Neurochemical and genetic factors in panic disorder: a systematic review.

This systematic review addresses the complex nature of Panic Disorder (PD), characterized by recurrent episodes of acute fear, with a focus on updating and consolidating knowledge regarding neurochemical, genetic, and epigenetic factors associated with PD. Utilizing the PRISMA methodology, 33 original peer-reviewed studies were identified, comprising 6 studies related to human neurochemicals, 10 related to human genetic or epigenetic alterations, and 17 animal studies. The review reveals patterns of altered expression in various biological systems, including neurotransmission, the Hypothalamic-Pituitary-Adrenal (HPA) axis, neuroplasticity, and genetic and epigenetic factors leading to neuroanatomical modifications. Noteworthy findings include lower receptor binding of GABAA and serotonin neurotransmitters in the amygdala. The involvement of orexin (ORX) neurons in the dorsomedial/perifornical region in triggering panic reactions is highlighted, with systemic ORX-1 receptor antagonists blocking panic responses. Elevated Interleukin 6 and leptin levels in PD patients suggest potential connections between stress-induced inflammatory changes and PD. Brain-derived neurotrophic factor (BDNF) and tyrosine receptor kinase B (TrkB) signaling are implicated in panic-like responses, particularly in the dorsal periaqueductal gray (dPAG), where BDNF's panicolytic-like effects operate through GABAA-dependent mechanisms. GABAergic neurons' inhibitory influence on dorsomedial and posterior hypothalamus nuclei is identified, potentially reducing the excitability of neurons involved in panic-like responses. The dorsomedial hypothalamus (DMH) is highlighted as a specific hypothalamic nucleus relevant to the genesis and maintenance of panic disorder. Altered brain lactate and glutamate concentrations, along with identified genetic polymorphisms linked to PD, further contribute to the intricate neurochemical landscape associated with the disorder. The review underscores the potential impact of neurochemical, genetic, and epigenetic factors on the development and expression of PD. The comprehensive insights provided by this systematic review contribute to advancing our understanding of the multifaceted nature of Panic Disorder and pave the way for targeted therapeutic strategies.

Comparison of early risk factors between healthy siblings and subjects with schizophrenia and bipolar disorder.

Introduction: The following work aims to compare the types and magnitude of risk events in patients with Schizophrenia and Bipolar Disorder and each of those groups with of a group of healthy siblings, exploring differences and similarities of the two psychotic disorders. Methods: Retrospective interviews were conducted with 20 families to investigate maternal and obstetric health, social support and the presence of early trauma for the affected family members and healthy siblings. Mothers were interviewed with the Prenatal Psychosocial Profile and each family participant was assessed with the Early Trauma Inventory, Screening Questionnaire of the Genomic Psychiatry Cohort and the Diagnostic Interview for Psychosis and Affective Disorders. Results: Obstetric and gestational history, pregnancy weight changes and early trauma were associated with offspring's mental illness, including statistically significant findings for complications of pregnancy, pregnancy weight changes, general trauma, physical punishment and emotional abuse. Conclusion: These findings highlight the different risk factor exposures that occur within a family, which may increase the risk for severe mental illness.

Integrating neuroscience and humanities in healthcare evolution: a multidisciplinary perspective / Integração das neurociências e das ciências humanas na evolução dos cuidados de saúde: uma perspetiva multidisciplinar

The trajectory of healthcare has evolved from ancient holistic practices to the present biomedical model, reflecting the dynamic interplay between scientific progress, technological advancements, and the integration of humanistic values. While biomedical advancements have revolutionized medical treatments, there is an emerging recognition of the importance of integrating neuroscience and humanities to foster holistic patient care and understanding. This paper aims to explore the historical development of medicine, emphasizing the convergence of neuroscience, psychiatry, and neurology within the biomedical framework. Additionally, it investigates the resurgence of humanities in healthcare and its role in promoting patientcentered care. Through a comprehensive review of literature, this study traces the historical roots of medicine and examines the interdisciplinary intersections of neuroscience, psychiatry, neurology, and medical humanities. The exploration reveals the significant contributions of interdisciplinary approaches in enhancing patient-centered care, fostering a comprehensive understanding of health and well-being, and shaping modern healthcare practices. The integration of neuroscience and humanities offers valuable insights into the complexities of human health, bridging legacy practices with innovative approaches. Embracing this interdisciplinary perspective is crucial for promoting holistic healthcare, emphasizing patient-centered care, and enriching the understanding of health and well-being in contemporary healthcare settings.

