Definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in amyotrophic lateral sclerosis (ALS): Consensus from ALS and Motor Neuron Disease Scientific Department of the Brazilian Academy of Neurology / Definições, fenomenologia, diagnóstico e manejo das desordens do riso e do choro em esclerose lateral amiotrófica (ELA): Consenso do Departamento Científico de ELA e Doença do Neurônio Motor da Academia Brasileira de Neurologia

Abstract The spectrum of neuropsychiatric phenomena observed in amyotrophic lateral sclerosis (ALS) is wide and not fully understood. Disorders of laughter and crying stand among the most common manifestations. The aim of this study is to report the results of an educational consensus organized by the Brazilian Academy of Neurology to evaluate the definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in ALS patients. Twelve members of the Brazilian Academy of Neurology - considered to be experts in the field - were recruited to answer 12 questions about the subject. After exchanging revisions, a first draft was prepared. A face-to-face meeting was held in Fortaleza, Brazil on 9.23.22 to discuss it. The revised version was subsequently emailed to all members of the ALS Scientific Department from the Brazilian Academy of Neurology and the final revised version submitted for publication. The prevalence of pseudobulbar affect/pathological laughter and crying (PBA/PLC) in ALS patients from 15 combined studies and 3906 patients was 27.4% (N = 1070), ranging from 11.4% to 71%. Bulbar onset is a risk factor but there are limited studies evaluating the differences in prevalence among the different motor neuron diseases subtypes, including patients with and without frontotemporal dementia. Antidepressants and a combination of dextromethorphan and quinidine (not available in Brazil) are possible therapeutic options. This group of panelists acknowledge the multiple gaps in the current literature and reinforces the need for further studies.

Resumo O espectro de fenômenos neuropsiquiátricos observados na ELA é amplo e não completamente entendido. Desordens do riso e do choro estão entre as manifestações mais comuns. O objetivo deste estudo é relatar os resultados de um Consenso organizado pela Academia Brasileira de Neurologia para avaliar definições, fenomenologia, diagnóstico, e manejo dos distúrbios do riso e do choro em pacientes com ELA. Doze membros da Academia Brasileira de Neurologia - considerados experts na área - foram recrutados para responder 12 questões na temática. Depois da verificação das revisões, um primeiro manuscrito foi preparado. Após, foi realizado um encontro presencial em Fortaleza, Brasil, em 23/09/2022, para discussão do conteúdo. A versão revisada foi posteriormente enviada por e-mail para todos os membros do Departamento Científico de DNM/ELA da Academia Brasileira de Neurologia e a versão final revisada foi submetida para publicação. A prevalência da síndrome pseudobulbar em pacientes com ELA em 15 estudos combinados com 3906 pacientes foi de 27,4% (n = 1070), variando entre 11,4% e 71%. Início bulbar é um fator de risco, mas há limitados estudos avaliando as diferenças em prevalência entre os diferentes subtipos de Doença do Neurônio Motor, incluindo pacientes com e sem Demência Frontotemporal. Antidepressivos e uma combinação de dextrometorfana e quinidina (indisponíveis no Brasil) são opções terapêuticas possíveis. Esse grupo de panelistas reconhece as múltiplas demandas não atendidas na literatura atual e reforça a necessidade de futuros estudos.

Celestina, SUS e Sertão: uma experiência de palhaçaria na educação popular em saúde / Celestina, SUS and Sertão: a therapy clown experiment in popular education in health

Resumo Objetivo de promover reflexão sobre a palhaçaria, à luz da Educação Popular em Saúde. Descreve e analisa intervenções realizadas entre outubro de 2020 e dezembro de 2021, com usuários e servidores públicos no Sertão Central. A palhaça abriu alas para a territorialização e se mostrou potente tecnologia para uma atuação humanizada da enfermeira residente. Como interlocutora entre o saber científico e o popular, em sua corporalidade cenopoética, lidava de forma criativa e leve com assuntos tabus para a saúde comunitária, promovendo uma educação problematizadora e dialógica com seu público. A experiência fez-nos refletir nas lacunas de investimentos para viabilizar projetos como esse, fortalecendo a institucionalização da Educação Popular em Saúde. Assim, defendemos a implementação de formações e oficinas sobre conceitos, desafios e potencialidades da Educação Popular em Saúde. A palhaçaria, como proposta de atuação, é tecnologia transformadora que inspira o protagonismo à comunidade por meio de conhecimento, cuidado amoroso e arte.

Abstract The scope of this paper is to elicit reflection on therapy clowns in the realm of Popular Education in Health. It describes and analyzes interventions conducted between October 2020 and December 2021 between civil service workers and patients in the Sertão Central hinterlands. Therapy clowning paved the way as a potent technology for humanized care treatment by the resident nurse. As an intermediary between scientific and popular knowledge, in its scenopoetic approach, it dealt creatively and humorously with taboo subjects for community health, promoting a light-hearted interaction experience with its audience. The experience revealed some points about the scarcity of investment to make projects like this viable, thereby empowering the institutionalization of Popular Education in Health. For this reason, we advocate the implementation of training sessions and workshops on concepts, challenges, and potentialities in Popular Education in Health. Therapy clowning, as a proposed action, is a transformative technology that inspires a proactive approach in the community through knowledge, loving care, and art.

