Family care of people with severe mental disorders: an integrative review / Cuidado familiar de pessoas com doenças mentais graves: uma revisão integrativa / Cuidado familiar de la persona con trastorno mental grave: una revisión integradora

OBJECTIVE: to analyze the scientific literature on home-based family care of people with severe mental illness. METHOD: integrative review of 14 databases (CINALH, Cochrane Plus, Cuidatge, CUIDEN, Eric, IBECS, EMI, ISOC, JBI COnNECT, LILACS, PsycINFO, PubMed, SciELO, and Scopus) searched with the key words "family caregivers", "severe mental illness", and "home" between 2003 and 2013. RESULTS: of 787 articles retrieved, only 85 met the inclusion criteria. The articles appeared in 61 journals from different areas and disciplines, mainly from nursing (36%). The countries producing the most scientific literature on nursing were Brazil, the UK, and the US, and authorship predominantly belonged to university centers. A total of 54.12% of the studies presented quantitative designs, with descriptive ones standing out. Work overload, subjective perspectives, and resources were the main topics of these papers. CONCLUSIONS: the international scientific literature on home-based, informal family care of people with severe mental disorder is limited. Nursing research stands out in this field. The prevalent topics coincide with the evolution of the mental health system. The expansion of the scientific approach to family care is promoted to create evidence-based guidelines for family caregivers and for the clinical practice of professional caregivers. .

OBJETIVO: analisar a produção científica sobre o cuidado familiar de pessoas com transtorno mental grave em casa. MÉTODO: revisão integrativa de 14 bases de dados (CINALH, Cochrane Plus, Cuidatge, CUIDEN, Eric, IBECS, EMI, ISOC, JBI Connect, LILACS, PsycInfo e PubMed, SciELO, e Scopus), com as palavras-chave "cuidadores familiares", "TMG" (transtornos mentais graves ) e "casa", realizada entre 2003 e 2013. RESULTADOS: dos 787 artigos retornados, somente 85 atenderam os critérios de inclusão. Os artigos vieram de 61 periódicos de diferentes áreas e disciplinas, principalmente de enfermagem (36%). Os países com maior produção científica sobre enfermagem foram o Brasil, o Reino Unido e os Estados Unidos, e a autoria era predominantemente de centros universitários. Um total de 54,12% dos estudos apresentou delineamento quantitativo, e os descritivos se destacaram. Os principais temas desses trabalhos foram sobrecarga de trabalho, perspectivas subjetivas e recursos. CONCLUSÕES: a produção cientifica internacional sobre o cuidado familiar informal de pessoas com doenças mentais graves em casa é limitada. A pesquisa em enfermagem se destaca nesse campo. Os temas prevalentes coincidem com a evolução do sistema de saúde mental. Estimula-se a expansão da abordagem científica do cuidado familiar de modo a encontrar evidências para criar guias para cuidadores familiares e para a prática clínica de cuidadores profissionais. .

OBJETIVO: analizar la producción científica sobre el cuidado familiar de la persona con trastorno mental grave en el hogar familiar. MÉTODO: revisión integradora en 14 bases de datos (CINALH, Cochrane Plus, Cuidatge, CUIDEN, Eric, IBECS, IME, ISOC, JBI ConNECT, LILACS, PsycInfo, PubMed, SciELO y Scopus), con las palabras clave "cuidadores familiares", "TMG" y "hogar"; realizada entre 2003 y 2013. RESULTADOS: de 787 artículos recuperados, sólo 85 cumplieron con los criterios de inclusión. Los artículos procedieron de 61 revistas de diferentes áreas y disciplinas destacando la disciplina de enfermería (36%). Los países con mayor producción científica sobre enfermería fueron Brasil, Reino Unido y EEUU. En la autoría predominaron los centros universitarios. El 54,12% de los estudios presentó diseño cuantitativo, sobresaliendo los descriptivos. Las temáticas destacadas fueron sobrecarga, perspectivas subjetivas y recursos. CONCLUSIONES: la producción científica internacional sobre el cuidado informal familiar de la persona con trastorno mental grave, en el contexto del hogar familiar, es limitada. En este campo, destaca la investigación de enfermería. Las temáticas prevalentes coinciden con la evolución del sistema de salud mental. Se estimula la ampliación del abordaje científico del cuidado familiar con el fin de encontrar evidencias para la elaboración de guías de cuidadores familiares y para la práctica clínica de cuidadores profesionales. .

Changes in gene expression following androgen receptor blockade is not equivalent to androgen ablation by castration in the rat ventral prostate.

