Los síntomas melancólicos del filósofo en las Intercenales (1424-1439) de Leon Battista Alberti / The melancholy of the philosopher in the Intercenales (1424-1439)

This essay analyzes the presence of the modern concept of melancholy in the Intercenales (1424-1439) by the humanist Leon Battista Alberti. The Intercenales is a collection of satirical, allegorical and moralizing writings composed with the purpose of entertaining an audience of close friends. In spite of the fact that the term "melancholia" does not appear in the text, this paper argues that Alberti's character of "the philosopher" is melancholic, since he is "ill in the soul" (suffering from morbus animi), and his illness is evidenced by a series of physical and psychological symptoms associated with melancholy in the classical and medieval medical traditions. These symptoms are stomach pain, pallor, insomnia, a rich memory, a propensity to study at night, and an ability to have premonitory dreams. With this characterization Alberti promotes a connection between melancholy and being a genius, which is distinctive to the Renaissance and the basis for the modern concept of melancholy. The essay concludes that the ultimate purpose of the Intercenales is to cure, from a literary and philosophical point of view, the illness of the melancholic philosopher.

Una lectura del caso Schreber / A reading of Schreber case

ara esbozar el problema de la psicosis en psicoanálisis, es importante conocer el análisis que Freud realiza sobre la paranoia en referencia al caso Schreber (Puntualizaciones psicoanalíticas sobre un caso de paranoia -Dementia paranoides- descrito autobiográficamente). De este modo, la paranoia se constituye como un elemento de especial relevancia para interrogar el estatuto de la psicosis, puesto que esquizofrenia o melancolía (en su vertiente psicótica) son tratadas en un segundo plano al ser construidos los fundamentos en el campo psicoanalítico por Freud y Lacan. Por lo tanto, se busca hacer un recorrido teórico del historial clínico de Schreber, presentado por Freud en el año de 1911 y del cual se pueden extraer las primeras teorizaciones del ámbito psicoanalítico en cuanto a la psicosis se refiere.

To outline the problem of psychosis in psychoanalysis, it is important to know Freud's analysis of paranoia in reference to the Schreber case (psychoanalytic notes on a case of paranoia -Dementia paranoides- described autobiographically). In this way, paranoia is constituted as an element of special relevance to interrogate the status of psychosis, since schizophrenia or melancholy (in its psychotic aspect) are treated in the background when the foundations are constructed in the psychoanalytic field by Freud. and Lacan. Therefore, we seek to make a theoretical overview of Schreber's clinical history, presented by Freud in the year 1911 and from which the first theorizations of the psychoanalytic field can be extracted as far as psychosis is concerned.

Detection of prodromal symptoms of relapse in mania & unipolar depression by relatives & patients.

Background & objectives: Detection of prodromal symptoms among patients with mania by their immediate relatives has been seldom examined. We carried out this study to examine the ability to detect and report prodromol symptoms of manic relapses by patients themselves and their relatives. Methods: The ability of patients and their relatives to detect prodromal symptoms was examined among 60 remitted patients, 30 each with DSM-IV diagnoses of bipolar disorder and recurrent depressive disorder, with recent manic/depressive relapses, and their 60 immediate relatives, using an instrument composed of items from common symptom-scales, as well as by unstructured interview. Results: Seventy per cent of patients with mania reported prodromes prior to relapse. This was significantly (P<0.01) less than the proportion of their relatives (97%), as well as the proportion of patients with unipolar depression (93%), reporting prodromal symptoms (P<0.05) among patients. Mean duration of the prodromal period reported by patients with mania was about 20 days (median-10 days); relatives reported durations which were longer by about 5 days. Prodromes of unipolar depression (mean 42.7 days; median- 21 days), were significantly longer than of mania, when reported by patients, but not by their relatives. Differences in reporting of prodromes, between relatives and patients seen in mania, were not observed in unipolar depression. The number and type of prodromal symptoms of mania reported was similar among patients and relatives. Interpretation & conclusions: Our findings showed that relatives of patients with mania were better at detecting prodromes of relapse; thus, input from relatives can improve the early detection of prodromal symptoms to prevent relapses of bipolar disorder.

