Características básicas do transtorno do pânico

The aim of this paper is to characterize the Panic Disorder (PD) with an emphasis on diagnosis and treatment. PD is one of the anxiety disorders, characterized by recurrent panic attacks accompanied by a persistent preoccupation with additional attacks and maladaptive behavioral changes (American Psychiatric Association – DSM-V). Its etiology is not known, but should involve an interaction of genetic, developmental and environmental factors that result in changes in the functioning of some brain areas. The pharmacological treatment of choice is with the use of selective serotonin reuptake inhibitors, which has a latency of 20 for 30 days for the beginning of the therapeutic effectO objetivo é caracterizar o Transtorno do Pânico (TP) com ênfase em seu diagnóstico e tratamento. O TP é um dos transtornos de ansiedade, caracterizado por ataques de pânico recorrentes acompanhados por uma persistente preocupação com ataques adicionais e alterações mal adaptativas do comportamento (Associação Americana de Psiquiatria - DSM-V). Sua etiologia ainda não é conhecida, mas deve envolver uma interação de fatores genéticos, de desenvolvimento e ambientais que resultam em altera- ções no funcionamento de algumas áreas cerebrais. O tratamento farmacológico de primeira escolha é com o uso de antidepressivos inibidores seletivos da recaptação de serotonina, os quais apresentam uma latência de 20 a 30 dias para o início do efeit

Basic features of generalized anxiety disorder

Este texto é dirigido à alunos de graduação com o objetivo de caracterizar o Transtorno de Ansiedade Generalizada (TAG) com ênfase em seu diagnóstico e tratamento. O TAG é um dos transtornos psiquiá- tricos mais subdiagnosticados. Caracteriza-se por preocupação persistente e excessiva acompanhada de sintomas físicos relacionados a hiperatividade autonômica e a tensão muscular. Apresenta comorbidade frequente com depressão e outros transtornos de ansiedade. A abordagem psicoterápica, num sentido amplo, deve ser prioritária no tratamento desse distúrbio e o tratamento farmacológico, quando indicado, não deve ser a única opção terapêuticaThis text is addressed to medical undergraduate students with aim to characterize Generalized Anxiety Disorder (GAD) with emphasis on diagnosis and treatment. GAD is one of the most psychiatric disorders under-diagnosed. The main characteristic of GAD is persistent and excessive worry accompanied by physical symptoms related to autonomic hyperactivity and muscle tension. The comorbidity with depression and other anxiety disorders is frequently. The psychotherapeutic approach, in a wide sense, must be a priority in the treatment of this disease and, when indicated, the pharmacological treatment should not be the only therapeutic optio

A Faculdade de Medicina de Ribeirão Preto e a Reforma Universitária: o sonho de 1968

The objective of this review is to describe the participation of the lecturers and students of the School of Medicine of Ribeirão Preto (FMRP) in discussions on reform of the University of São Paulo (USP), which occurred in the year 1968. These discussions occurred in committees composed of equal numbers of lecturers and students (parity committees) and resulted in a proposal for reform adopted by an assembly of the FMRP, specially created for this purpose. The paper discuss also the context and influence of these discussions in the reform approved by the University Council at the beginning of 1969 and that became known as Hélio Lourenço's statute.O objetivo dessa revisão é descrever a participação de docentes e discentes da Faculdade de Medicina de Ribeirão Preto (FMRP) nas discussões sobre a reforma da Universidade de São Paulo (USP), que ocorreram no ano de 1968. Essas discussões ocorreram em comissões compostas por igual número de docentes e discentes (comissões paritárias) e resultaram numa proposta de reforma aprovada por uma assembléia da FMRP, especialmente criada com essa finalidade. O artigo discute, também, o contexto e a influência dessas discussões na reforma aprovada pelo Conselho Universitário da USP, no início de 1969 e que ficou conhecido como Estatuto Hélio Lourenço

Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature

<p>Abstract</p> <p>Background</p> <p>Cannabis intoxication is related to a number of physical and mental health risks with ensuing social costs. However, little attention has been given to the investigation of possible pharmacological interactions in this condition.</p> <p>Objective</p> <p>To review the available scientific literature concerning pharmacological interventions for the treatment of the acute effects of cannabis.</p> <p>Methods</p> <p>A search was performed on the <it>Pubmed</it>, <it>Lilacs</it>, and <it>Scielo </it>online databases by combining the terms <it>cannabis, intoxication, psychosis, anxiety</it>, and <it>treatment</it>. The articles selected from this search had their reference lists checked for additional publications related to the topic of the review.</p> <p>Results</p> <p>The reviewed articles consisted of case reports and controlled clinical trials and are presented according to interventions targeting the physiological, psychiatric, and cognitive symptoms provoked by cannabis. The pharmacological interventions reported in these studies include: beta-blockers, antiarrhythmic agents, antagonists of CB-1 and GABA-benzodiazepine receptors, antipsychotics, and cannabidiol.</p> <p>Conclusion</p> <p>Although scarce, the evidence on pharmacological interventions for the management of cannabis intoxication suggests that propanolol and rimonabant are the most effective compounds currently available to treat the physiological and subjective effects of the drug. Further studies are necessary to establish the real effectiveness of these two medications, as well as the effectiveness of other candidate compounds to counteract the effects of cannabis intoxication, such as cannabidiol and flumazenil.</p

