Manuel Esteves

A study of the sexuality of opiate addicts.

The influence of heroin use on sexual behavior was studied in individuals attending a drug abuse program in Porto, Portugal. As we expected, drug abuse was found mainly to adversely affect sexual behavior. A minority of patients reported improvement in sexual behavior with heroin use. Almost all patients remained sexually active and took no special precautions to prevent sexually transmitted diseases. Some patients reported heroin-related sexual effects to be a motivating factor for ceasing drug abuse.

Drugs of Abuse and Sexual Functioning

The use of mind-altering substances can be found in very different cultures and traced back thousands of years; the same is true for the searching of drugs that could increase sexual functioning. In this text, we explore the relation between drugs of abuse and sexuality in three domains: drugs and sexual dysfunctions, drugs and risky sexual behavior and drugs used as sexual aids. Although some drugs can increase sexual response in the early stages of the addiction career, particularly in those with a previous sexual dysfunction, the chronic use of substances tends to deteriorate all stages of sexual response in both male and female abusers. There is sufficient evidence for considering that drug use before or during sexual intercourse can, in certain circumstances, elevate the risk of unwanted pregnancy or sexually transmitted diseases. Specific prevention strategies should be addressed to this population. Some psychotropic drugs are sometimes used as sexual aids. This can have some risks and should alert the therapist to a possible underlying and undiagnosed sexual problem.

The origin of dementia Praecox

Throughout history, insanity--including dementia praecox--has been a complex problem. In the search for a better understanding of dementia praecox, several theories arose from the pre-Kraepelinian concept of human madness that led to the proposal of a new definition in anatomicoclinical terms. This short historical review begins in classical times and ends with the formulation of the concept of dementia praecox in 1896 by Emil Kraepelin (1856 1926).

Clozapine-induced palilalia?.

Introduction: Palilalia is an acquired speech disorder characterised by involuntary and spontaneous repetition of words or phrases two or more times in a row. It can occur in a variety of disorders including postencephalic parkinsonism, pseudobulbar palsy, schizophrenia, Gilles de la Tourette syndrome and others. Clinical Case: We describe a case of a 28-year-old man with refractory schizophrenia that developed palilalia with 300 mg of clozapine. In the patient evaluation we found unspecific alterations in the electroencephalogram, with normal blood tests and cerebral magnetic resonance imaging. Palilalia disappeared with lowering doses of clozapine. Discussion: The appearance of palilalia induced by clozapine is a rare pharmacologic side-effect which physicians should be familiarised with when evaluating this symptom presentation.

The influence of espresso coffee on neurocognitive function in HIV-infected patients

ABSTRACT The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm3, undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.

The utility of intravenous clomipramine in a case of Cotard's syndrome

Dear Editor, Cotard’s syndrome is a rare clinical event, characterized by negation delusion (individuals feel major changes in their bodies and deny the existence of one or several parts of their organs or bodies) and nihilistic delusion (individuals believe that they or all people are dead). First described in 1880 by Jules Cotard as negation delirium, the term Cotard’s syndrome was proposed in 1893 by Emil Regis. We describe the case of a patient admitted to the psychiatric ward of Hospital Ulysses Pernambucano, in Recife, northeastern Brazil and diagnosed with Cotard’s syndrome. M., 59 years old, male, was brought to the psychiatric emergency service of the hospital with complaints of insomnia, soliloquy, attempts to escape from home, suicide attempts by throwing himself in front of moving cars, and nonsense talk. He had dropped out of drug treatment two months earlier. The patient reported hearing voices making comments about him and giving him commands, as well as the existence of animals eating his body. He informed that he no longer had a body, but rather only a spirit, as he was already dead. He did not fear anything, as no one could kill him again (sic). Upon clinical examination, he was barefoot, wearing only shorts (no shirt), showed an unkempt beard and poor hygiene. He also showed alert consciousness, partial disorientation to time, a suspicious attitude, worn-out appearance, personal self-reference, deeply depressed mood, psychomotor retardation, insisting that he was not worth anything, that nobody wanted him there for 60 days already, and that he was paying for what he had done wrong. He also reported not having blood pressure, or blood, and that his body was broken, and that something very bad was about to happen. The patient was diagnosed with Cotard’s syndrome secondary to major depression with psychotic symptoms. He was treated with imipramine 150 mg/day and risperidone 4 mg/day for 60 days, and was discharged asymptomatic afterwards. Even though this disorder was first described by Cotard as a new type of depression, Regis later proposed that this syndrome could be associated with several medical conditions, e.g., psychotic depression, schizophrenia, neurosyphilis, and multiple sclerosis. Comorbidity between Cotard’s syndrome and Capgrass syndrome (individuals believe that family members have been replaced with doubles) is also common. Currently, Cotard’s syndrome is no longer classified as an independent disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) or in the International Classification of Diseases, Tenth Revision (ICD-10). Rather, in the DSM-IV-TR, nihilistic delusion is classified as a mood-congruent delusion within a depressive episode with psychotic features. It is important to emphasize that our case was absolutely compatible with the different descriptions available in the literature for Cotard’s syndrome, with features such as a depressed mood, nihilistic delusion, and delusions of guilt and immortality. Treatment of Cotard’s syndrome should focus on the underlying condition. Even though electroconvulsive therapy has been the treatment most frequently indicated in the literature, some reports of the combined use of psychotic and antidepressant drugs can also be found when psychotic depression is the underlying illness. Despite the absence of reports describing the combined use of imipramine and risperidone, the therapy was effective in remitting psychotic depression symptoms in our patient.

With regard to a case of unipolar mania

MFS, mulher de 52 anos, professora primaria, recorreu a urgencia por causa de insonia total, excesso de autoconfianca e envolvimento em multiplas atividades com duracao de uma semana. Apresentava-se com irritabilidade, agitacao, elacao do humor, verborreia, desinibicao sexual, atividade delirante persecutoria, ausencia de . Tinha