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1.
Ágora (Rio J. Online) ; 23(1): 2-11, Jan.-Apr. 2020.
Article in Portuguese | LILACS (Americas), INDEXPSI | ID: biblio-1059217

ABSTRACT

RESUMO: O objetivo deste artigo é apresentar em linhas gerais de que maneira a psicose é diagnosticada e tratada pela psicoterapia institucional. Partiremos da tese de doutorado de Tosquelles, na qual a psicose é pensada como fenômeno existencial comparável à experiência de fim de mundo. Trata-se aqui de salientar a importância da compreensão da experiência do doente e de sua elaboração criativa no desenvolvimento do quadro psicótico. Em seguida, analisaremos de que maneira Oury une a teoria de Tosquelles à psicanálise para desenvolver uma clínica multirreferencial e polifônica. No interior desse quadro teórico e prático, buscaremos traçar a inflexão política que Guattari dará à experiência clínica da psicoterapia institucional.


Abstract: The purpose of this article is to outline how psychosis is diagnosed and treated by institutional psychotherapy. We will begin with Tosquelles' doctoral thesis, in which psychosis is thought as an existential phenomenon comparable to the experience of the end of the world. It is important to emphasize the importance of understanding the patient's experience and his creative elaboration in the development of the psychotic picture. Then, we will analyze how Oury unites the theory of Tosquelles to psychoanalysis to develop a multirreferential and polyphonic clinic. Within this theoretical and practical framework we will trace the political inflection that Guattari will attribute to the experience of self-management proposed by institutional psychotherapy.


Subject(s)
Psychotic Disorders , Schizophrenia , Organizations , Psychotherapy
2.
Invest. educ. enferm ; 38(1): [E06], febrero 15 2020. Diagram 1, Tab 1, Tab 2, Tab 3, Tab 4
Article in English | LILACS (Americas), COLNAL | ID: biblio-1051974

ABSTRACT

Objective. To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. Methods. This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient­Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment. Results. Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06) over seven days interval. Conclusion. The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.


Objetivo. Evaluar la efectividad de la terapia Milieu en la reducción de las tasas de conflicto y contención entre los pacientes con esquizofrenia. Métodos. Este estudio utilizó un diseño cuasi experimental con grupo control no equivalente y evaluación pre y posintervención. Cien pacientes con esquizofrenia hospitalizados en salas psiquiátricas en un hospital público en Karnataka (India) se asignaron de forma no aleatoria a los grupos experimental (n=50) y control (n=50). El grupo experimental recibió la terapia de Milieu, además del tratamiento hospitalario de rutina. La terapia de Milieu incluyó la modificación ambiental y la estructuración de las actividades de la sala, el establecimiento de una interacción efectiva con el paciente y la enseñanza a los cuidadores sobre el manejo del comportamiento conflictivo del paciente. El grupo control recibió solamente el tratamiento de rutina en el hospital. Las medidas de resultado (tasas de conflictos y de contención) se evaluaron en ambos grupos en los días de inicio, 2º, 3º y 15º posadmisión. El Patient­Staff Conflict Checklist Shift Report (PCC-SR) se utilizó para la recolección de la información acerca de las tasas de conflicto y contención. Resultados. En comparación con el grupo de control, los participantes del grupo experimental mostraron una disminución en el comportamiento agresivo, el comportamiento de autolesión y el comportamiento de incumplimiento de las reglas generales al inicio y al segundo, tercer y décimo quinto día (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06). Conclusión. Los hallazgos del presente estudio proporcionaron evidencia de la efectividad de la Terapia Melieu en la reducción de comportamientos conflictivos en el paciente esquizofrénico hospitalizado en fase aguda. La Terapia Milieu debe considerarse como una parte integral en los entornos de atención de estos pacientes.


