Dorgival Caetano

Elevated thalamic and prefrontal regional cerebral blood flow in obsessive-compulsive disorder: a SPECT study

Functional neuroimaging studies have pointed to a possible role of cerebral circuits involving the prefrontal and anterior cingulate cortices, the striatum, and thalamus in the pathophysiology of obsessive-compulsive disorder (OCD). Regional cerebral blood flow (rCBF) of 16 drug-free Brazilian patients with OCD and 17 healthy subjects matched for age, gender, handedness and level of education was measured with [99m-Tc] HMPAO single photon emission computed tomography. Analysis of covariance identified four regions of interest with significantly higher rCBF: the right superior and inferior frontal cortex and the right and left thalamus. Positive correlations between symptom severity measured by Clinical Global Impression scores and rCBF were found in the right and left inferior frontal lobes and in the right basal ganglia. Compulsive behavior was inversely correlated with rCBF in the right thalamus, and duration of illness correlated positively with rCBF in the right and left superior frontal lobes and with the right thalamus. The findings of this SPECT study conducted in Brazil are in agreement with prior studies and provide additional support for the involvement of prefrontal-subcortical circuits in the pathophysiology of OCD. Furthermore, the study suggests that similar brain mechanisms appear to be involved cross-culturally.

Neuropsychological performance and regional cerebral blood flow in obsessive-compulsive disorder.

Convergent findings from neuropsychological and neuroimaging studies have suggested that neural dysfunction in frontal-subcortical circuits may play a central role in the pathophysiology of obsessive-compulsive disorder (OCD). To further examine the relationship between these two sets of findings we investigated both neuropsychological functions and regional cerebral blood flow (rCBF) in a combined study. Fourteen unmedicated patients fulfilling DSM-IV criteria for OCD and 14 healthy controls matched for age, gender, handedness, and education were assessed on neuropsychological tests that included Trail Making Test (TMT), Rey Complex Figure Test (RCF) (copy and 5-min recall), Verbal Fluency Test (VFT), and Wisconsin Card Sorting Test (WCST). rCBF was studied with 99 mTc-hexamethyl-propyleneamine-oxime (HMPAO) single photon emission computed tomography (SPECT). Patients performed more poorly than controls (P<.05) on RCF (copy), VFT, and WCST (perseverative errors). Spearmans correlations indicated that severity of OCD correlated inversely with performance on the RCF (copy and recall scores) and positively with rCBF in the right thalamus. Positive correlations were observed between nonperseverative errors (WCST) and rCBF in frontal areas and anterior cingulate. Perseverative errors (WCST) correlated negatively with rCBF in the right thalamus. These findings are consistent with most previously published studies and suggest neural dysfunctions in the frontal-subcortical circuits probably more pronounced in the right hemisphere. They also extend the existing research, showing associations between deficits in cortical-subcortical circuitry and performance on neuropsychological tests of controlled attention and visuospatial functions.

Placebo-controlled study of tianeptine in major depressive episodes.

The efficacy and safety of tianeptine were compared, in the course of a multicentre randomised, double-blind, parallel group study, to those of placebo in the treatment of Major Depressions and Bipolar Disorder, Depressed with or without melancholia, without psychotic features. After a 1-week run-in placebo period, 126 depressed out-patients presenting DSM-III-R Major Depression or Bipolar Disorder, Depressed, with a total MADRS score of at least 25, were treated for 42 days with either tianeptine (25-50 mg/day) or placebo. Efficacy assessments were MADRS, CGI, HARS, Zung Depression Self Rating Scale and a VAS. Better efficacy of tianeptine was shown, and confirmed by covariance analyses, in final MADRS scores of the intention-to-treat population, of patients treated for at least 14 days and of completers; also in CGI items 1 and 2, MADRS item 10, and VAS. The results confirmed the efficacy of tianeptine (mean dosage: 37.5 mg/day) in the treatment of Major Depression and Bipolar Disorder, Depressed, with or without melancholia, compared to placebo. Tianeptines acceptability did not differ from that of placebo. For adverse events, a higher incidence of headaches was found with tianeptine.

Prevalência de transtornos mentais menores em estudantes universitários

Prevalence of minor mental disorders in undergraduate students. The present study had as its main objective to estimate the prevalence of Minor Mental Disorders (TMM) in students enrolled in the courses offered at State University of Mato Grosso do Sul (Computer Science, Law, Arts, and Nursing), and at Federal University of Mato Grosso do Sul (Nursing) to investigate the relationship of MMD with both sociodemographic variables and learning process. This was a transversal study that included all students of all years in each course, enrolled in the first semester of 2002. The sample was composed of 558 students: 396 (71%) females and 161 (29%) males. Two self-report questionnaires (QSG-60 and QDSD) were used for collection of data. A prevalence of 25% of MMT was found among the students and the main disorder was psychosomatic disturbance.

ACUTE PSYCHOTIC DISORDERS INDUCED BY TOPIRAMATE Report of two cases

We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.