Involution of the rat ventral prostate and concomitant modulation of gene expression post-castration is a well- documented phenomenon. While the rat castration model has been extensively used to study androgen regulation of gene expression in the ventral prostate,it is not clear whether all the gene expression changes post-castration are due to androgen depletion alone. To obtain insights into this, we performed differential display reverse transcriptase polymerase chain reaction (DD-RT-PCR) which resulted in the identification of castration and/or flutamide-regulated genes in the rat ventral prostate. These include clusterin, methionine adenosyl transferase II alpha, and prostate-specific transcripts such as PBPC1BS, S100RVP and A7. While clusterin, PBPC1BS and methionine adenosyl transferase II alpha are regulated by both castration and flutamide, S100 RVP and A7 are regulated by castration alone. Interestingly, we show that flutamide, unlike castration, does not induce apoptosis in the rat ventral prostate epithelium, which could be an underlying cause for the differential effects of castration and flutamide treatment. We propose that castration leads to enrichment and depletion of stromal and epithelial cell types, respectively, resulting in erroneous conclusions on some of the cell type-specific transcripts as being androgen regulated.

Effects of endocrine disrupting chemicals on expression of phospholipid hydroperoxide glutathione peroxidase mRNA in rat testes

Phospholipid hydroperoxide glutathione peroxidase(PHGPx), an antioxidative selenoprotein, is modulated byestrogen in the testis and oviduct. To examine whetherpotential endocrine disrupting chemicals (EDCs) affectthe microenvironment of the testes, the expression patternsof PHGPx mRNA and histological changes were analyzedin 5-week-old Sprague-Dawley male rats exposed to severalEDCs such as an androgenic compound [testosterone (50,200, and 1,000microg/kg)], anti-androgenic compounds [flutamide(1, 5, and 25mg/kg), ketoconazole (0.2 and 1mg/kg), anddiethylhexyl phthalate (10, 50, and 250mg/kg)], andestrogenic compounds [nonylphenol (10, 50, 100, and 250mg/kg), octylphenol (10, 50, and 250mg/kg), and diethyl-stilbestrol (10, 20, and 40microg/kg)] daily for 3 weeks via oraladministration. Mild proliferation of germ cells andhyperplasia of interstitial cells were observed in the testesof the flutamide-treated group and deletion of thegerminal epithelium and sloughing of germ cells wereobserved in testes of the diethylstilbestrol-treated group.Treatment with testosterone was shown to slightly decreasePHGPx mRNA levels in testes by the reverse transcription-polymerase chain reaction. However, anti-androgeniccompounds (flutamide, ketoconazole, and diethylhexylphthalate) and estrogenic compounds (nonylphenol,octylphenol, and diethylstilbestrol) significantly up-regulated PHGPx mRNA in the testes (p<0.05). Thesefindings indicate that the EDCs might have a detrimentaleffect on spermatogenesis via abnormal enhancement ofPHGPx expression in testes and that PHGPx is useful as abiomarker for toxicity screening of estrogenic or anti-androgenic EDCs in testes.

Effect of Flutamide in Mouse Spermatogenesis and on the Function of Seminal Vesicle and Prostate

RESUMEN: La espermatogénesis está regulada por el eje hipotálamo-hipófisis-gónada, y los andrógenos juegan un rol fundamental en sus últimas etapas. La administración del antiandrógeno flutamida interfiere con ella y con la función de órganos andrógeno dependientes (próstata (P) y vesícula seminal (VS)). En este estudio se inyectó flutamida (10 mg/Kg peso corporal) a 10 ratones y vehículo al control(n=6). Los ratones se sacrificaron a las 24(n=5) y 72(n=5) horas. En cortes de testículo se midió el diámetro del túbulo (TD) y la altura del epitelio (EH). P y VS se maceraron, y se determinaron las concentraciones de fructosa (VS) y zinc (P). No existe diferencia significativa en el TD entre los grupos. Sin embargo, el grupo de 72 h presenta menor EH respecto al control (p<0.01). La fructosa es menor sólo a las 72 h (p<0.01), intervalo en el cual se presenta la mayor concentración de zinc (p<0.01). La disminución de la EH se explicaría por el desprendimiento de las espermátidas elongadas, debido al bloqueo del efecto de la testosterona, sin reflejarse en el TD a intervalo corto. La disminución de fructosa refleja claramente la deprivación de andrógenos, en tanto que la concentración prostática aumentada a 72 hrs sugiere deficiencia en la secreción de zinc.

