Radicular Groove Accessory Canal Morphology in Mandibular First Premolars: Micro-computed Tomographic Study.

INTRODUCTION: The purpose of this study was to investigate the morphologic features of radicular groove accessory canals (RGACs) in mandibular first premolars and their relationship to root anatomy by micro-computed tomographic imaging. METHODS: A total of 154 single-rooted mandibular first premolars with radicular grooves were selected. The teeth were scanned by micro-computed tomographic imaging, and the following parameters were recorded: (1) the presence of RGACs, (2) the origin of RGACs, (3) the position of the RGAC foramen in the groove in relation to root length, (4) the foramen diameter, (5) the type of groove present according to the Arizona State University dental anthropology scoring system (ASUDAS), and (6) the type of anatomy present according to Vertucci's classification. The data were recorded and statistically analyzed using the chi-square test (P < .05). RESULTS: The incidence of RGACs in the teeth was 49.9%. The average distance from the cementoenamel junction plane to the RGAC foramen was 8.83 ± 2.53 mm, and the majority of the RGAC foramina were located in the middle third. Regarding the severity of the groove, the presence of RGACs was significantly higher for groups ASUDAS 3 and 4 compared with ASUDAS 1 and 2 (85.7% and 14.3%, respectively). The presence of at least 1 RGAC was greatest for Vertucci type V (46%) and for more complex types (46%) when compared with Vertucci types I and III. CONCLUSIONS: Mandibular first premolars with radicular grooves often present with RGACs. An association between the internal and external anatomy and the presence of RGACs was detected in this study.

Deciphering Endodontic Microbial Communities by Next-generation Sequencing.

INTRODUCTION: Biofilms are present in more than 70% of endodontically diseased teeth. Through the advancements in the next-generation sequencing (NGS) technologies, microbiome research has granted a deeper analysis of the microbial communities living in human hosts. Here, we reviewed previous studies that used NGS to profile the microbial communities of root canals. METHODS: A total of 12 peer-reviewed articles from PubMed were identified and critically reviewed. The study criteria were as follows: NGS platforms, sequenced bacterial hypervariable regions, teeth diagnosis with available patient information, sample characteristics, collection method, and microbial signatures. RESULTS: The most common NGS platforms used were 454 pyrosequencing (Roche Diagnostic Corporation, Risch-Rotkreuz, Switzerland) and Illumina-based technology (Illumina Inc, San Diego, CA). The hypervariable regions sequenced were between the V1 and V6 regions. The patient and sample population ranged from ages 12-76 years and asymptomatic and symptomatic teeth diagnosed with pulp necrosis with or without apical periodontitis. Microbial sampling was conducted directly from the infected pulp or the extracted teeth. The most abundant phyla were Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, and Fusobacteria. The most frequently detected genera were Prevotella, Fusobacterium, Porphyromonas, Parvimonas, and Streptococcus. Other notable microbial signatures at different taxa levels were identified but were widely variable between studies. CONCLUSIONS: Technologies based on high-throughput 16S ribosomal RNA NGS can aid in deciphering the complex bacterial communities of root canal biofilms. Thus far, only a few studies have been published with relatively small sample sizes, variable sample collection protocols, and community analyses methods. Future larger clinical studies are essential with validated standardized protocols for improved understanding of the pathogenic nature of bacterial biofilm communities in root canals.

Self-Harm in Adolescents: A Self-Report Survey in Schools from Lisbon, Portugal.

The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in a large sample of Portuguese adolescents. A total of 1,713 pupils, aged 12 to 20 years, completed an anonymous questionnaire in a school setting. In all, 7.3% reported at least 1 episode of SH: rates were 3 times higher for females than males. Almost half reported repeated SH, most commonly self-cutting. Anxiety, depression, and substance abuse were linked to SH, and particularly repeated SH. Anxiety, trouble with the police, and exposure to SH or suicide of others, were independently associated with SH in both genders. These findings indicate that SH is a public health concern in Portugal as in other European countries.

Mental health outcomes in times of economic recession: a systematic literature review.

BACKGROUND: Countries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations' health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes. METHODS: Literature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered. RESULTS: One-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours. CONCLUSION: On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession.

Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon.

INTRODUCTION: Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. MATERIAL AND METHODS: For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. RESULTS: From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p < 0.001), family history of suicide (p < 0.01), divorced or widowed marital status (p < 0.013), and severe mental illness (p < 0.015). In 41.6% of the patients the follow-up status was unknown. Regarding satisfaction, only 19.5% gave a valid answer: 2.7% 'mildly satisfied', 4.4% 'moderately satisfied', and 12.5% 'very satisfied'. DISCUSSION: The Pierce Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. CONCLUSION: The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.

Introdução: Alguns estudos têm alertado para a sobrecarga de tentativas de suicídio nas urgências médicas. Neste estudocaracterizamos os doentes suicidas numa urgência médica portuguesa. Material e Métodos: Durante três anos, todos os doentes observados pelo primeiro autor, em urgências médicas, após tentativa suicida, foram incluídos no estudo. A intencionalidade da tentativa suicida foi determinada com a Pierce Suicide Intent Scale. O seguimento foi registado recorrendo ao processo clínico, e o nível de satisfação a chamada telefónica. Resultados: Dos 120 doentes incluídos 70,8% eram mulheres e a média de idades foi 42,35 anos. A intencionalidade suicida (Pierce Suicide Intent Scale) foi baixa em 30,1%, média em 59,3% e elevada em 10,6%. Os principais preditores de intencionalidade suicida foram: género masculino (p < 0,001), história familiar de suicídio (p < 0,01), divórcio ou viuvez (p < 0,013) e doença mental grave (p < 0,015). Em 41,6% dos doentes não se apurou seguimento. Quanto à satisfação, apenas 19,5% deram resposta válida: 2,7% 'ligeiramente satisfeito', 4,4% 'moderadamente satisfeito', e 12,5% 'muito satisfeito'. Discussão: A Pierce Suicide Intent Scale é um instrumento útil na avaliação do comportamento suicida na urgência médica. Ocomportamento suicida de elevada intencionalidade está relacionado com género masculino, problemas sociais e antecedentes psiquiátricos pessoais e familiares. Conclusão: Os registos administrativos da urgência médica são ainda pouco rigorosos. As variáveis relacionadas com intencionalidade suicida são as mesmas que são descritas noutros países. Dos doentes a que conseguimos chegar, um quinto mostrou-se satisfeito com o seguimento. Mais estudos são necessários para compreender o comportamento suicida em Portugal.

Coping strategies in adolescents who self-harm.

BACKGROUND: Adolescent self-harm (SH) is a major public health concern, associated with poor outcomes. The use of ineffective coping is often referred to in explanatory models of adolescent SH. AIMS: To assess the relationship between SH and coping strategies in a large sample of school-aged adolescents. METHOD: A sample of public school students (n = 1,713), aged between 12 and 20 years, were examined using an anonymously completed questionnaire. SH was defined according to strict criteria through a two-stage procedure. Study participants were divided into two groups: no self-harm and lifetime self-harm. The differences between groups were explored, including logistic regression analyses (controlling for anxiety and depression effects), to reveal which coping strategies better predicted lifetime SH. RESULTS: The use of nonproductive strategies was associated with SH in both genders, particularly self-blame and tension reduction. Strategies involving consulting significant others for support were used less in the SH group, especially among male subjects. The preferential use of a productive coping style was negatively associated with the SH group in both genders. CONCLUSION: The results support previous data regarding a different pattern of coping strategies used by adolescents who harm themselves. The use of self-rating instruments and the cross-sectional nature of the study limit our results.

In vitro antimicrobial effects of 3 root canal sealers on Actinomyces radicidentis.

