Using Prazosin to Treat Posttraumatic Stress Disorder and Associations: A Systematic Review.

OBJECTIVE: A central adrenergic hyperactivation is described in the neurobiology of posttraumatic stress disorder (PTSD) with probable variable symptomatic impact. Few studies have evaluated using the alpha-1 adrenergic antagonist prazosin for such symptoms; however, given the likely pathophysiology involved, this drug may play an important role in the pharmacological approach to PTSD. METHODS: This study assessed articles already published on the use of prazosin through a systematic review along a timeline in view of the symptomatic target of difficult access by standardized treatments. The impact of using this medication for the general symptoms of PTSD is also discussed. Several databases were searched for articles in the literature on the use of prazosin to treat PTSD. RESULTS: A total of 168 articles were found containing search terms in the title or abstract. Overall, 85 articles met the criteria described, and 48 studies were explored to conduct the present systematic review. Most articles showed some improvement after prazosin administration, especially in relation to sleep symptoms (nightmares and night waking). Only one article demonstrated no improvement after the use of this drug. More randomized studies are needed. CONCLUSION: Several clinical studies demonstrated the relevant role of prazosin for treating PTSD symptoms. Prazosin is an affordable and cost-effective pharmacological option compared to other drugs used to treat PTSD.

Macro e micro-olhares na prevenção do suicídio: um aprendizado de mão dupla / Macro and micro looks at suicide prevention: two-way learning / Macro y micro miradas a la prevención del suicidio: aprendizaje bidireccional / Macro et microregards sur la prévention du suicide: un apprentissage à double sens

Este trabalho, escrito a seis mãos, busca oferecer olhares distintos e complementares a respeito de um tema multifacetado: a prevenção ao suicídio. Os autores trazem dados atualizados das taxas de suicídio no Brasil e no mundo, com a informação alarmante de que os números no Brasil cresceram, enquanto no mundo caíram. Tratam de políticas públicas que se mostraram efetivas na diminuição dos casos, contextualizam a intersecção teórica e clínica desse tema entre psicanálise e psiquiatria, discorrem a respeito das reações contratransferenciais do profissional da saúde mental ao lidar com a problemática dos pacientes que apresentam ideação, plano ou tentativa de suicídio com uma vinheta clínica ilustrativa e encerram o trabalho abordando uma perspectiva ética não comum à nossa cultura brasileira, de que existem países que reconhecem como legítimo o desejo de morte de pacientes com transtornos mentais graves, sendo possível a realização oficial e assistida da eutanásia.

This work, written by six hands, seeks to offer different and complementary perspectives on a multifaceted theme: suicide prevention. The authors provide up-to-date data on suicide rates in Brazil and around the world, with alarming information that numbers in Brazil have grown while in the world they have fallen. They present public policies that have been effective in reducing cases, contextualize the theoretical and clinical intersection of this theme between psychoanalysis and psychiatry, discuss the countertransference reactions of mental health professionals when dealing with the problem of patients with ideation, plan or attempt of suicide with an illustrative clinical vignette and conclude the work presenting an ethical perspective not common to our Brazilian culture, that there are countries that recognize as legitimate the wish of death of patients with severe mental disorders being possible the official and assisted accomplishment of euthanasia.

Este trabajo, escrito a seis manos, busca ofrecer perspectivas diferentes y complementarias sobre un tema multifacético: la prevención del suicidio. Los autores aportan datos actualizados sobre las tasas de suicidio en Brasil y en todo el mundo, con información alarmante de que las cifras en Brasil han aumentado, mientras que en el mundo han disminuido. Presentan políticas públicas que han sido efectivas en la reducción de casos, contextualizan la intersección teórica y clínica de este tema entre el psicoanálisis y la psiquiatría, discuten las reacciones de contratransferencia de los profesionales de la salud mental al tratar el problema de los pacientes con ideación, plan o intento de suicidio con un caso clínico ilustrativo y concluyen el trabajo presentando una perspectiva ética no común a nuestra cultura brasileña, de que existen países que reconocen como legítimo el deseo de muerte de pacientes con trastornos mentales graves, siendo posible la realización oficial y asistida de la eutanasia.