Prevalência de transtornos mentais em trabalhadores de uma universidade ­ pública do estado de São Paulo

Em uma amostra com 552 trabalhadores de uma universidade publica do interior do estado de Sao Paulo, realizou-se um estudo epidemiologico de corte transversal, objetivando estimar a prevalencia anual de Suspeicao para Transtornos Mentais (STM). Foi utilizado o Questionario de Morbidade Psiquiatrica de Adultos-QMPA (SANTANA, 1982) em versao validada para uso em populacao trabalhadora (GUIMARAES, 1992). Encontrou-se uma prevalencia anual de 35% de STM. Associacoes estatisticamente significativas foram obtidas entre STM e: genero (p = 0,01); estado civil (p = 0,05); religiao (p = 0,05); renda familiar (p = 0,01); maior numero de faltas/mes (p = 0,00). Nao foram encontradas associacoes estatisticamente significativas entre STM e: idade, escolaridade, local de trabalho. Obteve-se somente uma tendencia a associacao entre STM e mudanca de local de trabalho no ultimo ano (p = 0,08). A alta prevalencia de STM encontrada alerta para a magnitude do problema na organizacao, evidenciando a urgencia da implantacao de medidas preventivas relativas aos fatores psicossociais de risco e a necessidade de intervencoes adequadas para o enfrentamento dos mesmos.

Utilização do serviço de saúde mental em uma universidade pública

Abstract: With the purpose of affording promotion and intervention proposalson mental health care of undergraduate students of the State University ofSouth Mato Grosso (UEMS), the main objective of this study is to verify theindex of the service utilization and to characterize the attendants’ clients bydemographic and clinical variables. The study includes all the patients files ofthe Psychological Counseling Center of UEMS from May 2000 to July 2001.Which is retrospective and exploratory study. The profile of the clientsattended in the mental health service shows that 9.5% of the undergraduatestudents between 19 and 20 years old (88%), in which most are women(83%), look for psychological help because of psychological difficulties (44.7%)and generalized anxiety (38.3%). These results shows that the existence of aMental Health Service Center at a university could, besides identifing andtreating psychological and psychiatric disturbs, be used to create a betterplan on the attendance of their students’ necessities.

Cholesterol levels in panic disorder, generalized anxiety disorder and major depression

Serum plasma total cholesterol levels were measured in 85 male or female outpatients with panic disorder (PD; N=41), generalized anxiety disorder (GAD; N=23) and major depression (MD; N=21) according to DSM-IV criteria. All the patients had a mean cholesterol level within the normal range; males (N=22) and females (N=63) had approximately the same serum cholesterol levels (p >.05). No significant differences in cholesterol levels emerged between PD, GAD and MD patient groups. Both female PD and female GAD subjects had a mean cholesterol level similar to their male counterparts (p>. 05). It is concluded that both Hayward and colleagues and Bajwa et al. findings could not be replicated by our study.

Mortalidade em pacientes psiquiátricos: revisão bibliográfica

OBJETIVO: Avaliar as informacoes referentes as taxas de mortalidade em pacientes psiquiatricos publicadas na literatura cientifica. METODOS: Nesta revisao bibliografica (bases de dados, sites e periodicos especializados) foram selecionados estudos descritivos e interpretativos que avaliaram as seguintes dimensoes: caracterizacao sociodemografica, co-morbidades clinicas, tempo de tratamento e diagnosticos relacionados a mortalidade psiquiatrica. As bases de dados avaliadas foram Medline, SciELO e LILACS. RESULTADOS: Os estudos selecionados sobre o tema sugerem que individuos com transtornos mentais maiores tem menor tempo de sobrevida em relacao a populacao geral, e ha diferencas significativas de mortalidade entre pacientes institucionalizados e aqueles que frequentam servicos extra-hospitalares. A politica de desinstitucionalizacao do paciente psiquiatrico, que se iniciou no ultimo seculo, tem causado reducao dos leitos psiquiatricos em todos os paises; seus efeitos para a saude geral dos doentes mentais ainda nao estao muito claros e necessitam de mais investigacoes. CONCLUSAO: E necessaria a implantacao de intervencoes preventivas e terapeuticas que visem a saude geral dos pacientes psiquiatricos em todos os niveis de assistencia de saude mental.

Urinary pH in panic disorder

Urinary pH was evaluated in panic disorder (PD) patients compared with both psychiatric and healthy control subjects. Fourteen PD patients, eight major depressive disorder (MDD) patients, and 14 healthy control (HC) subjects were examined. All patients were drug-free and met DSM-IV diagnostic criteria. The PD patients had lower urinary pH and higher levels of anxiety than both MDD and HC subjects. Additionally, urinary pH inversely correlated with anxiety levels. Although preliminary, these findings suggest that PD patients have lower urinary pH than MDD and HC subjects. Future studies that simultaneously examine both urinary and blood pH in larger numbers of PD patients and patients with other anxiety disorders, before and after treatment, need to be conducted.