tissue. The blood-brain barrier (BBB) and the blood-retinal barrier (BRB) separate cerebral parenchyma and retina from the circulating blood and both express tight junctions and membrane transporters, allowing a precise regulation of the exchanges between the blood and nervous tissues. We studied a new cationic transporter functionally evidenced at the mouse BBB. This molecularly unknown transporter belong to the solute carrier super family (SLC) and is a proton antiporter. It could constitute a new actor in the cerebral permeability and may be a new brain access pathway. First, we worked on the functional identification studying new substrates and new localization. Psychotropic brain transport was studied in vivo by brain in situ perfusion on mouse and in vitro with human immortalized endothelial cells (hCMEC/D3). We showed that cocaine brain entry depends on passive diffusion but also mainly on a proton antiporter. Brain entry rate of drugs of abuse is associated with modulation of addiction liability, making this transporter a new component of brain entry of cocaine, and also nicotine and some amphetamines such as ecstasy and MDPV. This proton antiporter appears to be a new potential target in addiction. Various chemical entities interact with this transporter; however concentrations used to inhibit the transporter are much higher than the one possibly found in the blood. In order to help find or design new selective and potent inhibitors, we developed a pharmacophore model of the proton antiporter inhibitors using in vitro data and the FLAPpharm approach. The model predicts well new possible inhibitors of this transporter. We also studied the impact of the ABC transporters and the proton antiporter at the BBB and the BRB using specific or multi-specific substrates such as verapamil. The proton antiporter is functionally expressed at the BRB and transports clonidine, DPH and verapamil. However, for the multi-specific (P-gp and SLC) compound verapamil, influx transport by the proton antiporter is visible at the BBB only when P-gp efflux is neutralized. On the contrary, at the BRB, the proton antiporter influx is always visible. This is certainly due to the lower impact (by 6.3 fold) of P-gp at the BRB compared to the BBB. These results show the difficulty to predict the functional impact of a transporter for multi-specific compounds and a probable transport prioritization. Finally we worked on the molecular identification of the proton antiporter using a photolabeling method. This work evidenced the importance of the proton antiporter in the brain distribution of psychotropic and drugs of abuse and opened toward new perspectives in addiction and transport comprehension.

O objetivo geral deste estudo foi investigar os fatores associados a Transtornos Mentais Comuns (TMC) e ao consumo de psicofármacos em Unidades Básicas de Saúde (UBSs) de Ribeirão Preto. É um estudo epidemiológico, transversal e correlacional com plano amostral estratificado e proporcional (n=430). Cada estrato foi formado pela maior UBS em número de usuários, na área de abrangência de cada um dos cinco distritos de saúde da cidade. Foram instrumentos de pesquisa: questionários sociodemográfico, econômico, farmacoterapêutico e de histórico de saúde; Self Reporting Questionnaire (SRQ-20), para estimar a prevalência de TMC e World Health Organization Quality of Life Assessment-Brief (WHOQOL-brief), para mensurar escores de qualidade de vida (QV) na amostra. TMC, uso de psicofármacos e QV foram considerados variáveis dependentes. Foram variáveis explicativas: sociodemográficas e econômicas, farmacoterapêuticas e histórico de saúde. Para a abordagem de TMC e uso de psicofármacos como variáveis dependentes, foram realizadas as análises: univariada (teste de Qui-quadrado) e regressão logística multivariada. Para a análise de QV, foram utilizados: t-teste de Student e regressão linear múltipla. Foram consideradas significativas as associações nas quais p<0,05. A prevalência de TMC foi de 41,4%, e a de consumo de psicofármacos foi de 25,8%. Os fatores preditores de TMC foram uso de psicofármacos (OR=3,88; IC95% 2,34-6,41) e sexo feminino (OR=1,96; IC95% 1,04- 3,69). Pelo teste Qui-quadrado, houve associação entre ser positivo para TMC e número de tipos de medicamentos e número de comprimidos por dia (p<0,05). Quanto