Cet ouvrage, écrit à six mains, cherche à offrir des regards différents et complémentaires sur un thème aux faces multiples : la prévention du suicide. Les auteurs fournissent des données actualisées sur les taux de suicide au Brésil et dans le monde, avec une information alarmante selon laquelle les chiffres au Brésil ont augmenté tandis que dans le reste du monde, ils ont diminué. Ces chercheurs présentent des politiques publiques qui se sont montrées efficaces pour la réduction du nombre de cas, qui contextualisent l'intersection théorique et clinique de ce thème entre psychanalyse et psychiatrie et, au moyen d'une vignette clinique illustrative, ils exposent des réactions de contre-transfert du professionnel de la santé mentale lorsqu'il est en face de la problématique des patients atteints d'idéation, ayant un projet de suicide ou qui en ont fait une tentative. Ils terminent le travail, en présentant une perspective éthique qui n'est pas habituelle dans la culture brésilienne, c'est-à-dire, qu'il est des pays qui reconnaissent comme légitime le désir de décès des patients souffrant de troubles mentaux graves où il est possible la réalisation officielle et assistée de l'euthanasie.

Diagnosis and implications in the therapeutic management of patient with afebrile neurolepctic malignant syndrome.

This report aims at raising clinical awareness for the diagnosis of atypical presentations of neuroleptic malignant syndrome (NMS). We describe the case of a female patient with NMS symptoms, except fever, after starting the use of chlorpromazine. The afebrile condition delayed the consideration of NMS by the emergency clinicians who provided her initial assessment. Before this consideration, an anticholinergic agent, not recommended at this condition, was inadvertently prescribed. This might have contributed to the worsening of symptoms. NMS is a life-threatening idiosyncratic reaction most often seen as complication of antipsychotic treatment. Its clinical spectrum is broad and its diagnosis should be considered even if the patients do not fulfill all the possible described symptoms.

Suicide prevention training for professionals in the public health network in a large Brazilian city.

The objective of this study was to improve health professionals' knowledge and attitudes toward suicide prevention. A suicide prevention training of 18 hours duration was conducted with 270 health professionals, mainly primary care workers, who were routinely involved with patients at high risk for suicide. Questionnaires were used to assess changes in attitudes and knowledge. The score in the knowledge questionnaire, with 21 points as maximum value, increased from 8.9 to 13 points (p < .001, significance level of 95%). Of the 25 questionnaire items representing attitudes, 18 showed significant change after the training. This training model has enhanced knowledge and attitudes toward suicide prevention in healthcare workers.

Factors associated with repeated suicide attempts. Preliminary results of the WHO Multisite Intervention Study on Suicidal Behavior (SUPRE-MISS) from Campinas, Brazil.

BACKGROUND: This study compares sociodemographic and clinical characteristics of 102 first-time hospital-treated suicide attempters (first-evers) with a group of 101 repeat suicide attempters (repeaters) consecutively admitted to a general hospital in Brazil, during the intake phase of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). AIMS: To compare sociodemographic and clinical characteristics of first-time hospital-treated suicide attempters (first-evers) with a group of repeat suicide attempters (repeaters). METHODS: A standardized interview and psychometric scales were administered to all patients. RESULTS: Repetition was associated with being of female sex (OR = 2.7; 95% confidence interval (CI) = 1.2-6.2), a housewife (OR = 3.8; 95% CI = 1.2-11.8), and having a score above median on the Beck Depression Inventory (OR = 5.2; 95% CI = 1.7-15.6). CONCLUSIONS: The findings suggest that repeaters, namely, depressed housewives who have attempted suicide previously, need specific treatment strategies in order to avoid future suicide attempts.

Gender differences in suicide attempts: preliminary results of the multisite intervention study on suicidal behavior (SUPRE-MISS) from Campinas, Brazil / Diferenças entre os sexos nas tentativas de suicídio: resultados iniciais do estudo multicêntrico de intervenção no comportamento suicida (SUPRE-MISS) obtidos em Campinas, Brasil

OBJECTIVE: To identify sociodemographic, psychosocial and clinical differences between men and women who attempted suicide and were seen at a university general hospital. METHOD: This is a non-controlled cross-sectional study, sub-project of the Multisite Intervention Study on Suicidal Behavior by the World Health Organization. A standardized interview that comprised psychometric scales was used. The comparison between genders was made by means of uni and multivariate logistic regression. RESULTS: 210 subjects (68.1 percent women) participated. Women had worse scores on the WHO Well-Being Index (p = 0.005), the Beck Depression Inventory (p = 0.01) and the Psychiatric Disability Assessment Schedule (p = 0.03). In the multivariate logistic regression, men presented more mental disorders due to alcohol and drug use (26.1 percent vs 7 percent, p = 0.02) and used alcohol at the suicide attempt more frequently (28.3 percent vs 16 percent, p = 0.03). Men reported that most of the time they had been feeling "active and vigorous" (50 percent vs 22 percent, p < 0.001). Women had had more physical and sexual abuse (27 percent vs 8.7 percent, p = 0.01). CONCLUSION: There are some distinctive characteristics between men and women who attempt suicide. Such differences may also be present in the general population and suggest there is a need for further studies, as well as the adoption of different strategies in suicide prevention for men and women.