OBJECTIVE: To determine the in vitro antimicrobial effects of 3 endodontic sealers--AH Plus, Sealapex, and Tubli-Seal--on Actinomyces radicidentis, a bacterial species commonly found in root canals. METHODS: Prior to the experimental procedures, bacterial identification tests, such as Gram staining, catalase, and API 20A, were performed, and the bacteria were identified as A. radicidentis. The agar diffusion susceptibility test was performed to determine the areas of bacterial growth inhibition and, consequently, the microbial resistance of the 3 sealers against A. radicidentis. Chlorhexidine was used as a positive control, and saline solution was used as a negative control. RESULTS: Tubli-Seal cement had an average diameter of inhibition zones in the 3 panels of 22.73 mm, that of AH Plus was 17.13 mm, and that of Sealapex, 11.99 mm. A one-way ANOVA test showed that there were significant differences between the 3 cements (p < 0.05). CONCLUSION: Tubli-Seal showed the highest levels of antimicrobial activity, which was followed by AH Plus with the next highest levels and, finally, Sealapex with the lowest levels of antimicrobial activity.

[Adaptation and psychometric proprieties study for the Portuguese version of the Adolescent Coping Scale - Escala de Coping para Adolescentes]. / Estudo de Adaptação e Características Psicométricas da Versão Portuguesa da Adolescent Coping Scale - Escala de Coping para Adolescentes.

INTRODUCTION: Coping is a psychological process that prompts the individual to adapt to stressful situations. The Adolescent Coping Scale is a widely used research and clinical tool. This study aimed to develop a Portuguese version of the Adolescent Coping Scale and to analyze the strategies and coping styles of young people in our sample. MATERIAL AND METHODS: An anonymous questionnaire comprising the Adolescent Coping Scale was submitted and replied by 1 713 students (56% female, from 12 to 20 years, average age 16) The validity study of the scale included: principal component and reliability analysis; confirmatory analysis using structural equation modelling Subsequently, a gender comparison of both the strategies and the coping styles was conducted through independent samples t tests. RESULTS: The final structure of the Adolescent Coping Scale adaptation retained 70 items assessing 16 coping strategies grouped into three major styles. The scales showed good internal consistency (Cronbach alpha values between 0.63. and 0.86, with the exception of one dimension that as shown a value of 0.55) and the confirmatory model showed a good fit (goodness of fit index values between 0.94 e 0.96). Two coping strategies were eliminated on statistical grounds (insufficient saturations of items in the corresponding dimensions). We found that the style of coping focused on problem solving is the most used by youths from our sample, in both sexes. Females had higher mean values in non-productive coping style and reference to others. DISCUSSION: This adapted version has high similarity with the original scale, with expectable minor changes, given that coping is influenced by cultural, geographical and socio-economic variables. CONCLUSION: The present study represents an important part of the validation protocol Portuguese Adolescent Coping Scale, including its linguistic adaptation and its internal consistency and factor structure studies.

Introdução: O coping é um processo psicológico que leva ao ajustamento individual perante situações de stress. A Adolescent Coping Scale é um instrumento de investigação e uma ferramenta clínica, amplamente utilizada. O presente estudo tem como objectivos desenvolver uma versão Portuguesa da Adolescent Coping Scale e analisar as estratégias e estilos de coping dos jovens da nossa amostra.Material e Métodos: Um questionário anónimo compreendendo a Adolescent Coping Scale obteve respostas de 1 713 alunos (56% do sexo feminino, com idades compreendidas entre os 12 e os 20 anos e uma média etária de 16). O estudo de validade da escala contemplou: análise em componentes principais e avaliação da consistência interna; análise confirmatória através de modelo de equações estruturais. Posteriormente, foram comparadas por género as estratégias e estilos de coping da amostra (testes t para amostras independentes).Resultados: A estrutura final da adaptação da Adolescent Coping Scale reteve 70 itens, que avaliam 16 estratégias de coping agrupadas em três estilos distintos. As escalas apresentaram bons valores de consistência interna (alfas de Cronbach compreendidos entre 0,63 e 0,86, com a exceção de uma dimensão que apresentou um valor de 0,55) e o modelo confirmatório demonstrou bom fit (goodness of fit index compreendidos entre 0,94 e 0,96). Foram eliminadas duas estratégias de coping por motivos estatísticos (ausência de saturação de itens suficientes nas dimensões correspondentes). Verificámos que o estilo de coping focado na resolução do problema é aquele maioritariamente utilizado pelos adolescentes da nossa amostra, em ambos os sexos. No sexo feminino observaram-se valores médios mais elevados nos estilos de coping não produtivo e de referência a outros.Discussão: A versão adaptada apresenta elevada semelhança com a escala original, com alterações minor espectáveis tendo em conta que o coping é influenciado por variáveis culturais, geográficas e sócioeconómicas.Conclusão: O presente estudo representa uma parte importante do protocolo de validação Portuguesa da Adolescent Coping Scale, nomeadamente a sua adaptação linguística, estudo da consistência interna e da estrutura fatorial.

