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This study aims to shed light on the construction of the concept of mania in the field of psychopathology. The article addresses the historical evolution of mania, from manic-depressive illness to the diagnosis of bipolar and schizoaffective disorders. It was observed that the current concept of mania is a product of the second half of the 19th century, although it originates from the classical Greek period, when it was understood as a way of being, and then, throughout history, was reduced to a psychopathological symptom. Currently, mania is again being considered in a broader sense, as manic functioning, but without excluding its symptomatic condition. It is from this position that we situate it as a phenomenon, encompassing the symptom and the lived experience, from the perspective constructed from phenomenological psychopathology, which looks at the manic experience not by reducing it to a natural fact, but by understanding it as a historical-cultural phenomenon, constructed in the world of human relationships.

Resumos Esta pesquisa teve como objetivo compreender a construção do conceito de mania no campo psicopatológico. Aborda-se a evolução histórica da mania, desde a doença maníaco-depressiva até o diagnóstico de transtornos bipolares e esquizoafetivos. Observou-se que o atual conceito de mania é um produto da segunda metade do século XIX, embora oriundo do período clássico grego quando era entendido como um modo de ser, e depois, ao longo da história, foi reduzido a um sintoma psicopatológico. Atualmente, a mania volta a ser considerada de forma mais ampla, como um funcionamento maníaco, mas sem descartar sua condição sintomática. É a partir dessa posição que a situamos como fenômeno, englobando o sintoma e o vivido, a partir da perspectiva construída a partir da psicopatologia fenomenológica que olha a experiência maníaca não reduzindo-a a um fato natural, mas como fenômeno histórico-cultural, construída no mundo das relações humanas.

Cette recherche vise à comprendre la construction du concept de manie dans le champ psychopathologique. L'évolution historique de la manie, de la maladie maniaco-dépressive aux diagnostics de troubles bipolaires et schizo-affectifs, est abordée. Il a été observe que le concept actuel de manie est un produit de la seconde moitié du XIXe siècle, bien qu'originaire de lapériode grecque classique où il était compris comme une manière d'etre, puis réduit à un symptôme psychopathologique tout au long de l'histoire. Actuellement, la manie est à nouveau considérée au sens large comme un fonctionnement maniaque, mais sans exclure sa condition symptomatique. C'est à partir de cette position que nous la situons comme un phénomène, englobant le symptôme et le vécu, dans la perspective construite par la psychopathologie phénoménologique qui envisage l'expérience maniaque en ne la réduisant pas à un fait naturel, mais comme un phénomène historico-culturel construit dans le monde des relations humaines.

Esta investigación tuvo como objetivo comprender la construcción del concepto de mania en el campo psicopatológico. Se aborda la evolución histórica de la manía desde la enfermedad maníaco-depresiva hasta los diagnósticos de trastorno bipolar y esquizoafectivo. Se observó que el concepto actual de manía proviene de la segunda mitad del siglo XIX, aunque tuvo su origen en la época clásica griega cuando la entendía como una forma de ser y luego, a lo largo de la historia, se redujo a un síntoma psicopatológico. Actualmente, la manía vuelve a considerarse de forma más amplia como un funcionamiento maníaco, sin descartar su condición sintomática. En esta posición se constituye un fenómeno que abarca el síntoma y lo vivido desde la perspectiva construida en la psicopatología fenomenológica que no mira la experiencia maníaca como un hecho natural, sino como un fenómeno históricocultural construido en el mundo de las relaciones humanas.

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Introduction: It is reported a case of a 57-year-old woman with multiple psychiatric hospitalizations, during which different diagnostic hypotheses and therapeutic procedures were proposed. Case report: After analyzing the patient's clinical records, the medical team proposed a diagnosis of Schizoaffective Disorder. This disorder presents a high risk of recurrent hospitalizations and high costs associated with therapeutic and follow-up withdrawal, yet there is limited data to assess the post-discharge critical periods. Final considerations: Further research in this area is required to adopt effective therapeutic strategies, reduce the probability of hospital admissions, improve prognosis, and lessen associated financial costs.

