Esquizofrenia: se a morte acontece sem aviso prévio, o que devemos propor para o futuro próximo?

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaNational Institutes of Health National Institute of Mental HealthUNIFESP, EPMSciEL

Bioconcentration of Triclosan, Methyl-Triclosan, and Triclocarban in the Plants and Sediments of a Constructed Wetland

Triclosan and triclocarban are antimicrobial compounds added to a variety of consumer products that are commonly detected in waste water effluent. The focus of this study was to determine whether the bioconcentration of these compounds in wetland plants and sediments exhibited species specific and site specific differences by collecting field samples from a constructed wetland in Denton, Texas. The study showed that species-specific differences in bioconcentration exist for triclosan and triclocarban. Site-specific differences in bioconcentration were observed for triclosan and triclocarban in roots tissues and sediments. These results suggest that species selection is important for optimizing the removal of triclosan and triclocarban in constructed wetlands and raises concerns about the long term exposure of wetland ecosystems to these compounds

Construcción y validez, una prueba rápida para determinar la funcionalidad familiar

Introducción: Tanto las familias de la antigüedad como aquellas de las sociedades mo- dernas son dinámicas y evolutivas, sus funciones van acorde con alguna etapa de la sociedad. Con el paso del tiempo y el apoyo de intervenciones diversas, la familia mo- derna tiene cinco funciones principales: cuidado, afecto, expresión de la sexualidad y regulación de la fecundidad, socialización y estatus o nivel social.Objetivo: Elaborar y Determinar la validez de una prueba rápida para medir la funciona- lidad familiar.Diseño: Validación de instrumentos.Participantes: Jefes de familia que acudieran a consulta externa de la unidad de Medi- cina Familiar.Mediciones principales: Se diseñó un cuestionario con 5 preguntas para evaluar de forma rápida la funcionalidad familiar, cada una de éstas con 3 opciones de respuesta. El pilotaje fueron 40 jefes de familia.Resultados: Posterior a la evaluación de 3 expertos se modificaron las preguntas porque éstas utilizaban términos técnicos para el lector, las familias; finalmente, hubo una sola pregunta para cada una de las funciones de la familia propuestas por el consenso mexi- cano de medicina familiar de 2005. La confiabilidad se obtuvo con la determinación de un Alfa de Cronbach de .73, para la validez se realizó una correlación de Pearson ítem-test obteniendo un valor significativo con una r > .35 para cada ítem.Conclusión: Esta prueba es una opción válida y confiable para determinar la funcionali- dad familiar aplicable en la consulta del primer nivel de atención

Construcción y validez, una prueba rápida para determinar la funcionalidad familiar

Introducción: Tanto las familias de la antigüedad como aquellas de las sociedades mo- dernas son dinámicas y evolutivas, sus funciones van acorde con alguna etapa de la sociedad. Con el paso del tiempo y el apoyo de intervenciones diversas, la familia mo- derna tiene cinco funciones principales: cuidado, afecto, expresión de la sexualidad y regulación de la fecundidad, socialización y estatus o nivel social.Objetivo: Elaborar y Determinar la validez de una prueba rápida para medir la funciona- lidad familiar.Diseño: Validación de instrumentos.Participantes: Jefes de familia que acudieran a consulta externa de la unidad de Medi- cina Familiar.Mediciones principales: Se diseñó un cuestionario con 5 preguntas para evaluar de forma rápida la funcionalidad familiar, cada una de éstas con 3 opciones de respuesta. El pilotaje fueron 40 jefes de familia.Resultados: Posterior a la evaluación de 3 expertos se modificaron las preguntas porque éstas utilizaban términos técnicos para el lector, las familias; finalmente, hubo una sola pregunta para cada una de las funciones de la familia propuestas por el consenso mexi- cano de medicina familiar de 2005. La confiabilidad se obtuvo con la determinación de un Alfa de Cronbach de .73, para la validez se realizó una correlación de Pearson ítem-test obteniendo un valor significativo con una r > .35 para cada ítem.Conclusión: Esta prueba es una opción válida y confiable para determinar la funcionali- dad familiar aplicable en la consulta del primer nivel de atención

A Case of a Reversible Cause of Psychosis: Thyroid Storm

Thyroid storm, an exaggerated manifestation of thyrotoxicosis, is a rare and life-threatening endocrine emergency. Physical and emotional stressors can precipitate thyroid storm in patients with underlying thyrotoxic conditions. Patients present with cardiac, GI and CNS dysfunction. The Burch-Wartofsky point scale predicts the likelihood of thyroid storm based upon the presence of these CNS, GI, and cardiovascular symptoms along with thermoregulatory dysfunction. A score of 45 or greater on this scale is indicative of thyroid storm. Treatment of thyroid storm includes a beta blocker, a thionamide, iodine solution, a glucocorticoid, and a bile acid sequestrant. Thyroid storm is a recognized cause of secondary psychosis. Though psychosis due to thyrotoxicosis was first reported in the literature in 1840, few cases have been reported since that time. The most common symptoms of psychosis in these patients include mania, paranoia, hallucinations, and delusions. Abnormal vital signs such as tachycardia, hypertension, and an irregular pulse can help distinguish secondary from primary psychosis. If thyrotoxicosis is a suspected cause of psychosis, then TSH, thyroxine, and thyroid antibodies should be measured. Treatment of the underlying thyrotoxicosis is curative. We present the case of a 28-year-old female with a several psychosocial stressors that presented to the emergency department with symptoms of a manic episode. Work-up included CBC, CMP, CSF studies, HIV panel, urinalysis, UDS, salicylate levels, urine drug screen, K2, Spice, LSD, lead level, Head CT, and Brain MRI. All tests were negative or within normal limits. The patient was initially started on benzodiazepines and then switched to an antipsychotic. After discontinuation of benzodiazepines, the patient\u27s heart rate increased from 110-150s with sinus tachycardia. TSH was In conclusion, thyroid storm should be listed as a differential in patients presenting with psychosis and abnormal vital signs