Affective temperaments and self-harm in adolescents: a cross-sectional study from a community sample.

BACKGROUND: Adolescent self-harm (SH) is a major health problem potentially associated with poor outcomes including reduced life expectancy and risk of completed suicide in adulthood. Several studies point to the role of possible constitutional vulnerabilities that could predispose to this behavior. This study sets out to assess the relationship between SH and affective temperaments (AT) in adolescents. METHODS: A cross-sectional sample of public school students (n=1713), with age limits between 12 and 20, was examined using anonymously completed self-report instruments including 'The Lifestyle & Coping Questionnaire' and the 'Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto-questionnaire' (TEMPS-A). SH was defined according to strict criteria through a two-stage procedure. Statistical significance of associations with SH for categorical variables was assessed in bivariate analysis. AT predictors of lifetime SH were examined in multivariate logistic regression analyses. RESULTS: Lifetime SH was reported by 7.3%, being about three times more frequent in females. SH was associated, in both genders, with a significant deviation on depressive, cyclothymic and irritable dimensions of TEMPS-A. After multivariate logistic regression adjusted to family typology, smoking status, alcohol and drug consumption, only depressive temperament remained significantly associated as a predictor of SH in both genders. LIMITATIONS: The use of self-rating instruments and the cross-sectional nature of the study limit our results. CONCLUSIONS: Cyclothymic, irritable and especially depressive temperament might represent an important marker of vulnerability to SH in both male and female adolescents.

Association between deliberate self-harm and coping in adolescents: a critical review of the last 10 years' literature.

Coping is commonly associated with deliberate self-harm (DSH) in adolescents. This article reviews the published literature from 2000 to 2010, aiming to highlight the current evidence supporting this association. Eighteen studies met the inclusion criteria, a total sample of 24,702 subjects was obtained and 17% were DSH cases. Emotion-focused coping style and in particular avoidant coping strategies have consistently been associated with DSH in adolescents. Problem-focused coping style seems to have a negative relation. Most studies were cross-sectional, which seriously limits our conclusions on causality. There is a clear need for more systematic studies, performed in accordance with consensual methodology.

[Attention-deficit hyperactivity disorder in adults: implications to forensic medicine]. / Perturbação de hiperactividade e défice de atenção em adultos: implicações médico-legais.

Attention-deficit hyperactivity disorder (ADHD) in adults has been associated to a higher probability of problems with justice. Studies in prison populations disclosed higher prevalence of this disturbance. ADHD association with personality disorders and higher substance abuse could partially help in the explanation of this phenomenon. Based in a literature review, the authors present a reflection on the possible implications of the ADHD diagnosis to Forensic Medicine. After a brief review of the clinical aspects, epidemiology, etiology and nosology of ADHD, its repercussions in the sphere of justice are analysed, namely the prevalence of associated criminality, risk factors and the co-morbidity with personality disorders and substance abuse. These elements are used as a base to the discussion of the results and to a subsequent reflection on the question of (in)imputability related with this disorder.

[Club drugs]. / Club drugs: Um Novo Perfil de Abuso de Substâncias em Adolescentes e Jovens Adultos.

Club drugs are the following substances: Methylenedioxymethamphetamine (MDMA); Methamphetamine; Lysergic Acid Diethylamide (LSD); Ketamine; Gamma-hydroxybutyrate (GHB) and Flunitrazepam. These substances are mainly used by adolescents and young adults, mostly in recreational settings like dance clubs and rave parties. These drugs have diverse psychotropic effects, are associated with several degrees of toxicity, dependence and long term adverse effects. Some have been used for several decades, while others are relatively recent substances of abuse. They have distinct pharmacodynamic and pharmacokinetic properties, are not easy to detect and, many times, the use of club drugs is under diagnosed. Although the use of these drugs is increasingly common, few health professionals feel comfortable with the diagnosis and treatment. The authors performed a systematic literature review, with the goal of synthesising the existing knowledge about club drugs, namely epidemiology, mechanism of action, detection, adverse reactions and treatment. The purpose of this article is creating in Portuguese language a knowledge data base on club drugs, that health professionals of various specialties can use as a reference when dealing with individual with this kind of drug abuse.

