Psychiatric morbidities after stroke in Asia: A systematic review

Background@#Stroke is currently the second leading cause of death worldwide and is one of the leading causes of long-term disability . Mood disorders are prevalent after a stroke and may hinder physical, functional, and cognitive recovery; hence, it is undeniably necessary to recognize them early. Stroke mortality is generally higher in Asia as most of the countries therein are in economic transition . Socioeconomic status is a major contributor to stroke burden as greater odds of disability are found in patients with lower educational status and income. @*Objectives@#The primary objective of this study is to identify the psychiatric morbidities commonly seen after a stroke in Asia. @*Search Methods@#The following databases were utilized for extensive literature search: PubMed (January 2002 to June 2022), Cochrane Library (January 2002 to June 2022), and EBSCO (January 2002 to June 2022). The search made use of keyword combinations, Boolean operators "AND" and "OR," truncations, and field tags last October 2022. @*Selection Criteria@#Articles on the prevalence and cross-sectional studies were included if they involved stroke survivors who developed post-stroke psychiatric morbidities in Asia. Additional inclusion criteria consisted of studies that have to be written in the English language and having free full texts available. @*Data Collection and Analysis@#This systematic review made use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. The JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data was used in the assessment for the quality of articles to be included in this systematic review. @*Results and Conclusion@#Affective disorders and generalized anxiety disorder were the common psychiatric morbidities identified post-stroke. The Hospital Anxiety and Depression Scale (HADS) may be used to diagnose post-stroke depression and anxiety. Males in their middle to late adulthood with higher National Institutes of Health Stroke Scale (NIHSS) scores and poor stroke outcomes (higher scores in the Modified Rankin Scale) were associated with a higher likelihood of developing the aforementioned psychiatric morbidities.

Audiência de Custódia e seus paradoxos frente à pessoa com transtorno mental em conflito com a lei / Custody hearings and their paradoxes for people with mental disorders in conflict with the law / Audiencia de custodia y sus paradojas frente a la persona con trastorno mental en conflicto con la ley

Este artigo teve como objetivo analisar os efeitos da psiquiatrização da loucura nos discursos de autoridades judiciais nas decisões frente aos flagrantes de pessoas com transtorno mental em conflito com a lei, nas Audiências de Custódias (ACs) de um estado brasileiro. Por meio de uma abordagem qualitativa, foram realizadas cinco entrevistas em profundidade com juízes, analisadas sob as perspectivas da análise do discurso de Michel Foucault. Os resultados/discussão foram descritos a partir de dois eixos: o primeiro versa sobre psiquiatrização da AC: o louco em privação de liberdade; e o segundo problematiza o risco como dispositivo de captura e privação da liberdade. Conclui-se que, ainda que as ACs tenham sido produzidas como dispositivo para garantia da liberdade, afere-se que em seus discursos os participantes da pesquisa apresentam ideias da loucura como risco, que justificam o aprisionamento. (AU)

This article analyzes the effects of the psychiatrization of madness in the discourse of judicial authorities in decisions in response to flagrant offences committed by people with mental disorders during custody hearings (CHs) in a Brazilian state. We conducted a qualitative study involving five in-depth interviews with judges analyzed from the perspective of Foucauldian discourse analysis. The results are described in two core areas: the psychiatrization of the custody hearing - mad people deprived of their liberty; and problematizing risk as a device of capture and deprivation of liberty. We concluded that, although custody hearings were supposedly created as a device for guaranteeing liberty, the participants' discourses present ideas of madness as risk, justifying imprisonment. (AU)

