Psicofarmacoterapia para o clínico geral / Pharmacotherapy for general practitioners

O objetivo deste artigo é introduzir o aluno de graduação na área da saúde, em especial o aluno de Medicina, no campo da psicofarmacoterapia para o tratamento dos transtornos mentais. Para isso, serão revisados os principais psicofármacos utilizados na atualidade, seus mecanismos de ação, suas indica- ções e contra-indicações, seus efeitos colaterais, oferecendo ainda diretrizes para o seu uso na prática clínica diária.(AU)

The objective of this article is to introduce the graduate students of healthcare courses, especially medical students, into the psychopharmacotherapy field for the treatment of mental disorders. To this aim, we performed a comprehensive review of the main psychoactive drugs used today, their mechanisms of action, indications and contraindications, side effects. We also provided guidelines for their use in daily clinical practice. (AU)

Efficacy of psychoeducation in bipolar patients: systematic review of randomized trials

Bipolar disorder is a recurrent and chronic disorder with significant morbidity and mortality. Currently, pharmacological treatment is considered indispensable in bipolar disorder. However, despite advances in this area, treatment remains suboptimal. A large body of research has shown that innumerable psychosocial factors influence the emergence of mood disorders. Therefore, in addition to pharmacological strategies, psychological interventions are increasingly recognized as an essential component in the treatment of bipolar patients. Among the various approaches of psychosocial interventions, psychoeducation (PE) has been one of the most used. Thus, the aim of this review was to evaluate the efficacy of PE in the clinical course, treatment adherence, and psychosocial functioning of bipolar patients by collecting data from controlled trials that used solely PE as a psychosocial approach. A systematic review of the literature was performed in the PubMed and SCOPUS databases, without date limits, using the following keywords: Psychoeducation and Bipolar disorder. We found 13 randomized controlled trials. Psychoeducation significantly improved the clinical course, treatment adherence, and psychosocial functioning of bipolar patients. It also reduced the number of relapses and recurrences per patient and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower in patients who received PE. Although we found a limited number of randomized controlled trials that evaluated the efficacy of PE in bipolar disorder, the studies showed positive results in reducing relapse rates and improving long-term treatment adherence. Additionally, PE intervention improves the knowledge of the illness for both patients and caregivers to reduce their distress and improve overall social functioning.

Analysis of the occurrence of early life stress in adult psychiatric patients: a systematic review

The purpose of the paper was to conduct a systematic review of early life stress and its association with psychiatric disorders in adulthood. The occurrence of early stress has lasting negative consequences on the individual, with psychopathology onset one of the most important consequences. The degree of early life stress is associated with the severity of psychiatric disorders and disability in adulthood. Methodology: We conducted a search of two databases (PubMed and SciELO), limited to the time span 1990-2010, using the following keywords: child abuse, maltreatment, early stress, and psychiatric disorders. Thirty-one papers were selected for this review. Results: We found that the subtypes of early life stress such as emotional and physical neglect and sexual, emotional, and physical abuse have associations with several psychiatric disorders, but the Borderline Personality Disorder and Mood Disorders are more associated with the categories listed. Conclusions: Exposure to adversities in childhood and adolescence is predictive of psychiatric disorders in adulthood. More studies are needed to understand the mechanisms by which early life stress is a risk factor for future psychopathology.

Early life stress, HPA axis, and depression

Considerable evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology, especially depression. The most recent studies reviewed herein suggest that early life stressors are associated with an increased risk for mood disorders in adulthood. This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and depression and the role of early life stress as an important risk factor for HPA axis dysregulation. The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortisolemia and reduced inhibitory feedback. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the depressive syndrome. Interestingly, persistent HPA hyperactivity has been associated with higher rates of relapse. These studies suggest that an evaluation of the HPA axis during antidepressant treatment may help identify patients who are at a higher risk for relapse. These findings suggest that this dysregulation of the HPA axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. Evidence has consistently demonstrated that glucocorticoid receptor function is impaired in major depression, but few studies have assessed the activity of mineralocorticoid receptors in depression. Thus, more studies are needed to elucidate this issue.