A trajetória dos cuidados de saúde evoluiu das antigas práticas holísticas para o atual modelo biomédico, reflectindo a interação dinâmica entre o progresso científico, os avanços tecnológicos e a integração de valores humanísticos. Embora os avanços biomédicos tenham revolucionado os tratamentos médicos, há um reconhecimento emergente da importância de integrar as neurociências e as humanidades para promover a compreensão e os cuidados holísticos dos doentes. Este artigo tem como objetivo explorar o desenvolvimento histórico da medicina, salientando a convergência da neurociência, da psiquiatria e da neurologia no quadro biomédico. Além disso, investiga o ressurgimento das humanidades nos cuidados de saúde e o seu papel na promoção de cuidados centrados no doente. Através de uma revisão exaustiva da literatura, este estudo traça as raízes históricas da medicina e examina as intersecções interdisciplinares da neurociência, psiquiatria, neurologia e humanidades médicas. A exploração revela os contributos significativos das abordagens interdisciplinares para melhorar os cuidados centrados no doente, promover uma compreensão abrangente da saúde e do bem-estar e moldar as práticas modernas de cuidados de saúde. A integração das neurociências e das humanidades oferece conhecimentos valiosos sobre as complexidades da saúde humana, fazendo a ponte entre práticas antigas e abordagens inovadoras. A adoção desta perspetiva interdisciplinar é crucial para promover cuidados de saúde holísticos, enfatizando os cuidados centrados no doente e enriquecendo a compreensão da saúde e do bem-estar nos contextos de cuidados de saúde contemporâneos.

Treatment of depression during pregnancy: a protocol for systematic review and meta-analysis.

Introduction: Major Depressive Disorder (MDD) is a chronic, recurrent, and highly prevalent disease that is associated with significant functional disability. During pregnancy, the prevalence of the disease is approximately 20%, with 12% of these, requiring treatment to avoid important negative consequences for the mother-baby binomial. Risk-benefit assessment of the use of antidepressants during pregnancy is mandatory, in addition to knowledge of the long-term effects of prenatal exposure to these drugs in the offspring. In this study, we will perform an updated systematic review and meta-analysis to explore the treatment of depression during pregnancy, along with its effectiveness, safety, and possible harm to women and children. Materials and methods: We will search for publications in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, Scopus, Lilacs, and PsycINFO. The reference lists of the included studies will be manually reviewed to identify potentially relevant studies. There will be no restrictions on language or date of publication. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias (RoB2) instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aimed to ascertain the efficacy and safety of antidepressants in pregnant women and children. Ethics and dissemination: Ethical approval was not required as individual patient data were not collected. Dissemination: Plan to publish a systematic review in an open-access medical journal at the end of the process. Systematic Review Registration: PROSPERO, CRD42023447694.

Therapist-Guided Versus Self-Guided Cognitive-Behavioral Therapy: A Systematic Review.

Objective: To evaluate traditional versus guided cognitive-behavioral therapy (CBT) with the use of applications and technological innovations.Data Sources: A systematic search was conducted in the MEDLINE/PubMed, SciELO, and Cochrane Library databases and included randomized controlled trials (RCTs) from inception to March 30, 2023, with no language restrictions. Only RCTs with available text were included, which is valid from the app versus traditional CBT comparison perspective. The search terms were "apps" OR "app" AND "cognitive behavior therapy" OR "self-guided cognitive behavioral therapy" OR "cognitive behavior therapy" OR "CBT" OR "self-guided CBT" OR "iCBT" OR "unguided iCBT."Study Selection: Six RCTs were included in this review.Results: The results of all the studies were positive for the use of applications and the internet, and the findings were encouraging for new methods of guided therapy and the inclusion of technology.Conclusions: There is a need for studies that assess the mental health of individuals using and supporting technology, but these findings are encouraging for the continuation of the research.Prim Care Companion CNS Disord 2024;26(2):23r03566. Author affiliations are listed at the end of this article.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties-A multicenter cross-sectional study.