Effects of cannabinoid drugs on the deficit of prepulse inhibition of startle in an animal model of schizophrenia: the SHR strain

Clinical and neurobiological findings suggest that the cannabinoids and the endocannabinoid system may be implicated in the pathophysiology and treatment of schizophrenia. We described that the spontaneously hypertensive rats (SHR) strain presents a schizophrenia behavioral phenotype that is specifically attenuated by antipsychotic drugs, and potentiated by proschizophrenia manipulations. Based on these findings, we have suggested this strain as an animal model of schizophrenia. the aim of this study was to evaluate the effects of cannabinoid drugs on the deficit of prepulse inhibition (PPI) of startle, the main paradigm used to study sensorimotor gating impairment related to schizophrenia, presented by the SHR strain. the following drugs were used: (1) WIN55212,2 (cannabinoid agonist), (2) rimonabant (CB1 antagonist), (3) AM404 (anandamide uptake inhibitor), and (4) cannabidiol (CBD; indirect CB1/CB2 receptor antagonist, among other effects). VVistar rats (VVRs) and SHRs were treated with vehicle (VEH) or different doses of WIN55212 (0.3, 1, or 3 mg/kg), rimonabant (0.75, 1.5, or 3 mg/kg), AM404 (1, 5, or 10 mg/kg), or CBD (15, 30, or 60 mg/kg). VEH-treated SHRs showed a decreased PPI when compared to VVRs. This PPI deficit was reversed by 1 mg/kg WIN and 30 mg/kg CBD. Conversely, 0.75 mg/kg rimonabant decreased PPI in SHR strain, whereas AM404 did not modify it. Our results reinforce the role of the endocannabinoid system in the sensorimotor gating impairment related to schizophrenia, and point to cannabinoid drugs as potential therapeutic strategies.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Pharmacol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin, BR-04039032 São Paulo, BrazilUniv São Paulo, Dept Neurosci & Behav, BR-14049 Ribeirao Preto, BrazilNatl Council Sci & Technol Dev, Natl Inst Sci & Technol Translat Med, Ribeirao Preto, BrazilUniversidade Federal de São Paulo, Dept Pharmacol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin, BR-04039032 São Paulo, BrazilFAPESP: FAPESP - 2010/07994-3Web of Scienc

Cannabidiol Prevents Motor and Cognitive Impairments Induced by Reserpine in Rats

Cannabidiol (CBD) is a non-psychotomimetic compound from Cannabis sativa that presents antipsychotic, anxiolytic, anti-inflammatory, and neuroprotective effects. In Parkinson's disease patients, CBD is able to attenuate the psychotic symptoms induced by L-DOPA and to improve quality of life. Repeated administration of reserpine in rodents induces motor impairments that are accompanied by cognitive deficits, and has been applied to model both tardive dyskinesia and Parkinson's disease. The present study investigated whether CBD administration would attenuate reserpine-induced motor and cognitive impairments in rats. Male Wistar rats received four injections of CBD (0.5 or 5 mg/kg) or vehicle (days 2-5). On days 3 and 5, animals received also one injection of 1 mg/kg reserpine or vehicle. Locomotor activity, vacuous chewing movements, and catalepsy were assessed from day 1 to day 7. On days 8 and 9, we evaluated animals' performance on the plus-maze discriminative avoidance task, for learning/memory assessment. CBD (0.5 and 5 mg/kg) attenuated the increase in catalepsy behavior and in oral movements - but not the decrease in locomotion induced by reserpine. CBD (0.5 mg/kg) also ameliorated the reserpine-induced memory deficit in the discriminative avoidance task. Our data show that CBD is able to attenuate motor and cognitive impairments induced by reserpine, suggesting the use of this compound in the pharmacotherapy of Parkinson's disease and tardive dyskinesia.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Fed Sao Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pharmacol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychobiol, Sao Paulo, BrazilUniv Sao Paulo, Dept Neurosci & Behav, Ribeirao Preto, BrazilNatl Council Sci & Technol Dev, Natl Inst Translat Med, Ribeirao Preto, BrazilInterdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilDepartment of Pharmacology, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilDepartment of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilFAPESP: 2010/07994-3FAPESP: 2015/03354-3CNPq/MS/SCTIE/DECIT: 26/2014CNPq/MS/SCTIE/DECIT: 466805/2014-4Web of Scienc

Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil

Objective: To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Methods: Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients` results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Results: Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. Conclusions: These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners. (c) 2008 Elsevier Inc. All rights reserved