Objetivo. Avaliar a eficácia da terapia Milieu na redução das taxas de conflito e contenção entre pacientes com esquizofrenia. Métodos. Este estudo utilizou um desenho quase-experimental com um grupo controle não equivalente e avaliação pré e pós-intervenção. Cem pacientes com esquizofrenia hospitalizados em salas psiquiátricas em um hospital público de Karnataka (Índia) foram designados não aleatoriamente para os grupos experimental (n = 50) e controle (n = 50). O grupo experimental recebeu terapia Milieu, além de tratamento hospitalar de rotina. A terapia de Milieu incluiu modificação ambiental e estruturação das atividades da enfermaria, estabelecendo uma interação efetiva com o paciente e ensinando os cuidadores sobre o gerenciamento do comportamento conflitante do paciente. O grupo controle recebeu apenas tratamento hospitalar de rotina. As medidas de resultado (taxas de conflito e contenção) foram avaliadas em ambos os grupos nos dias de início, 2, 3 e 15 após a admissão. O Relatório de Mudança de Lista de Verificação de Conflitos entre Pacientes e Funcionários (PCC-SR) foi usado para coletar informações sobre taxas de conflitos e contenção. Resultados. Comparados ao grupo controle, os participantes do grupo experimental mostraram uma diminuição no comportamento agressivo, no comportamento autolesivo e no não cumprimento das regras gerais no início e no segundo, terceiro e décimo quinto dia (F = 4,61, p <0,004, η2 = 0,04; F = 11,92, p <0,001, η2 = 0,11; F = 6,94, p <0,001, η2 = 0,06). Conclusão Os achados do presente estudo forneceram evidências da eficácia da Terapia Melieu na redução de comportamentos conflitantes no paciente esquizofrênico hospitalizado na fase aguda. A terapia Milieu deve ser considerada como parte integrante do ambiente de atendimento desses pacientes.


Subject(s)
Humans , Psychiatric Department, Hospital , Schizophrenia , Self-Injurious Behavior , Inpatients , Milieu Therapy
3.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 27-32, Jan.-Feb. 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1055350

ABSTRACT

Objective: Patients with schizophrenia have visual processing impairments. The main findings from the literature indicate that these deficits may be related to differences in paradigms, medications, and illness duration. This study is part of a large-scale study investigating visual sensitivity in schizophrenia. Here we aimed to investigate the combined effects of illness duration and antipsychotic use on contrast sensitivity function. Methods: Data were collected from 50 healthy controls and 50 outpatients with schizophrenia (classified according to illness duration and medication type) aged 20-45 years old. The contrast sensitivity function was measured for spatial frequencies ranging from 0.2 to 20 cycles per degree using linear sine-wave gratings. Results: Patients with an illness duration > 5 years had more pronounced deficits. Differences in the combined effects of illness duration and antipsychotic use were marked in patients on typical antipsychotics who had been ill > 10 years. No significant differences were found between typical and atypical antipsychotics in patients with an illness duration < 5 years. Conclusion: Visual impairment was related to both long illness duration and medication type. These results should be tested in further studies to investigate pharmacological mechanisms.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Vision Disorders/chemically induced , Psychiatric Status Rating Scales , Schizophrenia/complications , Time Factors , Vision, Ocular/drug effects , Contrast Sensitivity/drug effects , Case-Control Studies , Chlorpromazine/adverse effects , Treatment Outcome , Middle Aged
4.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 22-26, Jan.-Feb. 2020. tab
Article in English | LILACS (Americas) | ID: biblio-1055359

ABSTRACT

Objective: German psychiatrist Kurt Schneider proposed the concept of first-rank symptoms (FRS) of schizophrenia in 1959. However, their relevance for diagnosis and prediction of treatment response are still unclear. Most studies have investigated FRS in chronic or medicated patients. The present study sought to evaluate whether FRS predict remission, response, or improvement in functionality in antipsychotic-naive first-episode psychosis. Methods: Follow-up study of 100 patients at first episode of psychosis (FEP), with no previous treatment, assessed at baseline and after 2 months of treatment. The participants were evaluated with the standardized Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) and for presence of FRS. Results: Logistic regression analysis showed that, in this sample, up to three individual FRS predicted remission: voices arguing, voices commenting on one's actions, and thought broadcasting. Conclusion: Specific FRS may predict remission after treatment in FEP patients. This finding could give new importance to Kurt Schneider's classic work by contributing to future updates of diagnostic protocols and improving estimation of prognosis.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Psychotic Disorders/diagnosis , Psychotic Disorders/drug therapy , Schizophrenia/diagnosis , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Psychiatric Status Rating Scales , Reference Values , Remission Induction , Logistic Models , Predictive Value of Tests , Follow-Up Studies , Treatment Outcome
6.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(6): 499-510, Nov.-Dec. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1055341

