Patologia Psiquiátrica nos Cuidados Primários de Saúde

É consensual a alta prevalência de patologia psiquiátrica ao nível dos Cuidados Primários Saúde. Consensual será também o papel fulcral que estes mesmos Cuidados desempenham enquanto primeiro filtro na abordagem dos problemas psiquiátricos, reconhecendo-se que, frequentemente, o Clínico Geral é o agente melhor posicionado para uma correcta abordagem diagnóstica e terapêutica deste tipo de problemas. Assume-se assim como necessidade objectiva que o Clínico Geral tome a seu cargo a maioria destes doentes e proceda à referenciação criteriosa duma minoria verdadeiramente necessitada de cuidados mais especializados. Em termos práticos, configura-se como prioritária uma progressiva melhoria da capacidade de actuação dos Clínicos Gerais, na área da Saúde Mental. É portanto neste contexto que surge a importância da articulação dos Serviços de Psiquiatria com os Centros de Saúde e a relevância do trabalho Consiliar e de Ligação do Psiquiatra junto dos Clínicos Gerais. No presente artigo os autores tecem algumas considerações e lançam diversas questões sobre o tema em apreço, procurando abordar determinados aspectos centrais, nomeadamente, as particularidades de apresentação da patologia psiquiátrica nos Cuidados de Saúde Primários, em particular da “depressão”, e decorrendo deste facto, as dificuldades na avaliação e abordagem das perturbações mentais neste setting particular

Da Doença Mental à Violência

Resumo: Os comportamentos violentos no âmbito da doença mental têm sido motivo de intenso debate e crescente investigação. A complexidade da questão e a sua importância clínica e social moveram-nos na elaboração do presente artigo, com o qual pretendemos, a partir de uma revisão da literatura existente, a contextualização daquela relação à luz dos actuais conhecimentos científicos

From Psychiatry to Law

Após uma breve introdução, é feito um enquadramento jurídico-penal da doença mental, bem como uma descrição sumária do conceito de inimputabilidade. É ainda considerada a questão da aplicação das medidas de segurança, citando-se a contribuição dos autores que mais se têm salientado neste campo e as actuais perspectivas sobre o tema

Perfeccionismo no transtorno obsessivo-compulsivo e nos transtornos alimentares

OBJETIVO: Este estudo tem dois objetivos principais. Primeiro, avaliar as dimensões do perfeccionismo no transtorno obsessivo-compulsivo e nos transtornos alimentares em comparação com duas amostras controle: psiquiátrica (depressão/ansiedade) e não clínica. Segundo, avaliar se o perfeccionismo é um traço de personalidade especificamente relacionado com estas diferentes condições clínicas. MÉTODO: 39 pacientes com transtorno obsessivo-compulsivo, 24 com transtornos alimentares, 65 com um diagnóstico de depressão e/ou ansiedade (todos estes pacientes encontravam-se em regime de ambulatório) e 70 controles não clínicos completaram a versão portuguesa da Multidimensional Perfectionism Scale. RESULTADOS: Comparativamente à amostra não clínica, todas as amostras clínicas apresentaram níveis significativamente mais elevados na Multidimensional Perfectionism Scale total, no Perfeccionismo Auto-Orientado e no Perfeccionismo-Socialmente-Prescrito. Não houve diferenças estatisticamente significativas no Perfeccionismo-Auto-Orientado e na Multidimensional Perfectionism Scale total nas três amostras clínicas. No entanto, a amostra com transtornos alimentares apresentou níveis significativamente mais elevados de Perfeccionismo-Socialmente-Prescrito, comparativamente à transtornos alimentares e à amostra psiquiátrica (depressão/ansiedade). CONCLUSÃO: O perfeccionismo revelou estar associado a uma grande variedade de condições psicopatológicas. Contudo, as diferenças encontradas entre a amostra de transtornos alimentares, de transtorno obsessivo-compulsivo e a psiquiátrica no Perfeccionismo-Socialmente-Prescrito necessitam de investigação subsequente no sentido de clarificar a especificidade desta dimensão com os transtornos alimentares

Understanding valuation of travel time changes: are preferences different under different stated choice design settings?

Stated choice (SC) experiments are the most popular method to estimate the value of travel time changes (VTTC) of a population. In the simplest VTTC experiment, the SC design variables are time changes and cost changes. The levels of these variables create a particular setting from which preferences are inferred. This paper tries to answer the question “do preferences vary with SC settings?”. For this, we investigate the role of the variables used in the SC experiment on the estimation of the set of VTTC (i.e. mean and covariates). Ideally, one would like to observe the same individuals completing different SC experiments. Since that option is not available, an alternative approach is to use a large dataset of responses, and split it according to different levels of the variable of interest. We refer to this as partial data analysis. The estimation of the same model on each sub-sample provides insights into potential effects of the variable of interest. This approach is applied in relation to three design variables on the data for the last national VTTC study in the UK, using state-of-the-art model specifications. The results show several ways in which the estimated set of VTTC can be affected by the levels of SC design variables. We conclude that model estimates (including the VTTC and covariates) are different in different settings. Hence by focussing the survey on specific settings, sample level results will be affected accordingly. Our findings have implications for appraisal and can inform the construction of future SC experiments

Brain changes associated with cognitive and emotional factors in chronic pain : a systematic review