Introdução: é relatado o caso de uma mulher de 57 anos com múltiplas hospitalizações psiquiátricas, durante as quais diferentes hipóteses diagnósticas e terapêuticas associadas foram propostas. Relato do caso: Após análise dos registos clínicos, a equipa médica propôs o diagnóstico de Perturbação Esquizoafetiva. Esta Perturbação apresenta um elevado risco de re-internamento, para além do custo associado ao abandono do seguimento clínico e terapêutico. Porém, não existem dados suficientes que avaliem os períodos pós-alta. Consideracoes finais: Portanto, tornam-se necessárias pesquisas mais amplas na área para adotar estratégias terapêuticas eficazes, reduzir a probabilidade de re-internamento, melhorar o prognóstico e minimizar os custos financeiros associados.

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Objective: To describe the admissions of patients diagnosed with severe mental illness (SMI) and anxiety disorder in a regional hospital; to explore factors related to the patient's referrer upon admission and prolonged stay. Materials and methods: Cross-sectional study of episodes of admission to the regional Psychiatric Hospitalization Unit over a period of 11 years with ICD-10 diagnostic codesF20-29, F30-39, F60-69 and F40-48. The data was extracted through the Admissions Unit and the information from the electronic medical record. For the statistical treatment, descriptive or inferential tests were used with a confidence level of 95%. Results: 961 patients were included (2,324 total discharges), aged 40.8±14.0 years. The most frequent reasons for admission were: positive symptoms (agitation, delusions and hallucinations), followed by suicidal ideation and attempt. The main remitting agent of the patients was the family itself. Approximately 1/5 of the cases were referred by the health system itself, and » of those admitted had self-excluded themselves from specialized supervision for more than a year. Conclusions: The problems that caused the admission and its origin, as well as its lack of follow-up, can be considered as a clear opportunity for improvement in the follow-up of patients with severe mental illness. An orientation towards proactivity, acting before the decompensation, would contribute to improving the care and quality of life of patients with severe mental illness and their environment.

Objetivo: Describir los ingresos de pacientes diagnosticados de enfermedad mental grave y trastorno de ansiedad en un hospital comarcal; explorar los factores relacionados con la derivación del paciente al ingreso y con estancia prolongada. Materiales y métodos: Estudio de corte transversal de los episodios de ingreso en la Unidad de Hospitalización Psiquiátrica comarcal en un periodo de 11 años con los códigos diagnósticos CIE-10 F20-29, F30-39, F60-69 y F40-48. Se extrajeron los datos a través de la Unidad de Admisión y la información de la historia clínica electrónica. Para el tratamiento estadístico se usaron pruebas descriptivas o inferenciales con nivel de confianza del 95%. Resultados: Se incluyeron 961 pacientes (2.324 altas totales), con edad de 40,8±14,0 años. Los motivos más frecuentes de ingreso fueron: síntomas positivos (agitación, delirios y alucinaciones), seguidos de ideación e intento de suicidio. El principal agente remisor de los pacientes fue la propia familia. Aproximadamente 1/5 de casos fue derivado por el propio sistema sanitario, y » de los ingresados se había autoexcluido de la supervisión especializada durante más de un año. Conclusiones: Los problemas causantes del ingreso y su procedencia, así como su falta de seguimiento, pueden considerarse como una oportunidad clara de mejora en el seguimiento del paciente con enfermedad mental grave. Una orientación hacia la proactividad, actuando antes de la descompensación, contribuiría a mejorar la asistencia y calidad de vida de los pacientes con enfermedad mental grave y su entorno.

