Narcissism and helplessness: some considerations about interpersonal relationships today

Este ensaio objetiva problematizar o fenômeno do narcisismo na atualidade, partindo da hipótese de que as relações interpessoais se configuram pelo desamparo em sua dimensão traumática, e não como abertura à alteridade. Isso se daria assim porque, no atual cenário social, as relações humanas tendem a não oferecer apoio e suporte alteritário para a transformação e o desenvolvimento do sujeito, pois o coloca diante de três ameaças desagregadoras: o vazio solitário, a invasão do outro e a impotência. Na ausência de relações de amparo, o outro aparece como ameaça diante da qual o narcisismo advém como possibilidade de defesa e prevalece em sua forma de narcisismo regenerador.This essay aims to discuss the phenomenon of narcissism today, starting from the hypothesis that interpersonal relationships are configured by helplessness in its traumatic dimension, and not as an opening to alterity. This would be so because, in the current social scenario, human relationships tend to lack help and alteritarian support for subjects’ transformation and development, posing three disruptive threats to them: lonely emptiness, invasion of the other and impotence. In the absence of supportive relationships, the other appears as a threat against which narcissism emerges as a possibility of defense, prevailing in the form of regenerating narcissism

Lifetime Prevalence, Age and Gender Distribution and Age-of-Onset of Psychiatric Disorders in the Sao Paulo Metropolitan Area, Brazil: Results from the Sao Paulo Megacity Mental Health Survey

Objectives: To estimate prevalence, age-of-onset, gender distribution and identify correlates of lifetime psychiatric disorders in the Sao Paulo Metropolitan Area (SPMA). Methods: The Sao Paulo Megacity Mental Health Survey assessed psychiatric disorders on a probabilistic sample of 5,037 adult residents in the SPMA, using the World Mental Health Survey Version of the Composite International Diagnostic Interview. Response rate was 81.3%. Results: Lifetime prevalence for any disorder was 44.8%; estimated risk at age 75 was 57.7%; comorbidity was frequent. Major depression, specific phobias and alcohol abuse were the most prevalent across disorders; anxiety disorders were the most frequent class. Early age-of-onset for phobic and impulse-control disorders and later age-of-onset for mood disorders were observed. Women were more likely to have anxiety and mood disorders, whereas men, substance use disorders. Apart from conduct disorders, more frequent in men, there were no gender differences in impulse-control disorders. There was a consistent trend of higher prevalence in the youngest cohorts. Low education level was associated to substance use disorders. Conclusions: Psychiatric disorders are highly prevalent among the general adult population in the SPMA, with frequent comorbidity, early age-of-onset for most disorders, and younger cohorts presenting higher rates of morbidity. Such scenario calls for vigorous public health action.State of Sao Paulo Research Foundation (FAPESP) [03/00204-3]State of Sao Paulo Research Foundation (FAPESP)Vitoria Foundation for Science and Technology (FACITEC) [002/2003]Vitoria Foundation for Science and Technology (FACITEC)Sao Paulo State Secretaria de Seguranca Publica, through Professor Wagner Farid GattazSao Paulo State Secretaria de Seguranca Publica, through Professor Wagner Farid GattazUnited States National Institute of Mental Health [R01MH070884]United States National Institute of Mental HealthJohn D. and Catherine T. MacArthur FoundationJohn D. and Catherine T. MacArthur FoundationPfizer FoundationPfizer FoundationU.S. Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]US Public Health ServiceFogarty International CenterFogarty International Center [FIRCA R03-TW006481]Pan American Health OrganizationPan American Health OrganizationEli Lilly & Company FoundationEli Lilly & Company FoundationOrthoMcNeil Pharmaceutical, Inc.Ortho-McNeil Pharmaceutical, Inc.GlaxoSmithKlineGlaxoSmithKlineBristolMyers SquibbBristol-Myers SquibbShireShir

Análisis transcriptómico de la formación de xilema traumático en Pinus canariensis Chr. Sm. ex D.C.

Analizamos la formación del xilema traumático hibridando un microarray con muestras recogidas a tres tiempos tras la realización de la herida (H1, H2 y H3), comparándolo con la formación de madera no traumática

Prevalence and clinical profile of chronic pain and its association with mental disorders

OBJECTIVE: To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS: The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years) residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037) using the Composite International Diagnostic Interview (CIDI 3.0), with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR) have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI). RESULTS: The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3–54.8) and 31.0% (95%CI 29.2–32.7), respectively. Joints (16.5%, 95%CI 15.4–17.5) and back or neck (15.5%, 95%CI 14.2–16.9) were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4–7.8), and the mean average pain was 5.5 (95%CI 5.2–5.6); the mean treatment response was 6.3 (95%CI 6.0–6.6). Mean pain duration was 16.1 (95%CI 15.6–17.0) days a month and 132 (95%CI 126–144) minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3–3.3), anxiety disorders (OR = 2.1, 95%CI 1.9–3.0), and mood disorders (OR = 3.3, 95%CI 2.4–4.1). CONCLUSIONS: A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent

São Paulo megacity - um estudo epidemiológico de base populacional avaliando a morbidade psiquiátrica na região metropolitana de São Paulo: objetivos, desenho e implementação do trabalho de campo

The São Paulo Megacity Mental Health Survey is a population-based cross-sectional survey of psychiatric morbidity, assessing a probabilistic sample of household residents in the São Paulo Metropolitan Area, aged 18 years and over. Respondents were selected from a stratified multistage clustered area probability sample of households, covering all 39 municipalities, without replacement. Respondents were assessed using the World Mental Health Survey version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), which was translated and adapted into the Brazilian-Portuguese language. Data was collected between May 2005 and April 2007 by trained lay interviewers. The World Mental Health Survey version of the Composite International Diagnostic Interview comprises clinical and non-clinical sections, arranged as Part I and Part II, producing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, and the International Classification of Diseases - 10th Revision. Mood, anxiety, impulse-control and substance use disorders, and suicide-related behavior, considered core disorders, as well as socio-demographic information, were assessed in all respondents. Non-clinical modules and non-core clinical sections (obsessive-compulsive disorder, post-traumatic stress disorder, gambling, eating disorders, neurasthenia, pre-menstrual disorders, psychotic symptoms and personality traits) were assessed in a sub-sample (2,942 respondents), composed by all respondents with at least one core disorder and a 25% random sample of those who were non-cases. A total of 5,037 individuals were interviewed, with a global response rate of 81.3%. Saliva samples were collected from 1,801 respondents, with DNA extracted stored pending further investigations.O Estudo Epidemiológico dos Transtornos Mentais São Paulo Megacity é um estudo de corte transversal de base populacional avaliando a morbidade psiquiátrica em uma amostra probabilística da população geral residente na Região Metropolitana de São Paulo, com 18 anos ou mais. Respondentes foram selecionados através de um processo probabilístico multiestratificado de domicílios, cobrindo os 39 municípios, sem substituição. Respondentes foram avaliados usando a versão desenvolvida para o Estudo Mundial de Saúde Mental (World Mental Health Survey) do Composite International Diagnostic Interview da Organização Mundial da Saúde, que foi traduzido e adaptado para o Português vigente no Brasil. A coleta de dados ocorreu entre maio/2005 e abril/2007, por entrevistadores treinados. O WMH-CIDI é composto por seções clínicas e não-clínicas, dispostas em duas partes, gerando diagnósticos de acordo com o Manual Diagnóstico e Estatísticos de Doenças Mentais - Quarta Edição e a Classificação Internacional de Doenças - 10ª Revisão. Todos os respondentes receberam os módulos de avaliação de transtornos do humor, de ansiedade, do controle de impulsos, decorrentes do uso de substâncias psicoativas e comportamento suicida, considerados transtornos nucleares, assim como foram coletados dados sociodemográficos. Módulos não-clínicos e clínicos complementares (transtornos obsessivo-compulsivos, estresse pós-traumático, jogo patológico, alimentares, pré-menstruais, neurastenia, sintomas psicóticos e rastreio de personalidade) foram aplicados àqueles que tiveram pelo menos um dos transtornos nucleares e a uma amostra aleatória de 25% dos negativos (2.942 respondentes). Um total de 5.037 indivíduos foi entrevistado, com uma taxa global de resposta de 81,3%. Amostras de saliva foram coletadas de 1.801 respondentes, com extração de DNA e armazenamento para investigação futura.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundo de Apoio à Ciência e Tecnologia do Município de Vitória(NIH/NIMH) United States National Institute of Mental HealthMacArthur FoundationPfizer FoundationUS Public Health Service(NIH) Fogarty International Cente

De novo assembly and annotation of a transcriptome during xylogenesis in Pinus canariensis Chr. Sm. ex DC

Nowadays, there is a great amount of genomic and transcriptomic data available about forest species, including ambitious projects looking for complete sequencing and annotation of different gymnosperm genomes [1, 2]. Pinus canariensis is an endemic conifer of the Canary Islands with re-sprouting capability and resilience against fire and mechanical damage, as result of an adaptation to volcanic environments. Additionally, this species has a high proportion of axial parenchyma compared with other conifers, and this tissue connects with radial parenchyma allowing transport of reserves. The most internal tracheids stop accumulating water [3], and get filled of resins and polyphenols synthesized by the axial parenchyma; this is the so-called ?torch-heartwood? [4], which avoids decay. This wood achieves very high prices due to its particular resistance to rot. These features make P. canariensis an interesting model species for the analysis of these developmental processes in conifers. In this study we aim to perform a complete transcriptome annotation during xylogenesis in Pinus canariensis, using next-generation sequencing (NGS) -Roche 454 pyrosequencing-, in order to provide a genomic resource for further analysis, including expression profiling and the identification of candidate genes for important adaptive features