ABSTRACT

Objective: To analyze the efficacy and safety of paliperidone palmitate 3-monthly (PP3M) in Latin American patients with schizophrenia vs. rest-of-world (ROW). Methods: We analyzed data from two multinational, double-blind (DB), randomized, controlled phase 3 studies including patients with schizophrenia (DSM-IV-TR) previously stabilized on PP1M/PP3M (open-label [OL] phase). Patients were randomized to PP3M or PP1M (noninferiority study A) and PP3M or placebo (study B) in DB phase. The subgroup analysis included Latin American (Argentina, Brazil, Colombia, Mexico) patients. Primary efficacy endpoints were relapse-free rates (study A) and time-to-relapse (study B). Results: In study A, 63/71 (88.7%) and in study B 38/43 (88.4%) Latin American patients completed the DB phase. In study A, relapse-free percentage was similar in Latin America (PP3M: 97%, PP1M: 100%) and ROW (PP3M: 91%, PP1M: 89%). In study B, median time-to-relapse was not estimable in the Latin American subgroup for either placebo or PP3M groups, nor for the ROW PP3M group; the median time-to-relapse in the ROW placebo group was 395 days. Caregiver burden improved in patients switching from oral antipsychotics (OL baseline) to PP3M/PP1M in DB phase (Involvement Evaluation Questionnaire score mean ± SD change, -9.4±15.16; p < 0.001). Treatment emergent adverse events with PP3M during DB phase were similar in Latin America (study A: 24/34 [70.6%]; study B: 15/21 [71.4%]) and ROW (study A: 318/470 [67.7%]; study B: 84/139 [60.4%]) subgroups. Conclusion: PP3M was efficacious and showed no new safety concerns in patients with schizophrenia from Latin America, corroborating ROW findings. Clinical trial registration: NCT01515423, NCT01529515


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Schizophrenia/drug therapy , Antipsychotic Agents/administration & dosage , Paliperidone Palmitate/administration & dosage , Recurrence , Time Factors , Placebo Effect , Double-Blind Method , Surveys and Questionnaires , Reproducibility of Results , Treatment Outcome , Kaplan-Meier Estimate , Secondary Prevention , Latin America , Middle Aged
7.
Arch. Clin. Psychiatry (Impr.) ; 46(6): 165-168, Nov.-Dec. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1054913

ABSTRACT

Abstract Objective Schizophrenia is a complex and chronic psychiatric disorder. In recent years, studies have found glutamatergic system participation in its etiopathogenesis, especially through aberrant NMDA receptors functioning. Thus, drugs that modulate this activity, as amantadine and memantine, could theoretically be used in its treatment. To perform a systematic literature review about memantine and amantadine use as adjunct in schizophrenia treatment. Methods A systematic review of papers published in English indexed in the electronic database PubMed ® using the terms "memantine", "amantadine" and "schizophrenia" published until October 2016. Results We found 144 studies, 8 selected for analysis due to meet the objectives of this review. Some of these have shown benefits from such drug use, especially in symptoms measured by PANSS and its subdivisions, while others do not. Discussion: The data in the literature about these drugs use for schizophrenia treatment is still limited and have great heterogeneity. Thus, assay with greater robustness are needed to assess real benefits of these drugs as adjuvant therapy.