OBJECTIVE: To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. RESULTS: The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. DISCUSSION: CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. CONCLUSION: The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

Prevalence of postpartum depression symptoms in high-income, and low- and middle-income countries in the Covid-19 pandemic: a systematic review with meta-analysis.

OBJECTIVE: To perform a meta-analysis and comparison between high-income, and low- and middle-income countries postpartum depression symptoms prevalences. METHODS: PubMed, Embase, Virtual Health Library, Scopus, Web of Science, PsycINFO and CINAHL databases were searched until October 2022 for studies that collected data from pandemic. The metaprop command was used in the Stata statistical software v.12.0 to run a random-effects meta-analysis. RESULTS: A total of 15 studies with 4,788 postpartum women were included. The overall prevalence of postpartum depression symptoms was 31% (95% CI: 21.85-40.99). The pooled prevalence of postpartum depression symptoms among women from high-income countries [30.5% (95% CI: 16.95-46.02)] did not differ significantly from that among women from low- and middle-income countries [31.5% (95% CI: 19.26-45.15)]. However, studies that analyzed women up to one month after childbirth had a lower prevalence of postpartum depression symptoms [17.5% (95% CI: 9.85-26.62)] compared to those that observed them up to one year after childbirth [38.3% (95% CI: 33.96-42.83)]. CONCLUSIONS: The prevalence of postpartum depression symptoms was high regardless of the country's human development index and it must be regularly tracked around the world to assess, discuss, and recommend more assertive steps that may be implemented based on the particular characteristics of each country.

Cross-cultural adaptation of the Mind-Wandering Questionnaire (MWQ) for Brazilian Portuguese and evidence of its validity

Objective: To adapt the Mind-Wandering Questionnaire (MWQ) for the Brazilian context and present evidence of validity based on its internal structure. Methods: A total of 2,682 Brazilian adults from different regions of the country took part in this study. Confirmatory factor analyses and multigroup confirmatory factor analyses (MGCFA) were performed to assess the factor structure of the MWQ. McDonald's omega (ω) was generated to provide reliability indexes. Results: The analyses demonstrated an adequate factor structure for the MWQ adapted to the Brazilian context, corroborating the original article's single-factor model and other adaptation studies. Furthermore, the results demonstrated the instrument's reliability in a Brazilian population (ω = 0.88). Conclusion: The MWQ is thus an adequate, reliable, and quickly administered instrument for those whose aim is to measure deliberate and spontaneous MW in Brazil.

Cross-cultural adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to Brazilian Portuguese and its psychometric properties—A multicenter cross-sectional study

Abstract Objective To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. Results The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. Discussion CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. Conclusion The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.

Trastorno Límite de la Personalidad y Filicidio: Discusión de caso

La violencia contra los niños es una preocupación muy importante en el sistema de salud pública. El filicidio es un acto deliberado de una madre o un padre que mata a su propio hijo. El objetivo de este estudio es describir un caso de filicidio asociado a la presencia del Trastorno Límite de la Personalidad (TLP), analizando la evaluación de la imputabilidad criminal relacionada con este caso, utilizando el criterio biopsicológico. Medidas de protección a los niños deben ser ofrecidas de forma activa cuando los padres tienen estrés y falta de equilibrio emocional, y al mismo tiempo deben cuidar a los niños.

Violence against children is a very important concern in the public health system. Filicide is a deliberate act of a mother or father killing his own child. The aim of this study is to describe a case of filicide associated with the presence of borderline personality disorder, discussing the evaluation of criminal imputability related to this case, using the biopsychological criterion. Child protection measures should be actively offered when parents have stress and lack of emotional balance while needing to care for children.

Use of transcranial magnetic stimulation in the treatment of nonfluent primary progressive aphasia: a case report.

Primary progressive aphasia comprises a group of neurodegenerative diseases characterized by progressive speech and language dysfunction. Neuroimaging (structural and functional), biomarkers, and neuropsychological assessments allow for early diagnosis. However, there is no pharmacological treatment for the disease. Speech and language therapy is the main rehabilitation strategy. In this case report, we describe a female patient diagnosed with nonfluent primary progressive aphasia who underwent sessions of high-frequency transcranial magnetic stimulation in the left dorsolateral prefrontal cortex and showed improvement in depression scores, naming tasks in oral and written speech, and comprehension tasks in oral and written discourse.