Analysis of smile exposure and related factors in young people aged 20 to 30 with convex facial profiles / 口腔疾病防治

Objective @#To study smile exposure in 20- to 30-year-olds with convex facial profiles and to explore the correlation between smile exposure and other aesthetic indicators, as well as psychological factors. @*Methods @# This study obtained ethical approval from the hospital. After they gave informed consent and portrait authorization, 80 young subjects aged 20-30 with convex facial profiles had their dynamic postural smile and spontaneous laughter recorded. The videos were imported into Photoshop CC software, key frames were selected, and the smile exposure was measured. The three-dimensional information of the subject's face in a resting state was obtained, the relevant aesthetic indicators were measured, and the satisfaction degree of their smile and laughter were evaluated. Correlation analysis was conducted for smile exposure and the relevant aesthetic indicators and subjective psychological evaluation.@*Results @# There were statistically significant differences in smile exposure, smile patterns, relevant aesthetic indicators and subjective psychological evaluation between males and females aged 20 to 30 (P<0.05). There was a large gap between males and females in the average opening degree when laughing, males having 5 times that of females, while the average gingival exposure height of the maxillary central incisor in males was approximately 1/2 of that in females. The average nasolabial angle of males (99.80° ± 7.96°) was larger than that of females (96.26° ± 7.31°) (P<0.05), while the average ratio of upper lip length to the length of the lower 1/3 of the face of males (33.73% ± 2.35%) was less than that of females (38.57% ± 2.76%) (P<0.05). The average psychological score of males (57.75±13.46) was higher than that of females (53.69±17.95) (P<0.05). The ratios of maxillary teeth and gingival exposure to oral fissure in the postural smile were positively correlated with the nasolabial angle. The oral fissure width in spontaneous laughter was negatively correlated with psychological score.@*Conclusion @# Convex-faced males and females aged 20 to 30 have different smile exposures and smile patterns. Males tend to smile more openly with a larger opening and less gingival exposure, while females tend to grin with a small opening and more gingival exposure. Smile exposure is positively correlated with nasolabial angle and negatively correlated with smile satisfaction.

Impact of Laughter Therapy on Anxiety and Pain in Pediatric Dentistry: A Double-Blinded Randomized, Controlled Clinical Trial

Abstract Objective: To evaluate the effect of laughter therapy on reducing anxiety and pain during dental procedures in children 5-7 years of age. Material and Methods: 48 children aged 5-7 years were included in this cross-over double-blinded clinical trial after the parents completed the Screen for Child Anxiety Related Disorder questionnaire (SCARED). After allocation into two groups: laughter intervention (A) and neutral intervention (B), the anxiety as well as pain were determined by Modified Child Dental Anxiety Scale Faces questionnaire (MCDASF) and the Wong-Baker Faces Scale, respectively. Also, the child's behavior during the treatment was recorded using the Sound, Eye, Motor scale (SEM). Data were analyzed by SPSS 21 using Paired t-test, Independent t-test, Chi-square, Mann-Whitney and Wilcoxon's test. Results: The mean score of anxiety in the laughter intervention group (17.42±2.74) was significantly less than (22.06±2.16) in the neutral intervention group (p=0.000) and lower in boys in both groups (p=0.000, p=0.047). The mean pain severity reported by the children in the neutral intervention group (5.33±1.81) was higher than in the laughter intervention group (2.38±1.87; p=0.00) and higher in girls in both groups (p=0.02; p=0.03). Conclusion: The laughter intervention before dental procedures had a significant effect on reducing anxiety and pain during dental treatment (AU).

La risa contagiosa como vocalización provocadora de expresiones faciales y electromiográficas relacionadas con emociones positivas en los oyentes / Contagious laughter as a provocative vocalization of facial and electromyographic expressions related to positive emotions in listeners

Resumen A pesar de su relevancia para la comprensión de la expresión emocional vocal, el estudio de la risa contagiosa se encuentra en sus primeras etapas de investigación y aún no se ha establecido su naturaleza ni la de las respuestas que esta provoca. Teniendo esto en cuenta, el propósito de este estudio fue determinar si los estímulos acústicos de risa contagiosa, además de generar conductas de risa o sonrisa, provocan en los oyentes las expresiones faciales, electromiográficas y cardíacas de una emoción positiva. Para esto, se contó con la participación de 60 universitarios de ambos sexos con edades entre los 18 y los 30 años en un diseño experimental intrasujeto con mediciones en la condición de línea de base y en exposiciones a diferentes estímulos de risa contagiosa, donde se verificaron tres hipótesis en las que se comparó expresiones faciales de alegría (medidas con el software FaceReader), amplitud electromiográfica (EMG) del músculo cigomático mayor (medida con el módulo EMG-100 del Biopac) e intervalos R-R como indicadores de frecuencia cardíaca (medidos con el módulo ECG-100 del Biopac) entre las diferentes condiciones. Como resultado, se encontraron diferencias significativas en los porcentajes de las expresiones faciales de alegría y amplitud EMG del cigomático al comparar las condiciones de línea de base y estímulos de risa más contagiosa, y de risas más y menos contagiosas; no obstante, no se encontraron diferencias significativas en los intervalos R-R en ninguna de las condiciones comparadas. Como conclusión, se comprobó la naturaleza emocional positiva de la risa/sonrisa provocada por estímulos de risa contagiosa y la proporcionalidad entre la intensidad de las expresiones faciales y las respuestas EMG elicitadas por esta risa y el grado de contagio percibido de la misma.

