RESUMO

The effective pharmacological treatment of depression started in 1958 with the introduction of iproniazide and imipramine. New agents quickly followed with more specific actions and a safer side effect profile. Very recently, fourth generation antidepressants with dual action have been introduced. These new agents pose a challenging dilemma. Is it better to develop drugs ever more selective towards specific monoamine receptor subpopulations, or drugs that act upon several monoamines in a more focused way? The priority seems to be the investigation of the interactions of the various monoaminergic systems. This paper reviews the clinical use of the new antidepressants that implement the notion of dual action as an important element for efficacy combined with receptor-specific action as a basis for tolerability.

Assuntos

RESUMO

The effective pharmacological treatment of depression started in 1958 with the introduction of iproniazide and imipramine. New agents quickly followed with more specific actions and a safer side effect profile. Very recently, fourth generation antidepressants with dual action have been introduced. These new agents pose a challenging dilemma. Is it better to develop drugs ever more selective towards specific monoamine receptor subpopulations, or drugs that act upon several monoamines in a more focused way? The priority seems to be the investigation of the interactions of the various monoaminergic systems. This paper reviews the clinical use of the new antidepressants that implement the notion of dual action as an important element for efficacy combined with receptor-specific action as a basis for tolerability.

Assuntos

RESUMO

OBJECTIVE: The development of instruments to measure emotional maladjustment in diabetic Hispanic populations has received little attention. We present the development and validation of the Diabetes Emotional Adjustment Scale in Spanish. METHOD: An eighteen-item self-administered scale was construed to assess emotional adjustment in Spanish-speaking diabetic patients and the psychometric properties of the scale were assessed. The scale was applied to a sample of sixty patients and scale scores were correlated with scores on a battery of Spanish versions of established measures of psychological distress, to assess concurrent validity. Test-retest reliability was established four years later re-examining thirty-eight of the initial sixty-patients sample. RESULTS: Split-half reliability and test-retest reliability were satisfactory. There were significant correlations between the scale results and measures of depression, trait-anxiety, family adjustment, and locus of control of behavior. A principal component analysis with varimax rotation yielded a six-factor solution explaining 50.4 percent of the total variance. CONCLUSIONS: The scale is useful as a screening instrument, but the confirmation of factor structure stability and the correlation of the scale results with objective measures of metabolic control, require further investigation.

Assuntos

RESUMO

The aim of this paper is to attempt a classification of aggressive behavior based on neurobiological mechanisms and to shed some light on the pharmacological treatment of this condition. Drugs that enhance serotonin transmission are indicated in conditions related to decreased serotonergic transmission. Dopamine blockers are useful in the acute control of aggression and the violence displayed by schizophrenic patients. Clozapine probably has an anti-aggressive effect independent of its antipsychotic action. Noradrenergic agents have been shown effective in chronic aggression of organic brain syndromes. Gabaergic drugs are effective in acute aggression and in organic brain syndromes.

Assuntos

RESUMO

The aim of this paper is to attempt a classification of aggressive behavior based on neurobiological mechanisms and to shed some light on the pharmacological treatment of this condition. Drugs that enhance serotonin transmission are indicated in conditions related to decreased serotonergic transmission. Dopamine blockers are useful in the acute control of aggression and the violence displayed by schizophrenic patients. Clozapine probably has an anti-aggressive effect independent of its antipsychotic action. Noradrenergic agents have been shown effective in chronic aggression of organic brain syndromes. Gabaergic drugs are effective in acute aggression and in organic brain syndromes

Assuntos

RESUMO

The Capgras' syndrome is the delusional belief that a person or object has been replaced by an identical duplicate, usually with evil intent. A clinical, psychometric and electroencephalographic study of 9 patients afflicted with this syndrome and its variants was performed. The clinical course and the therapeutic response were assessed during the follow up that run between 2 and 11 years. The aim of this paper is to discuss the etiologically relevant psychodynamic, organic and mythological issues and to postulate an explanatory model that integrates limbic mechanisms, affect recognition processes, psychodynamic factors and anthropological aspects.

