Ayahuasca: what mental health professionals need to know

Background Ayahuasca is a psychoactive ethnobotanical concoction that has been used for decades by indigenous groups of the Northwestern Amazon and by syncretic religious organizations for ritual and therapeutic purposes. In the last two decades, it is being used worldwide in evolving practices. Ayahuasca seem to therapeutic effects, but controlled studies are lacking. Moreover, its safety and toxicity are not completely understood. Objectives To present an overview of the effects of ayahuasca based on the most recent human studies. Methods Narrative review. Results Ayahuasca administration in controlled settings appears to be safe from a subjective and physiological perspective, with few adverse reactions being reported. More frequent adverse reactions occur in non-controlled settings. Prolonged psychotic reactions are rare and seem to occur especially in susceptible individuals. Ayahuasca showed antidepressive, anxiolytic, and antiaddictive effects in animal models, observational studies, and in open-label and controlled studies. Discussion Ayahuasca administration in controlled settings appear to be safe. Moreover, ayahuasca seem to have therapeutic effects for treatment-resistant psychiatric disorders that should be further investigated in randomized controlled clinical trials. However, medical complications and cases of prolonged psychotic reactions have been reported, and people with personal or family history of psychotic disorders should avoid ayahuasca intake

Síndrome de burnout ou estafa profissional e os transtornos psiquiátricos

BACKGROUND: Burnout syndrome is consequent of prolonged levels of stress in the works environment. OBJECTIVE: The aims of this article are to obtain information about the syndromes prevalence in Brazil and in other countries, the risk factors responsible for its development, its association with psychiatric disorders and consequences for the individual and for the organization. METHODS: It was carried out a review using database from MedLine, Scielo, American Psychiatry Association, Evidence-Based Mental Health, American College of Physicians, Agency for Healthcare Research and Quality, National Guideline Clearinghouse and from World Health Organization, between 1985 and 2006. CONCLUSION: The prevalence is still uncertain, but data suggest that it could affect a significant number of individuals, range from aproximately 4% to 85.7% according to the studied population. It could be presented as a comorbidity with some psychiatric illnesses like depressive disorder. The effects of burnout could interfere negatively in the individual level (physical, mental, professional and social); professional level (slow and negligent service to the patient/customer, impersonal contact with colleagues and/or patient/customers); and organizational level (conflict with the teams members, turnover, absenteeism, diminishing of services quality). More researches should be carried out to organizations make positive changes based in scientific evidences.CONTEXTO: A síndrome de burnout é conseqüente a prolongados níveis de estresse no trabalho e compreende exaustão emocional, distanciamento das relações pessoais e diminuição do sentimento de realização pessoal. OBJETIVO: O objetivo deste artigo foi realizar uma revisão bibliográfica a respeito da síndrome no Brasil e em outros países, considerando sua prevalência, possíveis fatores de risco para seu desenvolvimento, sua associação com outros transtornos psiquiátricos e conseqüências para o indivíduo e a organização em que trabalha. MÉTODOS: Realizou-se uma revisão bibliográfica utilizando-se a base de dados da MedLine, Scielo, American Psychiatry Association, Evidence-Based Mental Health, American College of Physicians, Agency for Healthcare Research and Quality, National Guideline Clearinghouse e da Organização Mundial da Saúde no período compreendido entre 1985 e 2006. CONCLUSÃO: A prevalência da síndrome de burnout ainda é incerta, mas dados sugerem que acomete um número significativo de indivíduos, variando de aproximadamente 4% a 85,7%, conforme a população estudada. Pode apresentar comorbidade com alguns transtornos psiquiátricos, como a depressão. Os efeitos do burnout podem prejudicar o profissional em três níveis: individual (físico, mental, profissional e social), profissional (atendimento negligente e lento ao cliente, contato impessoal com colegas de trabalho e/ou pacientes/clientes) e organizacional (conflito com os membros da equipe, rotatividade, absenteísmo, diminuição da qualidade dos serviços). Mais pesquisas devem ser realizadas para que mudanças positivas nas organizações de trabalho sejam baseadas em evidências científicas

Espectroscopia de próton por ressonância magnética de lobo frontal em esquizofrênicos: revisão crítica da metodologia