ao uso de psicofármacos, os fatores preditores foram TMC (OR=3,9; IC95% 2,36-6,55), doenças clínicas (OR=5,4, IC95% 2,84-10,2) e baixa escolaridade (OR=1,7; IC95% 1,02-2,92). Segundo o t-teste de Student, pacientes com TMC apresentaram escores de QV menores que pacientes negativos para TMC, em todos os domínios (p<0,05). TMC foi o fator que mais contribuiu no modelo de regressão linear para piores escores de QV. O uso de psicofármacos influenciou negativamente os padrões de QV nos domínios físico e psicológico do WHOOQL- brief. Os resultados deste estudo apontam para a necessidade de estratégias em atenção básica à saúde (ABS) que busquem contemplar a integralidade dos indivíduos, visto a associação entre TMC, uso de psicofármacos e QV com variáveis sociodemográficas e econômicas. Os resultados com QV permitem a suposição de que quer estivessem em uso de psicofármacos ou não, os indivíduos apresentaram- se em sofrimento / The general aim of this study was to investigate the factors associated with Common Mental Disorders (CMD) and the use of psychotropic drugs in Basic Health Units (BHU), in Ribeirão Preto. This is an epidemiological cross-sectional and correlational study, with stratified proportional sampling plan. Each strata was formed by the largest BHU in the number of attendees in the coverage area of each of the five health districts in the entire city. The interview subjects included 430 individuals who had medical appointments scheduled in the BHUs. These elements were used as research instruments: economic, socio-demographic, and pharmacotherapeutic questionnaires; a self-reporting questionnaire (SRQ-20), to estimate the prevalence of CMDs; and a World Health Organization Quality of Life Assessment - Brief (WHOQOL-brief) to measure quality of life scores (QOL) in the sample. The dependent variables included CMD, the use of psychotropic drugs, and QOL. The explanatory variables involved socio-demographic, economic, and pharmacotherapeutic factors, as well as health history. While analyzing TMC and the use of psychotropics drugs as dependent variables, univariate (chi -square) analysis and a multivariate logistic regression were conducted. For the analysis of QOL, a Student t - test and a multiple linear regression were used. In associations in which p<0.05 were considered significant. The prevalence of CMDs was 41.4% and psychotropic drug was 25.8%. Predictors of CMD included the use of psychoactive drugs (OR = 3.88, 95% CI 2.34 to 6.41) and female gender (OR = 1.96, 95% CI 1.04 to 3.69). Information gathered by the Chi-square test indicated an association between being positive for TMC and the number of types of medications and the number of tablets per day (p<0.05.) Regarding the use of psychotropic drugs, the predictors were TMC (OR = 3.9; 95% CI 2.36 to 6.55), physical illness (OR = 5.4, 95% CI 2.84 to 10.2), and lower education (OR = 1, 95% CI 1.02 to 2.92). According to the Student t-test, patients with CMD had lower QOL scores than patients who were negative for TMC across all domains (p < 0.05). CMD was the major contributing factor in the linear regression model for lower QOL scores. The use of psychotropics negatively influenced the patterns of QOL, in the physical and psychological domains of WHOOQL-brief. The results of this study point to the need for strategies in primary health care (PHC) which seek to consider the individuals as a whole, since there was association between CMD, use of psychotropic drugs, and QOL with socio-demographic and economic variables. The results involving QOL allow for the assumption that, whether or not there was use of psychotropic drugs, individuals presented in distress

In this thesis I explore functions of the neuromodulator dopamine in the context of autonomous learning and behaviour. I first investigate dopaminergic influence within a simulated agent-based model, demonstrating how modulation of synaptic plasticity can enable reward-mediated learning that is both adaptive and self-limiting. I describe how this mechanism is driven by the dynamics of agentenvironment interaction and consequently suggest roles for both complex spontaneous neuronal activity and specific neuroanatomy in the expression of early, exploratory behaviour. I then show how the observed response of dopamine neurons in the mammalian basal ganglia may