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BACKGROUND: Evidence suggests that schizophrenia (SCZ), schizoaffective disorder (SAD) and bipolar disorder (BPD) share genetic risk variants. ZNF804A gene has been associated with these disorders in different populations. GWAS and candidate gene studies have reported association between the rs1344706 A allele with SCZ, SAD and BPD in European and Asian populations. In Mexican patients, no studies have specifically analyzed ZNF804A gene variants with these disorders. The aim of the study was to analyze the rs1344706 and identify common and rare variants in a targeted region of the ZNF804A gene in Mexican patients with SCZ, BPD and SAD compared with a control group. METHODS: We genotyped the rs1344706 in 228 Mexican patients diagnosed with SCZ, SAD and BPD, and 295 controls. Also, an additional sample of 167 patients with these disorders and 170 controls was analyzed to identify rare and common variants using the Sanger-sequence analysis of a targeted region of ZNF804A gene. RESULTS: Association analysis of rs1344706 observed a higher frequency of A allele in the patients compared with the control group; however, did not show statistical differences after Bonferronís correction (χ2 = 5.3, p = 0.0208). In the sequence analysis, we did not identify rare variants; however, we identified three common variants: rs3046266, rs1366842 and rs12477430. A comparison of the three identified variants between patients and controls did not show statistical differences (p > 0.0125). Finally, haplotype analysis did not show statistical differences between SCZ, SAD and BPD and controls. CONCLUSIONS: Our findings did not support the evidence suggesting that ZNF804A gene participates in the etiology of SCZ, SAD and BPD. Future studies are needed in a larger sample size to identify the effect of this gene in psychiatric disorders.

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Objective: Switching between second-generation antipsychotics (SGAs) is a common clinical practice in the treatment of schizophrenia and schizoaffective disorders due to differences in the drugs' tolerability and safety profiles as well as the challenge of obtaining an ideal response. However, the factors associated with SGA switching remain uncertain and related real-world data are scarce. The main objective was to identify the factors associated with the switching of SGAs in patients with schizophrenia or schizoaffective disorder. Methods: We conducted a retrospective cohort study of outpatients with schizophrenia or schizoaffective disorder, who were aged ≥18 years and received a SGA (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a Brazilian pharmaceutical assistance program for at least 3 months. We identified SGA users from 2008 to 2017 by using a national administrative database (Ambulatory Information System-SIA/SUS). The factors associated with the switches were evaluated by Cox proportional hazards regression and adjusted for sex and age; the confidence interval was set at 95% (95% CI). Results: In total, 563,765 patients were included. Female sex, advanced age of ≥70 years, residence in the Brazilian northeast region, and the type of antipsychotic used were associated with an increased risk of switching (p < 0.001). The incidence of switching ranged from 37.6/100 person-years for clozapine users to 58.2/100 person-years for risperidone users. Compared to the adjusted hazard ratio, for clozapine users, the corresponding ratios for risperidone, ziprasidone, quetiapine and olanzapine were 1.59 (95% CI, 1.57-1.61), 1.41 (95% CI, 1.39-1.44), 1.25 (95% CI, 1.23-1.26) and 1.11 (95% CI, 1.10-1.12) respectively. Conclusion: The groups most susceptible to SGA switching in real-life setting were older individuals, women, and those living in the Brazilian northeast region. Risperidone was associated with the highest risk of switching and as expected, clozapine was associated with the lowest risk of switching than that associated with the other SGAs.

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Paciente de 47 años, casada, con 3 hijos. Antecedentes de patología psiquiátrica en madre y hermano. Sin antecedentes psiquiátricos previos. Ingresa hace 4 años al Servicio. Con síntomas polimorfos, varios diagnósticos desde el ingreso, pero con respuesta al tratamiento y con periodos de estabilidad psicopatológica demás de un año. Conocida en varios dispositivos del servicio. Diagnósticos: Trastorno Delirante, Obs. Trastorno Afectivo Bipolar, Trastorno Esquizoafectivo

Patient 47 years old, married, with 3 children. History of psychiatric pathology in mother and brother. No previous psychiatric history. Enter the Service 4 years ago. With polymorphic symptoms, several diagnoses from admission, but with response to treatment and with periods of psychopathological stability over a year. Known in several service devices. Diagnoses: Delusional Disorder, Obs. Bipolar Affective Disorder, Schizoaffective Disorder

