O retrato da psiquiatria pelos cinemas norte-americano e brasileiro

INTRODUCTION: As cinema has an easy accessibility, it seems to influence society's image of psychiatry. OBJECTIVES: To accomplish a systematic review of the literature about the portrayal of psychiatry in American and Brazilian films. METHODS: With no date limits, we searched the databases: LILACS, MedLine, PsychLit, PsycINFO and SciELO. We used the following terms in English and, in LILACS and SciELO, their equivalent in Portuguese: "psychiatry" AND/OR "motion pictures as topic". A manual search was also done. Accurate inclusion and exclusion criteria were stipulated. RESULTS: Twenty indexed articles and two books. In American cinema, the data have allowed to identify a constant stereotyped portrayal of different aspects of psychiatry, its ambivalent image and five distinct phases of its depiction. In Brazilian cinema, the few studies about the image of psychiatry have focused on "The retaken" phase. The majority of its films have showed some psychopathological content. DISCUSSION: As almost all articles have been descriptive, it was difficult to establish a comparison among them. However, it was possible to draw a parallel between US films and Brazilian ones. CONCLUSION: The portrayal of psychiatry differs between American and Brazilian cinema mainly because the sample of analyzed movies came from very distinct periods.INTRODUÇÃO: Em virtude de sua fácil acessibilidade, o cinema parece influenciar bastante a imagem que a sociedade faz da Psiquiatria. OBJETIVO: Realizar uma revisão sistemática da literatura sobre o retrato da Psiquiatria pelos cinemas norte-americano e brasileiro. MÉTODOS: Sem limite de data, fez-se uma busca bibliográfica manual e nos seguintes bancos de dados: LILACS, MedLine, PsychLit, PsycINFO e SciELO. Usaram-se as seguintes combinações de descritores em inglês e, nas bases LILACS e SciELO, os correspondentes em português: "psychiatry" E/OU "motion pictures as topic". Estipularam-se critérios precisos de inclusão e exclusão. RESULTADOS: Vinte artigos indexados e dois livros. No cinema norte-americano, tais fontes evidenciaram um constante retrato estereotipado de diferentes aspectos da Psiquiatria, cuja imagem se mostrou ambivalente e com cinco fases distintas de sua representação. No cinema brasileiro, os escassos estudos se limitaram praticamente à fase de "Retomada" e mostraram que a maioria dos filmes apresentava algum conteúdo psicopatológico. DISCUSSÃO: Apesar da dificuldade de comparação entre as fontes encontradas, uma vez que quase todas eram descritivas, foi possível traçar um paralelo do retrato da Psiquiatria entre as películas dos Estados Unidos e as nacionais. CONCLUSÃO: A representação da Psiquiatria difere bastante entre os cinemas norte-americano e brasileiro, sobretudo pela amostra de os filmes analisados abrangerem períodos bem distintos