As afasias progressivas primárias (APP) representam um grupo de doenças neurodegenerativas caracterizadas por disfunção progressiva da fala e da linguagem. A neuroimagem (estrutural e funcional), os biomarcadores e as avaliações neuropsicológicas permitem o diagnóstico precoce. No entanto, não há tratamento farmacológico para a doença. A terapia fonoaudiológica é a principal estratégia de reabilitação. Neste relato de caso, descrevemos uma paciente com diagnóstico de APP não fluente que foi submetida a sessões de estimulação magnética transcraniana de alta frequência no córtex pré-frontal dorsolateral esquerdo e apresentou melhora nos escores de depressão, nas tarefas de nomeação da fala oral e escrita e nas tarefas de compreensão da fala oral e escrita.

Prediction of declarative memory profile in panic disorder patients: a machine learning-based approach

Objective: To develop a classification framework based on random forest (RF) modeling to outline the declarative memory profile of patients with panic disorder (PD) compared to a healthy control sample. Methods: We developed RF models to classify the declarative memory profile of PD patients in comparison to a healthy control sample using the Rey Auditory Verbal Learning Test (RAVLT). For this study, a total of 299 patients with PD living in the city of Rio de Janeiro (70.9% females, age 39.9 ± 7.3 years old) were recruited through clinician referrals or self/family referrals. Results: Our RF models successfully predicted declarative memory profiles in patients with PD based on RAVLT scores (lowest area under the curve [AUC] of 0.979, for classification; highest root mean squared percentage [RMSPE] of 17.2%, for regression) using relatively bias-free clinical data, such as sex, age, and body mass index (BMI). Conclusions: Our findings also suggested that BMI, used as a proxy for diet and exercises habits, plays an important role in declarative memory. Our framework can be extended and used as a prospective tool to classify and examine associations between clinical features and declarative memory in PD patients.

[How studies on curare contributed to the development of neurophysiological research in Brazil]. / Importance des études transnationales sur le curare dans le développement de la recherche en neurophysiologie au Brésil.

Curare is a poison obtained from different species of plants in South America, which was used in arrows by the natives. Its lethal paralyzing potential and mechanism of action began to be explored in the 19th century. In this article, we highlight the research on this poison and the fruitful exchanges between the Brazilian Emperor Dom Pedro II and the researchers João Baptista de Lacerda, Louis Couty and Alfred Vulpian who contributed to the development of experimental neurophysiology in Brazil. Vulpian found that curare does not affect the nerve itself, but acts between the nerves and the muscle, through a "ligand substance" - this Vulpian's pioneering concept is often wrongly attributed to Claude Bernard. These prestigious scientists contributed to the transnational circulation of knowledge that later yielded in the preparation of curare purified extract used for convulsive therapy and anesthesia.

Title: Importance des études transnationales sur le curare dans le développement de la recherche en neurophysiologie au Brésil. Abstract: Le curare, un poison obtenu à partir de différentes espèces de plantes en Amérique du Sud, était utilisé sur les flèches par les autochtones. Son potentiel paralysant mortel et son mécanisme d'action ont commencé à être explorés par les chercheurs au XIXe siècle. Dans cet article, nous rappelons l'historique des recherches sur ce poison et les échanges entre l'empereur brésilien Dom Pedro II et les chercheurs João Baptista de Lacerda, Louis Couty et Alfred Vulpian qui ont beaucoup contribué au développement scientifique brésilien. Vulpian a découvert que le curare n'affecte pas le nerf lui-même, mais agit entre celui-ci et le muscle, par l'intermédiaire d'une « substance de liaison ¼ ­ ce concept développé par Vulpian est souvent attribué à tort à Claude Bernard. Les travaux pionniers de ces savants prestigieux ont ultérieurement abouti à la préparation d'extrait purifié de curare, d'intérêt thérapeutique majeur pour le traitement de convulsions et pour l'anesthésie.

Home care for the elderly with dementia: a systematic review.

Objetive: With the global population aging, there is a growing need for home-based care to meet the health needs of the elderly. However, the quality of care provided to the aged population is now arguably a significant challenge for most healthcare systems worldwide. Methods: The present review included 13 original studies on home care and its effects on dementia patients, describing how patient care and adequate treatment can be collaborative for their improvement, for case management, and optimizing pain control and specificities. Results: Among the findings, it was evidenced that the environment impacts the form of care, once being at home can improve communication and global monitoring of dementia patients. Conclusion: In addition to the results analyzed in this review, there is a need for future, well-designed studies on the different aspects of home care, highlighting the importance of evaluating the type of care for each patient in the quest to optimize the care.