Abstract Despite its relevance for the understanding of vocal emotional expression, the study of contagious laughter is in its early stages of research and neither its nature nor the nature of the responses it provokes have not yet been established. The purpose of this study was to determine whether the acoustic stimuli of contagious laughter, in addition to generating laughter or smiling behaviors, elicit in listeners the facial, electromyographic and heart expressions of a positive emotion. To this end, 60 university students of both sexes, aged between 18 and 30 years participated in an intrasubject experimental design with measurements in the baseline condition and in exposures to different contagious laughter stimuli, where three hypotheses were tested comparing facial expressions of joy (measured with the FaceReader software), electromyographic amplitude (EMG) of the zygomaticus major muscle (measured with the Biopac EMG-100 module) and RR intervals as indicators of heart rate (measured with the Biopac ECG-100 module) between the different conditions. As a result, significant differences were found in the percentages of facial expressions ofjoy and zygomatic EMG amplitude when comparing the baseline and stimulus conditions of more contagious laughter, and more and less contagious laughter. However, no significant differences were found in the R-R intervals in any of the compared conditions. In conclusion, the positive emotional nature of laughter / smile caused by contagious laughter stimuli and the proportionality between the intensity of the facial expressions and EMG responses elicited by this laughter and the perceived degree of contagiousness of laughter were verified.

La risa contagiosa como estímulo incondicionado en condicionamiento clásico de actitudes hacia marcas comerciales / Contagious Laughter as an Unconditioned Stimulus in Classical Conditioning of Attitudes Towards Commercial Brands

Resumen La literatura sobre condicionamiento clásico de actitudes (CCA) no reporta utilización de vocalizaciones humanas para crear o intensificar actitudes. El propósito del estudio fue comprobar la capacidad de los estímulos acústicos de risa contagiosa para originar actitudes positivas hacia marcas comerciales neutras cuando estos se utilizan como estímulos incondicionados en CCA. Participaron 60 universitarios de ambos sexos con edades entre 18 y 30 años y con base en un diseño experimental intrasujeto se aplicó el CCA, que implicó apareamiento simultáneo de marcas comerciales neutras con risas más y menos contagiosas. Se verificaron 5 hipótesis que compararon actitudes explícitas (medidas con diferencial semántico) e implícitas (medidas mediante un priming evaluativo y amplitud electromiográfica —EMC— del músculo cigomático) entre el pre- y el poscondicionamiento y entre marcas condicionadas con risas más vs. menos contagiosas. .on respecto a línea de base, se observaron mayores actitudes explícitas poscondicionamiento hacia marcas comerciales apareadas con risas más contagiosas; no se encontraron diferencias actitudinales explícitas entre marcas condicionadas con risas más vs. menos contagiosas. Sólo se evidenciaron diferencias actitudinales implícitas entre el pre y el poscondicionamiento de la marca comercial apareada con risa masculina más contagiosa. No se observaron diferencias en la amplitud EMG del cigomático entre el pre y el poscondicionamiento ni entre marcas comerciales apareadas con risas más vs. menos contagiosas. Concluimos que la risa contagiosa tiene capacidad para transferir valencia afectiva a estímulos neutros y no siempre se observa concordancia entre las actitudes explícitas e implícitas poscondicionamiento.

Abstract The literature on classical conditioning of attitudes (CCA) does not report the use of human vocalizations to create or intensify attitudes. This study aimed to test the ability of contagious laughter acoustic stimuli to elicit positive attitudes towards neutral commercial brands when used as unconditioned stimuli in CCA. 60 university students of both genders, aged between 18 and 30 years, participated. Based on an intra-subject experimental design the CCA was applied, which involved the simultaneous pairing of neutral commercial brands with more and less contagious laugher. Five hypotheses were tested comparing explicit (measured with semantic differential) and implicit attitudes (measured by evaluative priming and electromyographic amplitude -EMG- of the zygomatic muscle) between pre- and postconditioning and between commercial brands conditioned with more vs less contagious laugher. Concerning the baseline, there were greater explicit postconditioning attitudes towards commercial brands paired with more contagious laughter; no explicit attitudinal differences were found between brands conditioned with more vs. less contagious laughter. Only implicit attitudinal differences were evidenced between pre- and postconditioning for the commercial brand paired with the most contagious male laughter. No differences in the zygomatic EMG amplitude were observed between pre- and postconditioning or between commercial brands paired with more vs. less contagious laughter. We conclude that contagious laughter has the capacity to transfer affective valence to neutral stimuli and that concordance is not always observed between explicit and implicit postconditioning attitudes.

Neuropsiquiatría del síndrome de Susac: a propósito de un caso / Neuropsychiatry of Susac Syndrome: a Case Report

RESUMEN El síndrome de Susac es una entidad clínica poco frecuente, posiblemente mediada por un proceso autoinmune; la tríada clásica se compone de retinopatía, disminución en la agudeza auditiva y síntomas neuropsiquiátricos (encefalopatía). Hay pocos casos descritos con sintomatología neuropsiquiátrica como la sintomatología principal. Presentamos un caso de síndrome de Susac, que corresponde a una mujer de 34 arios, con predominio de sintomatologia neuropsiquiátrica, caracterizada por un síndrome de Klüver-Bucy parcial, un síndrome apático, risa y llanto patológico y alteraciones cognitivas de predominio atencional; dichos síntomas mejoraron cualitativamente con el uso de terapia inmunológica. Este caso revela la importancia de las manifestaciones neuropsiquiátricas como presentación clínica en pacientes con entidades neurológicas.

