Relação entre data de admissão hospitalar e período do ciclo menstrual de mulheres com diagnóstico de esquizofrenia

INTRODUÇÃO: Existem diferenças no curso da esquizofrenia entre homens e mulheres, sendo que nessas o início é mais tardio e o prognóstico melhor. Uma possível explicação para esse achado é a presença de estradiol, que pode agir como fator protetor. Essa possibilidade é reforçada por alguns fatores, como piora dos sintomas no período puerperal e perimenstrual, quando os níveis de estradiol estão mais baixos. MÉTODOS: Foram entrevistadas 39 pacientes com esquizofrenia admitidas consecutivamente para internação por exacerbação do quadro psicótico. As pacientes apresentavam ciclo menstrual regular e tinham idade média de 34,2 anos. Os sintomas esquizofrênicos foram medidos com a escala BPRS. O dia do ciclo em que elas se encontravam foi determinado na entrevista de admissão ou durante o período de internação, com a verificação de ocorrência de sangramento menstrual. As pacientes foram divididas em três grupos, de acordo com o período do ciclo menstrual no qual se encontravam no dia da internação. Foi feita comparação da distribuição observada com a distribuição esperada se não houvesse diferença no número de mulheres entre os três grupos. RESULTADOS: Foi observado que a maioria das pacientes estava no início ou no fim do ciclo menstrual quando foram internadas (qui-quadrado=6,02, p= 0,049). CONCLUSÕES: Existe uma relação entre internação em hospital psiquiátrico e período do ciclo menstrual no qual pacientes esquizofrênicas se encontram

Multimodal magnetic resonance imaging study of treatment-naïve adults with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-Deficit/Hiperactivity Disorder (ADHD) is a prevalent disorder, but its neuroanatomical circuitry is still relatively understudied, especially in the adult population. The few morphometric magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) studies available to date have found heterogeneous results. This may be at least partly attributable to some well-known technical limitations of the conventional voxel-based methods usually employed to analyze such neuroimaging data. Moreover, there is a great paucity of imaging studies of adult ADHD to date that have excluded patients with history of use of stimulant medication. METHODS: A newly validated method named optimally-discriminative voxel-based analysis (ODVBA) was applied to multimodal (structural and DTI) MRI data acquired from 22 treatment-naïve ADHD adults and 19 age- and gender-matched healthy controls (HC). RESULTS: Regarding DTI data, we found higher fractional anisotropy in ADHD relative to HC encompassing the white matter (WM) of the bilateral superior frontal gyrus, right middle frontal left gyrus, left postcentral gyrus, bilateral cingulate gyrus, bilateral middle temporal gyrus and right superior temporal gyrus; reductions in trace (a measure of diffusivity) in ADHD relative to HC were also found in fronto-striatal-parieto-occipital circuits, including the right superior frontal gyrus and bilateral middle frontal gyrus, right precentral gyrus, left middle occipital gyrus and bilateral cingulate gyrus, as well as the left body and right splenium of the corpus callosum, right superior corona radiata, and right superior longitudinal and fronto-occipital fasciculi. Volumetric abnormalities in ADHD subjects were found only at a trend level of significance, including reduced gray matter (GM) in the right angular gyrus, and increased GM in the right supplementary motor area and superior frontal gyrus. CONCLUSIONS: Our results suggest that adult ADHD is associated with neuroanatomical abnormalities mainly affecting the WM microstructure in fronto-parieto-temporal circuits that have been implicated in cognitive, emotional and visuomotor processes

Comparison of GM volumes between ADHD and HC.

<p>GM: Gray Matter; ADHD: Attention-Deficit/Hyperactivity Disorder; HC: Healthy Controls; FDR: False Discovery Rate; nonCom: comparison excluding the comorbidities AHD patients; <i>N</i>: number of significant voxels in each anatomical region; <i>t</i>: value calculated based on the means of Regional Analysis of Volumes Examined in Normalized Space (RAVENS) values of the significant voxels.</p><p>*Talairach coordinates represent center-of-mass obtained with the significance level of <i>p</i><0.001.</p><p>Comparison of GM volumes between ADHD and HC.</p

Voxel clusters of relatively increased fractional anisotropy in attention-deficit/hyperactivity disorder subjects compared to healthy controls are shown in red, overlaid on transaxial sections from a reference brain spatially normalized to the Montreal Neurological Institute stereotactic space, in neurological convention.

<p>Statistical maps are displayed with a statistical threshold of p<0.05, corrected for multiple comparisons (false-discovery rate). 1) Middle temporal gyrus white matter (WM) (right); 2) Middle temporal gyrus WM (left); 3) Superior frontal gyrus WM (right); 4) Middle frontal gyrus (right); 5) Cingulate gyrus (right); 6) Superior frontal gyrus (left); 7) Cingulate gyrus (left); 8) Postcentral gyrus (left). R: right.</p

Demographic and clinical characteristics of subjects with ADHD and HC.

