Flávio Valdozende Alheira

Plasma levels of D-serine in Brazilian individuals with schizophrenia

Changes in D-serine availability in the brain may contribute to the hypofunction of NMDA-glutamate receptors in schizophrenia; however, measurements of blood levels of D-serine in individuals with schizophrenia have not been consistent amongst previous studies. Here we studied plasma levels of D-serine and L-serine in 84 Brazilian individuals with schizophrenia and 75 gender- and age-matched controls. Plasma levels of D-serine and the ratio of plasma D-serine to total serine were significantly lower in individuals with schizophrenia as compared to the control group. Levels of D-serine were significantly and negatively correlated to the severity of negative symptoms of schizophrenia. We also observed that plasma levels of D-serine significantly decreased with aging in healthy controls. Our results suggest that the possible role of D-serine in the pathophysiology of schizophrenia should be further investigated, with possible implications for the drug treatment of this disorder.

Manejo de paciente agitado ou agressivo

OBJECTIVE: To review current data about the management of agitated or aggressive patients. METHOD: Through a search of databases (PubMed and Web of Science), empirical articles and reviews about pharmacological and non-pharmacological interventions for the management of agitation and /or violence were identified. RESULTS: The non-pharmacological management of agitation/aggression encompasses the organization of space and appropriateness of behavior and attitudes of health professionals. The main goal of pharmacological management is rapid tranquilization aimed at reducing symptoms of agitation and aggression, without the induction of deep or prolonged sedation, keeping the patient calm, but completely or partially responsive. Polypharmacy should be avoided, and doses of medications should be as small as possible, adjusted according to clinical need. Intramuscular administration of medication should be considered as a last resort and the options for the use of antipsychotics and benzodiazepines are described and commented. The physical management by means of mechanical restraint may be necessary in violent situations where there is risk to the patient or staff, and must meet strict criteria. CONCLUSION: Procedures must be carefully implemented to avoid physical and emotional complications for patients and staff.

Strategies for Preventing Adolescent Mercury Exposure in Brazilian Gold Mining Areas

Because gold is found in a powdered form, the use of mercury is necessary to form a mercury/ gold amalgam to make the extraction easier, normally at a 1/1 proportion. Thus for each kilogram of gold, an average of one kilogram of mercury is used. This proportion may vary from 0.8-1.3 (Pfeiffer, 1988; Couto, Camara and Sabrosa, 1988; Ferreira and Appel, 1990). In 1989 alone, mercury imports reached 339.9 tons (Hasse, 1993).

Metodologia para prevenir exposição ao mercúrio em adolescentes de garimpos de ouro em Mariana, Minas Gerais, Brasil

The main objective of this study was to promote the evaluation of an educational method to identify health risks among adolescents exposed to mercury by their work in gold mining production.The project was carried out with adolescents from a public school from the District of Monsenhor Horta, Municipality of Mariana, state of Minas Gerais. Statistical evaluation of the results revealed a significant increase in the amount of correct answers between the first and fifth stage concerning the definition of work accidents and its importance in relation to work-related diseases, accidents on route to and from the work place and violence at work site itself.

O papel dos glicocorticóides na expressão dos sintomas de humor: uma revisão

El objetivo de esta revision es verificar en la literatura una relacion entre niveles plasmaticos aumentados de corticosteroides y sintomas psiquiatricos, identificando las manifestaciones clinicas mas comunes y los tratamientos propuestos. Alteraciones en el eje hipotalamo-hipofisis-supra-renal (HHSR) llevando a una hipercortisolemia estarian asociadas a disturbios del humor, sobretodo depresion, mientras el uso de drogas glicocorticoides estaria relacionado al aparecimiento de sintomas psiquiatricos como: mania, depresion, labilidad afectiva e psicosis. El levantamiento bibliografico fue realizado a partir de los indexadores MEDLINE y BIREME en el periodo de 1993 a 2003 en ingles, frances y espanol, utilizando el entrecruce de las palabras clave: cortisol, corticosteroides, depresion, trastorno bipolar e psicosis. Fueron inclusos articulos originales (33) y de revision (22) y excluidos relatos de caso. Algunos estudios sugieren que altas concentraciones plasmaticas de cortisol, a largo plazo, pueden llevar a una depresion, proponiendo que la utilizacion de drogas antiglicocorticoides tendria un efecto antidepresivo. Otros, por otro lado, indican no haber asociacion entre hipercortisolemia e episodios decisivos.The objective of this study was to make a literature review on associations between high plasma levels of corticosteroids and psychiatry symptoms, as well as to identify the most common clinical manifestations and treatments suggested. Hipercortisolemia resulting from alterations in the HPA axis would be associated with mood disorders, especially depression, whereas the use of glucocorticoid drugs would be related to the occurrence of psychiatric symptoms such as mania, depression, affective lability and psychosis. The review was performed via Medline and Bireme indexes, and articles published in English, French and Spanish between 1993 and 2003 were included. The following keywords were used: cortisol, corticosteroids, depression, bipolar disorder and psychosis. Original (33) and review (22) articles were included in the review; case reports were excluded. Some studies suggest that long-term high plasma cortisol concentrations may cause depression, and that the use of antiglucocorticoid drugs would have an antidepressant effect. On the other hand, other studies do not show association between hypercortisolemia and depressive episodes.