ABSTRACT Susac syndrome is a rare clinical condition, possibly mediated by an autoimmune process; the classic triad is composed of retinopathy, decreased hearing acuity and neuropsychiatric symptoms (encephalopathy). There are few cases reported with neuropsychiatric symptoms as the main manifestation. We present a case of Susac syndrome in a 34-year-old female with a predominance of neuropsychiatric symptoms, characterised by partial Klüver-Bucy syndrome, apathy syndrome, pathological laughter and crying, and cognitive dysfunction predominantly affecting attention, which showed a qualitative improvement with the use of immunological therapy. This case report highlights the importance of neuropsychiatric manifestations as clinical presentation in patients with neurological conditions.

Effects of clown activities on patients eligible for palliative care in primary health care / Efectos de actividades clown en pacientes elegibles para cuidados paliativos en la atención primaria de salud / Efeitos de atividades clown em pacientes elegíveis para cuidados paliativos na atenção primária à saúde

ABSTRACT Objective: Evaluate the effects of clown activities on quality of life, depression, stress, anxiety, aid, and social support in patients eligible for palliative care (PC) attended in Primary Health Care (PHC). Method: A quasi-experimental study, with pre-intervention and post-intervention evaluation, carried out with 16 patients eligible for early PC in PHC in a Midwestern city. Patients received 24 visits with home-based clown activities. Results: The interventions evidenced improved quality of life and social support, with significant results for the Social Activities dimension (p = 0.023). Increased scores for Anxiety (p = 0.007) and Depression (p = 0.023) were also observed. Conclusion: Clown activities can bring positive results for the quality of life and social support of patients eligible for PC at home. They should be encouraged to interact with family knowledge and enhance humanized care, integral and centered on human relationships in PHC.

RESUMEN Objetivo: Evaluar efectos de actividades clown en calidad de vida, depresión, estrés, ansiedad, apoyo y soporte social en pacientes elegibles para cuidados paliativos (CP) atendidos en Atención Primaria de Salud (APS). Método: Estudio cuasi-experimental, con evaluación preintervención y posintervención, realizado con 16 pacientes elegibles para CP precoces en la APS en municipio del medio oeste. Pacientes recibieron 24 visitas con actividades clown domiciliarias. Resultados: Intervenciones evidenciaron mejora de la calidad de vida y del suporte social, con resultados significativos para la dimensión Actividades Sociales (p = 0,023). También se observó aumento de puntuación para Ansiedad (p = 0,007) y Depresión (p = 0,023). Conclusión: Actividades clown pueden traer resultados positivos a la calidad de vida y suporte social de pacientes elegibles para CP en domicilio. Deben ser incentivadas para interaccionar con el saber familiar y potencializar el cuidado humanizado, integral y centrado de las relaciones humanas en la APS.

RESUMO Objetivo: Avaliar os efeitos de atividades clown na qualidade de vida, depressão, estresse, ansiedade, apoio e suporte social em pacientes elegíveis para cuidados paliativos (CP) atendidos na Atenção Primária à Saúde (APS). Método: Estudo quase-experimental, com avaliação pré-intervenção e pós-intervenção, realizado com 16 pacientes elegíveis para CP precoces na APS em um município do Centro-Oeste. Os pacientes receberam 24 visitas com atividades clown domiciliares. Resultados: As intervenções evidenciaram melhora da qualidade de vida e do suporte social, com resultados significativos para a dimensão Atividades sociais (p = 0,023). Também observou-se aumento de pontuação para Ansiedade (p = 0,007) e Depressão (p = 0,023). Conclusão: As atividades clown podem trazer resultados positivos para a qualidade de vida e suporte social de pacientes elegíveis para CP em domicílio. Devem ser incentivadas para interagir com o saber das famílias e potencializar o cuidado humanizado, integral e centrado das relações humanas na APS.

A terapia do riso como ferramenta de cuidado com a criança hospitalizada: revisão integrativa da literatura / La risoterapia como herramienta de atención para niños hospitalizados: una revisión bibliográfica integradora / Laughter therapy as a care tool for hospitalized children: an integrative literature review

Objetivo: Investigar, na literatura nacional e internacional, o uso da terapia do riso junto às crianças hospitalizadas. Método: Revisão integrativa da literatura. As bases de dados pesquisadas foram MEDLINE®, Cumulative Index to Nursing and Allied Health Literature, PsycINFO®, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Banco de Dados em Enfermagem ­ Bibliografia Brasileira e Índice Bibliográfico Español em Ciencias de la Salud. Os termos utilizados identificados nos Descritores em Ciência da Saúde e nos Medical Subject Headings foram "terapia do riso", "criança", "pré-escolar" e "criança hospitalizada", além das palavras-chave "risoterapia", "riso-terapia" e "riso terapia" em diferentes combinações. O recorte temporal foi de 10 anos, a partir de 2008. Resultados: A amostra final para a análise foi constituída de 17 artigos, que foram organizados em três categorias: Risoterapia como estratégia para a diminuição da dor, do desconforto e do sofrimento; A diminuição do medo, do estresse e da ansiedade com a risoterapia e O Impacto psicossocial da risoterapia na criança hospitalizada. Conclusão: Foi possível perceber benefícios da terapia que incluem diminuição da dor, do estresse e da ansiedade e mudanças emocionais e sociais. Salienta-se a importância da temática, por meio da qual é possível oferecer ao paciente pediátrico um cuidado integral e humanizado.(AU)