Efeitos das células tronco adultas de medula óssea e do plasma rico em plaquetas na regeneração e recuperação funcional nervosa em um modelo de defeito agudo em nervo perfiférico em rato

OBJETIVOS: Foram avaliados os efeitos do uso de células tronco da medula óssea (CTM) e do plasma rico em plaquetas (PRP) na regeneração de nervos periféricos, utilizando um modelo estabelecido de regeneração de nervo ciático em ratos. MÉTODOS: Um defeito nervoso de 10 mm foi reconstruído com a utilização de um tubo de silicone preenchido com CTM, PRP ou ambos. O grupo controle recebeu somente o tubo de silicone. Foi realizado ainda um quinto grupo no qual o intervalo foi reconstruído utilizando o segmento ressecado do nervo. A função motora foi testada seis semanas após a cirurgia utilizando teste de marcha. Após o teste motor, os ratos foram anestesiados, o nervo ciático e o tubo foram ressecados e foi realizada microscopia eletrônica de transmissão. RESULTADOS: A análise quantitativa demonstra uma melhora na recuperação funcional no grupo CTM em comparação com os demais grupos. Regeneração nervosa foi demonstrada no grupo CTM por microscopia eletrônica de trasmissão com uma recuperação praticamente completa da anatomia neural. CONCLUSÃO: Nossos resultados sugerem que o uso de CTM associado com a técnica de tubulização promove uma satisfatória recuperação da função motora e regeneração nervosa.

OBJECTIVES: The effects of the use of bone marrow stem cells (MSC) and platelet-rich plasma (PRP) on peripheral nerves regeneration were assessed by using an established model of sciatic nerve regeneration in rats. METHODS: A 10-mm nervous defect was reconstructed by using a silicone tube filled with MSC, PRP or both. The control group received only the silicone tube. A fifth group was also set, in which the interval was reconstructed by using a dried segment of the nerve. Motor function was tested six weeks after surgery, by means of a gait test. After motor test, the rats were anesthetized, the sciatic nerve and the tube were dried, and the transmission electronic microscopy was performed. RESULTS: The quantitative analysis shows an improved functional recovery in MSC group compared to the other groups. Nervous regeneration was reported for MSC group by means of transmission electronic microscopy with an almost full recovery of the neural anatomy. CONCLUSION: Our results suggest that the use of MSC combined with tubing technique yields a satisfactory recovery of motor function and nervous regeneration.

Aspergilose orbitária: relato de caso / Ocular aspergillosis: case report

A presença de fungos na conjuntiva representa constante ameaça para os olhos, pois estes microrganismos, definidos como oportunistas, podem provocar infecções oculares graves, em situações como baixa resistência orgânica, uso de medicações imunossupressoras, antibióticos e alteração epitelial. O objetivo desta, é relatar um caso de aspergilose ocular em paciente imunodeprimida com diagnóstico de hemoglobinúria paroxística noturna. Paciente feminina de 51 anos, internou imunossuprimida e plaquetopênica com diagnóstico de hemoglobinúria paroxística noturna. Ao exame, apresentava acuidade visual de 20/40 OD (olho direito) e percepção luminosa OE (olho esquerdo). Apresentava à biomicroscopia hiposfagma, edema conjuntival bilateral e abscessos conjuntivais múltiplos em ambos os olhos; córnea transparente AO (ambos os olhos). Boa motilidade ocular. A fundoscopia em OD não demonstrava particularidades, em OE havia hemorragia macular. A tomografia computadorizada de órbita revelou infiltração de gordura periocular. A ressonância nuclear magnética mostrou os mesmos achados da tomografia computadorizada, compatível com celulite orbitaria. Foi realizada hemocultura que demonstrou crescimento de Aspergillus sp e a cultura do raspado conjuntival foi negativa. O tratamento sistêmico com anfotericina B demonstrou melhora do quadro ocular, que regrediu completamente após a introdução de colírio de natamicina a 5 por cento. As infecções orbitárias causadas por Aspergillus são incomuns, aparecendo usualmente em pacientes imunodeprimidos. Com freqüência têm curso insidioso, podendo ser confundidas com outros processos orbitarios. O comprometimento imunológico pode inibir a expressão dos sintomas locais e sistêmicos, resultando em confusão diagnóstica. O diagnóstico é feito com exames laboratoriais, mas a cultura pode ser negativa apesar do quadro clínico clássico, dificultando assim, o início do tratamento. Nesses casos inicia-se o manejo, segundo o quadro de sintomas.