El objetivo de este artículo fue analizar los efectos de la psiquiatrización de la locura en los discursos de autoridades judiciales en las decisiones ante los flagrantes de personas con trastorno mental en conflicto con la ley, en las Audiencias de Custodia (ACs) de un estado brasileño. Por medio de un abordaje cualitativo, se realizaron cinco entrevistas en profundidad con jueces, analizadas bajo las perspectivas del análisis del discurso de Michel Foucault. Los resultados/discusión se describieron a partir de dos ejes: el primero sobre psiquiatrización de la audiencia de custodia: el loco en privación de libertad y el segundo problematizando sobre el riesgo como dispositivo de captura y privación de la libertad. Se concluye que aunque las ACs se produjeron como dispositivo para garantía de la libertad, se verifica que en sus discursos los participantes en el estudio presentan ideas de locura como riesgo que justifica el aprisionamiento. (AU)

Childhood trauma and bipolar spectrum: a population-based sample of young adults

Abstract Introduction Childhood trauma has been suggested to be involved in susceptibility to bipolar disorder (BP). However, it remains unclear whether the occurrence of childhood trauma is differently distributed in subthreshold bipolar disorder (SBP). Objective To assess childhood trauma in young adults with SBP, as compared to young adults with BP and population controls (PC). Method This was a cross-sectional, population-based study. The Mini International Neuropsychiatric Interview (MINI) was used to define the groups with BP (subjects with a lifetime or current manic episode or lifetime or current hypomania with a history of a depressive episode), SBP (subjects with a history of hypomanic episode without lifetime or current depressive episode), and subjects without mood disorders (PC). Childhood trauma was assessed using de Childhood Trauma Questionnaire (CTQ). We investigated differences regarding childhood trauma across the three groups (BP, SBP and PC). Result Except for sexual abuse, all subtypes of childhood trauma remained associated with the BP group as compared to PC. Additionally, when we compared SBP and BP, significant differences were found only for emotional abuse. No significant differences were found in relation to childhood trauma between the SBP and PC groups after adjusting for confounding factors. Conclusion These findings suggest that investigating childhood trauma, with a particular focus on emotional abuse, could be considered a preventive measure and potentially improve the prognosis.

Perfil genético del trastorno bipolar en Panamá: análisis de genes relacionados y otros factores determinantes en una región de alta prevalencia de episodios maníacos en la República de Panamá / Genetic profile of bipolar disorder in Panama: related gene analysis and other determi­ning factors in a high prevalence region of manic episodes in the Republic of Panama

Introducción El Trastorno Bipolar es una enfermedad que causa discapacidad física y cognitiva, afectando tanto a hombres como mujeres, con edad de inicio temprano y con un alto componente hereditario. Objetivo Estimar el comportamiento del Trastorno Bi­polar, variables sociodemográficas, antecedentes y su relación con los genes CACNA1­C (12p13.3) y DAOA (13q34) entre personas de 18 años y más en áreas específicas de la Región de Azuero de Panamá. Metodología La muestra calculada fue de 267 perso­nas de 18 años y más (IC 95%) utilizando un muestreo aleatorio, de distribución propor­cional según sexo. Se utilizaron las variables: "trastorno bipolar" medido a través del cuestionario de trastornos del estado de ánimo (Mood Disorder Questionnaire, MDQ por sus siglas en inglés); "genes asociados a la bipolaridad" (genes CACNA1­C (12p13.3) y DAOA (13q34)); y un cuestionario de datos sociodemográficos y antecedentes persona­les ­ familiares. El análisis genético se realizó con PCR (tiempo real). Se utilizaron por­centajes como medida de frecuencia relativa y se consideró significancia estadística para un valor de p ≤ 0.05. Resultados La prevalencia de bipolaridad en la muestra es­tudiada fue 3.7% (IC 95% 3.5 ­ 4.1), siendo mayor en mujeres, 6.0% (IC 95% 5.9 ­ 6.3). El 74.2% (IC 95% 73.9 ­ 74.4) de los participantes tenía presente el polimorfismo del gen CACNA1­C (12p13.3), y 19.1% (IC 95% 18.9 ­ 19.4) el del gen DAOA (13q34). Para todas las variables de estudio, la presencia del gen CACNA1­C (12p13.3) fue mayor que la del gen DAOA (13q34). De los 10 casos con MDQ+, 3 presentaron el gen CAC­NA1­C. Conclusión Esta es la primera investigación sobre bipolaridad, genes y otros factores asociados en Panamá. El gen CACNA1­C fue más prevalente que el DAOA y se asoció más al MDQ +.