Objective: To investigate, in the Brazilian and international literature, the use of laughter therapy with hospitalized children. Methods: An integrative literature review. The databases searched were MEDLINE®, Cumulative Index to Nursing and Allied Health Literature, PsycINFO®, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Banco de Dados em Enfermagem ­ Bibliografia Brasileira and Índice Bibliográfico Español em Ciencias de la Salud. The index terms used on Descritores em Ciência da Saúde and Medical Subject Headings were "laughter therapy", "child", "preschool" and "hospitalized child", and the keywords "risotherapy" in different combinations. The timeframe was 10 years, starting from 2008. Results: The final sample for analysis consisted of 17 papers, organized into three categories: laughter therapy as a strategy to reduce pain, discomfort and suffering; Decreased fear, stress, and anxiety with laughter therapy; and the psychosocial impact of laughter therapy on hospitalized children. Conclusion: Some observed benefits from laughter therapy include decreased levels of pain, stress, and anxiety, as well as emotional and social changes. We emphasize the importance of this theme since it provides pediatric patients with a comprehensive and humanized care(AU)

Objetivo: Investigar en la literatura nacional e internacional el uso de la risoterapia con niños hospitalizados. Metodología: Revisión integrativa de literatura. Las bases de datos establecidas fueron: MEDLINE®, Cumulative Indexto Nursing and Allied Health Literature, PsycINFO®, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Banco de Dados em Enfermagem ­ Bibliografia Brasileira e Índice Bibliográfico Español en Ciencias de la Salud. Los descriptores utilizados identificados en los Descritores em Ciência da Saúde y Medical Subject Headings fueron: "terapia de la risa", "niño", "preescolar" y "hospitalizado", y la palabra clave "risoterapia" en sus diferentes combinaciones. El plazo fue de 10 años, a partir de 2008. Resultados: La muestra final para el análisis consistió en 17 artículos, agrupados en tres categorías: La risoterapia como estrategia para reducir el dolor, las molestias y el sufrimiento; Disminución del miedo, el estrés y la ansiedad con la risoterapia y El impacto psicosocial de la risoterapia en los niños hospitalizados. Conclusión: Fue posible obtener beneficios de la terapia que incluyen disminución del dolor, estrés, ansiedad y cambios emocionales y sociales. Se enfatiza la importancia del tema porque a través de él es posible ofrecer a los pacientes pediátricos una atención integral y humanizada..(AU)

Hypothalamic hamartoma with gelastic seizures: a case report

Hypothalamic Hamartoma (HH) may have diverse clinical manifestations. Its hallmark association is with gelastic seizures. Gelastic epilepsy is characterized by episodes of loud, hollow, mirthless, stereo-typed, forced laughter. The patient may stare and giggle briefly without any other motor manifestations. Hypothalamic hamartoma is most often the cause of gelastic seizures. Here, authors report a case of gelastic seizure with hypothalamic hamartoma in a 14-month-old boy with an associated tonic clonic seizure.' This case highlights the possibility of underdiagnosed hypothalamic hamartoma in younger age groups among pediatric population.

Efectividad de la risaterapia en manejo el dolor en pacientes pediátricos postoperados de apendicetomía / Effectiveness of laughter therapy in pain management in pediatric patients in postoperative appendectomy / Efetividades da risoterapia no manejo da dor em pacientes pediátricos em pósoperatório de apendicectomia

Objetivo: evaluar el efecto de la risaterapia en el manejo del dolor en pacientes pediátricos postoperados de apendicetomía versus pacientes que reciben tratamiento farmacológico. Método: ensayo clínico controlado, prospectivo, de corte longitudinal, en 32 pacientes divididos en 16 por grupo experimental y control, seleccionados aleatoriamente. El dolor fue evaluado en ambos grupos por la Escala Visual Análoga, constantes vitales, antes y después de la intervención de risaterapia y la terapia farmacológica. Resultados: la disminución del dolor mediante la risaterapia es efectiva (t= 4.138, p= .001; t=2.216, p = 0.043; respectivamente) en el grupo experimental versus en el grupo control, donde se aplico la terapia farmacologica (t= 5.436, p= .001; t=4.443, p = .001; respectivamente). Conclusión: la risaterapia tiene un impacto equitativo a la administración del medicamento en los pacientes pediátricos, además disminuye la frecuencia respiratoria y aumenta la saturación de oxígeno de los pacientes, al contrario de lo que sucede con el fármaco.

Objective: to evaluate the effect of laughter therapy on pain management in postoperative pediatric patients of appendectomy versus patients receiving pharmacological treatment. Method: controlled, prospective, longitudinal cut clinical trial, in 32 patients divided into 16 by experimental and control group, randomly selected. Pain was evaluated in both groups by the Visual Analog Scale, vital signs, before and after the intervention of laughter therapy and pharmacological therapy. Results: the decrease in pain through laughter therapy is effective (t = 4,138, p = .001; t = 2,216, p = 0.043; respectively) in the experimental group versus the control group, in which pharmacological therapy was applied (t = 5.436, p = .001; t = 4.443, p = .001; respectively). Conclusion: laughter therapy has an equitable impact on drug administration in pediatric patients, it also decreases respiratory rate and increases patients' oxygen saturation, unlike drug therapy

Objetivo: avaliar o efeito da risoterapia no manejo da dor em pacientes pediátricos em pós-operatório de apendicectomia versus pacientes em tratamento farmacológico. Método: ensaio clínico controlado, prospectivo e longitudinal, em 32 pacientes divididos em 16 por grupo experimental e controle, selecionados aleatoriamente. A dor foi avaliada em ambos os grupos pela Escala Visual Analógica, sinais vitais, antes e após a intervenção da risoterapia e terapia farmacológica. Resultados: a diminuição da dor através da terapia do riso é eficaz (t = 4.138, p = 0,001; t = 2,216, p = 0,043; respectivamente) no grupo experimental versus no grupo controle, onde a terapia farmacológica foi aplicada (t = 5,436, p = 0,001; t = 4,443, p = 0,001, respectivamente). Conclusão: a risoterapia tem um impacto equitativo à administração do medicamento em pacientes pediátricos, ademais diminui a frequência respiratória e aumenta a saturação de oxigênio dos pacientes, ao contrário do que ocorre com o fármaco.

