History of the nosologic characterization of bipolar disorder

The authors review briefly the history of bipolar disorder from Araeteus of Cappadocia to our times. The modern concept of bipolar disorder was built in France, through the work of Falret (1851) and Baillarger (1854). The pivotal concepts of Emil Kraepelin changed the basis of psychiatric nosology, and Kraepelin's unitary concept of manic-depressive insanity was largely accepted. Kraepelin and Weigandt's ideas on mixed states were a cornerstone to this unitary concept. After Kraepelin however, the ideas of Kleist and Leonhard, in Germany, and the work of Angst, Perris and Winokur emphasized the distinction between unipolar and bipolar forms of depression. More recently the emphasis changed again to the bipolar spectrum, which expanded to the borders of the normal temperaments (Akiskal and co-workers). At the end the authors summarize the controversies concerning the nosology of bipolar disorder and its boundaries with schizophrenia, schizoaffective disorders and cycloid psychosis.Os autores apresentam uma sintética revisão da história da doença bipolar, a partir de Araeteus da Capadócia até os tempos atuais. O conceito moderno de doença bipolar foi iniciado na França, com os trabalhos de Falret (1851) e Baillarger (1856). Os conceitos seminais de Emil Kraepelin mudaram as bases da nosologia psiquiátrica, e o seu conceito unitário a respeito da insanidade maníaco-depressiva foi amplamente aceito e adotado. As idéias de Kraepelin e Weigandt constituíram-se na pedra angular para sua concepção unitária da doença maníaco-depressiva. Depois de Kraepelin, no entanto, as idéias de Kleist e Leonhard, na Alemanha, e o trabalho de Angst, Perris e Winokur enfatizaram a distinção entre as formas unipolar e bipolar da depressão. Mais recentemente a ênfase mudou novamente para o espectro bipolar, que se estende até os limites dos temperamentos normais (Akiskal e colaboradores). Finalizando, os autores sumarizam as controvérsias quanto à nosologia do transtorno bipolar e suas fronteiras com a esquizofrenia, os quadros esquizoafetivos e as chamadas psicoses ciclóides.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESPUNIFESP, EPM, Depto. de PsiquiatriaUNIFESPSciEL

Bipolar disorder: evolution of the concept and current controversies

The author reviews the evolution of the concept of bipolar disorder as an ongoing process. Its roots can be found in the work of Araeteus of Capadocia, who assumed that melancholia and mania were two forms of the same disease. The modern understanding of bipolar disorder began in France, through the work of Falret (1851) and Baillarger (1854). The pivotal concepts of Emil Kraepelin changed the basis of psychiatric nosology, and Kraepelin's unitary concept of manic-depressive insanity was largely accepted. Kraepelin and Weigandt's ideas on mixed states were the cornerstone of this unitary concept. After Kraepelin, however, the ideas of Kleist and Leonhard, in Germany, as well as the work of Angst, Perris and Winokur, emphasized the distinction between unipolar and bipolar forms of depression. More recently, the emphasis has shifted again to the bipolar spectrum, which, in its mild forms, expanded to the limits of normal temperament. In concluding, the author summarizes the polemic aspects concerning the nosology of bipolar disorder and its boundaries in comparison with those of with schizophrenia, schizoaffective disorders and cycloid psychosisO autor revê o conceito de transtorno bipolar como um processo em evolução. Suas raízes podem ser encontradas no trabalho de Araeteus da Capadócia, que assumia serem a melancolia e a mania duas formas da mesma doença. A compreensão atual da doença bipolar começou na França, através dos trabalhos de Falret (1851) e Baillarguer (1854). Os conceitos fundamentais de Kraepelin mudaram as bases da nosologia psiquiátrica, e o conceito unitário de Kraepelin sobre a insanidade maníaco-depressiva passou a ser amplamente aceito. Depois de Kraepelin, no entanto, as idéias de Kleist e Leonhard, na Alemanha, e o trabalho subseqüente de Angst, Perris e Winokur enfatizaram a distinção entre as formas monopolares e bipolares da depressão. Mais recentemente a ênfase mudou novamente para o espectro bipolar, que em suas formas leves expande-se às bordas dos temperamentos normais. Finalizando, o autor sumariza os aspectos polêmicos da nosologia da doença bipolar e seus limites com as esquizofrenias, a doença esquizoafetiva e as psicoses ciclóides.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) da Universidade FederalUNIFESP, EPM, da Universidade FederalSciEL

Epidemiologia e aspectos transculturais do transtorno obsessivo-compulsivo

Epidemiological and phenomenological data are convergent and emphasize the similarities of obsessive-compulsive features among different cultures and geographic regions (North and South America, Europe, Africa, Asia). In the studies reviewed, obsessions and compulsions show to be very similar in their variety and content, regardless sociocultural differences and historical backgrounds. The influence of the culture was observed only circumstantially , for example, when shaping religious and sexual contents. The phenomenological homogeneity of obsessive-compulsive disorder, as a transhistorical and transcultural syndrome, suggests the existence of a setting of nuclear symptoms relatively independent of geographic, ethnic and cultural differences. The importance of biologic evolutionary and ethological studies is emphasized.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Monocyte subsets, stanford-A acute aortic dissection, and carotid srtery stenosis. new evidences