Assuntos

RESUMO

The Capgras' syndrome is the delusional belief that a person or object has been replaced by an identical duplicate, usually with evil intent. A clinical, psychometric and electroencephalographic study of 9 patients afflicted with this syndrome and its variants was performed. The clinical course and the therapeutic response were assessed during the follow up that run between 2 and 11 years. The aim of this paper is to discuss the etiologically relevant psychodynamic, organic and mythological issues and to postulate an explanatory model that integrates limbic mechanisms, affect recognition processes, psychodynamic factors and anthropological aspects

Assuntos

RESUMO

The case of a patient with both, the intermetamorphosis and the Foley syndromes is studied. Both of these syndromes are extremely infrequent and their coexistence in a single patient points up to a common etiopathogenic mechanism. The relevant literature is discussed and a limbic hyperconnection syndrome is proposed to explain the clinical findings as well as the positive response to valproic acid.

Assuntos

RESUMO

The Emotional Adjustment Scale for Diabetics (EAD) and the Brown Scale (SB) were used to evaluate 60 diabetic patients. The aim of the study was to compare the clinicians' ability to diagnose the emotional maladjustment with the results of a standardized instrument. A battery of psychosocial tests was also applied. The results showed that SB has low sensibility, specificity and positive predictive value which suggests that clinicians has less ability to diagnose emotional maladjustment than a standardized instrument. The analysis of tests results helped to identify predictive variables for the results of SB (personality factors) and the results of EAD (locus of control of behavior, age, escolarity and scales D and F of the Minimult). The findings are discussed in the light of the relevant literature.

Assuntos

RESUMO

A political conflict forced banks to close down in Panama during March 1988. Thus, thousand of families were unable to meet their most basic needs during that lapse of time. This paper describes a community intervention program that was set up in the midst of such an economic disaster. That program emphasized mental health consultation techniques to help devising an effective organizational action as well as developing standards to determine needs, and a clear-cut two-way communication with the affected families. The incidence of emotional disorder was assessed with the Self Report Questionnaire, and crisis intervention was offered to any people who should apply for it. Cognitive responses, coping behaviors, and social supports were also assessed. Results showed that those individuals excluded from a full participation in their culture were much more likely to develop emotional disorders. Finding that affected people showed a scarce self-help behavior was interpreted as a feature of the transcultural transaction between affected people, and professionals.

Assuntos

RESUMO

The author investigated the incidence of emotional problems in 96 persons affected by the economic disaster which occurred in Panama during the period in which banks were closed. The authors used the self-reporting questionnaire, a survey of the social support network, a psychiatric examination, cognitive appreciation and the subject's adaptive behavior. The results obtained suggest that individuals who are culturally isolated are more susceptible to present emotional disorders.

Assuntos

RESUMO

A political conflict forced banks to close down in Panama during March 1988. Thus, thousand of families were unable to meet their most basic needs during that lapse of time. This paper describes a community intervention program that was set up in the midst of such an economic disaster. That program emphasized mental health consultation techniques to help devising an effective organizational action as well as developing standards to determine needs, and a clear-cut two-way communication with the affected families. The incidence of emotional disorder was assessed with the Self Report Questionnaire, and crisis intervention was offered to any people who should apply for it. Cognitive responses, coping behaviors, and social supports were also assessed. Results showed that those individuals excluded from a full participation in their culture were much more likely to develop emotional disorders. Finding that affected people showed a scarce self-help behavior was interpreted as a feature of the transcultural transaction between affected people, and professionals.

RESUMO

The Authors describe the clinical histories of two patients who presented with the infrequent delusion of being infected with very tiny organisms which crawl in the skin (Ekbom's syndrome) and comments on its phenomenological characteristics and nosological classification. In their discussion they clarify aspects of the pathogenesis of delusions in this condition.