Palhaçoterapia em ambiente hospitalar: uma revisão de literatura / Clown therapy in the hospital setting: A review of the literature

Resumo A inserção do palhaço no hospital é relativamente recente e mais de 700 organizações realizam a palhaçoterapia nessas instituições no Brasil e em outras ao redor do mundo. Dada a ênfase na integralidade do cuidado e humanização da assistência à saúde, torna-se oportuno compreender e analisar a produção nacional e internacional do conhecimento científico sobre esta prática que desafia o modelo hegemônico de cuidado e potencialmente contribui na recuperação da saúde. Foi realizada uma revisão de literatura utilizando análise de conteúdo temática que analisou 18 publicações. As categorias que emergiram foram: respostas fisiológicas, comportamentais e emocionais; ansiedade pré-operatória; e ressignificação das práticas e do ambiente hospitalar. A literatura analisada aponta que a palhaçoterapia provoca diminuição significativa da ansiedade pré-operatória em crianças, comparativamente maior do que a obtida com o uso de um fármaco indutor de anestesia. A maior parte dos estudos investigou o uso da palhaçoterapia na adaptação à hospitalização, auxiliando na atribuição de novos significados. Apesar da baixa representatividade do tema no campo científico e mesmo não sendo amplamente aceita como prática de saúde, os resultados encontrados sugerem benefícios na utilização da palhaçoterapia em ambiente hospitalar.

Abstract The presence of clowns in hospitals is relatively recent and more than 700 organizations now perform clown therapy in hospitals in Brazil and around the world. Considering the emphasis on comprehensive care and the humanization of health, it is timely to understand and analyze the national and international scientific literature on clown therapy. This practice challenges the hegemonic biomedical model and potentially helps in the recuperation of health. A review of the literature was conducted and 18 publications were analyzed using thematic content analysis. The following categories arose from the analysis: physiological, behavioral, and emotional responses; presurgical anxiety and attribution of new meanings to practices and the hospital environment. Results have shown that clown therapy leads to a significant decrease in preoperative anxiety in children, even compared with the results obtained with the use of anesthesia-inducing drugs. Most studies investigated the use of clown therapy during patients' adaptation to hospitalization, helping them to attribute new meanings to this situation. Despite its low representation in the scientific field and the fact that it has not been widely accepted as a health practice, several studies have shown the benefits of using clown therapy in the hospital setting.

Effects of a Laughter Therapy on Depression, Anxiety, Fatigue and Quality of Sleep in Gastrointestinal Cancer Patients Post-Treatment: a Randomized Controlled Trial

PURPOSE: The purpose of this study was to examine the effect of laughter therapy on depression, anxiety, fatigue, and quality of sleep in gastrointestinal cancer survivors. METHODS: This study was a randomized controlled trial. We compared the effect of laughter therapy with usual care only in post chemotherapy gastrointestinal patients. Outcomes included changes in depression and anxiety (according to the Hospital Anxiety and Depression Scale), fatigue (according to the Fatigue Severity Scale), and quality of sleep (according to the Verran & Synder-Halpern Sleep Scale). Data was collected July 2015 through January 2016. Seventy nine participants who agreed to participate in this study were randomized to either the experimental group (n=40) or the control group (n=39). Therapy included eight sessions (60 minutes each, once weekly). Data were analyzed using the Windows SPSS 22.0 program. RESULTS: Laughter therapy was effective in reducing fatigue (p=.019) and increasing satisfaction of sleep (p=.030). There were no differences between the groups after therapy for depression (p=.129) and anxiety (p=.200). CONCLUSION: Results of this study indicate that laughter therapy may be an effective nursing intervention for improving the health status of gastrointestinal cancer survivors after chemotherapy.

Bergson y Freud: anidad y discrepancia acerca del fenómeno de la comicidad / Bergson and Freud: affinity and discrepancy on the comedy phenomenon

El presente trabajo indaga acerca de los puntos de afinidad y discrepancia entre dos prestigiosos autores que, contemporáneamente, se han ocupado de las condiciones de surgimiento de lo cómico. El primero de ellos, se trata de Henri Bergson, autor del conocido volumen titulado La risa; el segundo, que escribe tan sólo unos años después, es el propio Freud, autor del ensayo El chiste y su relación con lo inconsciente. En las siguientes páginas realizaremos una revisión de estas fuentes. Nos remitiremos también a una lectura común de ambos autores: El ingenioso hidalgo Don Quijote de la Mancha, de Miguel de Cervantes Saavedra. Examinaremos las caracterizaciones que ambos autores realizan de este conocido personaje a los fines de situar, con mayor precisión, los puntos de confluencia y diferenciación de estos dos teóricos. Para concluir, retomaremos la lectura realizada por Lacan de la obra del filósofo y escritor francés.

This work inquires into the points of affinity and discrepancy between two prestigious authors which, in a contemporary way, have been dealing with the emergence of the comic conditions. The first of them, Henri Bergson, author of the well-known volume entitled Laughter; the second one, who writes just a few years later, is Freud himself, author of the essay The joke and its relation to the unconscious. Through the following pages we are going to make a revision of these sources. We will also refer to a common reading of both authors: The Ingenious nobleman Don Quijote de la Mancha, written by Miguel de Cervantes Saavedra. We are going to explore the characterizations which both of them make around this known character in order to place, more accurately, the points of confluence and differentiation of these two theorists. To conclude, we will return to the reading made by Lacan of the work of the French philosopher and writer.