An emerging technique in chronic pain research is MRI, which has led to the understanding that chronic pain patients display brain structure and function alterations. Many of these altered brain regions and networks are not just involved in pain processing, but also in other sensory and particularly cognitive tasks. Therefore, the next step is to investigate the relation between brain alterations and pain related cognitive and emotional factors. This review aims at providing an overview of the existing literature on this subject. Pubmed, Web of Science and Embase were searched for original research reports. Twenty eight eligible papers were included, with information on the association of brain alterations with pain catastrophizing, fear-avoidance, anxiety and depressive symptoms. Methodological quality of eligible papers was checked by two independent researchers. Evidence on the direction of these associations is inconclusive. Pain catastrophizing is related to brain areas involved in pain processing, attention to pain, emotion and motor activity, and to reduced top-down pain inhibition. In contrast to pain catastrophizing, evidence on anxiety and depressive symptoms shows no clear association with brain characteristics. However, all included cognitive or emotional factors showed significant associations with resting state fMRI data, providing that even at rest the brain reserves a certain activity for these pain-related factors. Brain changes associated with illness perceptions, pain attention, attitudes and beliefs seem to receive less attention in literature. Significance: This review shows that maladaptive cognitive and emotional factors are associated with several brain regions involved in chronic pain. Targeting these factors in these patients might normalize specific brain alterations

Fluorometric Liposome Screen for Inhibitors of a Physiologically Important Bacterial Ion Channel

The bacterial K+ homeostasis machinery is widely conserved across bacterial species, and different from that in animals. Dysfunction in components of the machinery has an impact on intracellular turgor, membrane potential, adaptation to changes in both extracellular pH and osmolarity, and in virulence. Using a fluorescence-based liposome flux assay, we have performed a high-throughput screen to identify novel inhibitors of the KtrAB ion channel complex from Bacillus subtilis, a component of the K+ homeostasis machinery that is also present in many bacterial pathogens. The screen identified 41 compounds that inhibited K+ flux and that clustered into eight chemical groups. Many of the identified inhibitors were found to target KtrAB with an in vitro potency in the low µM range. We investigated the mechanisms of inhibition and found that most molecules affected either the membrane component of the channel, KtrB alone or the full KtrAB complex without a preference for the functional conformation of the channel, thus broadening their inhibitory action. A urea derivative molecule that inhibited the membrane component of KtrAB affected cell viability in conditions in which KtrAB activity is essential. With this proof-of-concept study, we demonstrate that targeting components of the K+ homeostasis machinery has the potential as a new antibacterial strategy and that the fluorescence-based flux assay is a robust tool for screening chemical libraries.This work was supported by FEDER funds through COMPETE 2020-POCI, Portugal 2020, and FCT – Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior: POCI-01-0145-FEDER-029863 (PTDC/BIA-BQM/29863/2017), and by “Fundação Luso-Americana para o Desenvolvimento” FLAD Life Science 2020 awarded to JM-C. We acknowledge FCT fellowship SFRH/BPD/105672/2015 and contract DL 57/2016/CP1355/CT0026 awarded to AF, fellowship SFRH/BPD/107785/2015 to AP, and fellowship SFRH/BD/123761/2016 to CT-D

Genetic analysis of the naked trait in panicles of hexaploid oat

The aim of this study was to estimate the number of genes that control the naked (hull-less) trait and the mode of expression of this characteristic in panicles of hexaploid white oat. Parents and the segregating population (in the F2 and F3 generations) were evaluated in regard to the presence and distribution of naked grains in panicles of individual oat plants. For each plant, a drawing of the main panicle was developed. From the drawings obtained in the progenies of the F2 population, six distinct phenotypic classes were produced. The expected phenotypic proportion of 3:9:4 (naked:segregating:hulled) was that which best fit by the Chi-square test. In the F3 generation, the results showed agreement with the hypothesis observed in the F2 generation. The naked trait in oat is passed on by two genes and the greatest expression of this trait occurs in the upper third of the panicles. Expression of this trait in oats is not complete, even in homozygous genotypes

Dissolution of anionic surfactant mesophases

Linear and circular solvent penetration experiments are used to study the dissolution of anionic SLE3S surfactant mesophases in water. We show that a lamellar (Lα) phase in contact with water will transit through a series of cubic, hexagonal, and micellar phase bands with sharp interfaces identified from their optical textures. In both linear and circular geometries, the kinetics of front propagation and eventual dissolution are well described by diffusive penetration of water, and a simple model applies to both geometries, with a different effective diffusion coefficient for water Df as the only fitting parameter. Finally, we show a surprising variation of dissolution rates with initial surfactant concentration that can be well explained by assuming that the driving force for solvent penetration is the osmotic pressure difference between neat water and the aqueous fraction of the mesophase that is highly concentrated in surfactant counterions

Advanced Technologies for Oral Controlled Release: Cyclodextrins for oral controlled release

Cyclodextrins (CDs) are used in oral pharmaceutical formulations, by means of inclusion complexes formation, with the following advantages for the drugs: (1) solubility, dissolution rate, stability and bioavailability enhancement; (2) to modify the drug release site and/or time profile; and (3) to reduce or prevent gastrointestinal side effects and unpleasant smell or taste, to prevent drug-drug or drug-additive interactions, or even to convert oil and liquid drugs into microcrystalline or amorphous powders. A more recent trend focuses on the use of CDs as nanocarriers, a strategy that aims to design versatile delivery systems that can encapsulate drugs with better physicochemical properties for oral delivery. Thus, the aim of this work was to review the applications of the CDs and their hydrophilic derivatives on the solubility enhancement of poorly water soluble drugs in order to increase their dissolution rate and get immediate release, as well as their ability to control (to prolong or to delay) the release of drugs from solid dosage forms, either as complexes with the hydrophilic (e.g. as osmotic pumps) and/ or hydrophobic CDs. New controlled delivery systems based on nanotechonology carriers (nanoparticles and conjugates) have also been reviewed