Objetivo: Com o envelhecimento da população mundial, há uma necessidade crescente de cuidados domiciliares para atender às necessidades de saúde dos idosos. No entanto, a qualidade dos cuidados prestados à população idosa é hoje indiscutivelmente um grande desafio para a maioria dos sistemas de saúde em todo o mundo. Métodos: A presente revisão incluiu 13 estudos originais sobre cuidados domiciliares e seus efeitos em pacientes com demência, descrevendo como o cuidado e o tratamento adequado do paciente podem ser colaborativos para sua melhora, para o gerenciamento de casos e a otimização do controle de sua dor e especificidades. Resultados: Entre os achados, evidenciou-se que o ambiente impacta a forma de atendimento, pois estar em casa pode melhorar a comunicação e o acompanhamento global dos pacientes em quadro demencial. Conclusão: Além dos resultados analisados nesta revisão, há a necessidade de futuros estudos bem elaborados sobre os diferentes aspectos da atenção domiciliar, destacando a importância de avaliar o tipo de cuidado de cada paciente na busca de otimizar o cuidado.

Cross-cultural Adaptation and Validity Evidence of the Mind-Wandering Questionnaire (MWQ) for Brazilian Portuguese.

OBJECTIVE: The objective of the present study is to adapt and present validity evidence based on the internal structure of the Mind-Wandering Questionnaire (MWQ) for the Brazilian context. METHODS: A total of 2682 Brazilian adults from different regions of the country have taken part in this study. Confirmatory factor analyses and multigroup confirmatory factor analyses (MGCFA) were performed to assess MWQ factor structure. McDonald's Omega (ω) was generated to provide reliability indexes. RESULTS: It was demonstrated an adequate factor structure of the MWQ for the Brazilian context, corroborating the original article's single-factor model and other adaptation studies. Further, the results demonstrated the reliability of the instrument for the Brazilian population (ω=0.88). CONCLUSIONS: The MWQ is thus an adequate, reliable, and quickly applicable instrument for those whose aim is to measure deliberate and spontaneous MW in Brazil.

Cognition in Schizophrenia: A Systematic Review of Wechsler Adult Intelligence Scale Studies.

Objective: To critically analyze the evidence regarding changes in verbal and performance intelligence quotient (IQ) in patients with schizophrenia.Data Sources: An English-language-only search was conducted in the PubMed, Cochrane Library, and LILACS databases for articles with study objectives that included Wechsler Adult Intelligence Scale (WAIS) assessment of cognitive functions in patients with schizophrenia. Descriptors were defined based on Medical Subject Headings, where associations of psychotic disorders related to the schizophrenia spectrum were suggested, as well as the "Wechsler Scales" descriptor. The search was conducted in November 2022 with no restriction on the date of publication to select studies that used any of the WAIS editions.Study Selection: Articles that met the inclusion criteria were selected after title and summary identification and full-text review.Results: A total of 28 articles were identified. All studies presented total IQ scores, but only 20 showed results for verbal IQ (n = 20) or performance IQ (n = 19). Analyzed data indicated patients had average performance on verbal comprehension features but low average performance on perceptual reasoning, working memory, and processing speed indices.Conclusions: Executive function deficits were found in the analyzed studies, which reflect difficulties in planning and impulse control-characteristics present in the diagnosis of schizophrenia. The identification of this neuropsychological functioning contributes to the understanding of the cognitive dynamics found in schizophrenia and may help in early diagnosis, reinforcing the hypothesis that cognitive performance may be one of the indicators of psychopathologic expression.Prim Care Companion CNS Disord 2023;25(5):22r03456. Author affiliations are listed at the end of this article.

Prediction of declarative memory profile in panic disorder patients: a machine learning-based approach.