Risoterapia: una terapia complementaria a la medicina occidental / Laughter therapy: a complementary therapy to western medicine / Risoterapia: uma terapia complementar à medicina ocidental

Resumen La enfermedad y la hospitalización son factores estresantes, las instituciones tienen el deber de manejar de forma integral la salud de los pacientes. Para esto existen múltiples terapias complementarias como la risoterapia. Estas se basan en el humor para la promoción de la salud y se encargan de divertir a las personas, llevando sonrisas donde predominan los descontentos. Sus beneficios son múltiples y sus contraindicaciones son pocas, lo que la convierte en una estrategia costo-efectiva para mejorar la calidad de vida durante la hospitalización. Con este artículo, se pretende, no solo mostrar los asuntos más relevantes en la risoterapia, sino también motivar a investigar, así como concientizar al lector de la importancia de apoyar este nuevo boom.

Abstract Disease and hospitalization are stressful factors, institutions have a duty to comprehensively manage patients' health. For this there are multiple complementary therapies such as laughter therapy. These are based on humor for health promotion and are responsible for entertaining people, bringing smiles where usually there is discontent. Its benefits are multiple and its contraindications are few, which makes it a cost-effective strategy to improve life quality during hospitalization. This article, aims not only to show the most relevant issues in laughter therapy, but also to motivate research, as well as to create awareness among readers of the importance of supporting this new boom.

Resumo A doença e a hospitalização são fatores estressantes; nesse sentido, as instituições têm o dever de lidar de forma integral com a saúde dos pacientes. Para isso, existem múltiplas terapias complementares como a risoterapia. Esta se baseia no humor para a promoção da saúde e encarrega-se de divertir as pessoas, levando sorrisos aonde predominam os descontentamentos. Seus benefícios são múltiplos e seus contraindicações são poucas, o que a torna uma estratégia custo-efetiva para melhorar a qualidade de vida durante a hospitalização. Com este artigo, pretende-se não só mostrar os assuntos mais relevantes na risoterapia, mas também motivar a pesquisar, bem como conscientizar o leitor da importância de apoiar esse novo boom.

Desarrollo de un Taller de Risaterapia con un grupo de personas mayores / Conducting a laughter therapy workshop with a group of elderly people / Desenvolvimento duma Oficina de terapia do riso com um grupo de pessoas idosas

Resumen Introducción: El proceso de envejecimiento en los países desarrollados conlleva que las personas mayores constituyan un grupo de edad al que prestar especial atención. En este contexto, se hace necesario implementar actividades que fomenten el envejecimiento activo y que repercutan en su bienestar psicosocial. Objetivo: en este estudio se investigan los beneficios de la participación en un taller de risaterapia sobre el bienestar subjetivo y psicológico de un grupo de personas mayores a partir de su experiencia. Metodología: estudio con enfoque cualitativo mediante entrevistas semiestructuradas a 57 personas mayores no institucionalizadas, con edades comprendidas entre los 60 y 88 años, socias de tres Centros de Día para personas mayores de la Gerencia Territorial de Servicios Sociales de Salamanca (Junta de Castilla y León). El taller de risaterapia se desarrolló durante cuatro sesiones de tres horas de duración cada una, con una periodicidad semanal. Resultados: El análisis de contenido de los discursos de los participantes desvelan categorías vinculadas a: crecimiento personal, mejora del estado de ánimo, valoración de la risa como actividad física y lúdica, incremento de la motivación y fortalecimiento de las relaciones interpersonales. Conclusiones: los resultados confirman los efectos positivos de los talleres de risaterapia sobre el bienestar psicológico y subjetivo de las personas mayores.

Abstract Introduction: Elderly people constitute an age group that requires special care. With this aim in mind, it has become necessary to implement activities to promote active aging and psychosocial wellbeing. Objective: This procedure researches the benefits of taking part in a laughter therapy workshop for an elderly group of people based on their experience. Methodology: This is a qualitative study conducted via the semi-structured interviewing of 57 non-institutionalized elderly people, of ages ranging from 60 to 88, members of three day centers for the elderly from the Salamanca Social Services Territorial Management Department (Junta de Castilla y León). The laughter therapy workshop was conducted in four 3-hour weekly sessions. Results: The analysis of the contents of the participants' discourses revealed categories related to personal growth, state of mind or mood improvement, laughter therapy assessment considering it a physical and a recreational activity, motivation enhancement and the strengthening of interpersonal relations. Conclusions: Results show the positive effects of the laughter therapy workshops on elderly people's psychological and subjective well-being.

Resumo Introdução: As pessoas idosas constituem um grupo de idade que requer especial atenção. Neste contexto, se faz necessário implementar atividades que fomentem o envelhecimento ativo e o seu bem-estar psicossocial. Objetivo: se investigam os benefícios da participação numa oficina de terapia do riso sobre o bem-estar subjetivo e psicológico dum grupo de personas idosas a partir da sua experiência. Metodologia: Estudo com enfoque qualitativo mediante entrevistas semiestruturadas de 57 pessoas idosas não institucionalizadas, com idades compreendidas entre os 60 e 88 anos, sócias de três Centros de Dia para pessoas idosas da Gerencia Territorial de Serviços Sociais de Salamanca (Junta de Castilla y León). A oficina de terapia do riso se desenvolveu quatro sessões de três horas de duração cada uma, com uma periodicidade semanal. Resultados: As análises de conteúdo dos discursos dos participantes revelam categorias vinculadas ao crescimento pessoal, melhora do estado de ânimo, valoração do riso como atividade física e lúdica, incremento da motivação e fortalecimento das relações interpessoais. Conclusões: Os resultados mostram os efeitos positivos das oficinas de terapia do riso sobre o bem-estar psicológico e subjetivo das pessoas idosas.