also be modelled by similar processes involving dopaminergic neuromodulation and cortical spike-pattern representation within an architecture of counteracting excitatory and inhibitory neural pathways, reflecting gross mammalian neuroanatomy. Significantly, I demonstrate how combined modulation of synaptic plasticity and neuronal excitability enables specific (timely) spike-patterns to be recognised and selectively responded to by efferent neural populations, therefore providing a novel spike-timing based implementation of the hypothetical ‘serial-compound' representation suggested by temporal difference learning. I subsequently discuss more recent work, focused upon modelling those complex spike-patterns observed in cortex. Here, I describe neural features likely to contribute to the expression of such activity and subsequently present novel simulation software allowing for interactive exploration of these factors, in a more comprehensive neural model that implements both dynamical synapses and dopaminergic neuromodulation. I conclude by describing how the work presented ultimately suggests an integrated theory of autonomous learning, in which direct coupling of agent and environment supports a predictive coding mechanism, bootstrapped in early development by a more fundamental process of trial-and-error learning.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-09-13T17:47:07Z No. of bitstreams: 1 MauricioFernandes.pdf: 1547228 bytes, checksum: 87d9e63be597d8eaf8f7a783479e1294 (MD5) / Made available in DSpace on 2017-09-13T17:47:07Z (GMT). No. of bitstreams: 1 MauricioFernandes.pdf: 1547228 bytes, checksum: 87d9e63be597d8eaf8f7a783479e1294 (MD5) Previous issue date: 2017-04-28 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão / INTRODUCTION: In Brazil, it is reported that a great part of the patients who arrive for the primary care service have as main complaint: sadness (depression) and / or anxiety, also with more complex disorders such as problems related to abuse of alcohol and serious and persistent mental disorders, such as schizophrenia and affective psychoses (bipolar mood disorder). In the pharmacogenetic studies of antidepressants and antipsychotics, cytochrome P450 (CYPs) enzymes have been shown to be one of the most significant targets in the interindividual changes in drug response kinetic parameters. OBJECTIVE: To characterize the frequency of CYP2D6 polymorphisms (*4, *6 and *17) in users of psychotropic therapy, especially tricyclic antidepressants and antipsychotics. METHODS: Cross - sectional, descriptive study carried out in the city of São Luis – MA. RESULTS: From a total of 105 charts, a sample of 43 patients was collected. The mean age was 40.98 (± 11.04) years, of which 24 (55.81%) were male and 19 (44, 19%) of females. Regarding the pharmacotherapy, all participants (100%) were on daily use of the antipsychotic haloperidol, seventeen (39.53%) patients used risperidone and one (2.32%) patient used amitriptyline (tricyclic antidepressant), all three drugs are substrates of the enzyme CYP2D6. For the polymorphism of CYP2D6, we had a prevalence of 11 (25.48%) for allele 4, and all the patients presented with this polymorphism were heterozygous, that means they had one polymorphic allele and one normal allele. For allele 17, we had a prevalence of 4 (9.3%), also all patients being heterozygous for this allele. Allele 6 did not appear in any patient in our study. We also had two patients who presented the polymorphisms for alleles * 4 and * 17 at the same time. CONCLUSION: This study was able to characterize the frequency of CYP2D6 (* 4, * 6 and 17 *) polymorphisms in users of psychotropic therapy, including tricyclic antidepressants and antipsychotics, in addition to contributing to a higher dose / response do medication, ensuring greater safety and efficacy in the use of medicines, improving the quality of life of patients. / INTRODUÇÃO: No Brasil, tem-se o relato de que grande parte dos pacientes que chegam para o atendimento na atenção primária apresentam, como principal queixa, tristeza (depressão) e/ou ansiedade, aparecendo também transtornos mais complexos como os problemas relacionados ao abuso de álcool, assim como os transtornos mentais graves e persistentes, como a esquizofrenia e as psicoses afetivas (transtorno bipolar do humor). Nos