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BACKGROUND: The behavioral variant frontotemporal dementia (bvFTD) shares some clinical features with severe mental disorders, such as bipolar affective disorder (BAD), schizophrenia (SCZ), and schizoaffective disorder (SZA), and at least for a small subgroup of patients, these conditions may share similar pathological genetic mutations. OBJECTIVES: To investigate the frequency of a past medical history satisfying diagnostic criteria for BAD, SCZ, and SZA in a bvFTD outpatient sample, and to compare the clinical profile of patients with and without a positive history. METHODS: Cross-sectional study in which participants were consecutively selected after receiving a diagnosis of probable bvFTD and had a caregiver interviewed with SCID-I. The sample was categorized into two groups: with (bvFTD+) or without (bvFTD-) prior medical history satisfying diagnostic criteria for BAD/SCZ/SZA. Subjects went through cognitive, functional, and neuropsychiatric evaluations. RESULTS: Overall, 46 bvFTD patients were included; bvFTD+ patients accounted for 36.9% of the sample. The main nosology fulfilling criteria was BAD (76.5%). The groups differed in Neuropsychiatric Inventory scores (p = 0.01), use of antipsychotics (p = 0.01), family history of psychosis (p = 0.01), presence of primitive reflexes (p = 0.04), Frontal Assessment Battery performance (p = 0.01), Ekman's facial emotion recognition test (p = 0.03), frequency of apathy (p = 0.03), and stereotyped behavior (p = 0.01). All these parameters were more frequent/worse in the bvFTD+ group. CONCLUSIONS: A prior medical history compatible with BAD/SCZ/SZA was found in more than 1/3 of this sample of bvFTD patients and was associated with subtle distinctive clinical features.

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Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.

Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.

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Impaired insight into illness, a core feature of schizophrenia with negative clinical implications, is a multidimensional phenomenon existing on a continuum. However, the degree to which illness perception in distinct cultures influences the appraisal of insight into illness in schizophrenia remains unclear. As such, we aimed to determine if the psychometric properties of the VAGUS insight into psychosis scale (www.vagusonline.com), which was originally assessed in English speaking Canadians, were similar in a sample of Latino Mexican Spanish speaking patients with schizophrenia. To accomplish this, the VAGUS - Self-Report (SR) version was translated from English to Spanish and psychometrically evaluated in 95 participants. The Spanish version of the VAGUS-SR was internally consistent (á¾³ = 0.713), and demonstrated good convergent and discriminant validity with the subscales of the Positive and Negative Syndrome Scale. Factor analysis identified two components of insight, congruent with two of the components of the English version of the VAGUS-SR. In conclusion, the VAGUS-SR is a brief, novel, and valid measure of insight into illness in schizophrenia, which demonstrated similar psychometric properties in two culturally and linguistically distinct samples with schizophrenia. Future studies should assess whether the VAGUS demonstrates similar psychometric properties in non-Western cultures.

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Resumen Introducción: Dentro del espectro de las enfermedades psiquiátricas, una de las más complejas es el trastorno esquizoafectivo debido al reto diagnóstico y al manejo psicofarmacológico. Esta enfermedad combina síntomas cardinales de la esquizofrenia con síntomas de trastornos del afecto. El tratamiento se enfoca entonces a mejorar los síntomas psicóticos y regular el estado de ánimo. Dentro de los fármacos que se utilizan se encuentran las benzodiacepinas, que deben retirarse gradualmente para evitar recaídas o síntomas de abstinencia. En este reporte comentamos el caso de una paciente que después del retiro gradual hasta la suspensión de clonazepam presentó síntomas depresivos que remitieron tras la reinstalación del fármaco. Reporte del caso: Mujer de 31 años de edad sin antecedentes de importancia para su padecimiento actual. Inició con síntomas psicóticos que requirieron hospitalización, donde se agregaron síntomas maniatiformes y se integró el diagnostico de episodio maniaco con síntomas psicóticos. Se manejó con un antipsicótico, estabilizador del estado de ánimo y benzodiacepinas, con lo que sus síntomas remitieron. A los dos años presentó un cuadro psicótico sin síntomas afectivos y se diagnosticó como trastorno esquizoafectivo según el DSM V. Por su mejoría se disminuyeron los fármacos de forma gradual. Tras la suspensión del clonazepam, la paciente presentó síntomas depresivos que remitieron al reinstalar el fármaco. Discusión: La aparición súbita de síntomas depresivos se consideró como una posible recaída dada la patología de base. Estrictamente hablando, la paciente no cumplía criterios para diagnosticar un síndrome de abstinencia a benzodiacepinas. En la literatura se reporta que en algunos casos los síntomas depresivos pueden ser parte de este espectro, sin embargo no se especifica ni temporalidad ni alguna otra característica relevante. Tras el reinicio del fármaco a la dosis mínima que utilizaba la paciente, en menos de dos semanas se logró la remisión total de un episodio que cumplía los criterios diagnósticos para un trastorno depresivo mayor. Esto nos permitió establecer una relación directa entre la suspensión del clonazepam y la aparición de dichos síntomas. Conclusiones: A pesar de que el manejo dependerá de las características de cada paciente y las preferencias de su médico, vale la pena tener en mente la aparición de síntomas poco usuales asociados con el uso de los fármacos aun a pesar de seguir los lineamientos establecidos para el cambio y suspensión, en este caso, de las benzodiacepinas.