Monocytes are a heterogeneous cell population distinguished into three subsets with distinctive phenotypic and functional properties: "classical" (CD14++CD16-), "intermediate" (CD14++CD16+), and "nonclassical" (CD14+CD16++). Monocyte subsets play a pivotal role in many inflammatory systemic diseases including atherosclerosis (ATS). Only a low number of studies evaluated monocyte behavior in patients affected by cardiovascular diseases, and data about their role in acute aortic dissection (AAD) are lacking. Thus, the aim of this study was to investigate CD14++CD16-, CD14++CD16+, and CD14+CD16++ cells in patients with Stanford-A AAD and in patients with carotid artery stenosis (CAS). Methods. 20 patients with carotid artery stenosis (CAS group), 17 patients with Stanford-A AAD (AAD group), and 17 subjects with traditional cardiovascular risk factors (RF group) were enrolled. Monocyte subset frequency was determined by flow cytometry. Results. Classical monocytes were significantly increased in the AAD group versus CAS and RF groups, whereas intermediate monocytes were significantly decreased in the AAD group versus CAS and RF groups. Conclusions. Results of this study identify in AAD patients a peculiar monocyte array that can partly explain depletion of T CD4+ lymphocyte subpopulations observed in patients affected by AAD.Monocytes are a heterogeneous cell population distinguished into three subsets with distinctive phenotypic and functional properties: classical (CD14++CD16-), intermediate (CD14++CD16+), and nonclassical (CD14+CD16++). Monocyte subsets play a pivotal role in many inflammatory systemic diseases including atherosclerosis (ATS). Only a low number of studies evaluated monocyte behavior in patients affected by cardiovascular diseases, and data about their role in acute aortic dissection (AAD) are lacking. Thus, the aim of this study was to investigate CD14++CD16-, CD14++CD16+, and CD14+CD16++ cells in patients with Stanford-A AAD and in patients with carotid artery stenosis (CAS). Methods. 20 patients with carotid artery stenosis (CAS group), 17 patients with Stanford-A AAD (AAD group), and 17 subjects with traditional cardiovascular risk factors (RF group) were enrolled. Monocyte subset frequency was determined by flow cytometry. Results. Classical monocytes were significantly increased in the AAD group versus CAS and RF groups, whereas intermediate monocytes were significantly decreased in the AAD group versus CAS and RF groups. Conclusions. Results of this study identify in AAD patients a peculiar monocyte array that can partly explain depletion of T CD4+ lymphocyte subpopulations observed in patients affected by AAD

Atypical antipsychotics in treatment refractory depression

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Centro de Estimulação CerebralUNIFESP, EPM, Centro de Estimulação CerebralSciEL

História da caracterização nosológica do transtorno bipolar

The authors review briefly the history of bipolar disorder from Araeteus of Cappadocia to our times. The modern concept of bipolar disorder was built in France, through the work of Falret (1851) and Baillarger (1854). The pivotal concepts of Emil Kraepelin changed the basis of psychiatric nosology, and Kraepelin's unitary concept of manic-depressive insanity was largely accepted. Kraepelin and Weigandt's ideas on mixed states were a cornerstone to this unitary concept. After Kraepelin however, the ideas of Kleist and Leonhard, in Germany, and the work of Angst, Perris and Winokur emphasized the distinction between unipolar and bipolar forms of depression. More recently the emphasis changed again to the bipolar spectrum, which expanded to the borders of the normal temperaments (Akiskal and co-workers). At the end the authors summarize the controversies concerning the nosology of bipolar disorder and its boundaries with schizophrenia, schizoaffective disorders and cycloid psychosis.Os autores apresentam uma sintética revisão da história da doença bipolar, a partir de Araeteus da Capadócia até os tempos atuais. O conceito moderno de doença bipolar foi iniciado na França, com os trabalhos de Falret (1851) e Baillarger (1856). Os conceitos seminais de Emil Kraepelin mudaram as bases da nosologia psiquiátrica, e o seu conceito unitário a respeito da "insanidade maníaco-depressiva" foi amplamente aceito e adotado. As idéias de Kraepelin e Weigandt constituíram-se na pedra angular para sua concepção unitária da doença maníaco-depressiva. Depois de Kraepelin, no entanto, as idéias de Kleist e Leonhard, na Alemanha, e o trabalho de Angst, Perris e Winokur enfatizaram a distinção entre as formas unipolar e bipolar da depressão. Mais recentemente a ênfase mudou novamente para o espectro bipolar, que se estende até os limites dos temperamentos normais (Akiskal e colaboradores). Finalizando, os autores sumarizam as controvérsias quanto à nosologia do transtorno bipolar e suas fronteiras com a esquizofrenia, os quadros esquizoafetivos e as chamadas psicoses ciclóides