estudos farmacogenéticos de antidepressivos e antipsicóticos, as enzimas do citrocromo P450 (CYPs) tem se mostrado um dos alvos mais significativos nas alterações interindividuais dos parâmetros cinéticos de resposta às drogas. OBJETIVO: caracterizar a frequência de polimorfismos do CYP2D6 (*4, *6 e 17*) em usuários da terapêutica com psicotrópicos, principalmente antidepressivos tricíclicos e antipsicóticos. MÉTODOS: Estudo transversal, descritivo realizado no Município de São Luís (MA). RESULTADO: De um total de 105 prontuários, coletou-se amostra de 43 pacientes, a média de idade foi de 40,98 (±11,04) anos, sendo 24 (55,81%) do sexo masculino e 19 (44,19%) do sexo feminino. Em relação à farmacoterapia, todos os participantes (100%) estavam em consumo diário do antipsicótico haloperidol, dezessete (39,53%) pacientes faziam uso de risperidona e um (2,32%) paciente utilizava amitriptilina (antidepressivo tricíclico), todos os três medicamentos são substratos da enzima CYP2D6. Para o polimorfismo da CYP2D6, tivemos para o alelo 4 uma prevalência de 11 (25,48%), sendo que todos os pacientes que apresentaram esse polimorfismo são heterozigotos, ou seja, apresentaram um alelo polimórfico e outro normal. Para o alelo 17, tivemos uma prevalência de 4 (9,3%), sendo também todos os pacientes heterozigotos para esse alelo. O alelo 6 não apareceu em nenhum paciente do nosso estudo. Tivemos também dois pacientes que apresentaram os polimorfismos para os alelos *4 e *17 ao mesmo tempo. CONCLUSÃO: Este estudo pôde caracterizar a frequência de polimorfismos do CYP2D6 (*4, *6 e 17*) em usuários da terapêutica com psicotrópicos, incluindo antidepressivos tricíclicos e antipsicóticos, além de contribuir para uma maior adequação da relação dose/resposta ao medicamento, garantindo maior segurança e eficácia quanto ao uso de medicamentos, melhorando a qualidade de vida dos pacientes.

Atualmente os benzodiazepínicos constituem o grupo de fármacos de prescrição mais consumidas em todo o mundo. Além da utilização desta classe farmacológica como fármacos de abuso, mais recentemente seu uso está associado a uma nova cultura psicodélica emergente. O termo \"club drugs\" tem sido usado para descrever estes fármacos que levam a efeitos psicodélicos e euforizantes. Acresça-se a isto à preocupante utilização destas substâncias em situações de estupro e/ou assalto, as chamadas \"drug-facilitated sexual assault\", destacando-se o flunitrazepam. Devido às pequenas doses administradas e a extensiva metabolização, a identificação do flunitrazepam e seus metabólitos torna-se dificultada em relação a outros benzodiazepínicos. O presente trabalho constitui validação de metodologia analítica que permita a correta identificação e quantificação de flunitrazepam e seu principal produto de biotransformação, o 7-aminoflunitrazepam, em soro. O método desenvolvido mostrou boa linearidade, precisão, exatidão, rendimento e capacidade de detectar os analitos mesmo em baixas concentrações, permitindo desta forma a inferência sobre a realidade dos casos onde se utiliza este fármaco sem fins terapêuticos. / Currently the benzodiazepines are one of the most consumed groups among the prescripton drugs in the world. Beside this, they have been used as drugs of abuse and more recently their use is associated with the new emerging psychodelic culture. The term \"club drugs\" has been used to describe these drugs that cause psychodelic and euphoric effects. In addition to this, there is a growing concern with the use of these substances related to \"drug-facilitated sexual assault\", among of which Flunitrazepan is pointed out as one of the most important . Due to the small doses involved in the consumption for this purpose and also the extense biotransformation, the identification of this analyte and its metabolites become more difficult than that of other benzodiazeines. This study provides an analytical validation method that enables correct identification and quantification of Flunitrazepam and its main biotransformation product, the 7-aminoflunitrazepam, in serum. The method developed demonstrates good linearity, precision, accuracy, recovery and capacity of detect the analytes, even in low concentration. Thus making possible to makes inferences regarding the reality of cases where it is used as a drug without therapeutic use.