Alterações cognitivas na depressão

Orientador: Claudio FernandesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Este estudo é uma revisão crítica da literatura sobre o comprometimento cognitivo encontrado nos quadros depressivos primários, não-bipolares. O objetivo foi a análise da natureza e do padrão desse comprometimento, o estabelecimento de associações entre as variáveis clínicas e o desempenho neuropsicológico, e a determinação das correlações entre os déficits cognitivos na depressão e seus substratos neurais subjacentes. Inicialmente, foram revistos os conceitos de depressão, suas características clínicas, as classificações atuais, o diagnóstico diferencial, a epidemiologia, as principais hipóteses etiológicas e a evolução. Discutiu-se a conceituação e as características das principais funções cognitivas, seguindo a abordagem neuropsicológica sugerida por Muriel Lezak, e descreveu-se os propósitos e os métodos da avaliação neuropsicológica das funções cognitivas. Organizou-se um painel das principais contribuições da neuropsicologia na área de saúde mental e descreveu-se a evolução histórica do conceito de déficit cognitivo relacionado à depressão, bem como as contribuições de diversos autores. Tanto o aspecto conceitual como a utilidade clínica da avaliação neuropsicológica foram abordados. A revisão da literatura foi realizada por meio da consulta a três bancos de dados: Medline, Psychlnfo e llLACS. Além disso, procedeu-se a uma extensiva busca manual a partir das referências bibliográficas listadas pelos artigos selecionados e capítulos de livros de expre'ssão na área de estudo. Foram incluídos nesta revisão os artigos que preencheram os seguintes critérios: publicados nos últimos dez anos, estudos clínicos com grupo controle, incluírem pacientes com diagnóstico de depressão primária, não bipolar (depressão maior pelos critérios do DSM-IV; episódio depressivo e transtorno depressivo recorrente pelos critérios da CID-lO), e apresentarem significância estatística. Foram selecionados 71 estudos, publicados entre 1989 e 1999, que satisfizeram esses critérios. Os resultados obtidos foram organizados de acordo com os principais tópicos relacionados aos Déficits cognitivos na depressão, isto é, sua naturezã, correlação com variáveis clínicas e substratos neurais. Concluindo, o autor comenta os resultados dos estudos revisados, assinalando quais apresentaram consistência e quais não. Aponta as principais limitações e falhas metodológicas observadas em alguns estudos, assinala' as discordâncias e concordâncias entre os autores, ressalta a importância clínica para o tratamento individualizado e sugere algumas pesquisas futuras no campo dos transtornos cognitivos e da depressãoAbstract: A review of the literature on cognitive impairment in primary non-bipolar depression was carried out. The aims were: 1. To examine the nature and pattem of cognitive impairments in depression; 2. the association between clinical variables and neuropsychological cognitive performance, and 3. correlation between cognitive deficits in depression and neural subtracts. First1y, it was reviewed the concept of depression, clinical characteristics, current classifications, differential diagnosis, epidemiology, main aetiological hypotheses and outcome. The main cognitive function concepts and characteristics were discussed, following the neuropsychological approach suggested by Muriel Lezak. The proposals and methods of neuropsychological assessment of cognitive functions are also discossed. A list of the more important contributions in neuropsychology and mental health conceming depression cognitive impairment is made. Concepts and clinical usefulness of neuropsychological evaluation were discussed. A systematic review of the literature was carried out at Medline, Psychlnfo and LlLACS, which was completed by a search at the citations in the references in the selected papers and book chapters related to depression and cognition. In order to be selected for this review the papers had to be published in the past Ia years, they should report on clinical studies with control group, and the patients included diagnosed as primary nonbipolar depression, major depression following DSM-IV criteria; or depressive episod~ or recurrent depressive disorder (CID-IO criteria). Seventy-one studies published between 1989 and 1999 met these criteria. The survey was organized by its main items reporting on depression and cognitive deficits. It included nature of cognitive deficits and its correlation with neural subtracts. Finally, ,the author comments on the studies reviewed and calls attention to the authors' agreements and disagreements as well as to consistencies and inconsistencies. He also pointed out to limitations and methodological pitfalls found in some studies, and higWights the clinical importance for an personalized treatment. He concludes by stressing the need for further research in depression and cognitive impairmentMestradoSaude MentalMestre em Ciências Médica

Switching from oral risperidone to flexibly dosed oral paliperidone extended-release: core symptoms, satisfaction, and quality of life in patients with stable but symptomatic schizophrenia: the RISPALI study