[Effectivity of screening, concepts and attitudes towards metabolic síndrome: a study in bipolar patients followed in Hospital Santa Maria psychiatric consultation]. / Efectividade do rastreio, análise de conceitos e atitudes perante o síndrome metabólico: um estudo em doentes bipolares da consulta de psiquiatria do Hospital Santa Maria.

INTRODUCTION: The Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance, associated with abdominal type obesity, hypertension, hyperglycemia and dyslipidemia. Epidemiological data indicates prevalence of MS of about 25%. Estimates point to higher prevalence of MS in bipolar (BP) patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched. OBJECTIVES: Test the viability of MS screening without using blood tests. Analyse knowledge and importance given to the issue of MS in Bipolar patients. METHODOLOGY: Observational, cross-sectional, exploratory study. Random sample of 15 BP patients, in euthymic phase, between 18 and 65 years. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis was investigated according to the International Diabetes Federation (IDF), including blood tests. Screening of MS was defined positive if blood pressure > or = to 130/85 or on anti-hypertensive medication and Abdominal Perimeter > 90 cm in males or > 80 cm in females. Afterwards a questionnaire about knowledge, attitudes and concerns on MS was applied. MAIN RESULTS: 14 patients completed the investigation protocol, 1 patient didn't do blood testing for unknown reasons. Five patients (36%) met IDF criteria for MS. Screening sensitivity was 80% and specificity 78% on our sample (1 false positive and 2 false negative). Twelve patients (80%) were overweight or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26, showing statistical significance. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control. CONCLUSIONS: Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.

Clinical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal.

Deliberate self-harm (DSH) among adolescents is a high-risk condition for suicide. The aim of the present study is to describe the characteristic clinical features of adolescents with DSH according to our local context (Lisbon, Portugal), using easily available information from clinical settings. A case control study was constructed from a sample of 100 adolescents (aged 12 to 21 years). The sample was divided into two groups: adolescents with and without DSH. Case files were examined and data was completed by clinical interviews. Demographic, psychosocial, and psychopathological data were assessed and compared. Ninety-eight subjects completed the protocol. The DSH group was associated with the following: suicidal ideation or suicidal behavior as consultation motive, emergency room referral, previous follow-up attempts, suicidal ideation, psychosocial difficulties, or lack of therapeutic goals. There was a nonsignificant trend towards diagnosis of depression in the DSH group. These results reflect our clinical practice with adolescents and add data about teenagers who self-harm to the literature. Prevention and early recognition of DSH (and frequently associated depression) in adolescents are essential and could be life-saving measures. An integrated approach, which takes into account psychosocial difficulties, family dysfunction, and negative expectations, seems to be of great importance.

[Liaison psychiatry in a general hospital: seven paradigmatic cases]. / Psiquiatria de ligação em hospital geral: sete casos paradigmáticos.

Through the use of case reports, this article reviews frequent causes that origin the need for psychiatric intervention in patients hospitalized in medical and surgical wards. Particular diagnosis aspects are focused, so is the necessity of integration of the biological, psychological and social dimensions of the patient. The integrated approach by the various members of the medical staff is also emphasised. The cases presented were observed in the Liaison Psychiatry Consult of the Psychiatry Service of Hospital Santa Maria, in Lisbon, between November 2007 and January 2008. Seven cases were selected because they reflect paradigms in the intervention of the Liaison Psychiatrist, and reflect the following psychiatric diagnosis: Panic Disorder; Paranoid Schizophrenia; Bipolar Disorder; Personality Disorder; Major Depression, Dementia and Abstinence Syndrome.