Introduction Bipolar disorder is a disease that causes physical and cognitive disability, affecting both men and women, with an early onset age and a high hereditary compo­nent. Objective To estimate Bipolar Disorder demeanor, sociodemographic variables, antecedents and its relationship with CACNA1­C (12p13.3) and DAOA (13q34) genes among people aged 18 years and over in specific areas of the Azuero Region of Pana­ma. Methodology The calculated sample was 267 people aged 18 and over (95% CI) using random sampling, proportional distribution according to sex. The variables were used: "bipolar disorder" measured through the Mood Disorder Questionnaire (MDQ); "genes associated with bipolarity" (CACNA1­C (12p13.3) and DAOA (13q34) genes); and a sociodemographic data questionnaire and personal ­ family background. The ge­netic analysis was performed with PCR (real time). Percentages were used as a re of relative frequency and statistical significance was considered for a value of p ≤ 0.05. Results The prevalence of bipolarity in the studied sample was 3.7% (CI 95% 3.5 ­ 4.1), being higher in women, 6.0% (CI 95% 5.9 ­ 6.3). 74.2% (CI 95% 73.9 ­ 74.4) of the participants were aware of the polymorphism of the CACNA1­C gene (12p13.3), and 19.1% (CI 95% 18.9 ­ 19.4) of the DAOA gene (13q34). For all study variables, the pre­sence of the CACNA1­C gene (12p13.3) was greater than that of the DAOA gene (13q34). Of the 10 cases with MDQ +, 3 presented the CACNA1­C gene. ConclusionThis is the first research on bipolarity, genes and other associated factors in Panama. The CACNA1­C gene was more prevalent than DAOA and was more associated with MDQ +.

O traço do personalismo das instituições assistenciais: doadores, doações e projeção social no Ceará oitocentista / The trait of personalism in charitable institutions: donors, donations, and social projection in nineteenth-century Ceará

Resumo No Brasil oitocentista evidenciou-se a emergência de instituições assistenciais. Por meio delas, os estados provinciais projetaram membros das elites políticas e econômicas nomeando-os grandes benfeitores. Homens de notoriedade local desempenharam papel na construção de determinados espaços asilares por meio de práticas que ratificaram seu prestígio social não apenas entre seus pares e para sua época, mas também para a memória e a história das instituições às quais estavam vinculadas. O artigo problematiza a construção de três instituições assistenciais no Ceará: Asilo de Mendicidade, Colônia Orfanológica Cristina e Asilo de Alienados São Vicente de Paula, cuja tônica discursiva e ações filantrópicas estavam inseridas no cenário da grande seca de 1877-1879.

Abstract In the nineteenth century, Brazil witnessed the emergence of the first welfare institutions. These became the platforms for provincial states to raise the status of their political and economic elite, naming them great benefactors. Men of local repute played active roles in building certain institutional spaces, employing practices that reinforced their social prestige not just among their peers and for their time, but also for the memory and history of the institutions with which they were involved. The building of three welfare institutions in the province of Ceará is problematized: Asilo de Mendicidade, Colônia Orfanológica Cristina, and Asilo de Alienados São Vicente de Paula, whose discourse and philanthropic actions were entangled with the great drought of 1877-1879.