Influence of ovariectomy and flutamide treatment on vaginal tissue and body weight

To determine the effect of flutamide on vaginal histology, and to ascertain whether flutamide regulates body weight gain in the ovariectomized rat model. We chose 36 sexually mature female Wistar-Albino rats in this study. The study took placed in the Department of Medical Science Application and Research Center of Dicle University, Diyarbakir, Turkey, in 2002. We divided the model rats into 3 groups: group 1 - control group, group 2 - sham-operated group and group 3 - bilaterally ovariectomized group. In addition, we gave flutamide to group 3. We found that the body weight was higher in the ovariectomized rats than the control rats. Furthermore, the body weight decreased a little after flutamide therapy. The thickness in the vaginal epithelium of the control group decreased, moreover, the appearance of stromal tissue was rather loose. After flutamide applications, infiltration of the stromal cells increased, the vaginal epithelial layer thickened and became keratinized. Microscopic papillae and anatomical processes appeared in the flutamide treated group. We observed that the antiandrogen drug flutamide is hormonally active and may exhibit estrogenic-antiestrogenic activity in rats. Our study may be a source for further research examining the relationship between the androgen receptor antagonist flutamide and reproductive function in female rats

Tissue alterations in the Guinea pig lateral prostate following antiandrogen flutamide therapy

The flutamide antiandrogenic effects on the Guinea pig male prostate morphology in puberal, post-puberal and adult ages were evaluated in the present study. Daily-treated group animals received flutamide subcutaneous injection at a dose of 10 mg/Kg body weight for 10 days. The control group animals received a pharmacological vehicle under the same conditions. The lateral prostate was removed, fixed and processed for light and transmission electron microscopy. The results revealed an increase of the acinus diameter in the treated puberal animals and straitness in the stromal compartment around the acini. The epithelial cells exhibited cubic phenotype. In the post-puberal and adult animals, a decrease of the acinus diameter was observed, as well as an increase of the smooth muscle layer and presence of the folds at epithelium. The ultrastructural evaluation of the secretory cells in the treated group demonstrated endomembrane enlargement, mainly in the rough endoplasmic reticulum and Golgi apparatus. In addition, a decrease of the microvilli and alterations in the distribution patterns and density of the stromal fibrillar components were observed. In conclusion, the flutamide treatment exerts tissue effects on the lateral prostate, promoting stroma/epithelium alterations.

Effects of Tributyltin Chloride on the Reproductive System in Pubertal Male Rats

Detrimental effects of tributyltin (TBT) chloride on the reproductive system were investigated in pubertal male rats. Sixty Sprague-Dawley rats aged with 35 days were assigned to six different groups; negative control receiving vehicle, positive control receiving methyltestosterone (10 mg/kg B.W.), TBT chloride (5 mg/kg B.W., 10 mg/kg B.W., and 20 mg/kg B.W.), and a combination of TBT chloride (10 mg/kg B.W.) and flutamide (10 mg/kg B.W). The animals were treated with test compounds by oral gavage daily for 10 days and sacrificed on the next day of the final treatment. The treatment with TBT chloride at the doses of 10 and 20 mg/kg B.W. significantly decreased seminal vesicle weights, compared to the negative control. The combined treatment of TBT chloride and flutamide caused a significant decrease in accessory sex organ weights, compared to the control and TBT chloride treatments. The treatment with TBT chloride or in the combination with flutamide increased detached debris and sloughed cells in the tubules of epididymis and narrowed seminal vesicles. In addition, the combined treatment with TBT chloride and flutamide caused a noticeable increase in serum androgen level, compared to the negative control.These results suggest that TBT chloride exposed during pubertal period cause partial reproductive disorders in male rats.

Morphologic and biochemical changes in male rat lung after surgical and pharmacological castration

The morphology of the rat lung was studied by light microscopy in different situations: after surgical and pharmacological castration and after administration of testosterone to the castrated rat to determine if the androgen is required to maintain the normal morphology of the lung. We also determined the effect of flutamide on the phospholipid composition of both the surfactant and microsomes of the lung. Rats were separated into five groups: I - control non-castrated rats, II - castrated rats sacrificed 21 days after castration, III - castrated rats that received testosterone daily from day 2 to day 21 after castration, IV - castrated rats that received testosterone from day 15 to day 21 after castration, and V - control rats injected with flutamide for 7 days. The amount of different phospholipids in the surfactant and microsomes of the lung was measured in group I and V rats. At the light microscopy level, the surgical and pharmacological castration provoked alterations in the morphology of the lung, similar to that observed in human lung emphysema. The compositions of surfactant and microsomes of the lung were similar to those previously reported by us for the surgically castrated rats. These results indicate that androgens are necessary for the normal morphology as well as for some metabolic aspects of the lung.