Assuntos

RESUMO

Twenty-five myocardial infarction patients, included in a comprehensive cardiac rehabilitation programme, were studied in order to assess the physical training effects upon several physiological parameters in a country with a tropical climate. Training consisted of three-times weekly supervised sessions with running, under telemetric control, accomplished continuously, during thirty minutes at 120 m/min as mean speed. Symptom-limited exercise stress testing was initially performed and repeated after three months of training. 88% of patients showed an increase in physical working capacity, 84% in exercise time duration and 80% in the myocardial efficiency index at subsequent ergometries. A decrease of double product and submaximal heart rate was observed. Angina, ECG ischaemic alterations and arrhythmias during exercise in the first test disappeared or occurred with higher workload in the second ergometry. Mean resting acid concentration, 1.28 +/- 0.36 mmol/l, increased immediately after exercise to 2.03 +/- 0.58 mmol/l. The prescribed physical training programme showed satisfactory results and increased the patients' quality of life, even in a humid and moderately hot climate.

Assuntos

RESUMO

A random sample of thirty families containing a member with a bipolar disorder were interviewed by a psychiatrist and two clinical psychologists with training in family evaluations and therapy. During the interview the family was given the task of discussing the possible causes of the patient's illness and to consider specific steps to help prevent relapses. The raters independently scored the Beavers Timberlawn Family Evaluation Scale and the Family Response to the Illness Scale. The patients were also evaluated using the Social Support Network Inventory, and a number of clinical and demographic indicators were routinely recorded. The research team showed good interrater reliability with the instruments, and evidence of validity is presented for the FRIS. A Cluster Analysis was performed and a two clusters solution was found. The first cluster contained twelve patients and the second is composed of eighteen patients. The clusters seem to differentiate patients along clinical outcome measures, drug compliance and cultural background. Family variables related to the structural dimensions of the system were found to cut across both clusters. Family variables measuring empathy, affect and expression of feelings were found to predict medication compliance and clinical outcome. The findings are discussed in the light of the concept of underorganization of family structures.

Assuntos

RESUMO

A random sample of thirty families containing a member with a bipolar disorder were interviewed by a psychiatrist and two clinical psychologists with training in family evaluations and therapy. During the interview the family was given the task of discussing the possible causes of the patients illness and to consider specific steps to help prevent relapses. The raters independently scored the Beavers Timberlawn Family Evaluation Scale and the Family Response to the Illness Scale. The patients were also evaluated using the Social Support Network Inventory, and a number of clinical and demographic indicators were routinely recorded. The research team showed good interrater reliability with the instruments, and evidence of validity is presented for the FRIS. A Cluster Analysis was performed and a two clusters solution was found. The first cluster contained twelve patients and the second is composed of eighteen patients. The clusters seem to differentiate patients along clinical outcome measures, drug compliance and cultural background. Family variables related to the structural dimensions of the system were found to cut across both clusters. Family variables measuring empathy, affect and expression of feelings were found to predict medication compliance and clinical outcome. The findings are discussed in the light of the concept of underorganization of family structures.

Assuntos

Assuntos

Assuntos

RESUMO

The results of a double blind trial of Viloxazine and Desipramine in 30 hospitalized depressives are reported. Hamilton's Rating Scale for Depression was the outcome criterion. No statistically significant differences were found between drugs in efficacy and onset of action. Patients on either drug showed a significant reduction in symptoms after one week of treatment and at the end of the trial. Side effects reported with Viloxazine were predominantly nausea and dizziness of a transient nature. Patients on Desipramine reported the usual side effects associated with antidepressant use and two of them had to be withdrawn from the trial because of an allergic rash. Laboratory values and EKG tracings did not show any trend of abnormalities. It is concluded that Viloxazine is an effective and safe antidepressive drug and seems to be particularly indicated in geriatric and cardiovascular patients with a concomitant depression.

Assuntos