Abstract Introduction: Within the spectrum of psychiatric illnesses one of the most complex is the schizoaffective disorder due to the fact that both, its diagnosis and pharmacological management are challenging. This disease combines cardinal symptoms of schizophrenia and mood disorders symptoms. The aim of the treatment focuses on improving both psychotic symptoms and mood stabilization. Benzodiazepines are frequently used, and should be gradually reduced in order to prevent either a relapse or withdrawal symptoms. Here, we report the case of a 31-year-old female patient that after a gradual reduction of benzodiazepines and the suspension of clonazepam developed depressive symptoms, which subsided after the drug reinstatement. Case report: A 31-year-old female with no relevant past medical history developed psychotic symptoms that required hospitalization. Maniac symptoms appeared and therefore, the diagnosis was a manic episode with psychotic symptoms. Antipsychotic drugs, a mood stabilizer and benzodiazepines were the treatment used and the patient showed clinical improvement. She was free of clinical manifestations for two years, until the patient presented a psychotic episode without mood symptoms; therefore she was diagnosed with schizoaffective disorder according to the DSM V criteria. After clinical improvement drugs were decreased gradually. Following the suspension of clonazepam the patient had depressive symptoms that disappeared after the reinstatement of the drug. Discussion: The sudden appearance of depressive symptoms was considered as a possible relapse linked to the underlying disease. Strictly speaking, the patient did not meet the criteria for benzodiazepine withdrawal syndrome. The literature reports that in some cases depressive symptoms may be part of this spectrum, however neither a temporality nor any other relevant characteristics were specified. After restarting the drug at the lowest dose that the patient used, total remission of the major depressive disorder was achieved in less than two weeks. This allowed us to establish, at our discretion, a direct link between the suspension of clonazepam and the appearance of these symptoms. Conclusion: Although the management depends on the characteristics of each patient and the physician preferences, it is worth keeping in mind the possibility of unusual symptoms that may appear even by following the correct guidelines established for a correct decrease doses and the suspension of benzodiazepines.

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Abstract Background Thought and language disorders are main features of adults with schizophrenia and bipolar disorders however studies on such abnormalities are scant in young patients with very early onset psychosis (VEOS). The aim of the present study is to assess the relationship between language and thought disorders in patients with very early onset schizophrenia (SCZ), schizoaffective disorders (SCA) and bipolar disorders (BD). Method Forty-one patients (18 SCZ, 16 BD, and 7 SCA) with mean age less than 15 years old were assessed through a series of neurocognitive and psycholinguistic tests, including the Thought, Language and Communication Scale (TLC). Results SCZ group performed worse in all tests as well as the TLC, followed by SCA and BD groups respectively. Thought disorders were related to deficits in executive functioning and semantic processing, and the metaphors’ test was the best predictor of TLC functioning. Discussion TD in SCZ, SCA and BD are one of the most important features in patients with VEOS and that the evaluation of metaphor comprehension can be an important instrument in the early detection of this disorder.