EL CORPUS ANALÓGICO: MICHEL FOUCAULT Y LA HISTORIA. EL PROCESO DE CONSTRUCCIÓN DE UN CORPUS: LOS CEMENTERIOS DE LA BAJA EDAD MEDIA

En este trabajo nos interesa demostrar las posibilidades de construir teóricamente un corpus. Para ello hemos partido de la idea de analogía tal como ha sido comprendida y expuesta por el filósofo Michel Foucault en La arqueología del saber. En base a esta idea, la construcción de un corpus se revela como un sistema de relaciones entre los factores que lo forman. La red de condicionantes históricos es, en cierto modo, el esqueleto de dicho corpus y su razón de ser. Tomando como objeto los cementerios de la Baja Edad Media, intentaremos demostrar la lógica metodológica de un corpus que se conforma a partir de la idea de analogía.Â

Biomechanical Effects of Obesity on Balance

International Journal of Exercise Science 5(4) : 301-320, 2012. The objective of this review was to analyze the current literature related to the effects of obesity on balance. These effects were observed during conditions of static balance, perturbed balance and dynamic balance during gait. The literature review included studies focused on the biomechanical effects of obesity, the relationship between weight loss and balance, and the relative efficacy of weight loss as a balance intervention. The older adult population, which faces increased risk of falls and related injuries, was highlighted where targeted research was available. The existing literature provides evidence for a strong link between obesity and balance impairments. This meta-analysis supports the efficacy of weight loss as an intervention to improve balance in the obese. Additional investigations are needed to confirm the reliability of relationships noted in this review paper, and to explore the potential of weight loss in simple and combined interventions. Future research should also determine whether efficacy differs among populations

Cognition, affection and interpersonal relationship of women with bipolar disorder

The bipolar affective disorder induces incapacitation and social isolation, and might lead to suicide. It was a clinical study of multiple cases using the following instruments: Beck Depression Inventory (BDI), Beck Suicide Inventory (BSI), Hamilton Scale of Depression (HAM-D) and the Rorschach, by Exner's Comprehensive System (CS). The objective was to analyze the affective, cognitive and interpersonal aspects of the patients. Four female out-patients who were previously diagnosed as bipolar depressive, by the Psychiatry Interview according to Diagnostic and Statistical Manual of Mental Disorders (SCIDI/CV-DSM-IV) criteria were studied. Results had indicated undervalued feelings about themselves, euphoric contents and lack of insight about the self-tolerance related to stress controls. Emotional and cognitive aspects have influenced the interpersonal context leading to increased suffering. Other qualitative and clinic data have been observed and commented.O transtorno afetivo bipolar causa incapacitação e isolamento social, podendo levar ao suicídio. Tratou-se de estudo clínico de casos múltipos com uso de: Inventário de Depressão (BDI) e Suicídio (BSI) de Beck, Escala de Depressão de Hamilton (HAM-D) e Rorschach, Sistema Compreensivo. O objetivo foi analisar os aspectos afetivos, cognitivos e interpessoais das pacientes. Quatro pacientes foram estudadas. Foram atendidas em ambulatório público e préviamente diagnosticadas com depressão bipolar, segundo Entrevista Psiquiátrica (SCID-I/CV-DSM-IV). Resultados indicaram sentimentos depreciativos na autoimagem, conteúdos eufóricos e falta de insight sobre a auto-tolerância ao estresse. Aspectos emocionais e cognitivos influenciaram no contexto interpessoal, acentuando o sofrimento. Outros dados qualitativos clínicos foram observados e comentados.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Fine structure of the chromospheric activity in Solar-type stars - The Halpha Line

A calibration of H-alpha as both a chromospheric diagnostic and an age indicator is presented, complementing the works previously done on this subject (Herbig 1985, Pasquini & Pallavicini 1991. The chromospheric diagnostic was built with a statistically significant sample, covering nine years of observations, and including 175 solar neighborhood stars. Regarding the age indicator, the presence of stars for which very accurate ages are determined, such as those belonging to clusters and kinematic groups, lends confidence to our analysis. We also investigate the possibility that stars of the same age might have gone through different tracks of chromospheric decay, identifying - within the same age range - effects of metallicity and mass. These parameters, however, as well as age, seem to be significant only for dwarf stars, losing their meaning when we analyze stars in the subgiant branch. This result suggests that, in these evolved stars, the emission mechanism cannot be magnetohydrodynamical in nature, in agreement with recent models (Fawzy et al. 2002c, and references therein). The Sun is found to be a typical star in its H-alpha chromospheric flux, for its age, mass and metallicity. As a byproduct of this work, we developed an automatic method to determine temperatures from the wings of H-alpha, which means the suppression of the error inherent to the visual procedure used in the literature.Comment: 10 pages, 10 figures, accepted for publication in Astronomy & Astrophysics. Nature of replacement: match astro-ph and ADS title (greek letter