Subject(s)
Humans , Schizophrenia/drug therapy , Amantadine/therapeutic use , Memantine/therapeutic use , Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors , Placebos , Psychiatric Status Rating Scales , Antipsychotic Agents/therapeutic use , Amantadine/adverse effects , Memantine/adverse effects , Double-Blind Method , Treatment Outcome , PubMed , Adjuvants, Anesthesia/therapeutic use
8.
Rev. chil. neuropsicol. (En línea) ; 14(2): 18-24, dic. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1102362

ABSTRACT

La presente investigación corresponde a un estudio no experimental, transversal y correlacional, cuyo objetivo fue identificar si existe relación entre funcionamiento social (FS) y cognitivo (FC) en pacientes con esquizofrenia, mediante la evaluación del funcionamiento social (SFS) y deterioro cognitivo (MoCA y SCIP-S) en una muestra de 12 pacientes (11 hombres y 1 mujer) entre los 22 y 70 años, de Medellín (Colombia), mediante muestreo no probabilístico por conveniencia. Se encontró que más de la mitad (n = 7) presenta un nivel superior de FS y casi el total de la muestra presenta deterioro cognitivo. Al correlacionar FS y FC se encontró que sólo SFS y MoCA se relacionan significativamente, mientras que la SCIP-S no presenta relación con SFS ni con MoCA. Aunque estos hallazgos no pueden ser concluyentes ni generalizables debido a limitaciones metodológicas, pueden ser usados como antecedente para futuros estudios.


A non-experimental, cross-sectional and correlational study was made, whose objective was to identify if there is a relationship between social functioning (SF) and cognitive functioning (CF) in patients with schizophrenia, through the evaluation of social functioning (SFS) and cognitive impairment (MoCA and SCIPS) in a sample of 12 patients (11 men and 1 woman) between 22 and 70 years old, from Medellín (Colombia), selected by non-probabilistic sampling for convenience. It was found that more than half of the participants (n = 7) present a higher level of SF and almost the total of the sample presents cognitive impairment. When correlating SF and CF it was found that only SFS and MoCA are significantly related, whereas SCIP-S has no relation with SFS or with MoCA. Although these findings cannot be conclusive or generalizable due to methodological limitations, they can be used as a background for future studies.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Schizophrenia/physiopathology , Schizophrenic Psychology , Cross-Sectional Studies
9.
Arch. Clin. Psychiatry (Impr.) ; 46(5): 132-136, Sept.-Oct. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1054906

ABSTRACT

Abstract Background The Brief Negative Symptom Scale (BNSS) assesses the presence and intensity of negative symptoms in schizophrenia. Objectives This study aimed to carry out the BNSS cross-cultural adaptation to the Brazilian Portuguese language and verify its content validity and reliability. Methods This is a methodological study that followed these steps: (1) implementation of the cross-cultural adaptation and translation protocol, (2) BNSS adapted content validation, and (3) reliability assessment. Six experts participated in the adaptation process. The sample consisted of 30 individuals diagnosed with schizophrenia and assisted at the Brazilian Psychosocial Care Center (CAPS), in João Pessoa, Paraíba, Brazil, which was the research setting. Results The cross-cultural adaptation was successful due to the values obtained for each aspect evaluated, such as semantic (0.922), idiomatic (0.910), experiential (0.961), and conceptual equivalence (0.974). The same happened with content validity regarding clarity of language (0.935), practical relevance (0.974), and theoretical relevance (0.948). Cronbach's alpha coefficient was 0.884 for the entire instrument, and the items ranged from 0.865 to 0.882. Discussion The BNSS adaptation process has shown to be satisfactory for use in the Brazilian context, constituting a useful clinical tool for teaching and research.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Psychiatric Status Rating Scales/standards , Schizophrenia/diagnosis , Schizophrenia/physiopathology , Translating , Brazil , Reproducibility of Results , Statistics, Nonparametric
10.
Rev. med. (Säo Paulo) ; 98(4): 241-253, jul.-ago. 2019.
Article in English | LILACS (Americas) | ID: biblio-1023526