Benzodiazepine use in Sao Paulo, Brazil

OBJECTIVES: To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of Sa˜o Paulo, Brazil. METHODS: 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS: The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged X50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION: These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required

Saúde sexual e reprodutiva em penitenciária feminina, Espírito Santo, Brasil

OBJECTIVE: To describe the sociodemographic profile and health problems of inmates in a women's prison. METHODS: A descriptive study was conducted from March to September 1997 in a women's prison in the state of Espírito Santo, Brazil. All inmates were invited to participate in the study. A total of 121 women aged more than 18 years were interviewed. A structured questionnaire was used to collect data on sociodemographics, clinical and criminal past history. Following the interview, subjects underwent clinical and gynecological examination. RESULTS: Of 121 women included in the study, the mean age was 30.2 years (SD 8.98) and the mean of schooling was 4.8 years (SD 3.50). All participants reported previous sexual activity, the mean age of the first sexual intercourse was 15.2 years (SD 2.55) ranging from 9 to 27 years. Previous STDs were reported by 28%; 12 (9.9%) were pregnant at the time. Teenage pregnancy was often reported. Most women reported no use of either any contraceptive methods or condoms. Tubal ligation was seen in 19.8% and abnormal Pap smear in 26.9%. CONCLUSIONS: Knowledge about health problems inside the prison system can contribute to promoting and increasing social rehabilitation. However, effective results could be seen only with collaboration between public health authorities and the prison system.OBJETIVO: Identificar o perfil sociodemográfico e as condições de saúde das mulheres encarceradas em penitenciária feminina. MÉTODOS: Foi realizado estudo descritivo de março a setembro de 1997, em penitenciária feminina do Estado do Espírito Santo. Todas as presidiárias foram convidadas a participar da pesquisa. Participaram 121 mulheres com idade superior a 18 anos, avaliadas por meio de entrevista aplicada, explorando informações sociodemográficas, clínicas e criminais, registradas em questionário estruturado, seguida de exame clínico-ginecológico. RESULTADOS: Um total de 121 mulheres foram incluídas. A média de idade das participantes foi de 30,2 anos (DP 8,98) e de escolaridade, 4,8 anos (DP 3,50). Todas já haviam tido atividade sexual pregressa; a idade média do primeiro coito foi de 15,2 anos (DP 2,55), variando de nove a 27 anos; e 28% apresentavam história de doença sexualmente transmissível (DST). Doze (9,9%) mulheres estavam grávidas no momento da entrevista. História de gravidez na adolescência foi freqüente. A maioria não adotava nenhum método contraceptivo e nem fazia uso de preservativos. Laqueadura tubária foi observada em 19,8% e citologia cervical anormal em 26,9%. CONCLUSÕES: O conhecimento sobre problemas de saúde existentes dentro do sistema carcerário pode contribuir para fortalecer e ampliar o papel de reabilitação que lhe é conferido. Entretanto, somente a cooperação entre os órgãos de saúde pública e o sistema penitenciário pode produzir resultados eficientes

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month nonheavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level

Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the São Paulo Megacity Study

Abstract Background With the recent increase in the prevalence of mental disorders in developing countries, there is a growing interest in the study of its consequences. We examined the association of depression, anxiety and any mental disorders with incremental health expenditure, i.e. the linear increase in health expenditure associated with mental disorders, and lost days of normal activity. Methods We analyzed the results from a representative sample survey of residents of the Metropolitan Region of São Paulo (n = 2,920; São Paulo Megacity Mental Health Survey), part of the World Mental Health (WMH) Survey Initiative, coordinated by the World Health Organization and performed in 28 countries. The instrument used for obtaining the individual results, including the assessment of mental disorders, was the WMH version of the Composite International Diagnostic Interview 3.0 (WMH-CIDI 3.0) that generates psychiatric diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Statistical analyses were performed by multilevel generalized least squares (GLS) regression models. Sociodemographic determinants such as income, age, education and marital status were included as controls. Results Depression, anxiety and any mental disorders were consistently associated with both incremental health expenditure and missing days of normal activity. Depression was associated with an incremental annual expenditure of R$308.28 (95$194.05-R$422.50), or US$252.48 in terms of purchasing power parity (PPP). Anxiety and any mental disorders were associated with a lower, but also statistically significant, incremental annual expenditure (R$177.82, 95$180.52, 95 % CI: 91.13–269.92, or US$145.64 and US$147.85 in terms of PPP, respectively). Most of the incremental health costs associated with mental disorders came from medications. Depression was independently associated with higher incremental health expenditure than the two most prevalent chronic diseases found by the study (hypertension and diabetes). Conclusions The fact that individuals with mental disorders had a consistent higher health expenditure is notable given the fact that Brazil has a universal free-of-charge healthcare and medication system. The results highlight the growing importance of mental disorders as a public health issue for developing countries