Hipomanía y corticoides en pacientes oncológicos. Reporte de un caso y revisión de la literatura / Hypomania and corticoids in oncological patients. Case report and literature review

Resumen Introducción: Cada año aumenta el número de personas que padece algún tipo de cáncer. Los corticoides son ampliamente utilizados en el tratamiento de los pacientes con cáncer y su uso no está exento de efectos adversos, muchas veces muy invalidantes. Objetivo: Presentar un caso clínico de un brote hipomaníaco en una paciente con cáncer de ovario usuaria de corticoides y realizar una revisión de la literatura del tema. Caso clínico: Paciente, portadora de un cáncer de ovario avanzado, tratado con cirugía y quimioterapia, debuta con episodios de vómitos que son manejados con dexametasona. Durante el tratamiento presenta insomnio, verborrea e ideas de grandiosidad, diagnosticándose un brote hipomaniaco secundario al tratamiento esteroidal. Discusión: En el caso de los pacientes oncológicos, e independientemente del uso de corticoides, aproximadamente el 50% de ellos presentará algún tipo de sintomatologia psiquiátrica, ahora bien, si a esto agregamos el uso de corticoides la incidencia puede aumentar hasta un 65% - 75%. La hipomanía da cuenta prácticamente del 50% de los trastornos psiquiátricos inducidos por corticoides. Con dosis menores de 40 mg/día sólo el 2% de los pacientes se verá afectado por este tipo de trastornos, mientras que con dosis entre 40 a 80 mg/día esta incidencia aumenta hasta un 5%. Conclusión: Los corticoides son ampliamente utilizados en pacientes oncológicos, sin embargo, su uso puede provocar trastornos psiquiátricos. Es importante dar a conocer más al equipo sanitario referente a la asociación de corticoides y cuadros psiquiátricos para su rápida detección y manejo clínico.

Introduction: Every year the number of people affecting by cancer increase. Corticosteroids are widely used in the treatment of patients with cancer and their use is not without adverse effects, often very disabling. Objective: Present a clinical case of hypomanic outbreak in a patient with ovarian cancer using corticosteroids and to carry out a review of the literature on the subject. Clinical case: Patient with an advanced ovarian cancer, treated with surgery and chemotherapy, debuts with episodes of vomiting that are managed with dexamethasone. During the treatment he presented insomnia, verbiage and grandiosity, diagnosing a hypomanic outbreak secondary to steroidal treatment. Discussion: In cancer patients, and independently of the use of corticosteroids, approximately 50% of them will present some type psychiatric disorder. With corticosteroids the incidence can increase up to 65%-75%. Hypomania accounts for almost 50% of psychiatric disorders induced by corticosteroids. With doses lower than 40 mg/day only 2% of patients will be affected by this type of disorders, while with doses between 40 to 80 mg/day this incidence increases up to 5%. Conclusion: Corticosteroids are widely used in cancer patients, however their use can cause psychiatric disorders. It is important to make the healthcare team more aware of the association of corticosteroids and psychiatric symptoms for rapid detection and clinical management.

A estética da degeneração e a expressão dos alienados: leituras de Júlio Dantas no Hospital de Rilhafoles / The aesthetics of degeneration and expressions of the alienated: readings from Júlio Dantas at the Rilhafoles Hospital

Resumo A proposta é apresentar, brevemente, o modo como as expressões artísticas dos alienados surgem como elemento discursivo na leitura médica e crítica de Júlio Dantas, tendo como ponto de partida sua tese, Pintores e poetas de Rilhafolles, apresentada, em 1900, como conclusão do curso de medicina, em Lisboa. Trata especialmente da averiguação dos métodos utilizados por Dantas em suas investidas e proposições conceituais sobre essa temática, considerando que seus interesses iam ao encontro de questões muito específicas: as características e as formas da degeneração social. O artigo também propõe a revisão de algumas das reverberações nos meios sociais e artísticos provocadas pela publicação da tese.

Abstract The proposal of this article is to briefly present how artistic expressions of the alienated appear as a discursive element in medical and critical readings of Júlio Dantas, starting with his thesis, Pintores e poetas de Rilhafolles, which he presented in 1900 as the conclusion to his medicine course in Lisbon. This particularly involves investigating the methods Dantas used in his invested and conceptual propositions on this topic, considering that his interests responded to very specific issues: the characteristics and forms of social degeneration. The article also reviews some of the reverberations in the social and artistic environments that were insulted by the publication of the thesis.