ABSTRACT

Introduction: Neural development is an enormously complex and dynamic process. From very early in brain development 'immune cells' play a key role in a number of processes including the formation and refinement of neural circuits, as well as sexual differentiation. There is a growing body of evidence that the immune system also plays an important role in the pathobiology of several neurodevelopmental and neuropsychiatric disorders. Objective: The goal of this article is to review the currently available data concerning the role of the 'immune system' in normal brain development, as well as its role in the pathobiology of neurodevelopmental and neuropsychiatric disorders. Methodology: We conducted a traditional literature search using PubMed and recent special issues of journals to locate relevant review articles. Results: The cellular and molecular processes that make up our 'immune system' are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that the immune system and neuroinflammation play important roles in the pathobiology of at least a subset of individuals with Autism Spectrum Disorder (ASD), schizophrenia, obsessive-compulsive disorder, Tourette syndrome and mood disorders, such as depression, as well as autoimmune and neurodegenerative disorders. Emerging evidence also points to the importance of the 'gut-brain axis' and an individual's microbiome, which can impact an individual's somatic and mental well-being. Conclusions: There are multidirectional interconnections across multiple biological systems in our brains and bodies that are mediated in part by the immune system. At present, however, the 'promise' of this field remains greater than the 'deliverables'. Time will tell whether novel interventions will be developed that will make a positive difference in the care of our patients. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to treatment.


Introdução: O desenvolvimento neural é um processo extremamente complexo e dinâmico. Tao pronto se inicia o desenvolvimento do cérebro, as "células imunológicas" desempenham um papel fundamental em vários processos, incluindo a formação e aperfeiçoamento de circuitos neurais, bem como a diferenciação sexual. Há um crescente corpo de evidências de que o sistema imunológico também desempenha um papel importante na fisiopatologia de diversos transtornos neurodesenvolvimentais e neuropsiquiátricos. Objetivo: O objetivo deste artigo é revisar os dados atualmente disponíveis sobre o papel do "sistema imunológico" em relação ao desenvolvimento normal do cérebro, bem como a fisiopatogenia dos transtornos de neurodesenvolvimento e neuropsiquiátricos. Metodologia: Foi realizada uma pesquisa bibliográfica tradicional para localizar artigos de revisão relevantes. Resultados: Os processos celulares e moleculares que compõem o nosso "sistema imunológico" são cruciais para o desenvolvimento normal do cérebro e a formação e manutenção de circuitos neurais. É cada vez mais evidente que o sistema imunológico e neuroinflamação desempenham papéis importantes na etiopatogenia de pelo menos um subconjunto de indivíduos com autismo, esquizofrenia, transtorno obsessivo-compulsivo, síndrome de Tourette, depressão e transtornos do humor, bem como distúrbios autoimunes e neurodegenerativos. Evidências emergentes também apontam para a importância do eixo intestino-cerebral e do microbioma de um indivíduo em relação à sua saúde e bem-estar somático e mental. Conclusões: Existem interconexões multidirecionais entre múltiplos sistemas biológicos em nossos cérebros e corpos que são mediados em parte pelo sistema imunológico. No momento, no entanto, a "promessa" desse campo continua sendo maior do que os "resultados finais". O tempo dirá se novas intervenções serão desenvolvidas que farão uma diferença positiva no cuidado de nossos pacientes. Também é possível que surjam biomarcadores válidos que orientarão uma abordagem mais personalizada ao tratamento.


Subject(s)
Autistic Disorder , Neuroimmunomodulation , Tourette Syndrome , Microglia , Mood Disorders , Neurodevelopmental Disorders , Autism Spectrum Disorder , Immune System , Immunity, Maternally-Acquired , Obsessive-Compulsive Disorder , Schizophrenia , Stress, Psychological , Cytokines , Depression , Allergy and Immunology
11.
Trends psychiatry psychother. (Impr.) ; 41(2): 104-111, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1014743

