Sandra Odebrecht Vargas Nunes

The role of oxidative and nitrosative stress in accelerated aging and major depressive disorder

Major depressive disorder (MDD) affects millions of individuals and is highly comorbid with many age associated diseases such as diabetes mellitus, immune-inflammatory dysregulation and cardiovascular diseases. Oxidative/nitrosative stress plays a fundamental role in aging, as well as in the pathogenesis of neurodegenerative/neuropsychiatric disorders including MDD. In this review, we critically review the evidence for an involvement of oxidative/nitrosative stress in acceleration of aging process in MDD. There are evidence of the association between MDD and changes in molecular mechanisms involved in aging. There is a significant association between telomere length, enzymatic antioxidant activities (SOD, CAT, GPx), glutathione (GSH), lipid peroxidation (MDA), nuclear factor κB, inflammatory cytokines with MDD. Major depression also is characterized by significantly lower concentration of antioxidants (zinc, coenzyme Q10, PON1). Since, aging and MDD share a common biological base in their pathophysiology, the potential therapeutic use of antioxidants and anti-aging molecules in MDD could be promising.

Características clínicas e qualidade de vida de fumantes em um centro de referência de abordagem e tratamento do tabagismo

OBJETIVO: Comparar, entre fumantes e nunca fumantes, os seguintes aspectos: qualidade de vida, IMC, hospitalizacoes, incapacidades, historia familiar de transtorno mental, doencas relacionadas ao uso de tabaco, depressao e uso de substâncias psicoativas. METODOS: Um total de 167 fumantes inscritos em um programa de cessacao do tabagismo no Centro de Referencia de Abordagem e Tratamento do Tabagismo da Universidade Estadual de Londrina e 272 nunca fumantes doadores de sangue foram incluidos no estudo. Foram utilizados um questionario estruturado para a coleta de dados sociodemograficos, Alcohol, Smoking and Substance Involvement Screening Test, World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF) e Fagerstrom Test for Nicotine Dependence, todos validados para uso no Brasil, assim como criterios diagnosticos para a pesquisa de transtornos depressivos. RESULTADOS: A media de idade para fumantes e nunca fumantes foi, respectivamente, de 45 e 44 anos. As mulheres predominaram nos dois grupos. Fumantes mais frequentemente apresentaram incapacidades laborais e domesticas, presenca de fumantes em casa, hospitalizacoes, transtorno depressivo, uso de sedativos, historia de transtorno mental na familia e piores escores em todos os dominios do WHOQoL-BREF. A media de idade do inicio do tabagismo em fumantes com depressao ou em uso de substâncias psicoativas foi mais baixa do que os sem essas comorbidades. Fumantes apresentaram mais frequentemente diabetes, hipertensao arterial, doencas cardiacas, doencas respiratorias e ulcera peptica do que os que nunca fumaram. O IMC medio foi menor entre fumantes do que nos que nunca fumaram. CONCLUSOES: Este estudo sugere que, no tratamento do tabagismo, deveriam ser identificados subgrupos de fumantes com caracteristicas especificas: inicio precoce do tabagismo, doencas que sofrem agravos pelo tabaco, depressao e uso de substâncias psicoativas.

Strategies for the Treatment of Antipsychotic-Induced Sexual Dysfunction and/or Hyperprolactinemia Among Patients of the Schizophrenia Spectrum: A Review

There is limited evidence for the management of sexual dysfunction and/or hyperprolactinemia resulting from use of antipsychotics in patients with schizophrenia and spectrum. The aim of this study was to review and describe the strategies for the treatment of antipsychotic-induced sexual dysfunctions and/or hyperprolactinemia. The research was carried out through Medline/PubMed, Cochrane, Lilacs, Embase, and PsycINFO, and it included open labels or randomized clinical trials. The authors found 31 studies: 25 open-label noncontrolled studies and 6 randomized controlled clinical trials. The randomized, double-blind controlled studies that were conducted with adjunctive treatment that showed improvement of sexual dysfunction and/or decrease of prolactin levels were sildenafil and aripiprazole. The medication selegiline and cyproheptadine did not improve sexual function. The switch to quetiapine was demonstrated in 2 randomized controlled studies: 1 showed improvement in the primary outcome and the other did not. This reviewed data have suggested that further well-designed randomized controlled trials are needed to provide evidence for the effects of different strategies to manage sexual dysfunction and/or hyperprolactinaemia resulting from antipsychotics. These trials are necessary in order to have a better compliance and reduce the distress among patients with schizophrenia.

Comunicação no ensino médico: estruturação, experiência e desafios em novos currículos médicos

This article relates an experience of a group of teachers of the Integrated Medical Course of the State University of Londrina in teaching communication in the Skills Module. The awareness of the importance of communication skills not only in the doctor-patient relationship but also in the evolution of diseases led to the design of a module with progressive difficulties throughout the first years of the course. The content of the module ranges from observation of patients in the waiting room to discussions on how to transmit information, treatment adherence and management of special groups of patients in different stages of life. The methods used include observation of patients, interviews, group discussions, role-playing, films, round tables, conferences and statements of patients. The evaluation occurs in two parts: formative and cognitive. The training of communication skills is aimed at developing the ability of the student to establish a good doctor-patient relationship, history taking and transmission of information and at promoting treatment adherence.