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INTRODUCTION: Despite being frequently diagnosed, there has been very limited study of efficacious treatments for schizoaffective disorder. Paliperidone had been approved for the treatment of schizoaffective disorder, and a recently completed relapse prevention study of the use of a once-monthly injectable paliperidone formulation has also led to an indication for that preparation to treat schizoaffective disorder. METHODS: To review the efficacy and tolerability of paliperidone for schizoaffective disorder, we conducted a systematic literature search of studies of paliperidone in the treatment of schizoaffective disorder, and briefly reviewed evidence regarding the somewhat controversial nature of that diagnostic entity. RESULTS: We located several studies of the use of paliperidone extended release in the treatment of schizoaffective disorder, but only one completed study of the use of paliperidone palmitate, which demonstrated efficacy in preventing relapse. Three other studies are currently recruiting participants. Efficacy and tolerability were similar to the profile of oral paliperidone in the treatment of individuals with schizophrenia. These results were similar for both individuals treated with paliperidone palmitate alone, and for those treated with paliperidone palmitate with adjunctive mood stabilizers and/or antidepressants. The use of paliperidone palmitate does not require initial co-administration of oral paliperidone, has relatively little risk of drug-drug interactions, and its pharmacokinetics are favorable for once-monthly administration, an important treatment option for individuals with psychotic disorders, who may often be non-adherent to effective medication regimens. CONCLUSION: Paliperidone palmitate is an approved treatment for schizoaffective disorder, and can be efficacious with or without commonly employed adjunctive treatments.

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Objective: To report the rare development of manic symptoms in a patient with schizophrenia and discuss its differential diagnosis. Case description: Diagnostic criteria were based on the International Classification of Diseases, 10th edition (ICD-10). A 63-year-old female (diagnosed with schizophrenia since she was 28) was brought to the emergency room with symptoms consistent with manic episode and physical examination suggestive of thyrotoxicosis. Graves' disease was confirmed by subsequent laboratory tests. She was treated successfully with radioiodine ablation, leading to full remission of manic symptoms. Comments: Schizophrenia is a chronic disease that affects about 1% of the population worldwide. The main symptoms of the disorder are altered affection, delusions, and hallucinations. Graves' disease is an autoimmune condition in which antibodies increase the production and release of thyroid hormones. There are reports about the development of mood symptoms in patients with Graves' disease that remit with adequate treatment. .

Objetivo: Relatar um caso raro de desenvolvimento de sintomas maníacos em uma paciente com esquizofrenia e discutir o diagnóstico diferencial desses sintomas. Descrição do caso: Foram utilizados como base os critérios diagnósticos da Classificação Internacional de Doenças, 10ª edição (CID-10). Paciente de 63 anos do sexo feminino e com diagnóstico de esquizofrenia desde os 28 anos foi levada a emergência com sintomas compatíveis com episódio de mania e exame físico sugestivo de tireotoxicose. Doença de Graves foi confirmada por exames subsequentes. A paciente foi tratada com sucesso com ablação por iodo radioativo, levando à remissão dos sintomas maníacos. Comentários: A esquizofrenia é uma doença crônica que afeta cerca de 1% da população mundial. Os principais sintomas do transtorno são o embotamento afetivo, alucinações e delírios. A doença de Graves é uma doença autoimune em que o estímulo humoral aumenta a produção e liberação de hormônios pela tireoide. Há relatos na literatura sobre o desenvolvimento de sintomas maníacos em pacientes com doença de Graves, os quais remitem mediante tratamento adequado. .

