Pattern of Tau forms in CSF is altered in progressive supranuclear palsy.

Cerebrospinal fluid (CSF) total Tau levels vary widely in neurodegenerative disorders, thus being not useful in their discrimination over Alzheimer disease. No CSF marker for progressive supranuclear palsy (PSP) is currently available. The aim of this study was to characterise and measure Tau forms in order to verify the differential patterns among neurodegenerative disorders. Seventy-eight patients with neurodegenerative disorders and 26 controls were included in the study. Each patient underwent a standardised clinical and neuropsychological evaluation, MRI, and CSF total-Tau and phospho-Tau dosage. In CSF and cerebral cortex, a quantitative immunoprecipitation was developed. An extended (55 kDa), and a truncated (33 kDa) forms of Tau were recognised. CSF samples were assayed, the optical density of the two Tau forms was measured, and the ratio calculated (Tau ratio, 33 kDa/55 kDa forms). Tau ratio 33 kDa/55 kDa was significantly decreased in patients with PSP (0.46+/-0.16) when compared to controls, including healthy subjects (1.16+/-0.46, P=0.002) and Alzheimer disease (1.38+/-0.68, P<0.001), and when compared to frontotemporal dementia (0.98+/-0.30, P=0.008) or corticobasal degeneration syndrome (0.98+/-0.48, P=0.02). Moreover, in PSP patients Tau form ratio was lower than in other neurodegenerative extrapyramidal disorders, such as Parkinson disease (1.16+/-0.26, P=0.002) and dementia with lewy bodies (1.44+/-0.48, P<0.001). Tau ratio 33 kDa/55 kDa did not correlate either with demographic characteristics, cognitive performances or with motor impairment severity. Truncated Tau production shows a different pattern in PSP compared to other neurodegenerative disorders, supporting the view of disease-specific pathological pathways. These findings are promising in suggesting the identification of a marker for PSP diagnosis in clinical practice.

Cerebrospinal fluid biochemical markers in early detection and in differential diagnosis of dementia disorders in routine clinical practice.

Measurement of total tau and amyloid beta1-42 (Ab42) in cerebrospinal fluid (CSF) improves diagnostic accuracy of Alzheimer's disease (AD). We examined a consecutive patient sample referred to our center for diagnostic assessment of cognitive decline. CSF tau and Abeta42 were assayed each week as routine neurochemical analyses. There were 119 patients investigated. These included 61 with probable AD (35 mild AD, 26 severe AD), 24 with mild cognitive impairment (MCI), 14 with vascular dementia, 11 with Lewy body dementia, and 9 with fronto-temporal dementia. Mild AD showed significantly lower CSF Abeta42 levels and significantly higher CSF tau levels than the other diagnostic groups; 79% of MCI patients had pathological values for both biomarkers. We confirm that these biomarkers have a role in the clinical work-up of patients with cognitive deficits.

Triterpene Biosynthesis in the Latex of Euphorbia lathyris: Effect of Calmodulin Antagonists and Chlorinated Phenoxy Compounds.

Recognized calmodulin antagonists and chlorinated phenoxyalkylamines were tested as inhibitors of mevalonate incorporation into triterpenols and their fatty acid esters in a centrifuged pellet from the latex of Euphorbia lathyris. The calmodulin antagonists, chlorpromazine (II), fluphenzine, and trifluoperazine were good inhibitors; I(50) values for II and trifluoperazine were 150 and 55 micromolar, respectively. Inhibition by the phenoxyalkylamines increased with increasing chlorine substitution, and I(50) for 2-(pentachlorophenoxy)ethyl N,N-diethylamine (IX) was 35 micromolar. The calmodulin-stimulated phosphodiesterase catalyzed hydrolysis of cAMP was used as an assay to quantitate the calmodulin antagonism of the tested compounds. Compounds II and IX were calmodulin antagonists over a concentration range similar to their effective range in the biosynthesis of triterpenes. The antagonism of the chlorinated phenoxy compounds increased in parallel to their inhibitory effect upon triterpene biosynthesis.

Triterpene Biosynthesis in the Latex of Euphorbia lathyris: Calmodulin Antagonists Are Ineffective in Whole Latex.

The calmodulin antagonists chlorpromazine, fluphenazine, trifluoperazine, and 2-(pentachlorophenoxy)ethyl N,N-diethylamine are not inhibitors of acetate incorporation into triterpenols (TOH) and their fatty acid esters (TE) in whole tapped latex from Euphorbia lathyris, although prior work demonstrated that these antagonists are good inhibitors of mevalonate incorporation into TOH and TE in a centrifuged pellet from the latex. Antagonist absorption into the endogenous terpene pool is the primary reason for antagonist ineffectiveness in whole latex; changes in the utilized substrate or chemical deactivation of the antagonists were ruled out as factors. A biosynthetically inactive, latex supernatant fraction containing the endogenous terpene pool was prepared. This fraction blocks antagonist action when added to the latex pellet, and proved to be a useful tool for demonstrating that inhibition of triterpene biosynthesis by a calmodulin antagonist is partially reversible.