<p>ADHD: Attention-Deficit/Hyperactivity Disorder; HC: Healthy Controls; SD: Standard Deviation; ASRS-18: Adult ADHD Self-Report Scale.</p><p>Demographic and clinical characteristics of subjects with ADHD and HC.</p

Voxel clusters of relatively reduced gray matter (A) and increased gray matter (B) in attention-deficit/hyperactivity disorder subjects compared to healthy controls are shown in red, overlaid on transaxial sections from a reference brain spatially normalized to the Montreal Neurological Institute stereotactic space, in neurological convention.

<p>Statistical maps are displayed with a statistical threshold of <i>p</i><0.001, uncorrected for multiple comparisons. A)1) Angular gyrus (Right); B)1) Supplementary motor area (right); B)2) Superior frontal gyrus (right). R: Right.</p

Voxel clusters of relatively decreased Trace in attention-deficit/hyperactivity disorder subjects compared to healthy controls (HC) are shown in red, overlaid on transaxial sections from a reference brain spatially normalized to the Montreal Neurological Institute stereotactic space, in neurological convention.

<p>Statistical maps are displayed with a statistical threshold of p<0.05, corrected for multiple comparisons (false-discovery rate). 1) Middle occipital gyrus white matter (WM) (left); 2) Caudate nucleus (right); 3) Splenium of corpus callosum (right); 4) Superior fronto-occipital fasciculus (right); 5) Body of the corpus callosum WM (left); 6) Superior corona radiata (right); 7) Superior longitudinal fasciculus (right); 8) Body of the corpus callosum (right); 9) Cingulate gyrus WM (right); 10) Precentral gyrus WM (right); 11) Middle frontal gyrus WM (left); 12) Superior frontal gyrus WM (right); 13) Middle frontal gyrus WM (right); 14) Cingulate gyrus WM (left). R: right.</p

Statistics obtained from the analysis of TR on ADHD < HC.

<p>TR: Trace; ADHD: Attention-Deficit/Hyperactivity Disorder; HC: Healthy Control; FDR: False Discovery Rate; nonCom: comparison excluding the comorbidities AHD patients; <i>N</i>: number of significant voxels in each anatomical region; <i>t</i>: value calculated based on the means of trace (TR) values of the significant voxels; WM: white matter.</p><p>*Talairach coordinates represent center-of-mass obtained with the significance level of <i>p</i><0.001.</p><p>Statistics obtained from the analysis of TR on ADHD < HC.</p

Attention deficit hyperactivity disorder (ADHD) in adults: social-demographic profile from a university hospital ADHD outpatient unit in São Paulo, Brazil Transtorno de déficit de atenção e hiperatividade (TDAH) no adulto: perfil sócio-demográfico de pacientes com TDAH atendidos em ambulatório de um hospital universitário de São Paulo, Brasil

PURPOSE: To describe the social-demographic variables, including interpersonal, academic, and professional performance in adult individuals with the diagnoses of attention deficit hyperactivity disorder (ADHD). There are no reports of this kind in the Brazilian population with ADHD. The ADHD is a common disorder, which can reach up to 3% of the general population. METHOD: Descriptive study of adults with ADHD, according to the DSM-IV criteria (American Psychiatric Association). The sample was selected from a specialized outpatient service in São Paulo city. The social-demographic data was obtained by personal interviews. RESULTS: There was a predominance of males in the sample (61.2%) and a high education level (90.2% had at least a high school degree) and 52% of the 102 patients had repeated their class at a least once during their school lives. In addition, 22.5% of the population sample were unemployed at the time of the interview. CONCLUSION: The distribution of the socio-demographic variables in adult ADHD is similar to other ADHD samples reported in other countries, despite the high education level met in our sample. Similarities between child and adult ADHD could also be traced.<br>OBJETIVO: Descrever as variáveis sócio-demográficas incluindo desempenho acadêmico, profissional e interpessoal em uma população adulta com diagnóstico de transtorno de déficit de atenção e hiperatividade (TDAH). Até o momento não há relato na literatura do perfil desses pacientes na população brasileira. O TDAH é comum na população geral, podendo chegar a 3% das pessoas. MÉTODO: Foram avaliados adultos que tomaram conhecimento do serviço de atendimento especializado em TDAH através da mídia. O diagnóstico de TDAH foi realizado utilizando-se os critérios da Associação Psiquiátrica Americana (DSM-IV). Os dados sócio-demográficos foram obtidos através de entrevista pessoal com cada paciente. RESULTADOS: 102 indivíduos preencheram critérios para TDAH. Houve predomínio do sexo masculino (61,2%) com alto nível de escolaridade (90,2% tinham no mínimo 2º grau completo). Cinquenta e três pacientes (52%) foram reprovados pelo menos uma vez durante vida estudantil. No momento da entrevista, 22,5% encontravam-se desempregados. CONCLUSÃO: Observou-se uma semelhança da distribuição das variáveis sócio-demográficas com os indivíduos adultos com TDAH de outros países, apesar da escolaridade ser acima da média nacional. Além disso, pode-se também observar semelhanças entre as populações infantil e adulta com TDAH