O ensino de psiquiatria, habilidades de comunicação e atitudes no currículo integrado do curso de Medicina da Universidade Estadual de Londrina

This article describes an experience of teaching psychiatry, communication skills, and attitudes in an integrated medical curriculum at the Londrina State University. The concept map of the thematic module of mental disorders and of behavior were proposed as a strategy promoting interdisciplinary meaningful learning of Psychiatry. Psychiatric knowledge is acquired through problem-based learning. Communication skills and attitudes are taught in different ways, with patients, with simulated patients, using videos, case reports, role-playing, and work in small groups. The methods used for evaluating the knowledge in psychiatry, the communication skills and the attitudes include summative and formative assessment designed to give the student a feedback on his progress in objective structured clinical examination (Osce), portfolios, and case reports. The psychiatric knowledge, communication skills, and attitudes are assimilated depending on meaningful learning as a teaching method and on the way the students are evaluated in their medical practice.

Adjunctive Treatment with Lodenafil Carbonate for Erectile Dysfunction in Outpatients with Schizophrenia and Spectrum: A Randomized, Double-Blind, Crossover, Placebo-Controlled Trial

INTRODUCTION.: Evidence is accumulating to support the presence of erectile dysfunction in patients with schizophrenia. This dysregulation may be amenable to therapeutic intervention to improve adherence and quality of life of patients who suffer from schizophrenia and schizoaffective disorders. AIM.: We aimed to evaluate the use of adjunctive medication lodenafil for the treatment of erectile dysfunction in outpatients with schizophrenia and spectrum. METHODS.: The design was a randomized, double-blind, crossover, placebo-controlled trial with lodenafil and it was carried at the Schizophrenia Outpatients Program. MAIN OUTCOME MEASURES.: The measures used to assess sexual dysfunction were Arizona Sexual Experiences Scale (ASEX) and International Index of Erectile Function (IIEF). The Positive and Negative Syndrome Scale (PANSS) and the Quality of Life Scale (QLS) were also used. The measures included the levels of prolactin, estradiol, luteinizing hormone, sex hormone-binding globulin, free testosterone, and total testosterone at baseline and end point. Lodenafil and placebo pills were used by the patients for 16 weeks. RESULTS.: Fifty male outpatients fulfilled the criteria and 94% of the participants completed the study. Lodenafil and placebo produced improvement in ASEX, IIEF scale, PANSS, and QLS, and there was no statistical difference between lodenafil and placebo groups in all sexual domains in the results of PANSS and QLS and in the results of hormone levels. CONCLUSION.: These results indicate that both lodenafil and placebo were effective in the treatment of erectile dysfunction for schizophrenia. Placebo effect is very important in patients with schizophrenia and this study showed the importance of discussing sexuality and trying to treat these patients. Further studies designed to test treatments of erectile dysfunction in patients who suffer from schizophrenia are necessary.

Folie à Deux and its interaction with early life stress: a case report.

BackgroundFolie à deux is a very rare psychiatric syndrome in which a psychotic symptom is transmitted from one individual to another. We present a case of folie à deux occurring during childhood, which is not an usual presentation of this syndrome. In this case, the disorder is correlated with child abuse and neglect, which possibly had a role in the development of the symptoms in our case.Case presentationWe present a case of folie à deux between an “induced” 9-year-old black Brazilian boy and the “inducer”, his grandmother. They were found to be sharing similar auditory and visual hallucinations and delusional beliefs. The boy was neglected by his parents and was being cared for by his grandmother, who had a history of mental disorder.ConclusionsThe close relationship between the boy and his grandmother, the family history of first-degree psychosis, and the child abuse and neglect suffered by the boy may have altered his vulnerability to early-onset psychosis and, in this case, folie à deux.

Transtorno depressivo e fibromialgia: associação com estresse de vida precoce. Relato de caso

JUSTIFICATIVA E OBJETIVOS: A associacao entre depressao, fibromialgia e maus tratos infantis sugere que ambas, dividem o modelo de traumatologia do desenvolvimento. O objetivo deste estudo foi apresentar um caso do transtorno depressivo e fibromialgia relacionado aos maus tratos na infância, bem como discutir as causas e as consequencias de ambos os diagnosticos. RELATO DO CASO: Paciente do sexo feminino, 54 anos, apresenta fibromialgia e transtorno depressivo recorrente, episodio atual grave, sem sintomas psicoticos, com sintomas somaticos ha cerca de seis meses. Com historia de eventos de vida negativos na infância com perda de relacao afetiva, problemas relacionados com abuso fisico alegado da crianca e experiencia pessoal amedrontadora na infância. CONCLUSAO: O estresse de vida precoce pode ser responsabilizado como fator causal dos sintomas dolorosos na depressao e fibromialgia.

Higher than normal plasma Iinterleukin-6 concentrations in brazilian patients with mood disorders

The aim of this work was to study the plasma concentration of IL-6 by ELISA in the patients with mood disorders and normal healthy donors. The plasma concentration of IL-6 was higher in the patients than in the control healthy group. Results suggested that IL-6 could serve as an immunological marker in mood disorder pathogenesis as well.