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OBJECTIVE: Research of electroencephalograph (EEG) power spectrum and mean frequency has shown inconsistent results in patients with schizophrenic, schizoaffective and bipolar disorders during medication when compared to normal subjects thus; the characterization of these parameters is an important task. METHODS: We applied quantitative EEG (qEEG) to investigate 38 control, 15 schizophrenic, 7 schizoaffective and 11 bipolar disorder subjects which remaine under the administration of psychotropic drugs (except control group). Absolute spectral power (ASP), mean frequency and hemispheric electrical asymmetry were measured by 19 derivation qEEG. Group mean values were compared with non parametrical Mann-Whitney test and spectral EEG maps with z-score method at p < 0.05. RESULTS: Most frequent drug treatments for schizophrenic patients were neuroleptic+antiepileptic (40% of cases) or 2 neuroleptics (33.3%). Schizoaffective patients received neuroleptic+benzodiazepine (71.4%) and for bipolar disorder patients neuroleptic+antiepileptic (81.8%). Schizophrenic (at all derivations except for Fp1, Fp2, F8 and T6) and schizoaffective (only at C3) show higher values of ASP (+57.7% and +86.1% respectively) compared to control group. ASP of bipolar disorder patients did not show differences against control group. The mean frequency was higher at Fp1 (+14.2%) and Fp2 (+17.4%) in bipolar disorder patients than control group, but no differences were found in frequencies between schizophrenic or schizoaffective patients against the control group. Majority of spectral differences were found at the left hemisphere in schizophrenic and schizoaffective but not in bipolar disorder subjects. CONCLUSION: The present report contributes to characterize quantitatively the qEEG in drug treated schizophrenic, schizoaffective or bipolar disorder patients.

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Introduction: Schizoaffective Disorder represents a controversial clinical entity, in regard to nosology and classification criteria. It has been considered as a variant of Schizophrenia, as a mixed entity between Schizophrenia and Bipolar Disorder and as a Bipolar Disorder subtype Method: Classificatory, clinical issues, neuropsychology and genetics research contributions are reviewed. Discussion and Conclusion: Schizoaffective Disorder concept at present time, differs from its original description, maintaining lack of definitive clarity with respect to its nosology. Considering neurocognitive impairment within its course, Schizoaffective Disorder looks much closer to affective psychosis than to Schizophrenia. From genetic research field emerges data that challenge the classic dichotomist distinction between affective psychosis and Schizophrenia established by E. Kraepelin, raising again the question about thinking in psychosis as a continuum in which Schizoaffective Disorder could represent an intermediate state...

Introducción: El Trastorno Esquizoafectivo constituye un área de controversias respecto a su nosología y criterios para su clasificación. Ha sido considerado como una variante de la Esquizofrenia, un cuadro mixto en el cual coexisten la Esquizofrenia y el Trastorno Bipolar y como un subtipo del Trastorno Bipolar. Método: Se revisan aspectos diagnósticos, clasificatorios y características psicopatológicas del trastorno en su concepción actual y aportes desde la perspectiva de la investigación neuropsicológica y la genética. Discusión y Conclusiones: El concepto actual de Trastorno Esquizoafectivo, difiere de su descripción original manteniéndose la falta de claridad definitiva respecto a su nosología. Tomando en consideración las alteraciones neurocognitivas que acompañan su evolución, el Trastorno Esquizoafectivo guardaría una mayor afinidad con las psicosis afectivas que con la Esquizofrenia. Desde la investigación genética surgen datos que cuestionan la distinción dicotómica clásica entre las psicosis afectivas y la Esquizofrenia establecida por E. Kraepelin, replanteándose la formulación de la psicosis en un continuum del cual el Trastorno Esquizoafectivo podría representar un estadio intermedio...

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BACKGROUND: Risperidone long-acting injection (RLAI) has been shown to be efficacious, improve compliance, and increase long-term retention rate on therapy. The aim of this work was to determine the effect of RLAI on clinical outcome and hospitalization rate in patients with schizophrenia or schizoaffective disorder enrolled in the electronic Schizophrenia Treatment Adherence Registry in Latin America. METHODS: Data were collected at baseline, retrospectively for the 12 months prior to baseline, and prospectively every three months for 24 months. Hospitalization prior to therapy was assessed by a retrospective chart review. Efficacy and functioning were evaluated using Clinical Global Impression of Illness Severity (CGI-S), Personal and Social Performance (PSP), and Global Assessment of Functioning (GAF) scores. Relapse and treatment were also registered. RESULTS: Patients were recruited in Mexico (n = 53), Brazil (n = 11), and Colombia (n = 15). Sixty-five percent (n = 52) were male, and mean age was 32.9 years. Patients were classified as having schizophrenia (n = 73) or schizoaffective disorder (n = 6). The mean dose of RLAI at six months was 34.1 mg (standard deviation = 10.2 mg). The percentage of hospitalized patients before treatment was 28.2% and 5.1% at six months after initiating RLAI (P < 0.001). Significant changes were registered on CGI-S, GAF, and PSP scores. CONCLUSIONS: RLAI was associated with an improvement in clinical symptoms and functioning, and a greater reduction in hospitalization.