A mistica da adocao: o adolescente e o lar substituto. / The mystic of adoption: The adolescent and the substitute home

As autoras apresentam um levantamento bibliografico sobre aspectos socio-culturais e psicologicos da adocao e descrevem uma pesquisa realizada no Setor de Adolescentes do Instituto de Psiquiatria da UFRJ.Com a finalidade de tracar um perfil dos adolescentes, atendidos no referido setor, que vivem em lares substitutos. Os dados foram obtidos atraves de anamneses efetuadas no bienio 80-81. Sao focalizados varios aspectos envolvidos na historia de vida desses adolescentes: privacao materna antes da passagem para o lar substituto, adequacao deste lar, idade em que ocorreu a passagem, ocorrencia ou nao de processo legal de adocao, motivacao dos pais para a adocao, diagnostico etc

Relacao medico-paciente em pediatria.Uma experiencia com pacientes de mucoviscidose. / Physician-patient relation in pediatrics. An experience in patients with mucoviscidosis

Atraves do relato da criacao e do desenvolvimento de um grupo de trabalho com pediatras, a semelhanca do modelo de Ballint, a autora procura estudar a relacao medico-paciente. Assinala os mecanismos inconscientes de defesa contra a ansiedade que o medico utiliza, especialmente quando lida com doencas cronicas e fatais como a mucoviscidose, a partir da analise do funcionamento de uma equipe e de seu relacionamento com criancas e familias. Ressalta a importancia da atuacao do psiquiatra auxiliando o pediatra na compreensao dos fenomenos emocionais que atuam na doenca, possibilitando que este estenda ao psicologico seu campo de intervencao terapeutica

Terapia da familia-adolescente-entre a teoria e a tecnica. / Family-adolescent therapy between theory and technic

Fragmentos de cinco casos clinicos sao apresentados, ilustrando como a variabilidade de intervencoes psicoterapicas liga-se a diversidade de circunstancias que envolvem o atendimento de familias com membros adolescentes. Como a adolescencia deveria ser um periodo plastico e criativo no desenvolvimento do individuo, o terapeuta de adolescentes deve ter qualidades que mimetizem, sem imitar, os aspectos flexiveis do adolescente. Esta flexibilidade deve ser estendida ao atendimento das familias, permitindo respostas novas a perguntas como: quem tratar, como tratar e quando tratar? A inexistencia de balizamento teorico seguro na orientacao de trabalhos terapeuticos com pequenos grupos, incluindo o grupo familiar, nao invalida a possibilidade de realizacao de experimentos tecnicos que precedam o surgimento de uma teoria sistematizada

Neurolepticos no tratamento de manutencao em esquizofrenia: mito ou necessidade? / Maintenance treatment of schizophrenia with neuroleptics: a real need or a medical tradition?

Havera alguma validade em mantermos nossos pacientes esquizofrenicos sob o uso continuo de neurolepticos, ou essa e mais uma das inquestionaveis tradicoes medicas? Muitos fatores contribuem para dificultar a avaliacao do tratamento neuroleptico de manutencao na esquizofrenia. Entre os principais incluem-se a questao do diagnostico psiquiatrico, as duvidas quanto a etiologia desta doenca o conceito de cura em psiquiatria, alem das influencias do contexto socio-economico-politico em que esta inserida a pratica medica. Uma revisao da literatura nao conduz ao estabelecimento de regras definidas de como usar os neurolepticos, sendo encontradas todas as matizes de opiniao, quanto a seu uso a longo prazo, desde a elegia ate a detracao. Apesar das controversias, podem ser demarcados alguns criterios para orientar o planejamento de um esquema terapeutico, levando-se em consideracao tanto os fatores clinicos como os componentes culturais e economicos da realidade do paciente

A cura de objetivo minimo. Uma experiencia em psicoterapia breve na adolescencia. / The cure of minimal objective. An experience in brief psychotherapy in adolescence

O presente trabalho foi realizado pela equipe do setor de adolescentes do Instituto de Psiquiatria da UFRJ. A ideologia do setor e ter uma equipe de profissionais treinados para atender a imperiosa demanda das diversas patologias da populacao que acorre a instituicao. Para isto, desenvolve um amplo espectro de tecnicas de atendimento: psicoterapia breve individual, psicoterapia breve de grupo, psicoterapia familiar breve, co-terapia, psicofarmacoterapia etc. O objetivo principal desta comunicacao e apresentar um pequeno modelo empirico, instrumentado na psicoterapia breve da adolescencia. Deste ponto de vista, tenta-se demonstrar que uma das dificuldades para o trabalho clinico reside em uma serie de ideias preconcebidas, que obstaculizam as tarefas assistenciais. Estas ideias funcionam como mitos, que impedem ou atrapalham o desenvolvimento da psicoterapia. Desenham-se alguns destes mitos, e se tenta ilustrar, mediante tres casos clinicos, o que nos chamamos de "cura de objetivo minimo" (C.O.M.).Esta cura de objetivo minimo consiste em tentar resolver, mediante abordagens multivariadas de ordem empirica que se vao apresentando.Neste sentido, o trabalho pretende mostrar que a resolucao de qualquer resistencia ou obstaculo ao tratamento e uma cura minima.resolucao de qualquer resistencia ou obstaculo ao tratamento e uma cura minima