Objective:The purpose of this prospective study was to evaluate the effects of switching from oral risperidone to flexibly dosed oral paliperidone extended-release (ER) in Brazilian adults with schizophrenia because of lack of efficacy, intolerability, or nonadherence after a minimum trial of 30 days on adequate (labeled) doses of oral risperidone, according to individual clinical judgment.Research design and methods:Subjects with Positive and Negative Syndrome Scale total scores above 78, and/or intolerable adverse effects, with risperidone received open-label paliperidone ER 3 to 12 mg daily for 26 (main phase) to 52 (extension phase) weeks.Clinical trial registration:Clinicaltrials.gov identifier: NCT01010776.Results:The intent-to-treat (efficacy) populations comprised 213 subjects in the main phase and 159 in the extension phase. of 213 subjects with baseline and post-baseline efficacy data, 154 (72.3%) switched from risperidone to paliperidone ER because of a lack of efficacy and 59 (27.7%) because of tolerability issues, according to individual clinical judgment. Paliperidone ER significantly (p < 0.0500) improved a broad spectrum of efficacy endpoints from baseline, as early as the first post-baseline visit (Visit 2; 4 weeks) and persisting through 26 to 52 weeks. On most efficacy endpoints, function improved from baseline to the first post-baseline visit (week 4) and remained significantly improved compared to baseline at each visit for paliperidone ER treatment, at weeks 8, 13, 26, 39, 26, and 52; data are reported herein mainly for 26 and 52 weeks compared to baseline. Significant improvements from baseline were observed for the Positive and Negative Syndrome Scale total score and subscale scores (each p < 0.0001 at 26 and 52 weeks vs. baseline); and personal and social functioning (p < 0.0001 at 26 and 52 weeks). Paliperidone ER also significantly improved health-related quality of life (Short-Form 36) from baseline, particularly on the Mental Component Summary (p = 0.0011 at 26 weeks and p = 0.0019 at 52 weeks). Treatment with paliperidone ER also significantly improved (vs. baseline) sleep quality (according to decreases on the Pittsburgh Sleep Quality Index; p < 0.0001 at each visit vs. baseline) and disease severity (Clinical Global Impression-Severity; p < 0.0001 at each visit vs. baseline). Paliperidone ER was well tolerated. Adverse events occurring in at least 10% of subjects in either phase were insomnia (14.9% in the main phase and 8.8% in the extension phase); increased body weight (10.7% and 12.6%, respectively); and anxiety (10.7% and 2.5%). Most of these adverse events were: 1) rated as mild or moderate; 2) did not prompt interventions such as paliperidone ER dose adjustment or interruption; and 3) decreased in frequency from the main to the extension phase.Conclusions:Oral paliperidone ER is a rational treatment alternative for patients with schizophrenia whose antipsychotic regimens are switched because of unsuccessful treatment with oral risperidone according to individual clinical judgment. Study limitations included the open-label study design, lack of placebo, and use of subjective clinical judgment to determine lack of efficacy, intolerability, or nonadherence with oral risperidone.Janssen-Cilag Farmaceutica Ltda., São Paulo, BrazilFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Janssen-CilagNovartisRocheEMS Pharmaceuticals, BrazilMoksha8Eli LillyBristol-Myers SquibbServierLundbeckQuintilesTevaCPPSSUniv São Paulo, Sch Med, Dept & Inst Psychiat, BR-05403010 São Paulo, BrazilUniv São Paulo, Sch Med, Lab Neurosci LIM27, BR-05403010 São Paulo, BrazilUniv Fed Goias, Dept Psychiat, Goiania, Go, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilInst Psychiat Prof Andro Teixeira Lima, Sorocaba, SP, BrazilCtr Psychiat & Res SR, Ctr Psychiat & Res, Rio de Janeiro, BrazilUniv Fed Bahia, Dept Neurosci & Mental Hlth, Salvador, BA, BrazilInst Social Secur Civil Servants Minas Gerais IPS, Dept Psychiat, Belo Horizonte, MG, BrazilHosp Bom Retiro, Curitiba, Parana, BrazilFac Med Marilia, Marilia, SP, BrazilUniv São Paulo, Inst Psychiat, BR-05403010 São Paulo, BrazilUniv Southern Santa Catarina, Neurosci Lab, Criciuma, SC, BrazilUniv Southern Santa Catarina, Natl Inst Translat Med INCT TM, Criciuma, SC, BrazilUniv Fed Parana, Fac Med, BR-80060000 Curitiba, Parana, BrazilFac Med ABC, Santo Andre, SP, BrazilJanssen Cilag Farmaceut Ltda, São Paulo, BrazilUniv Fed Rio de Janeiro, Inst Psychiat, BR-21941 Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilWeb of Scienc

Tratamento farmacológico do transtorno de ansiedade generalizada: perspectivas futuras Pharmacological treatment of generalized anxiety disorder: future perspectives

O presente artigo apresenta uma visão atualizada e ampla do tratamento farmacológico do transtorno de ansiedade generalizada (TAG). São revistos os medicamentos com eficácia comprovada em estudos controlados e atualmente disponíveis na clínica (benzodiazepínicos, buspirona, antidepressivos, betabloqueadores, antipsicóticos e extrato de kava-kava). A seguir, baseados nesses dados, propõe-se um algoritmo de tratamento do TAG. São apresentadas as principais linhas de pesquisa de novos fármacos ansiolíticos, descrevendo os principais achados clínicos e pré-clínicos.<br>This article presents an updated and broad perspective of the pharmacological treatment of generalized anxiety disorder (GAD). Medications proven to be efficacious in controlled studies and available in the clinic setting were reviewed (benzodiazepines, buspirone, antidepressives, beta-blocking agents, antipsychotics and kava-kava extract). From this data, an algorithm for GAD treatment is proposed. In addition, the main research lines on new anxiolytic drugs and their stage of clinical or pre-clinical development are presented