A importância de algumas abordagens psicoterápicas associadas à farmacoterapia no tratamento do Transtorno Depressivo Maior tem sido bastante destacada, no entanto, existem poucos dados sobre a Psicoterapia Psicodramática. O presente estudo comparou 20 pacientes com diagnóstico de TDM em uso de medicamentos antidepressivos e avaliados pela Escala de Depressão de HAM-D17 (escores entre 7 e 20), divididos em dois grupos: dez pacientes do Grupo Psicoterápico (GP) participaram de 4 sessões individuais de psicoterapia psicodramática e 24 de grupo. Dez pacientes do Grupo Controle (GC) não participaram de sessões psicoterápicas. Os dois grupos foram avaliados pela Escala de HAM-D17 e pela Escala de Adequação Social (EAS) no início e final do processo psicoterápico e o GP também foi avaliado pela Análise Sociométrica, fundamentada no método psicodramático. Em comparação ao GC, o GP apresentou uma melhora significativa quanto aos sintomas depressivos e ao funcionamento social, bem como uma expressiva mudança nos aspectos sociométricos investigados / The importance of several psychotherapic approaches associated to pharmacotherapy on the treatment of Major Depressive Disorder has been quite highlighted, although, there is little information as far as Psychodramatic Psychotherapy is concerned. The present study compared 20 patients diagnosed with MDD in use of antidepressant drugs and evaluated with the Hamilton Depression Scale (scores between 7 and 20), divided into two groups as follows: ten of the patients from the Psychotherapic Group (PG) took part in 4 individual psychodramatic psychotherapy sessions and 24 psychodramatic psychotherapy group sessions. Ten of the patients from the Control Group (CG) did not participate in the psychodramatic psychotherapy sessions. Both groups were evaluated with the HAM-D17 Scale and the Social Adjustment Scale - Self Report (SASSR) at the beginning and at the end of the psychotherapic process, and the PG was also evaluated through Sociometric Analysis, based on the psychodramatic method. In comparison to the CG, the PG presented a significant improvement regarding the symptoms of depression and social functioning, as well as an expressive change on the investigated sociometric aspects

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-08T18:44:55Z No. of bitstreams: 1 Marcela Potrich Peluffo.pdf: 226215 bytes, checksum: 738e3b8accac2fd4d75e3a41daded914 (MD5) / Made available in DSpace on 2015-04-08T18:44:55Z (GMT). No. of bitstreams: 1 Marcela Potrich Peluffo.pdf: 226215 bytes, checksum: 738e3b8accac2fd4d75e3a41daded914 (MD5) Previous issue date: 2014-03-27 / The World Health Organization estimated depression as the third cause of disability in the ranking of all diseases, responsible for 4.3% loss of healthy life years (DALY). The depressive disorder impairs the ability to function, leading to deficiency in the production of more than 50% of patients. The treatment may be pharmacotherapy, psychotherapy, and in some cases eletroconvulsive therapy. This study examined the prevalence of the use of antidepression medications in the city of São Paulo, Brazil and is part of a large study Pos traumatic stress disorder on the São Paulo city: prevalence, commordity and associated factors. This is a one phase cross-sectional survey carried out in São Paulo, Brazil. A multistage probability to size sampling scheme was performed in order to select the participants (3000). The measurements included psychiatric diagnoses (CIDI 2.1), and psychoactive medications. The interviews were carried between June/2007 February/2008. The statistical analyses will be weight-adjusted in order to take account of the design effects. The frequency of use of psychoactive medications in individuals with depressive disorder 13%, 12,8% make use of antidepressant medication and 8% benzodiazepines, so with a large number of concurrent