Attention in schizophrenia and in epileptic psychosis

The adaptive behavior of human beings is usually supported by rapid monitoring of outstanding events in the environment. Some investigators have suggested that a primary attention deficit might trigger symptoms of schizophrenia. In addition, researchers have long discussed the relationship between schizophrenia and the schizophrenia-like psychosis of epilepsy (SLPE). On the basis of these considerations, the objective of the present study was to investigate attention performance of patients with both disorders. Patient age was 18 to 60 years, and all patients had received formal schooling for at least four years. Patients were excluded if they had any systemic disease with neurologic or psychiatric comorbidity, or a history of brain surgery. The computer-assisted TAVIS-2R test was applied to all patients and to a control group to evaluate and discriminate between selective, alternating and sustained attention. The TAVIS-2R test is divided into three parts: one for selective attention (5 min), the second for alternating attention (5 min), and the third for the evaluation of vigilance or sustained attention (10 min). The same computer software was used for statistical analysis of reaction time, omission errors, and commission errors. The sample consisted of 36 patients with schizophrenia, 28 with interictal SLPE, and 47 healthy controls. The results of the selective attention tests for both patient groups were significantly lower than that for controls. The patients with schizophrenia and SLPE performed differently in the alternating and sustained attention tests: patients with SLPE had alternating attention deficits, whereas patients with schizophrenia showed deficits in sustained attention. These quantitative results confirmed the qualitative clinical observations for both patient groups, that is, that patients with schizophrenia had difficulties in focusing attention, whereas those with epilepsy showed perseveration in attention focus.

Decision support system for the diagnosis of schizophrenia disorders

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.

Estudo de confiabilidade da Escala Calgary de Depressäo para Esquizofrenia / Reliability study of the Portuguese version of the Calgary Depression Rating Scale to Schizophrenia

Os sintomas depressivos têm um impacto importante no curso e na qualidade de vida dos pacientes com esquizofrenia, podendo aparecer a qualquer momento ao longo da evoluçäo da doença. Como a identificaçäo e a mensuraçÝo dos sintomas depressivos säo consideradas difíceis nessa populaçäo, foi desenvolvida uma escala especialmente para esta, a Escala Calgary de Depressäo para Esquizofrenia (ECDE). O objetivo deste estudo foi avaliar a confiabilidade entre examinadores da versäo em português da ECDE. Quinze pacientes com esquizofrenia pelos critérios do DSM-IV foram avaliados por dois examinadores. Na análise dos itens a confiabilidae variou entre 0,63 e 1,00, mostrando bom desempenho da escala em nosso meio

Avaliaçåo da eficácia, tolerabilidade e segurança da sertalina (50 mg a 200 mg) durante 8 semanas no tratamento de 150 pacientes ambulatoriais com depressåo maior / Evaluation of effectiveness, tolerance and safety of sertraline (50 mg to 200 mg) during 8 weeks in the treatment of 150 patients outpatients with major depression

Os resultados de um estudo multicêntrico, aberto e nåo comparativo, no qual foram avalaiados 150 pacientes com diagnóstico de depressåo maior de acordo com os critérios da DSM-III-R, såo relatados. Os pacientes selecionados foram inicialmente submetidos a um período simples-cego, durante 2 semanas. Após essa fase, aqueles que preenchiam os critérios de inclusåo e exclusåo iniciaram o tratamento com sertralina 50mg/dia que poderia ser aumentada gradualmente até 200mg/dia, incrementos de 50mg, e intervalos de no mínimo 2 semanas, caso a resposta ao tratamento fosse insatisfatória, segundo a avaliaçåo do investigador. O tratamento com sertalina mostrou-se altamente eficaz no alívio da depressåo. como também nos sintomas associados ao quadro depressivo como, ansiedade, transtornos do sono, agitaçåo ou inibiçåo psicomotora, trabalho e atividades, entre outros. Um total de 84,2 por cento dos pacientes responderam satisfatoriamente ao tratamento com sertralina em doses felíveis. Em relaçåo à tolerabilidade, um total de 54 por cento dos pacientes apresentaram algum efeito adverso ao longo do tratamento, porém estes efeitos foram geralmente de intensidade leve ou moderada e apenas 4,6 por cento dos pacientes interromperam o tratamento prematuramente devido à ocorrência de eventos adversos

Experiencia da unidade psiquiatrica no Hospital Sao Paulo. / The experience of the psychiatric unit at the Hospital Sao Paulo

Os autores apresentam a experiencia da Unidade Psiquiatrica do Hospital Sao Paulo (hospital escola da Escola Paulista de Medicina. Relatam as dificuladades iniciais da implantacao de uma unidade psiquiatrica em hospital geral, seus problemas e preconceitos. Concluem ter sido a experiencia importante no sentido de se efetuar um "tipo cirurgico de psiquiatria", no dizer de Maxwell Jones e de permitir a integracao da psiquiatria com as demais disciplinas medicas

Psiquiatria e hospital geral. / Psychiatry and general hospital

Os autores relatam a experiencia vivenciada pelo Departamento de Psiquiatria da Escola Paulista de Medicina no hospital geral de ensino daquela instituicao, o Hospital Sao Paulo. Descrevem a importancia da existencia da unidade psiquiatrica, do servico de interconsultas e da presenca de psiquiatra fazendo parte da equipe de plantao do pronto-socorro geral. Discutem como a existencia de tais servicos contribuiu para uma mudanca de atitude do medico geral em relacao a situacao emocional dos pacientes e do atendimento de urgencia e encaminhamento de pacientes com problematica psiquiatrica

Estudo dos defeitos da impregnacao neuroleptica em pacientes esquizofrenicos atraves do metodo de Rorschach. / Effects of neuroleptic impregnation in schizophrenic patients by Rorschach method

Os autores pretendem estudar os efeitos do fenomeno de impregnacao neuroleptica - sindrome extrapiramidal - no processo terapeutico de pacientes exquizofrenicos. E bem conhecido que a impregnacao neuroleptica e o resultado da acao do neuroleptico nos nucleos basais do cerebro. Seus efeitos clinicos levam a uma acao antipsicotica seguida da remissao das alucinacoes e delirios nestes pacientes. Deste modo, pacientes com o diagnostico psiquiatrico de esquizofrenia paranoide (segundo Kraepelin e Bleuler) foram selecionados e submetidos ao exame de Rorschach em dois momentos: antes e durante a impregnacao.Estes pacientes foram selecionados entre aqueles internados no Hospital Psiquiatrico de Vila Mariana. Pacientes entre 25 e 35 anos foram examinadas psiquiatrica e psicologicamente