ABSTRACT

Abstract Introduction Schizophrenia is a severe mental disorder. While some antipsychotic medications have demonstrated efficacy in treating positive symptoms, there is no widely recognized treatment for negative symptoms, which can cause significant distress and impairment for patients with schizophrenia. Here we describe the rationale and design of the STARTS study (Schizophrenia TreAtment with electRic Transcranial Stimulation), a clinical trial aimed to test the efficacy of a non-pharmacological treatment known as transcranial direct current stimulation (tDCS) for treating the negative symptoms of schizophrenia Methods The STARTS study is designed as a randomized, sham-controlled, double-blinded trial evaluating tDCS for the treatment of the negative symptoms of schizophrenia. One-hundred patients will be enrolled and submitted to 10 tDCS sessions over the left dorsolateral prefrontal cortex (anodal stimulation) and left temporoparietal junction (cathodal stimulation) over 5 consecutive days. Participants will be assessed using clinical and neuropsychological tests before and after the intervention. The primary outcome is change in the Positive and Negative Syndrome Scale (PANSS) negative subscale score over time and across groups. Biological markers, including blood neurotrophins and interleukins, genetic polymorphisms, and motor cortical excitability, will also be assessed. Results The clinical results will provide insights about tDCS as a treatment for the negative symptoms of schizophrenia, and the biomarker investigation will contribute towards an improved understanding of the tDCS mechanisms of action. Conclusion Our results could introduce a novel therapeutic technique for the negative symptoms of schizophrenia. Clinical trial registration: ClinicalTrials.gov, NCT02535676 .


Resumo Introdução A esquizofrenia é um transtorno mental grave. Embora alguns medicamentos antipsicóticos tenham demonstrado eficácia no tratamento de sintomas positivos, não há tratamento amplamente reconhecido para sintomas negativos, o que pode causar sofrimento e prejuízo significativos para pacientes com esquizofrenia. Aqui descrevemos a fundamentação teórica e o design do estudo STARTS (Schizophrenia TreAtment with electRic Transcranial Stimulation), um ensaio clínico destinado a testar a eficácia de um tratamento não farmacológico conhecido como estimulação transcraniana por corrente contínua (ETCC) para tratar os sintomas negativos da esquizofrenia. Métodos O estudo STARTS foi concebido como um ensaio clínico randomizado, controlado por simulação, duplo-cego, avaliando a ETCC para o tratamento dos sintomas negativos da esquizofrenia. Cem pacientes serão incluídos e submetidos a 10 sessões de ETCC sobre o córtex pré-frontal dorsolateral esquerdo (estimulação anódica) e a junção temporoparietal esquerda (estimulação catodal) durante 5 dias consecutivos. Os participantes serão avaliados através de testes clínicos e neuropsicológicos antes e após a intervenção. O desfecho primário é a mudança na pontuação da subescala negativa da Escala da Síndrome Positiva e Negativa (Positive and Negative Syndrome Scale [PANSS]) ao longo do tempo e entre os grupos. Marcadores biológicos, incluindo neurotrofinas e interleucinas do sangue, polimorfismos genéticos e excitabilidade cortical motora, também serão avaliados. Resultados Os resultados clínicos fornecerão informações sobre a ETCC como um tratamento para os sintomas negativos da esquizofrenia, e a investigação dos biomarcadores contribuirá para uma melhor compreensão dos mecanismos de ação da ETCC. Conclusão Nossos resultados podem trazer uma nova técnica terapêutica para o tratamento dos sintomas negativos da esquizofrenia. Registro do ensaio clínico: ClinicalTrials.gov, NCT02535676.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Schizophrenia/therapy , Prefrontal Cortex , Transcranial Direct Current Stimulation/methods , Randomized Controlled Trials as Topic , Double-Blind Method , Treatment Outcome , Middle Aged , Neuropsychological Tests
12.
Ágora (Rio J. Online) ; 22(2): 246-253, maio-ago. 2019.
Article in Portuguese | LILACS (Americas), INDEXPSI | ID: biblio-1004865

ABSTRACT

RESUMO: Baseando-se na citação lacaniana "o dito esquizofrênico . . . sem a ajuda de nenhum discurso estabelecido", o artigo demonstra, desde a análise de fragmentos do caso clínico, como o conceito de discurso funciona como aporte clínico para o diagnóstico de esquizofrenia. A forma singular com que a paciente (não) se liga ao Outro permite analisar, sob um novo aspecto, os sintomas negativos da esquizofrenia. À luz da psicanálise, tais sintomas são abordados levando-se em conta a relação do sujeito com a linguagem. Discute-se, ainda, a função do semblante no discurso e como ela é desconstruída pela ironia do esquizofrênico.