Schizophrenic patients undergoing proton magnetic resonance spectroscopy show alterations in N-acetyl aspartate levels in several brain regions, indicating neuronal dysfunction. The present review focuses on the main proton magnetic resonance spectroscopy studies in the frontal lobe of schizophrenics. A MEDLINE search, from 1991 to March 2004, was carried out using the key-words spectroscopy and schizophrenia and proton and frontal. In addition, articles cited in the reference list of the studies obtained through MEDLINE were included. As a result, 27 articles were selected. The results were inconsistent, 19 papers reporting changes in the N-acetyl aspartate levels, while 8 reported no change. Methodological analysis led to the conclusion that the discrepancy may be due the following factors: (i) number of participants; (ii) variation in the clinical and demographic characteristics of the groups; (iii) little standardization of the acquisition parameters of spectroscopy. Overall, studies that fulfill strict methodological criteria show N-acetyl aspartate decrease in the frontal lobe of male schizophrenics.Pacientes esquizofrênicos submetidos à espectroscopia de próton por ressonância magnética demonstram alterações nos níveis de N-acetilaspartato em diversas regiões cerebrais, suportando a hipótese de disfunção neuronal nestas áreas. Objetiva-se apresentar uma revisão da literatura, sobre os principais estudos de espectroscopia de próton por ressonância magnética na região frontal em esquizofrênicos. Utilizou-se o indexador MEDLINE, no período entre 1991 e março de 2004, com o cruzamento dos termos spectroscopy, schizophrenia, proton e frontal. Foram selecionados 27 artigos originais, cujos resultados mostram-se discordantes quanto à alteração nos valores de N-acetilaspartato (19 artigos apresentaram alterações nos níveis de N-acetilaspartato e oito estudos não apresentam alterações). A presente revisão sugere que esta diversidade de resultados pode ser atribuída aos seguintes fatores: 1-número de participantes; 2- variação nas características clínicas e demográficas dos grupos; 3- pouca padronização dos parâmetros de aquisição dos espectros. Os artigos que satisfazem os critérios metodológicos mais rígidos sugerem diminuição de NAA no lobo frontal de esquizofrênicos do sexo masculino

Alterations in the stomatognathic system due to amyotrophic lateral sclerosis

Objectives: To compare the molar bite force, electromyographic activity, chewing efficiency and thickness of the masseter and temporalis muscles in individuals with amyotrophic lateral sclerosis (ALS) and healthy individuals. Material and Methods: Thirty individuals enrolled in the study were divided into the study group (with ALS, n=15) and control group (healthy individuals, n=15). Data regarding molar bite force (right and left), electromyographic activity (mandibular rest, right and left laterality, protrusion, and maximum voluntary contraction), chewing efficiency (habitual and non-habitual), and masticatory muscle thickness (rest and maximum voluntary contraction) were tabulated and subjected to statistical analysis (Student’s t-test, p≤0.05). Results: Comparisons between the groups demonstrated a statistically significant increase in the electromyographic activity of the right masseter (p=0.03) and left masseter (p=0.03) muscles during mandibular rest; left masseter (p=0.00), right temporalis (p=0.00), and left temporalis (p=0.03) muscles during protrusion; and right masseter (p=0.00), left masseter (p=0.00), and left temporalis (p=0.00) muscles during left laterality, in individuals with ALS as compared with healthy individuals. A statistically significant decrease was observed in the habitual chewing efficiency of the right masseter (p=0.00) and right temporalis (p=0.04) muscles in individuals with ALS. No statistically significant difference between the groups was found the masticatory muscle thickness and maximal molar bite force. Conclusions: ALS may lead to modifications in the activities of the stomatognathic system, including muscular hyperactivity and reduction in chewing efficiency; however, no change has been observed in the masticatory muscle thickness and molar bite force

Why we should use long-acting injectable antipsychotics more frequently

Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Department of Neuroscience and BehaviorConselho Nacional de Desenvolvimento Científico e Tecnológico National Science and Technology Institute for Translational MedicineUniversidade Federal do Rio Grande do Norte Department of Clinical MedicineUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUSP School of Medicine Department and Institute of PsychiatryUNIFESP, Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesSciEL

Associations between chronic pelvic pain and psychiatric disorders and symptoms

Background Chronic pelvic pain (CPP) is a complex condition wich is associated with emotional factors, specially depression and anxiety. Objectives To make a systematic review to provide a detailed summary of relevant literature on the association between CPP and different psychiatric disorders/symptoms. Methods A systematic review of articles in the international literature published between 2003 and 2014 was performed in the electronic databases PubMed, PsycINFO, LILACS, and SciELO using the terms (chronic pelvic pain) AND (psychiatry OR psychiatric OR depression OR anxiety OR posttraumatic stress OR somatoform). The searches returned a total of 529 matches that were filtered according to predefined inclusion and exclusion criteria. A total of 18 articles were selected. Results The investigations focused mainly on the assessment of depression and anxiety disorders/symptoms, with rather high rates (17-38.6%). Depression and anxiety symptoms were more prevalent among women with CPP compared to healthy groups. Comparisons between groups with CPP and with specific pathologies that also have pain as a symptom showed that depression indicators are more frequent in CPP. Depressive symptoms tend to be more common in CPP and have no particular association with pain itself, the core feature of CPP. Discussion Other aspects of CPP seem to play a specific role in this association. Anxiety and other psychiatric disorders require further investigation so that their impact on CPP can be better understood

Associations between chronic pelvic pain and psychiatric disorders and symptoms

Background Chronic pelvic pain (CPP) is a complex condition wich is associated with emotional factors, specially depression and anxiety. Objectives To make a systematic review to provide a detailed summary of relevant literature on the association between CPP and different psychiatric disorders/symptoms. Methods A systematic review of articles in the international literature published between 2003 and 2014 was performed in the electronic databases PubMed, PsycINFO, LILACS, and SciELO using the terms (chronic pelvic pain) AND (psychiatry OR psychiatric OR depression OR anxiety OR posttraumatic stress OR somatoform). The searches returned a total of 529 matches that were filtered according to predefined inclusion and exclusion criteria. A total of 18 articles were selected. Results The investigations focused mainly on the assessment of depression and anxiety disorders/symptoms, with rather high rates (17-38.6%). Depression and anxiety symptoms were more prevalent among women with CPP compared to healthy groups. Comparisons between groups with CPP and with specific pathologies that also have pain as a symptom showed that depression indicators are more frequent in CPP. Depressive symptoms tend to be more common in CPP and have no particular association with pain itself, the core feature of CPP. Discussion Other aspects of CPP seem to play a specific role in this association. Anxiety and other psychiatric disorders require further investigation so that their impact on CPP can be better understood

Severity of Sleep Bruxism and its Implications for the Stomatognathic System in Healthy Subjects

BACKGROUND: Sleep bruxism (SB) changes the functionality patterns of the stomatognathic system. However, its severity can be an aggravating factor in the function of this complex system. AIM: The purpose of the study was to investigate the stomatognathic system of healthy subjects with different severity of SB, as determined by BiteStrip. METHODS: Thirty-four subjects were divided into two groups: Mild SB (n = 15) and severe SB (n = 19). Electromyograph was used to evaluate the electromyographic activity of the right masseter (RM), left masseter (LM), right temporal (RT), and left temporal (LT) muscles at mandibular rest, right and left laterality, protrusion, and maximum voluntary contraction. Molar bite force was measured by the dynamometer. The data were tabulated and submitted for statistical analysis (p < 0.05). RESULTS: Molar bite force was significantly lower in the severe SB group. There was a significant increase in electromyographic activity in the severe SB group for the mandibular rest tasks (RM, RT, and LT), protrusion (RM, LM, RT, and LT), and right and left laterality in the temporalis muscles. There was a significant decrease in electromyographic activity in the severe SB group in maximum voluntary contraction for the masseter and temporalis muscles. CONCLUSION: Subjects with severe SB demonstrated greater functional impairment of the stomatognathic system, mainly affecting the electromyographic activity and molar bite force

Pathophysiology of mood disorders in temporal lobe epilepsy

Objective: There is accumulating evidence that the limbic system is pathologically involved in cases of psychiatric comorbidities in temporal lobe epilepsy (TLE) patients. Our objective was to develop a conceptual framework describing how neuropathological, neurochemical and electrophysiological aspects might contribute to the development of psychiatric symptoms in TLE and the putative neurobiological mechanisms that cause mood disorders in this patient subgroup. Methods: In this review, clinical, experimental and neuropathological findings, as well as neurochemical features of the limbic system were examined together to enhance our understanding of the association between TLE and psychiatric comorbidities. Finally, the value of animal models in epilepsy and mood disorders was discussed. Conclusions: TLE and psychiatric symptoms coexist more frequently than chance would predict. Alterations and neurotransmission disturbance among critical anatomical networks, and impaired or aberrant plastic changes might predispose patients with TLE to mood disorders. Clinical and experimental studies of the effects of seizures on behavior and electrophysiological patterns may offer a model of how limbic seizures increase the vulnerability of TLE patients to precipitants of psychiatric symptoms.FAPESPPROEXCNPqFAEP