Manejo psicofarmacológico en la vejez / Psychopharmacological management in elderly patients

Debido al aumento de la tasa de envejecimiento poblacional, las consultas psicopatológicas de este grupo etario se han incrementado, tendencia que parece continuar. La depresión ocupa de un 25 a un 30% de las consultas; suele ser subdiagnosticada y, en consecuencia, subtratada. Debido a esto, es de suma importancia conocer acerca de los procesos biológicos, psicológicos y sociales del envejecimiento, para dar lugar a un diagnóstico y tratamiento adecuados y un uso racional de los psicofármacos. Para ello, debemos conocer la farmacocinética y la farmacodinamia en la población adulta mayor a fin de evitar la polifarmacia, tan frecuente en este grupo. En este trabajo se describen las diferencias farmacocinéticas y farmacodinámicas entre el anciano y el adulto joven, las modificaciones en la absorción, la distribución, el metabolismo y la excreción relacionados con la edad, las diferencias en las respuestas a fármacos en relación a la cantidad y la sensibilidad de receptores en diferentes tejidos y la integridad de los mecanismos homeostáticos. Haciendo eje en los antidepresivos, se presenta una comparación de las vidas medias de estos fármacos y sus metabolitos en adultos y adultos mayores, así como las precauciones sugeridas al inicio y durante la medicación, las dosis para menores y mayores de 80 años y el tiempo de mantenimiento de la misma. Finalmente, se plantea la importancia de seleccionar el antidepresivo que más se ajuste al perfil de la depresión (inhibida, ansiosa) uni o bipolar, que posea mejores posibilidades de cumplimiento y que haya demostrado su eficacia, ala vez que se analizan diferentes estudios controlados, comparados y aleatorizados del uso de antidepresivos en adultos mayores.

A rise in the rate of population ageing has led to an increase in the number of psychopathological consultations across this age group, which is an ongoing trend. Depression accounts for 25 % to 30 % of consultations, and is usually underdiagnosed and, consequently, undertreated. it is therefore extremely important to be acquainted with the biological, psychological and social processes involve in ageing, since this will allow an appropriate treatment and diagnosis, as well as a rational use of psychopharmacological drugs. Hence, it is necessary to know about the pharmacokinetics and pharmacodynamics in elderly adult population to avoid plypharmacy, which is so frequent within this group. This article provides a description of the pharmacocinetic and pharmacodynamic differences between the elderly individual and the young adult, the changes in the absorption, distribution, metabolism, and excretion related with ageing, as well as the differences in the responses to pharmacological drugs, in terms of the quantity and sensitivity of the receptors from different tissues, and the integrity of the homeostatic mechanisms. A comparison is made, among adults and elderly adults, between the medium lifetime of such pharmacological drugs and the¡r metabolites, laying emphasis on antidepressants. The article also makes reference to the precautions that are suggested at the beginning of and during the administration of the medications, the doses for patients below and above the age of 80 years-old, as well as the length of maintenance of such doses. Finally, we discuss the importance of selecting an antidepressant that better adjusts to the depression profile (covert, anxious), unipolar or bipolar, that can offer a better chance of performance and that has proven efficacy. We also analyse the different controlled, comparative and randomized studies on the use of antidepresants in elderly adults.

Homicídio seguido de suicídio: relato de caso / Homicide followed by suicide: case report

Objetivo: Examinar o fenômeno clínico de homicídio seguido de suicídio (HS) a partir de um caso no qual o desfecho de suicídio não ocorreu por motivos alheios à vontade e às ações do sujeito. Descrição do caso: Trata-se do caso de um homem que matou sua namorada por ciúmes, por ocasião do término do relacionamento entre ambos, tentando, a seguir, o suicídio. No presente artigo, é dada especial ênfase aos aspectos forenses do caso, avaliado para fins de determinação de responsabilidade penal e acompanhado no Instituto Psiquiátrico Forense Dr. Maurício Cardoso, Porto Alegre (RS). Comentários: Ressalta-se que, ao se modificar o desfecho de um caso típico de HS, por não ter se consumado o suicídio do homicida, dois aspectos assumem relevância: as consequências legais a serem enfrentadas pelo sujeito e o manejo do impacto psíquico no sobrevivente. Do ponto de vista da prevenção, o conhecimento do fenômeno HS e dos fatores descritos como associados a ele justificaria uma constante atenção ao tema por parte dos profissionais de saúde mental. O presente relato foi autorizado pelo paciente através de termo de consentimento livre e esclarecido.

Objective: The clinical phenomenon of homicide followed by suicide (HS) is examined through a case in which suicide was avoided despite the individual’s will and actions. Case description: A man killed his girlfriend at the end of the relationship because of jealousy. After that, he attempted suicide. Special emphasis is given to the forensic aspects of the case, which has been assessed to determinate the individual’s criminal responsibility and has been followed up at the Forensic Psychiatric Institute Dr. Maurício Cardoso, in Porto Alegre, state of Rio Grande do Sul, Brazil. Comments: When the outcome of a typical case of HS is modified and the suicide of the murderer is not accomplished, two aspects become important: the legal consequences to be faced by the murderer and the management of the psychological impact on the survivor. Regarding prevention, the knowledge of HS and its associated factors require constant attention by mental health professionals. This report was authorized by the patient by means of informed consent.