Flutamida no tratamento da acne / Flutamide in acne treatment

FUNDAMENTOS - A flutamida é potente antiandrógeno näoö-esteróide, deprovido de outras propriedades hormonais ou näo-hormonais, utilizado no tratamento do câncer prostático avançado, e que possui marcada atividade no tratamento do hirsutismo e no bloqueio das glândulas sebáceas. OBJETIVOS - Avaliar a eficácia e segurança da flutamida oral em doses de 250mg/dia na acne näo responsiva aos tratamentos convencionais. MATERIAL E MÉTODOS - Trinta e oito mulheres voluntárias sadias, em idade fértil, com diferentes graus de intensidade de acne e níveis séricos de andrógenos normais foram tratadas com flutamida oral, 125mg/2x/dia por um período de até 18 meses, com acompanhamento clínico e laboratorial bimensal. RESULTADOS - Houve involuçäo total das lesöes clínicas em 34,2 porcento das pacientes, reduçäo de mais da metade da intensidade da acne em 47,4 porcento e reduçäo de menos de um terço das lesões em 7,8 porcento das pacientes. Em 10,6 porcento o quadro manteve-se inalterado ou até pior. Com essa dosagem, näo se observaram efeitos colaterais, clínicos ou laboratoriais, de monta. Após a suspensäo do fármaco, cerca de um terço das pacientes experimentou recidiva do quadro acnéico, com intensidades variáveis. CONCLUSÄO - Muito embora näo podendo ser considerada droga de rotina no tratamento da acne feminina, a flutamida pode constituir-se em alternativa terapêutica bastante útil no combate do hiperandrogenismo cutâneo para algumas pacientes selecionadas

The abnormal development of male sex organs in the rat using a pure antiandrogen and a 5-alpha-reductase inhibitor during gestation

Fueron estudiados los efectos de un antiandrógeno puro, la flutamida, y un inhibidor de la 5Ó-reductasa, la finestarida, sobre el desarrollo prenatal de los genitales externos y la próstata de la rata. En los grupos controles la distancia anogenital fue de 3.1 ñ 0.24mm en los recién nacidos machos, y de 1.2 ñ 10mm en las hembras. En los machos se observaron esbozos prostáticos en la porción cefálica de la uretra. Una dosis de 6mg/Kg/día de flutamida produjo una disminución signficativa de la distancia anogenital de los machos, pero no alteró el desarrollo de la próstata. A dosis más altas, la flutamida produjo la completa feminización de los genitales externos e inhibió la formación de la próstata. La administración de 2,8 y 16mg/Kg/día de finestarida condujo a una progressiva disminución de la distancia anogenital de los recién nacidos machos, pero no produjeron la abolición del desarrollo prostático. Sin embargo, la administración conjunta de 2mg/Kg/día de finestarida y 6mg/Kg/día de flutamida produjo una completa inhibición en el desarrollo de los esbozos prostáticos

Effect of antiandrogens on some key enzymes of glycolysis in epididymis and ventral prostate of rat.

Effect of three antiandrogens: cyproterone acetate (5 mg/day, sc), flutamide (5 mg/day, sc) and STS-557 (5 mg/day, po) and an estrogen, estradiol dipropionate (5 micrograms/day, sc) on some key enzymes of carbohydrate metabolism was investigated in adult rat epididymis and ventral prostate. Antiandrogens were administered for 21 days and estrogen for 14 days. All of them caused a significant decrease in the weight of epididymis, seminal vesicles and ventral prostate. A significant decrease in the specific activities of enzymes (hexokinase, phosphofructokinase, aldolase, glyceraldehyde phosphate dehydrogenase, pyruvate kinase, glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase) occurred only in the organs of estrogen treated rats; activities of some of the enzymes were lowered also in the prostate of STS-557 treated rats. Flutamide and cyproterone acetate were ineffective in this regard. The possible factors responsible for the ineffectiveness of synthetic antiandrogens in influencing epididymal metabolism are discussed.

Effects of castration, androgen replacement and flutamide treatment on the contractile function of the rat prostate

La actividad contráctil de la próstata fue registrada in vivo mediante un sistema de videograbación. En los animales controles fue registrado un aumento en el tono glandular luego de la aplicación de estímulos eléctricos sobre el ganglio hipogástrico o de la administración de norepinefrina o acetilcolina. En los animales castrados esta respuesta experimentó una progresiva declinación, aunque en las células musculares prostáticas no se observaron alteraciones ultraestructurales. Sin embargo, la actividad rítmica espontánea despareció tempranamente después de la castración. Tanto la testosterona como la 5 alfa-dihidrotestosterona restablecieron la función contráctil normal. También el tratamiento con Flutamida produjo una declinación en las respuestas, pero éstas mostraron valores inferiores a los obtenidos con la castración quirúrgica. Ni la vasectomía ni la epididimectomía produjeron alteraciones en la conducta contráctil de la próstata