Abstract: Based on the lacanian quotation: "the schizophrenic speech… with no help from a established discourse", this article shows how the concept of discourse works as a clinical contribution to the diagnosis of schizophrenia, by analyzing fragments from clinical cases. The singular way in which the patient (does not) bound to the Other allows the analysis of Schizophrenia's negative symptoms, grounded on new aspects. According to psychoanalysis, those symptoms are approached taking the subject's relation with language into account. This article also presents semblant's function in discourse and how it is deconstructed by the Schizophrenic's irony.


Subject(s)
Humans , Psychoanalysis , Schizophrenia , Oedipus Complex
15.
Fractal rev. psicol ; 31(1): 2-10, jan.-abr. 2019.
Article in Portuguese | LILACS (Americas), INDEXPSI | ID: biblio-989826

ABSTRACT

Objetivo: Analisar os cenários e desafios enfrentados pelos profissionais de saúde na assistência às pessoas com esquizofrenia na Atenção Básica. Método: Pesquisa qualitativa, de caráter descritivo-exploratório, realizada junto a médicos e enfermeiros que atuam na Atenção Básica do município de Pau dos Ferros, Rio Grande do Norte. Utilizaram-se entrevistas semiestruturadas com dez profissionais; as falas foram analisadas em quatro categorias, através da Análise de Conteúdo. Resultado: constatou-se que a assistência prestada à pessoa com esquizofrenia não consegue identificar e atender às suas reais necessidades e que as propostas das políticas públicas de saúde mental se distanciam da realidade, pois as ações na atenção básica se limitam à orientação da medicação e ao encaminhamento para o serviço de referência, o que contraria o princípio da integralidade da assistência, sendo necessárias aos profissionais da atenção básica maior autonomia e participação nesse processo. Para tanto, se faz imprescindível o uso de um trabalho integrado entre os profissionais, a adoção de um modelo de contrarreferência e a diversificação dos instrumentos de intervenção em saúde.(AU)


Objective: To analyze the scenarios and challenges faced by health professionals in the care of people with schizophrenia in Primary Care. Method: Qualitative research, descriptive and exploratory, performed with physicians and nurses who work in Primary Care in the city of Pau dos Ferros, Rio Grande do Norte. We used semi-structured interviews with ten professionals, the lines were analyzed in four categories, through Content Analysis. Result: was found that the assistance provided to the person with schizophrenia can not identify and meet their real needs and that the proposals of the public policies of mental health are distanced from the reality, since the actions in the basic attention are limited to the orientation of the medication and the referral service, which is contrary to the principle of integral care, and it is necessary for the primary care professionals to have greater autonomy and participation in this process. Therefore, it is essential to use integrated work among professionals, the adoption of a counter-reference model and the diversification of health intervention instruments.(AU)


Subject(s)
Humans , Primary Health Care , Schizophrenia
16.
Arch. Clin. Psychiatry (Impr.) ; 46(2): 33-39, Mar.-Apr. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1011143