Headache Attributed to Psychiatric Disorders

A 14-year-old girl came to the office because of permanent and refractory headaches. She was symptom-free until the age of 12, when she started suffering from occasional headache attacks, some of them preceded by syncope. The first spell occurred at an airport toilet just prior to a family trip, during which no abnormality was present. However, attacks increased to 4–5 per week right after returning to town, precluding her from attending school. The present frequency of faints is around twice a month.

El rol de los glicocorticóides en la expresión de los síntomas de humor: una revisión

El objetivo de esta revision es verificar en la literatura una relacion entre niveles plasmaticos aumentados de corticosteroides y sintomas psiquiatricos, identificando las manifestaciones clinicas mas comunes y los tratamientos propuestos. Alteraciones en el eje hipotalamo-hipofisis-supra-renal (HHSR) llevando a una hipercortisolemia estarian asociadas a disturbios del humor, sobretodo depresion, mientras el uso de drogas glicocorticoides estaria relacionado al aparecimiento de sintomas psiquiatricos como: mania, depresion, labilidad afectiva e psicosis. El levantamiento bibliografico fue realizado a partir de los indexadores MEDLINE y BIREME en el periodo de 1993 a 2003 en ingles, frances y espanol, utilizando el entrecruce de las palabras clave: cortisol, corticosteroides, depresion, trastorno bipolar e psicosis. Fueron inclusos articulos originales (33) y de revision (22) y excluidos relatos de caso. Algunos estudios sugieren que altas concentraciones plasmaticas de cortisol, a largo plazo, pueden llevar a una depresion, proponiendo que la utilizacion de drogas antiglicocorticoides tendria un efecto antidepresivo. Otros, por otro lado, indican no haber asociacion entre hipercortisolemia e episodios decisivos.The objective of this study was to make a literature review on associations between high plasma levels of corticosteroids and psychiatry symptoms, as well as to identify the most common clinical manifestations and treatments suggested. Hipercortisolemia resulting from alterations in the HPA axis would be associated with mood disorders, especially depression, whereas the use of glucocorticoid drugs would be related to the occurrence of psychiatric symptoms such as mania, depression, affective lability and psychosis. The review was performed via Medline and Bireme indexes, and articles published in English, French and Spanish between 1993 and 2003 were included. The following keywords were used: cortisol, corticosteroids, depression, bipolar disorder and psychosis. Original (33) and review (22) articles were included in the review; case reports were excluded. Some studies suggest that long-term high plasma cortisol concentrations may cause depression, and that the use of antiglucocorticoid drugs would have an antidepressant effect. On the other hand, other studies do not show association between hypercortisolemia and depressive episodes.

The role of glucocorticoids in the modulation of mood symptoms: a review

El objetivo de esta revision es verificar en la literatura una relacion entre niveles plasmaticos aumentados de corticosteroides y sintomas psiquiatricos, identificando las manifestaciones clinicas mas comunes y los tratamientos propuestos. Alteraciones en el eje hipotalamo-hipofisis-supra-renal (HHSR) llevando a una hipercortisolemia estarian asociadas a disturbios del humor, sobretodo depresion, mientras el uso de drogas glicocorticoides estaria relacionado al aparecimiento de sintomas psiquiatricos como: mania, depresion, labilidad afectiva e psicosis. El levantamiento bibliografico fue realizado a partir de los indexadores MEDLINE y BIREME en el periodo de 1993 a 2003 en ingles, frances y espanol, utilizando el entrecruce de las palabras clave: cortisol, corticosteroides, depresion, trastorno bipolar e psicosis. Fueron inclusos articulos originales (33) y de revision (22) y excluidos relatos de caso. Algunos estudios sugieren que altas concentraciones plasmaticas de cortisol, a largo plazo, pueden llevar a una depresion, proponiendo que la utilizacion de drogas antiglicocorticoides tendria un efecto antidepresivo. Otros, por otro lado, indican no haber asociacion entre hipercortisolemia e episodios decisivos.The objective of this study was to make a literature review on associations between high plasma levels of corticosteroids and psychiatry symptoms, as well as to identify the most common clinical manifestations and treatments suggested. Hipercortisolemia resulting from alterations in the HPA axis would be associated with mood disorders, especially depression, whereas the use of glucocorticoid drugs would be related to the occurrence of psychiatric symptoms such as mania, depression, affective lability and psychosis. The review was performed via Medline and Bireme indexes, and articles published in English, French and Spanish between 1993 and 2003 were included. The following keywords were used: cortisol, corticosteroids, depression, bipolar disorder and psychosis. Original (33) and review (22) articles were included in the review; case reports were excluded. Some studies suggest that long-term high plasma cortisol concentrations may cause depression, and that the use of antiglucocorticoid drugs would have an antidepressant effect. On the other hand, other studies do not show association between hypercortisolemia and depressive episodes.