The dexamethasone suppression test applied to inpatients of a Brazilian Psychiatric Hospital

1. The dexamethasone suppression test (DST) was applied to three groups of Brazilian psychiatric inpatients as follows: 93 patients were tested both on admission and at discharge; 166 patients wee tested only on admission, and 43 patients only at discharge. All patients were examined physically and diagnosed using the Research Diagnostic Criteria (RDC) and a history of drug use and weight loss one week before admission was obtained. 2. On admission, a suppression rate of 41% (106 positives testes for 259 patients) was obtained with the DST regardless of diagnostic group, whereas at discharge the rate was 27%. 3. The rate of nonsuyppressors in each diagnostic group on admission was highest among the endogenous major depressive patients (55%), followed by patients with drug-use disorders (48%), organic disorders (44%), and alcoholic patients (40%). 4. Since weight loss, unsupervised drug therapies and several organic pathologies, all of which are common events in Third World countries like Brazil, may lead to false DST positive results, 46% of the 106 nonsuppressors could be considered to be false positives. The rate of false positives would reach 74% if only the 23 primary endogenous major depressive nonsuppressor patients were considered. weight loss was the most common cause of nonsuppression responses. 5. In view of the poor living conditions of the population, the apparent deficiencies of the Public health Care system and the widespread, largely uncontrolled use of medications, it is suggested that the DST should be used cautiously, if ever, in Brazil and probably in other third World countries

Alteracoes afetivas ou alteracao de ritmo? / Affective disorders or rhythm changes?

As alteracoes psiquicas classificadas como afetivas incluem quadros nos quais as funcoes consideradas cognitivas e volitivas nao sao menos alteradas. Excluem outros quadros, nos quais o que se chama de afetividade esta igualmente alterado. Um rotulo precario, que nao permite concordancias entre outros autores e nao constitui uma boa base de pesquisa. Os estudos biorritmicos abrem perspectivas interessantes com a condicao de nao perderem o sentido auto-critico. O conceito mais abrangente de tempo pode situar num plano mais fertil as pesquisas de psicopatologia. O que se chama de afeto pode ser visto como uma caracteristica do vivido, relacionada com o tempo. Alergia, tristeza, podem corresponder a uma maneira de avaliar a vivencia do tempo acelerado ou retardado, em funcao de alteracoes na neurotransmissao e funcionamento do sistema nervoso

Estruturas delirantes e tratamento. / Deliriun and treatment

O delirio e tratado como alteracao da esfera cognitiva para uns e da esfera afetiva para outros. Achamos mais conveniente considerar o conceito de estrutura delirante, sem recorrer a precaria separacao de funcoes cognitivas, afetivas e volitivas. O delirio seria um modo de pensar e expressar-se que dispensa a logica, instrumento de comunicacao com os outros, de insercao na cultura. A aparente produtividade do delirio e apenas um recurso a formas pre-logicas de comunicacao, que vem a ocupar o vacuo aberto pela perda das capacidades logicas. A terapia teria como objeto re-estruturar as atividades neurofisioloficas para permitir vivencias reparadoras e consequente recuperacao da comunicacao logica