use of two medications. Among those who are using antidepressants, 63% use selective serotonin reuptake inhibitors, 34% use a tricyclic antidepressant and the other 3% make use of selective inhibitors of noradrenaline reuptake and various antidepressants. Was associated with the use of antidepressant medications females (2,7; IC 95% 1,5 ¿ 4,9), age over 30 years, being widowed or divorced or separate without living with the partner, with schooling above 13 years. It was concluded that there is a great way to go in our country in relation to mental health policies. Advances such as ensuring access to medicines and qualified professionals have already occurred, but show still insufficient. / A Organização Mundial da Saúde estima a depressão como a terceira causa de incapacidade no ranking de todas as doenças, responsável por 4,3% de perda de anos de vida saudáveis (DALY). O transtorno depressivo prejudica a capacidade laboral de mais de 50% dos pacientes. Os tratamentos podem ser farmacoterapia, psicoterapia e, em alguns casos, o tratamento eletroconvulsivante. O objetivo deste estudo foi avaliar o uso de medicamentos antidepressivos em indivíduos com diagnóstico de transtorno depressivo na população da cidade de São Paulo, Brasil. Um estudo de corte transversal foi realizado com amostra probabilística, em multiestágios, da população da cidade de São Paulo, Brasil. Foram entrevistados 2536 indivíduos. As medidas incluíram diagnósticos psiquiátricos (CIDI 2.1) e o uso de medicamentos psicoativos, incluindo antidepressivos. As entrevistas foram realizadas entre Junho/2007 e Fevereiro/2008. As estimativas foram ajustadas para o efeito do desenho por meio da análise de amostras complexas. A prevalência de uso de medicação psicoativa em indivíduos com transtorno depressivo foi de 13%, 12,8% utilizando de medicação antidepressiva e 8% benzodiazepínicos, portanto com número grande de uso concomitante das duas medicações. Entre aqueles que fazem o uso de antidepressivos, 63% usam inibidores seletivos da recaptação de serotonina, 34% usam antidepressivo tricíclico e os outros 3% fazem o uso de inibidores seletivos da recaptação de noradrenalina e antidepressivos variados. O uso de medicamentos antidepressivos esteve associado ao sexo feminino (2,2; IC 95% 1,0 ¿ 5,0), idade acima de 30 anos (2,7; IC 95% 1,1 ¿ 6,5), ser viúvo ou divorciado ou separado não morando junto com o parceiro (2,0; IC 95% 1,0 ¿ 4,2), com escolaridade acima de 13 anos (3,1; IC 95% 1,2 ¿ 7,9). Foi concluído que há um grande caminho a ser percorrido em nosso país em relação às políticas de saúde mental. Avanços como a garantia de acesso aos medicamentos e profissionais qualificados já ocorreram, mas se mostram ainda insuficientes.

To provide background information about previous findings about the prevalence of use, abuse and dependence of various substances (nicotine, alcohol, prescription and illicit drugs) findings of available epidemiological studies in Germany from the 1980s and 1990s are summarized and critically evaluated. Focusing on findings of substance use surveys in adolescents and young adults the review indicates: (a) a considerable number of large scale questionnaire surveys in general population samples documenting the frequency of use and patterns of use of most substances; (b) indications of increasing rates of drug use particularly in East Germany; (c) high rates of illicit drug use, mainly of cannabinoids, but also stimulants and hallucinogens, among young age groups. No data are available from substance use surveys or from clinical epidemiological studies allowing the determination of how frequent substance abuse and substance dependence diagnoses are in the general population or in adolescents and young adults. Priorities for future research to ameliorate this unsatisfactory situation are outlined with emphasis on research in adolescents and young adults.