The Effects of Laughter Therapy Program on Perceived Stress, and Psycho-Neuro-Endocrino-Immuno Responses in Obese Women

PURPOSE: The purpose of this study was to examine the effects of the laughter therapy program on perceived stress and psycho-neuro-endocrine-immune responses in obese women. METHODS: A nonequivalent control group with a pretest-posttest design was used. The participants (n=60), whose age ranged from 30 to 50 years (pre-menopausal and body mass index of over 25 kg/m2), were assigned to the experimental group (n=24) or control group (n=26). The experimental group was provided with the laughter therapy program (12 sessions) for 6 weeks. RESULTS: There were significant differences in perceived stress, psychological stress response, fasting blood sugar, interleukin-6, and tumor necrosis factor alpha between the two groups after the program. However, there were no significant differences in normalized low frequency (norm LF), normalized high frequency (norm HF), LF/HF ratio, and cortisol between the two groups after the program. CONCLUSION: It was found that the laughter therapy program had positive effects on some variables in terms of perceived stress and psycho-neuro-endocrine-immuno responses. It is suggested that the laughter therapy in this study can provide the direction for developing a program for obese women.

Pathological Laughter Associated With Cerebral Lupus: A Case Report

Pathological laughter, pseudobulbar affect or a myriad of its other synonyms, is a condition common secondary to neurological injury, presenting with uncontrolled laughing or crying, appearing to be mood-incongruent and significantly debilitating. The objective of this case report is to highlight a rare case of pathological laughter associated with Cerebral Lupus. Methods: We report a case of a 27-year-old lady presenting with signs and symptoms of stroke with dysarthria progressing to aphasia and then pathological laughter, with an underlying poorly controlled Systemic Lupus Erythematosus, manifesting as Cerebral Lupus. Results: An improvement in affect congruency followed by decreased frequency of outbreaks among bouts of pathological laughter. Conclusion: The combination of Escitalopram and Topiramate is effective in the symptomatic treatment of Pathological Laughter. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Terapia do riso como instrumento para o processo de cuidado na ótica dos acadêmicos de enfermagem / Laughter therapy as a tool for caring process from the viewpoint of nursing students

INTRODUÇÃO: O humor é uma estratégia de enfrentamento do estresse, mostrando sentimentos que geralmente são difíceis de expressar e que ajudam a lidar com o medo e as preocupações, evitando conflitos e aliviando a tensão. A terapia do riso pode ser utilizada como ferramenta terapêutica do humor, enfatizando a humanização do cuidado e promovendo melhora orgânica e emocional. OBJETIVO: Este estudo objetivou verificar a utilização e os benefícios da terapia do riso na ótica dos estudantes de enfermagem da Universidade Estadual de Feira de Santana. MÉTODOS: Trata-se de um estudo transversal analítico descritivo. A amostra foi constituída de 70 estudantes, sendo utilizado questionário individual, autoaplicável e pré-testado, composto de questões fechadas e abertas, que incluem variáveis sociodemográficas e relacionadas à terapia do riso, para que o aluno expresse sua crença sobre a terapia do riso. RESULTADOS: População predominantemente feminina, solteira e sem trabalho formal. Verificou-se que a maioria dos acadêmicos que cursaram a disciplina "Terapêuticas não Convencionais" conhecia e descreveu os benefícios da terapia do riso, sendo que um pequeno percentual dos que cursaram puderam presenciar ou utilizaram essa terapia. Foram observados no cliente benefícios como: elevação da autoestima, melhora da receptividade dos procedimentos, diminuição álgica e melhora do quadro clínico. CONCLUSÃO: Observou-se a necessidade de propagar, principalmente no âmbito acadêmico, a utilização de terapias integrativas como a terapia do riso, enquanto instrumento para o cuidar em enfermagem, visto que essa prática melhora a interação entre o enfermeiro e o cliente, e favorece a humanização do ambiente hospitalar.

INTRODUCTION: Humor is a stress coping strategy, which allows the expression of feelings that are often difficult to express and helps to handle fears and concerns. Thus, conflicts and tensions are relieved. The laughter therapy can use humor as a therapeutic tool, which emphasizes the humanization of care and promotes physical and emotional improvements. OBJECTIVE: This study aimed at verifying the use and benefits of laughter therapy from the viewpoint of nursing students from the State University of Feira de Santana. METHODS: Cross-sectional, analytical and descriptive study. The sample included 70 students and an individual, self-administered, and pre-tested questionnaire was applied. It consisted of closed and open-ended questions, with sociodemographic variables and questions related to laughter therapy, so that the students could express their beliefs about the laughter therapy. RESULTS: Population was predominantly female, single, and with no formal job. It was found that most academics who attended the course "Unconventional Therapies" knew and described the benefits of Laughter Therapy and a small already witnessed or used this therapy. Some benefits to the customers were observed, such as higher self-esteem, improved responsiveness to treatment, pain relief and clinical improvement. CONCLUSION: There is a need to disseminate, especially in the academic field, the use of integrative therapies such as laughter therapy as a tool for nursing care, as this practice improves the interaction between the nurse and the client and favors the humanization of hospital.