A wake-up call : Sleep physiology and related translational discrepancies in studies of rapid-acting antidepressants

Depression is frequently associated with sleep problems, and clinical improvement often coincides with the normalization of sleep architecture and realignment of circadian rhythm. The effectiveness of treatments targeting sleep in depressed patients, such as sleep deprivation, further demonstrates the confluence of sleep and mood. Moreover, recent studies showing that the rapid-acting antidepressant ketamine influences processes related to sleep-wake neurobiology have led to novel hypotheses explaining rapid and sustained antidepressant effects. Despite the available evidence, studies addressing ketamine's antidepressant effects have focused on pharmacology and often overlooked the role of physiology. To explore this discrepancy in research on rapid acting antidepressants, we examined articles published between 2009-2019. A keyword search algorithm indicated that vast majority of the articles completely ignored sleep. Out of the 100 most frequently cited pre clinical and clinical research papers, 89 % and 71 %, respectively, did not mention sleep at all. Furthermore, only a handful of these articles disclosed key experimental variables, such as the times of treatment administration or behavioral testing, let alone considered the potential association between these variables and experimental observations. Notably, in preclinical studies, treatments were preferentially administered during the inactive period, which is the polar opposite of clinical practice and research. We discuss the potential impact of this practice on the results in the field. Our hope is that this perspective will serve as a wake-up call to (re)-examine rapid-acting antidepressant effects with more appreciation for the role of sleep and chronobiology.Peer reviewe

SHAPS-C: the Snaith-Hamilton pleasure scale modified for clinician administration

Anhedonia, a diminished or lack of ability to experience and anticipate pleasure represents a core psychiatric symptom in depression. Current clinician assessment of anhedonia is generally limited to one or two all-purpose questions and most well-known psychometric scales of anhedonia are relatively long, self-administered, typically not state sensitive, and are unsuitable for use in clinical settings. A user-friendly tool for a more in-depth clinician assessment of hedonic capacity is needed. The present study assessed the validity and reliability of a clinician administered version of the Snaith-Hamilton Pleasure Scale, the SHAPS-C, in 34 depressed subjects. We compared total and specific item scores on the SHAPS-C, SHAPS (self-report version), Montgomery-Åsberg Depression Rating Scale (MADRS), and the Inventory of Depressive Symptomatology-Self Rating version (IDS-SR). We also examined construct, content, concurrent, convergent, and discriminant validity, internal consistency, and split-half reliability of the SHAPS-C. The SHAPS-C was found to be valid and reliable. The SHAPS and the SHAPS-C were positively correlated with one another, with levels of depression severity, as measured by the MADRS, and the IDS-SR total scores, and with specific items of the MADRS and IDS-SR sensitive to measuring hedonic capacity. Our investigation indicates that the SHAPS-C is a user friendly, reliable, and valid tool for clinician assessment of hedonic capacity in depressed bipolar and unipolar patients

Altered interaction with environmental reinforcers in major depressive disorder: Relationship to anhedonia

Anhedonia—defined as loss of interest or pleasure—is one of two core symptoms of major depressive disorder (MDD). Anhedonia may involve decreased enjoyment of potentially rewarding activities and decreased motivation to engage in such activities. Increased engagement with reinforcers—activities with the potential to be positive experiences—is a frequent target of cognitive-behavioral therapies. Nevertheless, how environmental reinforcers are perceived, and how decisions to approach or avoid them are made by individuals with MDD, is largely unknown. We developed an experimental Behavioral Approach Motivation Paradigm to study how activities are evaluated and approached in MDD. Twenty-one MDD participants and 23 healthy controls performed an experimental task that rated activity words for their hedonic value, then engaged in an approach-avoidance joystick task with each individual’s unique set of ‘liked’ and ‘disliked’ activity words. A negative correlation was observed between anhedonia and the number of ‘liked’ activities across participants. No significant difference between approach and avoidance behavior was found in direct comparisons between healthy controls and MDD participants; however, weaker avoidance and greater approach toward ‘disliked’ activities was found in MDD participants. This suggests negative bias in selecting environmental opportunities, potentially further compromising access to hedonic experiences in MDD

Computador e Sociedade: Uma metodologia para realização de campanhas de coleta de lixo eletrônico

Este artigo apresenta o planejamento de uma ação conjunta entre o IFMS e a Secretaria de Desenvolvimento da Prefeitura Municipal com o objetivo de divulgar, coletar, classificar e destinar o lixo eletrônico coletado, oriundo da cidade de Nova Andradina-MS