Clinical and demographic differences between voluntary and involuntary psychiatric admissions in a university hospital in Brazil / Diferenças clínicas e demográficas entre internações psiquiátricas voluntárias e involuntárias em um hospital universitário no Brasil / Las diferencias clínicas y demográficas entre los ingresos psiquiátricos involuntarios y voluntarios en un hospital universitario en Brasil

To assess the frequency of involuntary psychiatric hospitalizations from 2001 to 2008 and to determine associated clinical and socio-demographic characteristics, a retrospective cohort study was conducted. Adult admission data were collected from a university hospital in Brazil. Hospitalizations were classified as voluntary (VH) or involuntary (IH). Groups were compared using chi-square test for categorical variables and Mann-Whitney test for continuous non-parametric variables. The relative risk of certain events was estimated by the odds ratio statistic. Of 2,289 admissions, 13.3% were IH. The proportion of IH increased from 2.5% to 21.2% during the eight year period. IH were more frequently associated with female gender, unmarried status, unemployment, and more than 9 years of schooling. Psychotic symptoms were more common among IH. There were no differences in age, duration of hospitalization, or rate of attendance at first appointment after hospital discharge. Understanding of the characteristics associated with IH is necessary to improve the treatment of psychiatric disorders.

Uma coorte retrospectiva foi conduzida para avaliar a frequência de internações psiquiátricas involuntárias entre 2001 e 2008, e para determinar características clínicas e sociodemográficas associadas. Informações de internações de adultos foram coletadas de um hospital universitário no Brasil. As hospitalizações foram classificadas como voluntárias (HV) ou involuntárias (HI). Os grupos foram comparados pelo uso do teste qui-quadrado para variáveis categóricas e Mann-Whitney para variáveis contínuas não paramétricas. O risco relativo de certos eventos foi estimado por odds ratio. De 2.289 internações, 13,3% eram HI. A proporção de HI aumentou de 2,5% para 21,2% no período de oito anos. HI foram mais frequentemente associadas ao sexo feminino, estado civil solteiro, desemprego, e mais de 9 anos de escolaridade. Sintomas psicóticos foram mais comuns entre HI. Não houve diferenças na idade, tempo de internação e comparecimento na primeira consulta após a alta hospitalar. É necessário compreender características associadas com HI para melhorar o tratamento de transtornos psiquiátricos.

Un estudio de cohorte retrospectivo se realizó para evaluar la frecuencia de los ingresos psiquiátricos involuntarios entre 2001 y 2008, y para determinar las características sociodemográficas y clínicas asociadas. Las hospitalizaciones psiquiátricas de un hospital universitario en Brasil fueron clasificadas como voluntarias (HV) o involuntarias (HI). Los grupos se compararon mediante la prueba de chi-cuadrado para las variables categóricas y la prueba de Mann-Whitney para las variables continuas no paramétricas. El riesgo relativo de ciertos eventos se estimó por la odds ratio. De 2.289 hospitalizaciones, el 13,3% eran HI. La proporción de HI aumentó del 2,5% al 21,2% en ocho años. HI fueron más asociadas con el sexo femenino, estado civil soltero, desempleo, y más de 9 años de escolaridad. Los síntomas psicóticos fueron más comunes entre HI. No hubo diferencias en la edad, la duración de la estancia y la asistencia a la cita después del alta hospitalaria. Es necesario comprender las características asociadas con HI para mejorar el tratamiento de los trastornos psiquiátricos.

Neuroimaging in Alzheimer's disease: current role in clinical practice and potential future applications

'Alzheimer's disease is the most common cause of dementia and its prevalence is expected to increase in the coming years. Therefore, accurate diagnosis is crucial for patients, clinicians and researchers. Neuroimaging techniques have provided invaluable information about Alzheimer's disease and, owing to recent advances, these methods will have an increasingly important role in research and clinical practice. The purpose of this article is to review recent neuroimaging studies of Alzheimer's disease that provide relevant information to clinical practice, including a new modality: in vivo amyloid imaging. Magnetic resonance imaging, single photon emission computed tomography and 18F-fluorodeoxyglucose-positron emission tomography are currently available for clinical use. Patients with suspected Alzheimer's disease are commonly investigated with magnetic resonance imaging because it provides detailed images of brain structure and allows the identification of supportive features for the diagnosis. Neurofunctional techniques such as single photon emission computed tomography and 18F-fluorodeoxyglucose-positron emission tomography can also be used to complement the diagnostic investigation in cases of uncertainty. Amyloid imaging is a non-invasive technique that uses positron emission tomography technology to investigate the accumulation of the β-amyloid peptide in the brain, which is a hallmark of Alzheimer's disease. This is a promising test but currently its use is restricted to very few specialized research centers in the world. Technological innovations will probably increase its availability and reliability, which are the necessary steps to achieve robust clinical applicability. Thus, in the future it is likely that amyloid imaging techniques will be used in the clinical evaluation of patients with Alzheimer's disease.