El modelo tetradimensional clínico y neurobiológico del síndrome depresivo / The neurobiological and clinical tetradimensional model of the depressive syndrome

Se expone el concepto del síndrome depresivo como un hundimiento global o parcial de la vitalidad del ser humano, que puede afectar a sus cuatro vectores: el estado de ánimo, el impulso de acción, la sintonización con el mundo exterior y la regulación de los ritmos. Con arreglo a la causalidad fundamental de este síndrome se distinguen cuatro categorías de enfermedad depresiva: la depresión endógena, la psicógena, la situacional y la somató gena. Los factores causales inmediatos, o sea, los factores patogénicos, toman la forma de una serie de mecanismos neurobiológicos encadenados en cascada. Entre las cuatro dimensiones clínicas de la depresión (humor depresivo, anergia, discomunicación y ritmopatía) los mecanismos patogénicos neuroquímicos y neuroquímicos y neurofisiológicos y la acción farmacodinámica de los productos antidepresivos como una ordenación al tiempo clínica, neurobiológica y psicofarmacológica. Finalmente se orienta el enfoque de la detección y el diagnóstico de la depresión en el marco de l modelo tetradimesional, para lo cual se cuenta con un cuestionario cuyo resultado se plasma en forma de un depresograma.

The concept of depressive syndrome as a global or partial sinking or demise of human vitally is presented. This process affects four vectors of vitality: mood state, impulse to action, syntony with the external world, and rhythm regulation. On the basis of the syndrome's causality, four categories of depressive illness are de described: endogenous, psychogenic, situational and somatogenic. Immediate or pathogenic causal factors take the shape of a chain or a cascade of neurobiological mechanisms. A certain interaction is established between the four clinical dimensions of depression (depressive mood, anergia, miscommunication and rhythmopathy), the neurochemical and neurophysiological pathogenic mechanisms and the pharnacodynamic action of the antidepressants that lead to the conception of a tetra dimensional model of depression as a series of simultaneous clinical, neurobiological and psychopharmacological orders. Finally, the detection and diagnosis of depression in the context of the tetra dimensional model is presented, based on the use of a questionnaire that is then elaborated in the form of a depressogram or diagrammatic representation.

Psychological distress in patients listed for liver transplantation / Distress psicológico em pacientes na lista de espera para transplante de fígado

PURPOSE: To assess the level of depression in patients listed for liver transplantation. METHODS: Sixty-four adult patients, listed for liver transplantation, were submitted to psychological evaluation, including assessment of depression by means of the Beck Depression Inventory. RESULTS: Twenty-two percent of the patients had mild/major depression. The group consisted mainly of male patients aged 47 on average, with a history of alcohol abuse and a Meld (Model for End-Liver Disease) value of 14.5. Patients that had been awaiting liver transplant longer presented less severe liver disease according to the Child-Pugh criteria. CONCLUSION: It is extremely important to assess psychological distress in patients listed for liver transplantation. An interdisciplinary approach is essential to improve the patients' quality of life both in the pre- and post-transplant periods.

OBJETIVO: Avaliar o nível de depressão de doentes que aguardam em fila para transplante de fígado. MÉTODOS: Sessenta e quatro pacientes adultos, com indicação para transplante de fígado, foram submetidos à avaliação psicológica, incluindo depressão, através do Beck Depression Inventory, após a inclusão em lista de espera. RESULTADOS: Vinte e dois por cento dos pacientes apresentaram depressão moderada/grave. O perfil deste grupo foi caracterizado como sexo masculino, com idade média de 47 anos, presença de alcoolismo e Meld (Model for End-Liver Disease) de 14,5. Constatou-se que pacientes há mais tempo em lista apresentaram menor gravidade da doença hepática segundo a classificação de Child-Pugh. CONCLUSÃO: Ressalta-se a importância de avaliar o estado emocional de pacientes em fila de espera para transplante de fígado e da atuação interdisciplinar para melhoria da qualidade de vida dos pacientes, inclusive no pós-transplante.

¿Qué o quién nos espera? / ¿What or who is waiting for us?

Con el fin de proyectar el presente ensayo a la realidad actual de la niñez de nuestro país, es posible remontarnos a las noticias que a diario escuchamos o leemos, y de las cuales más del 60% de la niñez es protagonista. Las siguientes noticias son tomadas de los titulares de los 2 últimos meses (septiembre ­ octubre de 2002) de los diarios de la ciudad de Medellín.

In order to project this essay to the current reality of childhood in our country, it is possible to go back to the news we hear or read daily, and of which more than 60% of children are protagonists. The following news are taken from the headlines of the last 2 months (September - October 2002) of the newspapers in the city of Medellín.