Christian César Cândido de Oliveira

Diagnostic evaluation of children and adolescents in situation of social risk and vulnerability: conduct disorders, communication disorders or “context disorders”?

Ao se iniciar as avaliacoes diagnosticas e os atendimen-tos multidisciplinares de criancas e adolescentes em situacao de risco e vulnerabilidade social (dos quais, usuarios de drogas e vitimas de abuso fisico e sexual), atendidos pelo Programa Equilibrio, os profissionais envolvidos, dentre eles psiquiatras, pediatra, psicologos, terapeutas ocupacionais, assistentes sociais, psicope-dagogos, fisioterapeuta, perceberam que uma serie de adaptacoes deveria ser feita para realizar a abordagem e a anamnese dessa populacao. As alteracoes de comportamento, com agressividade fisica e verbal, inumeras vezes, pareciam substituir o comportamento e a comunicacao socialmente estrutu-rados. Iniciar intervencoes psicoterapicas ou mesmo orientar criancas a nao gritarem e mostrar a elas que se consegue alcancar o respeito das pessoas quando se utiliza uma comunicacao e um comportamento menos agressivos, e praticamente impossivel se nao for feita uma sensibilizacao antes a essas criancas. No entanto, minimizar a funcao das ameacas e do gritar e um ledo en-gano. Essa forma de expressao nas ruas e fundamental e, inumeras vezes, esta relacionada a sobrevivencia e a uma importante possibilidade de expressao do sentimento de ser ignorado pela sociedade – e uma forma de ser visto e ouvido em suas necessidades e desejos. Tambem em abrigos, os episodios de agitacao psicomotora podem ser interpretados como manifestacoes claras da necessidade de atencao individualizada. Assim, tem-se de considerar que essa forma de comportamento e expressao, fisica e verbal, faz parte do processo de interacao dessas crian-cas com o mundo a sua volta e tem sua funcao.Imaginar que deixarao de serem agressivas ou que terao um comportamento “mais educado e adequado” e impossivel, pois esse e o comportamento esperado e adaptado ao ambiente agressivo em que se encontram. Querer que essas criancas abandonem a linguagem transmitida por suas familias e entorno social seria como apagar parte de suas historias. E inviavel o trabalho de prevencao, a promocao de saude ou a reabilitacao de algum transtorno fisico, psiquico, emocional ou fonoaudiologico, quando o meio onde essas criancas vivem nao valoriza e nao respeita os individuos que nao gritam ou nao sao agressivos. Assim, quando deixam as ruas e sao acolhidas em abrigos, o trabalho terapeutico multidisciplinar tem como objetivo inicial ajuda-las a se adaptarem a esse ambiente mais favoravel para seu desenvolvimento, um contexto menos agressivo e amea-cador, no qual podem parecer desajustadas inicialmente, levando a diagnosticos precipitados, como transtornos de conduta, transtornos de impulso, transtornos de desatencao e hiperatividade, que nao se mantem ao longo do tempo.Uma crianca que sai de casa aos 6 anos de idade e vive ate os 11 anos nas ruas de uma grande cidade esta adaptada para viver em um ambiente assim, mas podera ficar bastante inadequada em uma sala de aula. Na rua, ela desenvolveu recursos necessarios para sobreviver neste contexto: reage rapidamente, nao fica muito tempo parada em um mesmo local, e impulsiva e percebe alteracoes minimas no ambiente ao seu redor, especialmente se essas alteracoes repre-sentam ameacas. Se colocada em uma sala de aula,

Linguagem e memória autobiográfica de adolescentes usuários de drogas

OBJETIVO: Resgatar, por meio da linguagem, a memoria autobiografica de adolescentes usuarios de drogas/alcool. METODOS: Participaram do estudo 25 adolescentes usuarios e 25 nao usuarios de alcool/drogas com idades entre 13 e 17 anos, do sexo masculino. Apos coleta da linguagem oral, a analise deste material foi baseada no modelo que privilegia a estrutura discursiva em cenario, complicacao, resposta interna, tentativa, consequencia e reacao. RESULTADOS: O grupo de usuarios produziu menos tentativa (p=0,010), consequencia (p= 0,030) e reacao (p= 0,023), indicando diferente perfil na linguagem de ambos os grupos. CONCLUSAO: O perfil da memoria autobiografica de adolescentes usuarios de drogas e diferente do de adolescentes nao usuarios. Este dado pode estar relacionado ao comprometimento no funcionamento cognitivo e/ou de linguagem, assim como de aspectos sociais e psiquicos, ocasionando interrupcoes na sequencia da lembranca.