[Psychopharmacology in medical illness: cardiology, nephrology, hepatology]. / Psicofármacos na doença médica: cardiologia, nefrologia, hepatología.

The high prevalence of psychiatric disturbances in the context of medical illness and its association with worse prognostic of the last one, are the reasons for which it becomes essential that the doctor, not psychiatrist, has the skills in the use of psychopharmaceuticals. A systematic review of the literature published until January of 2006 was done, through MEDLINE, using as key-words psychiatric illness, renal illness, hepatic illness, cardiovascular illness, psychopharmacology. The reviewed studies include original articles, reviews and observational studies. 39 articles were selected for its adequacy and acquired for the accomplishment of this revision. The authors intend to review the use of the several classes of psychopharmaceuticals, its risks and benefits, according to the different medical illnesses. The first part of this article will have is focus in the area of cardiology, nephrology and hepatology.

[Psychopharmacology and metabolic syndrome]. / Psicofármacos e síndroma metabólica.

Metabolic Syndrome consists in a group of metabolic changes, being the most important problem insulin resistence. Other important components of this syndrome are abdominal obesity, hypertension and hyperlipidemia /hypercholestrolemia. It was demonstrated that psychiatric patients have a greater risk to develop metabolic syndrome with a prevalence of 41%. Prevalence of this syndrome in psychiatric male patients is 138% higher than in general population and in female patients 251% higher. Some of the factors that can explain this increase of metabolic risk in psychiatric patients are psychiatric drugs. We preformed a systematic review of literature published until June, 2007, by means of MEDLINE. Studies reviewed include clinical cases, reviews, analytic and observational studies. We selected 72 articles. Authors pretend to understand the mechanisms, by which, different psychiatric drugs can influence metabolic syndrome, and strategies for prevention of this situation.

[Differences between SSRI's pharmacokinetics and pharmacodinamics]. / Diferenças farmacodinâmicas e farmacocinéticas entre os SSRI: implicações na prática clínica.

Selective serotonin reuptake inhibitors (SSRI) are nowadays the preferred treatment for patients with depression and anxiety disorders, when compared with traditional tricyclic antidepressants. All the SSRIs were designed to selectively potentiate serotonin [5-hydroxytryptamine (5-HT)] activity through inhibition of the 5 -HT neuronal reuptake transporter. However, despite a common mode of proven antidepressant efficacy and a similar range of indications, each SSRI has individual properties, not only pharmacodinamics, but also pharmacokinetics, which contributes for different pattern of clinical indications, side effects and interactions. The authors pretended to review the differences between each SSRI, in terms of metabolism and clinical goals. They analyzed several studies published in the last years, obtained through MedLine research. The authors describe how the unique secondary binding properties of each SSRI account for clinical significant differences in tolerability and side-effects profiles, particularly in some patients. Secondary properties within the class of SSRIs include some combinations of actions at noradrenergic, dopaminergic, muscarinic, cholinergic, histaminergic and sigma receptors. In addition, most SSRI inhibit al least one of the cytochrome P450 enzymes, resulting in potential pharmacokinetics interactions with co-prescribed drugs.

[Post-traumatic stress: the mechanisms of trauma]. / Stresse pós-traumático: Os mecanismos do trauma.

Since the first description of stress syndrome, by Hans Selye in 1936, much has been investigated concerning the etiological mechanisms of stress. In recent years the intense research in the field of the neurobiology of stress, namely in Post-Traumatic Stress Disorder (PTSD), revealed some of the mechanisms and neurological structures involved with stress. A systematic research of literature published until December of 2006 was made, through the MEDLINE using as keywords neurobiology, stress, post traumatic stress disorder, neuroendocrine, neurochemical, neuroimmunological, neuroimaging. Of a total of 70 found articles, 39 were selected by its adequacy and acquired for the accomplishment of this revision. Also, reference books were consulted for the areas of theoretical concepts of stress and phenomenology of trauma. The authors intend to review the way cerebral structures, multiple neuronal and hormonal ways form a complex mechanism of reaction to stress. It is intended with this article to demonstrate the relation between psychopathological events, namely in PTSD, the phenomenology of the trauma and neurobiological changes.