A loucura em Foucault: arte e loucura, loucura e desrazão / Madness in Foucault: art and madness, madness and unreason

Expõe as ideias contidas em escritos de Michel Foucault, Peter Pál Pelbart e Gilles Deleuze sobre a loucura e sua interface com a arte visando explorar os questionamentos desses autores sobre a relação entre arte e loucura. Parte da ideia de que a loucura não diz a verdade da arte, e vice-versa, mas que existem conexões entre ambas que devem ser abordadas para permitir uma reflexão mais profunda sobre o tema. Problematizam-se neste texto: a afirmação de que a loucura é a ausência de obra e a interferência disso na possibilidade de uma obra artística; e a ideia da loucura como linguagem interdita, ou seja, de que a loucura não traz apenas exclusão do corpo, mas também desqualificação do discurso.

After presenting the ideas on madness and its interface with art as expressed in the writings of Michel Foucault, Peter Pál Pelbart, and Gilles Deleuze, the article explores how these authors question the relationship between art and madness. It begins with the notion that madness does not tell the truth about art, and vice versa, but that there are links between both that must be delved into if we are to engage in deeper reflection on the topic. The text problematizes the statement that madness is the absence of an oeuvre and examines how this impacts the possibility of achieving an artistic oeuvre. It further problematizes the idea of madness as excluded language, that is, the idea that madness implies not only the exclusion of the body but also the disqualification of discourse.

A cena constituinte da psicose maníaco-depressiva no Brasil / The emergence of manic depressive psychosis as a diagnosis in Brazil

A intenção deste ensaio é esboçar a leitura da psicose maníaco-depressiva no Brasil, no começo do século XX. Destaca a transformação teórica ocorrida na psiquiatria brasileira, que se deslocou da tradição francesa para a alemã. Sublinha o modo como a problemática da histeria foi substituída pela da psicose maníaco-depressiva nesse contexto histórico.

This essay examines the early twentieth-century interpretation of manic depressive psychosis in Brazil, during a moment when Brazilian psychiatry witnessed a theoretical shift from the French to German traditions. It calls special attention to how the problem of hysteria was replaced by manic depressive psychosis within this historical context.

O intenso e vazio viver maníaco-melancólico / The intense and empty existence of the manic-melancholic

Introdução: A experiência maníaco-melancólica é marcada pelo sofrimento, restrição e perda da liberdade em seu modo-de-ser-no-mundo. É comum atitudes de estranhamento, afastamento não só da pessoa que vive essa experiência, como dos entes ao seu redor. Objetivos: Buscar uma aproximação entre a Mania e a Melancolia, considerando algumas similaridades na vivência dos existenciais como a espacialidade, a temporalidade, a corporeidade e a afinação. Métodos: Realizou-se uma revisão bibliográfica acerca da vivência maníaco-melancólica, pautada nos pressupostos do referencial Fenomenológico-Existencial. Resultados: Percebemos em ambas experiências um não desdobramento do tempo, uma não realização das possibilidades futuras, um não relacionamento com as coisas do mundo e uma perda de projeção da corporeidade no mundo.Conclusão: A Mania e a Melancolia são compreendidas não como uma doença, mas como um modo de ser no mundo em que a liberdade de escolhas de vir a ser encontra-se limitada.

Introduction: The manic-melancholic experience is marked by suffering, loss of freedom and constraint in their way-of-being in the world. It is common attitudes of estrangement, isolation not only the person living that experience, as the beings around him. Objectives: To find a rapprochement between mania and melancholy, considering some similarities in the experience of existential as spatiality, temporality, corporeality and tuning. Methods: We conducted a literature review about the manic-melancholic experience, based on the assumptions of the phenomenological approach: Existential. Results: We noticed in both experiments a non-split time, not a realization of future possibilities, not a relationship with things in the world and a loss of projection of embodiment in mundo.Conclusão: mania and melancholia are understood not as a disease, but as a way of being in the world where freedom of choice of being is limited.