Auditory-perceptual analysis of voice in abused children and adolescents ☆,☆☆

INTRODUCTION Abused children and adolescents are exposed to factors that can trigger vocal changes. OBJECTIVE This study aimed to analyze the prevalence of vocal changes in abused children and adolescents, through auditory-perceptual analysis of voice and the study of the association between vocal changes, communication disorders, psychiatric disorders, and global functioning. METHODS This was an observational and transversal study of 136 children and adolescents (mean age 10.2 years, 78 male) who were assessed by a multidisciplinary team specializing in abused populations. Speech evaluation was performed (involving the aspects of oral and written communication, as well as auditory-perceptual analysis of voice, through the GRBASI scale). Psychiatric diagnosis was performed in accordance with the DSM-IV diagnostic criteria and by applying the K-SADS; global functioning was evaluated by means of the C-GAS scale. RESULTS The prevalence of vocal change was 67.6%; of the patients with vocal changes, 92.3% had other communication disorders. Voice changes were associated with a loss of seven points in global functioning, and there was no association between vocal changes and psychiatric diagnosis. CONCLUSION The prevalence of vocal change was greater than that observed in the general population, with significant associations with communication disorders and global functioning. The results demonstrate that the situations these children experience can intensify the triggering of abusive vocal behaviors and consequently, of vocal changes.

The importance of multidisciplinary evaluation for differentiating between mental retardation and antisocial behavior in sex offenders: a case study

The World Health Organization considers sexual abuse in childhood to be a growing public health problem worldwide.1 The psychological and behavioral profile of sex offenders is a topic that has been widely investigated in the literature2-6 because the appropriate treatment of such individuals can prevent them from becoming repeat sex offenders. One important aspect of the aggressor profile is cognitive functioning.5,6 In some cases, sexual assaults are committed by individuals with intellectual disabilities that impair their capacity to critically analyze their actions.2 In other cases, sexual assaults can represent sadistic behavior related to antisocial personality disorder.2 The objective of this case report is to analyze the case of a teenager who was accused of sexually abusing a child and to determine whether the teenager should be diagnosed with mental retardation or early-onset antisocial behavior. This case exemplifies the need for multidisciplinary evaluation to establish a diagnosis and to develop appropriate treatments to prevent the recurrence of violence.

Oral communication self-perception in drugs users adolescents

Rev Bras Psiquiatr. 2006;28(4):339-42 effects of milnacipran on anxiety, it has been reported to be efficacious in the treatment of depression in patients with schizophrenia spectrum disorders. Six outpatients (4 males, 2 females) diagnosed with schizophrenia according to the DSM-IV and intense anxiety symptoms, although not meeting the criteria for any DSM-IV anxiety disorder, were studied in order to determine the efficacy of milnacipran in reducing anxiety symptoms in this population. All patients were under treatment with clozapine for refractory schizophrenia. The mean age of the subjects was 35 ± 5 years. The mean daily doses of clozapine and milnacipran were 700 mg and 100 mg, respectively. All subjects were submitted to blood workups as recommended for clozapine-treated patients. No hematologic abnormalities were found in this group. The efficacy of milnacipran in reducing anxiety symptoms, as characterized according to the Hamilton Anxiety Scale (HAMA), which was applied before treatment (T0), after 4 weeks of treatment (T4) and after 8 weeks of treatment (T8). The Brief Psychiatric Rating Scale (BPRS) was also applied at T0, T4 and T8 in order to evaluate possible worsening of schizophrenia symptoms due to treatment with the antidepressant. Comparisons between groups were made using paired Student’s t-tests. Table 1 shows the demographic data for the patients treated with milnacipran, as well as variations between T0 HAM-A and BPRS scores and those obtained at T4 and T8. The mean HAMA scores decreased significantly (p = 0.014) from T0 (32 ± 7) to T4 (27 ± 9), remaining stable between T4 and T8 (28 ± 10; p = 0.523). From T0 to T8, a trend toward decreasing HAM-A was found (p = 0.069). The mean BPRS score remained virtually unchanged (p = 0.087) from T0 (71 ± 18) to T4 (67 ± 21), from T4 to T8 (66 ± 24) (p = 0.884) and from T0 to T8 (p = 0.326). No patient reported adverse effects related to the treatment. Clearly, the small size of our sample precludes generalization, and studies involving larger samples are needed to confirm these findings. However, our results suggest that milnacipran might be effective in reducing anxiety symptoms in the fourth week of use, and this effect might be maintained until the eighth week of use. In addition, the tolerability profile and the low potential for drug interactions presented by milnacipran could make it a very useful alternative for treating anxiety in patients using clozapine, without the risk of drug interactions and worsening psychotic symptoms.

Impact of acupuncture on stress levels of professionals working with maltreated children

Occupational stress is recognised as a major risk to psychosocial wellbeing, which can undermine health.1 One of the major consequences of chronic stress is the development of the syndrome of burnout. Burnout constitutes a sense of failure and exhaustion, caused by an excessive decrease in energy, which may especially affect professionals who work in direct contact with people. Professionals who work with maltreated children and the socially vulnerable typically show high levels of stress due to the physical and mental overload caused by the excessive demands of their work, in terms of both quantity and emotional strain.2 Irrespective of treatment rationale, acupuncture treatment is often individualised. Thus, it is important to consider what the optimal treatment parameters are for the reduction of stress. It is of fundamental interest to investigate the influence of the needling location (eg, which traditional acupuncture points should be used) on stress …