OBJETIVO: Identificar diferenças entre os sexos em variáveis sociodemográficas, psicossociais e clínicas em indivíduos que tentaram o suicídio e foram atendidos em um hospital geral universitário. MÉTODO: Estudo transversal não-controlado, subprojeto do Estudo Multicêntrico de Intervenção no Comportamento Suicida, da Organização Mundial de Saúde. Utilizou-se uma entrevista padronizada, incluindo escalas psicométricas. A comparação entre os sexos foi feita usando-se regressão logística uni e multivariada. RESULTADOS: Dos 210 sujeitos, 143 (68,1 por cento) foram do sexo feminino. As mulheres tiveram piores escores no Índice de Bem-Estar OMS (p = 0,005), na escala de Beck de Depressão (p = 0,01) e na escala de Desempenho do Papel Social (p = 0,03). Na regressão logística multivariada, encontraram-se mais problemas por uso de álcool e drogas entre os homens (26,1 por cento vs 7 por cento, p = 0,02). Estes se valeram mais dessas substâncias na tentativa de suicídio (28,3 por cento vs 16 por cento, p = 0,03) e relataram que "vinham se sentindo vigorosos" a maior parte do tempo (50 por cento vs 22 por cento, p < 0,001). Mulheres relataram ter sofrido mais abuso físico e sexual (27 por cento vs 8,7 por cento, p = 0,01). CONCLUSÃO: Encontraram-se algumas características distintas entre homens e mulheres que tentaram suicídios. Tais diferenças, que podem estar igualmente presente na população geral, sugerem novos estudos e a adoção de diferentes estratégias visando à prevenção do suicídio entre homens e mulheres.

Psychosocial conditions and suicidal behavior in pregnant teenagers : a case-control study in Brazil.

OBJECTIVE: To compare the psychosocial profile and suicidal behavior of 110 pregnant teenagers (PT) with 110 non-pregnant teenagers (NPT). METHOD: Subjects were matched by age and residential district. The research instruments used were a structured clinical interview and a self-reporting questionnaire based on psychometric scales whose answers were subjected to univariate and multivariate logistic regression. RESULTS: Prevalence in the PT and the NPT groups were found to be as follows: attempted suicide (20.0 vs. 6.3%); depression (26.3 vs. 13.6%); anxiety (43.6 vs. 28.0%). Univariate analysis revealed the following significant associations with pregnancy: relocation in the previous 3 years (odds ratio (OR) = 6); years of schooling < or =7 (OR = 3.4); repeating a year in school (OR = 2.4); dropping out of school (OR = 5.2); death of a parent during childhood (OR = 2.9); use of alcohol/drugs in the family (OR = 2.5); previous attempted suicide (OR = 3.6); suicide by a relative (OR = 2.1); threats of physical/sexual abuse (OR = 3.5); depression (OR = 2.2); low level of social support (OR = 4.2); traumatic events (OR = 5.1) and psychosocial difficulties (OR = 4.4); prior use of tobacco and marijuana (OR = 4.0 and 4.8 respectively); weekly intake of alcohol over the previous 12 months (OR = 4.2). Multivariate analysis identified the following associations: relocation (OR = 6.4); prior use of tobacco (OR = 2.9); dropping out of school for a period in excess of 6 months (OR = 2.3); suicide by a social acquaintance (OR = 2.5). CONCLUSION: The PT case group exhibited a psychosocial profile whose characteristics clearly differentiate this group from the NPT control group. Preventive mental health care is needed to help PT because their behavioral pattern exposes them to high risk for suicide.

Gender differences in suicide attempts: preliminary results of the multisite intervention study on suicidal behavior (SUPRE-MISS) from Campinas, Brazil.