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OBJECTIVE: To review the efficacy of placebo in comparison with atypical and typical antipsychotics for the treatment of schizophrenia and schizoaffective disorder and to evaluate the pertinence of using placebo in clinical trials with antipsychotics. METHOD: Trials in which the atypical antipsychotics were compared with typical antipsychotics and placebo were included. A search was conducted using the terms "amisulpride", "aripiprazole", "clozapine", "olanzapine", "quetiapine", "risperidone", "sertindole", "ziprasidone" and "zotepine". Main efficacy parameters were calculated using the proportion of "events" (defined as a deterioration or lack of improvement by at least 20 percent in Positive and Negative Syndrome Scale or Brief Psychiatric Rating Scale) and the pooled relative risk with random effects, with their respective 95 percent confidence intervals. We also calculated the necessary sample sizes in studies in which the study drug is compared to a typical antipsychotic or placebo. RESULTS: The pooled efficacy rates observed were 40.8 percent, 34.9 percent and 21.3 percent for the atypical antipsychotics, typical antipsychotics and placebo, respectively. One hundred and sixty six patients would have to be included when a new drug is compared with placebo if calculation is based on a difference of 20 percent found between the atypical antipsychotic and placebo and 2,054 if the difference sought were that found between the atypical antipsychotic and the typical antipsychotic, i.e. 6 percent. The estimated therapeutic failures would be 115 of the 166 patients when the study drug is compared with placebo, and 1,274 failures in the 2,054 patients when the study drug is compared to the typical antipsychotic. CONCLUSIONS: Placebo controlled studies may reduce the number of individuals exposed to the harmful effects of ineffective drugs.

OBJETIVO: Revisar a eficácia do placebo em comparação com a dos antipsicóticos atípicos e típicos no tratamento da esquizofrenia e do transtorno esquizoafetivo, bem como avaliar a pertinência do uso do placebo nos ensaios clínicos com antipsicóticos. MÉTODO: Foram incluídos estudos nos quais os antipsicóticos atípicos foram comparados com antipsicóticos típicos e placebo simultaneamente. A pesquisa bibliográfica incluiu os termos "amisulprida", "aripiprazol", "clozapina", "olanzapina", "quetiapina", "risperidona", "sertindol", "ziprasidona" e "zotepina". Os principais parâmetros de eficácia foram a proporção de "eventos" (definidos como deterioração ou falta de melhora de pelo menos 20 por cento na Positive and Negative Syndrome Scale ou Brief Psychiatric Rating Scale) e os riscos relativos combinados (efeitos randômicos), com seus respectivos intervalos de confiança de 95 por cento. Foram também estimados os tamanhos de amostras nos estudos em que a droga pesquisada fosse comparada com um antipsicótico típico ou com placebo. RESULTADOS: As taxas de eficácia combinada foram de 40,8 por cento, 34,9 por cento e 21,3 por cento, respectivamente, para os antipsicóticos atípicos, antipsicóticos típicos e placebo. Cento e sessenta e seis pacientes teriam de ser incluídos quando a nova droga fosse comparada com placebo se os cálculos fossem baseados na diferença de 20 por cento encontrada entre o antipsicótico atípico e placebo, ao passo que 2.054 teriam de ser incluídos se a diferença procurada fosse aquela encontrada entre o antipsicótico atípico e o antipsicótico típico, isto é, 6 por cento. Os insucessos terapêuticos estimados seriam de 115 entre os 166 pacientes quando a droga em estudo fosse comparada com placebo, e de 1.274 entre os 2.054 pacientes quando fosse comparada com um antipsicótico típico. CONCLUSÕES: Os estudos controlados por placebo podem reduzir o número de indivíduos expostos aos efeitos prejudiciais de drogas ineficazes.

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