Políticas de saúde mental e mudanças na demanda de serviços de emergência Mental health policies and changes in the emergency services profile

OBJETIVO: Verificar as mudanças ocorridas em um serviço de emergências psiquiátricas de um hospital universitário de Ribeirão Preto-SP (EP-RP), em função de mudanças nas políticas de saúde mental da região. MÉTODOS: Os dados sobre os atendimentos foram colhidos em arquivos do EP-RP, período de 1988 a 1997. Foram estudadas as variáveis sexo, faixa etária, procedência e diagnóstico principal. Os dados sobre as mudanças nas políticas de saúde mental, na região, foram obtidos de documentos das secretarias de saúde do estado e do município. RESULTADOS: O aumento a cada ano do número de atendimentos realizados acompanhou o progressivo envolvimento do EP-RP na rede de serviços de saúde mental. Em 1995 a procura pelo serviço foi 2,3 vezes maior do que em 1988. Nesse período o atendimento no EP-RP deu apoio às mudanças nas políticas de saúde mental na região, que resultaram na redução de 654 leitos psiquiátricos. Em 1996 e 1997 houve uma diminuição do total de atendimentos em cerca de 20% com relação a 1995, acompanhando o aumento do número e da capacidade de atendimento dos serviços extra-hospitalares. A partir de 1990 o serviço passou a atender uma maior proporção de pacientes mais velhos, do sexo masculino, com diagnóstico de dependência de substâncias e transtornos psicóticos e uma proporção menor de quadros não psicóticos. CONCLUSÕES: As mudanças observadas no EP-RP correlacionam-se com as das políticas de saúde mental na região de Ribeirão Preto, como a instalação da Central de Vagas Psiquiátricas, em 1990, a redução de leitos psiquiátricos a partir de 1993 e a criação e/ou ampliação de serviços extra-hospitalares a partir de 1995.<br>OBJECTIVE: To verify the modifications observed in a school hospital psychiatric emergency unit in Ribeirão Preto - SP, Brazil (EP-RP), due to alterations in the mental health policies implemented in this region. METHODS: Data about attendances was collected from university hospital files of the EP-RP, from 1988 to 1997. The following variables were studied: sex, age, origin and main diagnosis. Data about changes in mental health policies of the region was obtained from documents of the city and state departments of health. RESULTS: The yearly increase in the number of attendances followed the progressive involvement of EP-RP with the mental health service network, as the number of patients who looked for the service in 1995 was 2.3 times greater than in 1988. During this period, attendance at the EP-RP gave support to the modifications in the mental health policies in this region, resulting in a reduction of 654 psychiatry beds. In 1996 and 1997, a reduction of about 20% was observed in the total of attendance, as compared to 1995, result from an increase in the attendance capacity and number of the extra-hospital services. Since 1990, the EP-RP started to attend a higher proportion of older, male patients, with drug dependency and psychotic disorders and a lower proportion of non-psychotic patients. CONCLUSIONS: The changes observed in the EP-RP are related to modifications in the Ribeirão Preto region mental health policies, like the psychiatric beds control, installed in 1990, the reduction of psychiatric beds after 1993, and the creation and/or amplification of extra-hospital services, in 1995

Políticas de saúde mental e mudanças na demanda de serviços de emergência

OBJETIVO: Verificar as mudanças ocorridas em um serviço de emergências psiquiátricas de um hospital universitário de Ribeirão Preto-SP (EP-RP), em função de mudanças nas políticas de saúde mental da região. MÉTODOS: Os dados sobre os atendimentos foram colhidos em arquivos do EP-RP, período de 1988 a 1997. Foram estudadas as variáveis sexo, faixa etária, procedência e diagnóstico principal. Os dados sobre as mudanças nas políticas de saúde mental, na região, foram obtidos de documentos das secretarias de saúde do estado e do município. RESULTADOS: O aumento a cada ano do número de atendimentos realizados acompanhou o progressivo envolvimento do EP-RP na rede de serviços de saúde mental. Em 1995 a procura pelo serviço foi 2,3 vezes maior do que em 1988. Nesse período o atendimento no EP-RP deu apoio às mudanças nas políticas de saúde mental na região, que resultaram na redução de 654 leitos psiquiátricos. Em 1996 e 1997 houve uma diminuição do total de atendimentos em cerca de 20% com relação a 1995, acompanhando o aumento do número e da capacidade de atendimento dos serviços extra-hospitalares. A partir de 1990 o serviço passou a atender uma maior proporção de pacientes mais velhos, do sexo masculino, com diagnóstico de dependência de substâncias e transtornos psicóticos e uma proporção menor de quadros não psicóticos. CONCLUSÕES: As mudanças observadas no EP-RP correlacionam-se com as das políticas de saúde mental na região de Ribeirão Preto, como a instalação da Central de Vagas Psiquiátricas, em 1990, a redução de leitos psiquiátricos a partir de 1993 e a criação e/ou ampliação de serviços extra-hospitalares a partir de 1995