OBJECTIVE: To identify sociodemographic, psychosocial and clinical differences between men and women who attempted suicide and were seen at a university general hospital. METHOD: This is a non-controlled cross-sectional study, sub-project of the Multisite Intervention Study on Suicidal Behavior by the World Health Organization. A standardized interview that comprised psychometric scales was used. The comparison between genders was made by means of uni and multivariate logistic regression. RESULTS: 210 subjects (68.1% women) participated. Women had worse scores on the WHO Well-Being Index (p = 0.005), the Beck Depression Inventory (p = 0.01) and the Psychiatric Disability Assessment Schedule (p = 0.03). In the multivariate logistic regression, men presented more mental disorders due to alcohol and drug use (26.1% vs 7%, p = 0.02) and used alcohol at the suicide attempt more frequently (28.3% vs 16%, p = 0.03). Men reported that most of the time they had been feeling "active and vigorous" (50% vs 22%, p < 0.001). Women had had more physical and sexual abuse (27% vs 8.7%, p = 0.01). CONCLUSION: There are some distinctive characteristics between men and women who attempt suicide. Such differences may also be present in the general population and suggest there is a need for further studies, as well as the adoption of different strategies in suicide prevention for men and women.

Maintained attitudinal changes in nursing personnel after a brief training on suicide prevention.

Nursing personnel (N = 317) working at a general hospital attended a 6-hour training program on suicide prevention. They answered anonymously pre- and post-training the Suicide Behavior Attitude Questionnaire (SBAQ), which comprises 21 visual analogue scale items divided in three factorial subscales. The results indicated there were positive changes in the attitudes and these gains were significantly maintained at the 6-month follow-up evaluation. Improvement was in the Feelings and Professional Capacity subscales (ANOVA; p = 0.0001 and 0.01, respectively). There was no change on the Right to Suicide subscale. Because attitudes influence the effectiveness of health care personnel interventions, our findings may have important implications for the development of suicide prevention programs.

Prevenção do comportamento suicida / Suicide prevention

A mortalidade por suicídio tem aumentado significativamente nos últimos anos, situando-se entre as dezprincipais causas de morte, considerando todas as faixas etárias, e entre as duas ou três mais freqüentes emadolescentes e adultos jovens. Este fenômeno não só é uma tragédia pessoal, mas também representa umsério problema de saúde pública. Assim sendo, programas de prevenção devem ser prioridade no planejamentoe na política pública dos países. Este artigo aponta quais são os fatores de proteção e de risco àocorrência do suicídio e destaca os pontos mais comuns presentes nos planos nacionais de prevenção aosuicídio de vários países apresentando também, os objetivos a serem alcançados com as Diretrizes Nacionaisde Prevenção do suicídio lançadas no Brasil pelo Ministério da Saúde em agosto de 2006.

Mortality resulting from suicide has grown considerably over the last years. It is ranked amongst the tenmost frequent causes of death comprising all age groups. When it comes to adolescents and young adults, itis ranked amongst the two or three most frequent causes. This phenomenon not only reflects a personaltragedy, but also represents a severe public health problem. Therefore, all countries should include preventiveprograms and campaigns amongst their priorities. This article presents factors of high risk as well as factorsthat can prevent suicide. It also highlights the most common issues presented by national prevention plans ofsuicide of several countries. Moreover, it presents the objectives to be achieved, proposed by the NationalGuidelines for suicide prevention launched by the Brazilian Health Ministry in August 2006.

Prevenção do comportamento suicida / Suicide prevention

A mortalidade por suicídio tem aumentado significativamente nos últimos anos, situando-se entre as dezprincipais causas de morte, considerando todas as faixas etárias, e entre as duas ou três mais freqüentes emadolescentes e adultos jovens. Este fenômeno não só é uma tragédia pessoal, mas também representa umsério problema de saúde pública. Assim sendo, programas de prevenção devem ser prioridade no planejamentoe na política pública dos países. Este artigo aponta quais são os fatores de proteção e de risco àocorrência do suicídio e destaca os pontos mais comuns presentes nos planos nacionais de prevenção aosuicídio de vários países apresentando também, os objetivos a serem alcançados com as Diretrizes Nacionaisde Prevenção do suicídio lançadas no Brasil pelo Ministério da Saúde em agosto de 2006(AU)

Mortality resulting from suicide has grown considerably over the last years. It is ranked amongst the tenmost frequent causes of death comprising all age groups. When it comes to adolescents and young adults, itis ranked amongst the two or three most frequent causes. This phenomenon not only reflects a personaltragedy, but also represents a severe public health problem. Therefore, all countries should include preventiveprograms and campaigns amongst their priorities. This article presents factors of high risk as well as factorsthat can prevent suicide. It also highlights the most common issues presented by national prevention plans ofsuicide of several countries. Moreover, it presents the objectives to be achieved, proposed by the NationalGuidelines for suicide prevention launched by the Brazilian Health Ministry in August 2006(AU)

Nursing personnel attitudes towards suicide: the development of a measure scale.

