Entre o cérebro e a clínica ampliada: psiquiatria biológica e reforma psiquiátrica no Brasil

Este artigo discute duas mudanças ocorridas na atenção psiquiátrica do Brasil nos últimos vinte anos: a adoção do modelo científico neurobiológico da psiquiatria dos EUA pela psiquiatria brasileira, enquanto especialidade médica; e a consolidação do movimento da Reforma Psiquiátrica, pela aprovação da lei 10216, de abril de 2001, que levou à implantação de um modelo de desinstitucionalização na rede de Saúde Mental e a adoção de práticas renovadas de assistência, a chamada clínica da atenção psicossocial. O trabalho critica as distorções oriundas do reducionismo fisicalista gerado pela psiquiatria biomédica contemporânea. Também analisa a assistência oferecida pelos dispositivos da Reforma Psiquiátrica, destacando a necessidade de uma abordagem multiparadigmática dos transtornos mentais graves. Dessa forma, é possível levar em conta aspectos biológicos, corporais, subjetivos, simbólicos e sociais do adoecimento mental, numa interação complexa e complementar, que permita a prática renovada da atenção em Saúde Mental

Interobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator

OBJECTIVES: To evaluate the interobserver agreement for the Neoplastic Spine Instability Score (SINS) among spine surgeons with or without experience in vertebral metastasis treatment and physicians in other specialties. METHODS: Case descriptions were produced based on the medical records of 40 patients with vertebral metastases. The descriptions were then published online. Physicians were invited to evaluate the descriptions by answering questions according to the Neoplastic Spine Instability Score (SINS). The agreement among physicians was calculated using the kappa coefficient. RESULTS: Seventeen physicians agreed to participate: three highly experienced spine surgeons, seven less-experienced spine surgeons, three surgeons of other specialties, and four general practitioners (n = 17). The agreement for the final SINS score among all participants was fair, and it varied according to the SINS component. The agreement was substantial for the spine location only. The agreement was higher among experienced surgeons. The agreement was nearly perfect for spinal location among the spine surgeons who were highly experienced in vertebral metastases. CONCLUSIONS: This study demonstrates that the experience of the evaluator has an impact on SINS scale classification. The interobserver agreement was only fair among physicians who were not spine surgeons and among spine surgeons who were not experienced in the treatment of vertebral metastases, which may limit the use of the SINS scale for the screening of unstable lesions by less-experienced evaluators

As origens do alienismo no Brasil: dois artigos pioneiros sobre o Hospício de Pedro II

O artigo discute dois trabalhos que, de forma pioneira, descreveram o funcionamento do Hospício de Pedro II, primeira instituição psiquiátrica do Brasil: L'hospice Pedro II et les Alienés au Brésil, de Phillipe-Marius Rey (1875); e Visite a L'sile de Pedro II a Rio de Janeiro, de François Jouin (1880). O contexto histórico de criação do hospício e seu funcionamento inicial são analisados. Sua construção é correlacionada à afirmação política do Segundo Reinado. Aspectos referentes à organização do alienismo no país e às características raciais da sociedade brasileira são abordados

Laminectomy without instrumentation for surgical treatment of metastatic spinal cord compression

OBJECTIVE: To analyze the development of mechanical complications as a result of spinal decompression or cauda equina in patients with metastatic tumors of the spine via laminectomy or laminoartrectomy without fixation. METHODS: We studied the medical records of all patients submitted to spine decompression with laminectomy without fixation. The decompression was indicated to treat cord compression or cauda equina caused by metastatic tumors. Patients were evaluated for the development of postoperative mechanical instability by comparing the preoperative radiological examinations with the latest one available in the medical record review.. In these images, we evaluated the emergence of new deformity in the sagittal or coronal planes and translational deformity. We consider new deformity, signs of deformity greater or equal to 5° in the coronal or sagittal planes and signs of increased vertebral translation greater than or equal to 3 mm. RESULTS: No patient developed radiological instability in the period evaluated with an average follow-up of 163.24 days (3-663). The complication rate in our sample was not higher than the previously reported in the literature. CONCLUSION: Isolated laminectomy at one or more levels is a safe procedure for the treatment of metastatic spinal cord compression where the spine is judged stable before surgery

Interobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator

OBJECTIVES: To evaluate the interobserver agreement for the Neoplastic Spine Instability Score (SINS) among spine surgeons with or without experience in vertebral metastasis treatment and physicians in other specialties. METHODS: Case descriptions were produced based on the medical records of 40 patients with vertebral metastases. The descriptions were then published online. Physicians were invited to evaluate the descriptions by answering questions according to the Neoplastic Spine Instability Score (SINS). The agreement among physicians was calculated using the kappa coefficient. RESULTS: Seventeen physicians agreed to participate: three highly experienced spine surgeons, seven less-experienced spine surgeons, three surgeons of other specialties, and four general practitioners (n = 17). The agreement for the final SINS score among all participants was fair, and it varied according to the SINS component. The agreement was substantial for the spine location only. The agreement was higher among experienced surgeons. The agreement was nearly perfect for spinal location among the spine surgeons who were highly experienced in vertebral metastases. CONCLUSIONS: This study demonstrates that the experience of the evaluator has an impact on SINS scale classification. The interobserver agreement was only fair among physicians who were not spine surgeons and among spine surgeons who were not experienced in the treatment of vertebral metastases, which may limit the use of the SINS scale for the screening of unstable lesions by less-experienced evaluators