ABSTRACT

Abstract Objective To compare sex difference in metabolic effect of olanzapine versus aripiprazole on schizophrenia. Methods A twelve-week prospective open-label cohort study to compare four subgroups according to first-episode schizophrenia patients' type of drug usage and sex: female aripiprazole (n = 11), male aripiprazole (n = 11), female olanzapine (n = 10), and male olanzapine (n = 11) for body mass index, fasting serum triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose. Results Aripiprazole may be associated with weight gain in female patients with low-baseline weight. Aripiprazole may have an adverse effect of weight and favorable effects of circulating glucose and lipid on female over male schizophrenia patients. The aripiprazole-induced changes in glucose and lipid may be independent of body fat storage, especially for female schizophrenia patients. Olanzapine may have adverse effects of weight, glucose and lipid profiles on female over male schizophrenic patients. Discussion Our findings fill the gap in knowledge and provide a sex-specific guidance to psychiatrist better tailoring treatment to individual sex-differential characteristics and a key clue to understand the sex-differential mechanism of antipsychotics-induced metabolic dysfunction.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Blood Glucose/drug effects , Lipid Metabolism/drug effects , Aripiprazole/adverse effects , /adverse effects , Schizophrenia/drug therapy , Triglycerides/blood , Weight Gain/drug effects , Body Mass Index , Sex Factors , Prospective Studies , Lipoproteins, HDL/blood , Lipoproteins, LDL/blood
20.
Trends psychiatry psychother. (Impr.) ; 41(1): 94-102, Jan.-Mar. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1004845

ABSTRACT

Abstract Introduction Emotional intelligence (EI) is a theoretical construct postulated by Mayer and Salovey to designate the ability to perceive, understand, use and manage emotions. The study of EI in schizophrenia offers new insights into the disorder's cognitive and functional impacts. Objectives To comprehensively review studies analyzing EI impairment in schizophrenia spectrum disorders using standardized instruments. Methods Searches were run on MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov and SciELO databases. The only validated instrument used was the Multifactor Emotional Intelligence Scale (MSCEIT). Articles that used all branches of the MSCEIT to assess EI in schizophrenia spectrum disorders and healthy controls were included in the review. Results We found 30 articles on this topic. The studies analyzed showed a significant impairment of MSCEIT total score in patients with schizophrenia spectrum disorders when compared to healthy controls. In relation to the MSCEIT branches, understanding of emotions and management of emotions are the most impaired branches. Conclusion Since most studies are cross-sectional, it is not possible to establish a cause and effect relationship between EI deficits and schizophrenia spectrum disorders. Therefore, longitudinal studies are needed to establish a clearer relationship between these variables. By so doing, we may be able to intervene for prevention and management of these disorders, aiming at better quality of life for patients.


Resumo Introdução Inteligência emocional (IE) é um constructo postulado por Mayer e Salovey para designar a habilidade de perceber, entender, utilizar e gerenciar emoções. O estudo de IE em esquizofrenia oferece novos insights quanto ao impacto deste transtorno em funções cognitivas e funcionais. Objetivos Conduzir revisão da literatura que analisa o prejuízo em IE nos transtornos do espectro da esquizofrenia utilizando instrumentos padronizados. Métodos Buscas foram realizadas nos bancos de dados MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov e SciELO. O único instrumento validado utilizado foi a Multifactor Emotional Intelligence Scale (MSCEIT). Artigos que utilizaram todas as ramificações da MSCEIT para avaliar IE em transtornos do espectro da esquizofrenia e em controles saudáveis foram incluídos na revisão. Resultados Encontramos 30 artigos no tópico estudado. Os estudos analisados mostraram um prejuízo significativo da IE pela MSCEIT em pacientes com transtornos do espectro da esquizofrenia quando comparados com controles saudáveis. Em relação às ramificações da MSCEIT, compreensão das emoções e gerenciamento das emoções foram as ramificações com maior prejuízo. Conclusão Devido à maior parte dos estudos serem estudos transversais, não é possível estabelecer uma relação de causa e efeito entre os déficits em IE e transtornos do espectro da esquizofrenia. Portanto, estudos longitudinais são necessários para se estabelecer uma relação mais clara entre essas variáveis. Assim, talvez possamos intervir na prevenção e manejo desses transtornos, para uma melhor qualidade de vida dos pacientes.


Subject(s)
Humans , Psychotic Disorders/physiopathology , Schizophrenia/physiopathology , Emotional Intelligence/physiology
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