OBJECTIVE: To describe the construction of the Suicide Behavior Attitude Questionnaire (SBAQ) which measures attitudes of nursing personnel towards suicide, and verify attitude differences among these professionals. METHODS: The Suicide Behavior Attitude Questionnaire comprises 21 visual analogue scale items (beliefs, feelings and reactions on suicidal patients) selected from a pool of attitude statements generated by focal groups and experts' judgement. The questionnaire was completed by 317 nursing professionals who worked in a teaching hospital. Factor analysis and internal consistency were calculated. RESULTS: Three interpretable factors were extracted, accounting jointly for 40% of the total variance: Feelings when caring for the patient, Professional Capacity and Right to Suicide, comprising 7, 4 and 5 items, respectively. The Cronbach's alpha coefficients were 0.7, 0.6 and 0.5, respectively. Greater Professional Capacity was reported by nursing assistants and those who had already took care of suicidal patients. The belief that a person does not have the right to commit suicide was stronger among older professionals, those who had never taken care of suicidal patients, those who had a family history of suicide, those who were Protestants and that used to go more frequently to church services. CONCLUSIONS: The Suicide Behavior Attitude Questionnaire proved to be user-friendly and quite a simple instrument to assess attitude towards suicide among nursing personnel.

Atitudes do pessoal de enfermagem em relação ao sucídio: a criação de uma escala de avaliação / Nursing personnel attitudes towards suicide: the development of a measure scale

OBJECTIVE: To describe the construction of the Suicide Behavior Attitude Questionnaire (SBAQ) which measures attitudes of nursing personnel towards suicide, and verify attitude differences among these professionals. METHODS: The Suicide Behavior Attitude Questionnaire comprises 21 visual analogue scale items (beliefs, feelings and reactions on suicidal patients) selected from a pool of attitude statements generated by focal groups and experts' judgement. The questionnaire was completed by 317 nursing professionals who worked in a teaching hospital. Factor analysis and internal consistency were calculated. RESULTS: Three interpretable factors were extracted, accounting jointly for 40% of the total variance: Feelings when caring for the patient, Professional Capacity and Right to Suicide, comprising 7, 4 and 5 items, respectively. The Cronbach's alpha coefficients were 0.7, 0.6 and 0.5, respectively. Greater Professional Capacity was reported by nursing assistants and those who had already took care of suicidal patients. The belief that a person does not have the right to commit suicide was stronger among older professionals, those who had never taken care of suicidal patients, those who had a family history of suicide, those who were Protestants and that used to go more frequently to church services. CONCLUSIONS: The Suicide Behavior Attitude Questionnaire proved to be user-friendly and quite a simple instrument to assess attitude towards suicide among nursing personnel.

OBJETIVO: Descrever a construção do Questionário sobre a Atitude Frente ao Comportamento Suicida (QACS), que mede as atitudes do pessoal de enfermagem em relação aos suicidas e verifica as diferenças de atitude entre esses profissionais. MÉTODOS: O Questionário sobre a Atitude Frente ao Comportamento Suicida compreende uma escala de 21 itens visuais análogos (crenças, sentimentos e reações em relação a pacientes suicidas) selecionados a partir de uma série de frases sobre as atitudes geradas a partir de grupos focalizados e o julgamento de especialistas. O questionário foi completado por 317 profissionais de enfermagem que trabalhavam em um hospital escola. Foram calculadas a análise fatorial e a consistência interna.RESULTADOS: Foram extraídos três fatores interpretáveis, responsáveis em conjunto por 40% da variância total: Sentimentos ao tratar do paciente, a Capacidade Profissional e o Direito ao Suicídio, englobando 7, 4 e 5 itens, respectivamente. Os coeficientes do alfa de Cronbach foram 0,7, 0,6 e 0,5, respectivamente. Uma maior Capacidade Profissional foi relatada por assistentes de enfermagem e aqueles que já tinham cuidado de pacientes suicidas. A crença de que uma pessoa não possui o direito de cometer suicídio foi mais forte entre profissionais mais velhos, entre aqueles que não tinham nunca cuidado de pacientes suicidas, aqueles com histórico familiar, os que eram protestantes e costumavam freqüentar mais cultos religiosos. CONCLUSÕES: O Questionário sobre a Atitude Frente ao Comportamento Suicida comprovou ser de fácil uso e ser um instrumento bem simples para avaliar a atitude em relação aos suicidas por parte do pessoal de enfermagem.