OBJECTIVE: To develop a classification framework based on random forest (RF) modeling to outline the declarative memory profile of patients with panic disorder (PD) compared to a healthy control sample. METHODS: We developed RF models to classify the declarative memory profile of PD patients in comparison to a healthy control sample using the Rey Auditory Verbal Learning Test (RAVLT). For this study, a total of 299 patients with PD living in the city of Rio de Janeiro (70.9% females, age 39.9 ± 7.3 years old) were recruited through clinician referrals or self/family referrals. RESULTS: Our RF models successfully predicted declarative memory profiles in patients with PD based on RAVLT scores (lowest area under the curve [AUC] of 0.979, for classification; highest root mean squared percentage [RMSPE] of 17.2%, for regression) using relatively bias-free clinical data, such as sex, age, and body mass index (BMI). CONCLUSIONS: Our findings also suggested that BMI, used as a proxy for diet and exercises habits, plays an important role in declarative memory. Our framework can be extended and used as a prospective tool to classify and examine associations between clinical features and declarative memory in PD patients.

Relationship between epileptic seizures and criminal behavior: a systematic literature review / Relação entre crises epilépticas e comportamento criminoso: uma revisão sistemática da literatura

Objective: The principal objective aims to assess a possible relationship between epilepsy and aggressive behavior. Secondarily, we intend to study how epilepsy relates to criminal liability. Methods: A systematic literature review was performed, using the Web of Science,United States National Library of Medicine (PubMed),and Scielo databases. The searches were conducted in May-June 2022 and covered the period from 2000 to 2022. Eligibility criteria consisted on original articles in English and Portuguese that were interested in the association of epilepsy, criminal behavior (with aggression directed to others), criminal liability in adults with epilepsy. Results: The search yielded 921 results, 794 of which in PubMed, 115 in Web of Science, and 12 in Scielo. Articles that failed to meet the inclusion criteria (206) and duplicates (201) were excluded. Conclusion: There were no findings to indicate a significant increase in aggressive behaviors in individuals with epilepsy. However, it was possible to identify a higher prevalence of aggressive acts in males with epilepsy, besides the presence of comorbidities with mental disorders and substance use. In addition, the results suggest that in criminal offenders with epilepsy, the seizures originated in the temporal and frontal cerebral lobes. Further researchis necessary on the relationship between epilepsy, criminality, and criminal liability in order to produce more robust data to support legal proceedings.

Objetivo: O objetivo principal visa avaliar uma possível relação entre epilepsia e comportamento agressivo. Secundariamente, pretendemos estudar a relação entre epilepsia e responsabilidade penal. Método: Foi realizada uma revisão sistematizada da literatura, utilizando as bases de dados Web of Science, United States National Libraryof Medicine (PubMed) e Scielo. As buscas ocorreram no período de maio e junho de 2022, verificando o período de 2000 à 2022. Os critérios de elegibilidade consistiram em artigos originais em inglês e português, com interesse na associação entre epilepsia, comportamento criminoso (com violência direcionada a outros) e responsabilidade penal em adultos com epilepsia. Resultados: Foram encontrados 921 resultados na busca, sendo 794 na base de dados PubMed, 115 na Web of Science, e 12 na Scielo.Aqueles que não preencheram os critérios de inclusão (206) e duplicados (201) foram excluídos. Conclusão: Não houveram achados suficientes que indicassem um aumento significativo de comportamentos agressivos na população epiléptica. Entretanto, em relação a esse aspecto, foi possível estabelecer maior prevalência no sexo masculino, presença de comorbidades com transtornos mentais, além de uso de substâncias. Além disso, os resultados sugerem que, em infratores epilépticos, as crises foram provenientes das regiões temporo-frontais do cérebro. Em suma, é importante que a relação entre comportamento criminoso, epilepsia e imputabilidade penal continue sendo estudada, de modo a trazer dados mais sólidos para embasar procedimentos judiciais.

Matricide and schizophrenia- psychopathological, psychodynamic, and forensic aspects: a case report.

Matricide is the murder of a mother by her son or daughter, a form of homicide rarely seen in psychiatric practice. A narrative review was conducted on the relationship between matricide and schizophrenia, followed by a case report in Brazil of a schizophrenic patient who murdered his mother and was submitted to forensic psychiatric assessment for criminal liability. The article discusses psychopathological, psychodynamic, and forensic aspects related to the case. The observation of ambivalent and conflictive relations between schizophrenic individuals and their mothers suggests the need for family-level interventions to resolve the understandable occurrence of emotional conflicts, which can serve as stimuli that trigger the murder.