Padronização de testes para avaliação do estado de mania e potencial anti-maníaco de um agonista do receptor NOP

Bipolar disorder is characterized by mood impairment, alternating between mania/hypomania and depression, and its exact pathophysiology is already unknown. The treatment of bipolar disorder is based on prevention of the manic and depressive episodes using mood stabilizers. Nociceptin/orfanin FQ (N/OFQ) is an endogenous heptadecapeptide which binds as an agonist to NOP receptor, which is a G-coupled inhibitory receptor. N/OFQ and its receptor modulate a lot of functions in the organism, including emotional processes. It is known that the plasmatic concentration of N/OFQ is altered in patients in both phases depressive and manic of bipolar disorder and it is assumed that this system has a role on the etiology of this disorder. Concerning mania, the animal models used in research tend to focus in an unique aspect of the manic behavior, as hyperactivity or agressivity. In the 60’s, the hole board test was proposed, and it consists of an apparatus with holes where a behavior known as head-dippings is measured. High levels of head-dippings are suggestive of neophilia, while low levels can be characteristic of an anxious-like behavior. As the increase of exploratory and goal-directed behavior are characteristics of manic behavior, this test could help in mania research. Thus, this work was organized in 3 steps and aims to: (1) investigate the induction of a manic-like state promoted by ouabain, a Na+/K+-ATPase inhibitor, in the mouse open field test; (2) set up the hole board as a test to measure manic-like behaviors; and (3) investigate the N/OFQ effects in prevention of this kind of behavior on hole board. Male Swiss mice were used in this study, and they take part of only one of the described steps. Depending on the step performed, mice received one or more of the following treatments: (1) ouabain 10-6 , 10-5 , 10-4 , 10-3 or 10-2 M, intracerebroventricular (icv); (2) sodium valproate 300 mg/kg, intraperitoneal (ip); (3) sodium valproate 400 mg/kg, ip; (4) diazepam 1 mg/kg, ip; (5) methylphenidate 10 mg/kg, ip; and (6) N/OFQ 0,1 or 1 nmol, icv. The results suggest that hole board can be used to evaluate a manic state, through analysis of different animal behaviors. However, it was not possible to standard the model of Na+ /K+ -ATPase dysfunction through ouabain administration in mice. Moreover, the data suggest that N/OFQ, at the doses tested, has not affected the methylphenidate-induced mania-like behavior. Taken together, the results point to a new approach of manic research, through the hole board using. However, more studies are necessary in order to verify the role of N/OFQ system on bipolar disorder.

Representações sociais de familiares sobre o atendimento das emergências psiquiátricas

The reformist movements in the field of mental health have pointed battle flags, among which the prioritization of production of mental health care out of the asylum environment should be highlighted, aiming the reduction of psychiatric beds, greater control over the hospitalization, family co-participation and the rescue of the citizenship of the social players involved. With the progressive reduction of asylum beds, associated with a lot of structural problems in the health services, the occurrence of crises outside the hospital environment has been increasingly frequent, thus giving the family an important therapeutic role. In face of this scenario, there is an urgent need to understand the social construction of the care for psychiatric emergencies, identifying the meanings assigned by family members to their constituent aspects. This study seeks to answer the following research question: what are the social representations of family members about the care of psychiatric emergencies in the city of Mossoró, Rio Grande do Norte? Therefore, the aim is to analyze the social representations of family members about the care of psychiatric emergencies in the city of Mossoró, Rio Grande do Norte. This is an exploratory and descriptive study, with a mixed approach, making use of multimethods: for collection, the semi-structured interview and the Technique of Free Association of Words; for data analysis, the Thematic Analysis of Bardin and its steps was used, with the informational support of the softwares ALCESTE (Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte) and Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires); and the theoretical support of social representations. The study participants totaled 72, and they were selected from the following criteria: older than18 years, with degree of kinship with users suffering from some mental and behavioral disorder, and who have already witnessed a situation of crisis, rescued by the SAMU or other means and taken to the psychiatric hospital or general emergency room. Preliminary results point out: 1.Previous note of the research project with the aim to disseminate it in the scientific community and ensure the intellectual property of the work; 2.The contextual analysis of the care for emergencies in the study place. Reflection about the phenomenon provide a name to the care for the psychiatric emergencies, which is called immediate context; the technical and operational aspects that influence the care, as a specific/ general context; and mental health policies in Brazil are identified as metacontext; 3. The systematic review from randomized clinical trials in the databases PubMed, COCHRANE, LILACS, SciELO and SCIRUS, with the use of the descriptors: ‘Physical restraint’, ‘Psychiatric emergency services’, ‘Restraint’, ‘Physical and Emergency Services’, ‘Psychiatric’. Only one work met the search protocol criteria: a short-term essay that records limited results about the proportion of people who are in restraint and seclusion. It does not show statistically significant results in relation to indications, contraindications and risks of the use of physical restraint; 4. The social representations of the care for psychiatric emergencies. The study results point to the presence of five thematic categories: 1. feeling in the face of the crisis/care; 2. thoughts and perspectives about the crisis/care; 3. centrality of care in the medical- medication-hospitalization triad; 4. the thinking/acting in the face of the use of physical restraint and police force; 5. periodicity of crises. The central core of the representation is in the first category, whilst the peripheral elements are in the third and fifth categories. The contrast zone is in the second and fourth categories. The sadness is the most prominent element of the structure. The social representations about the care for psychiatric crises are at a time of transition between the hegemonic and reformist models, with the traditional aspects being predominant, but already showing peripheral and contrast elements that point to a possible change in the representational field.

Características psicológicas do paciente obeso grave e suas implicações pós-operatórias na cirurgia bariátrica

Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach – Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compulsão Alimentar Periódica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group – and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.

Estudo comparativo entre antipsicóticos atípicos no tratamento da esquizofrenia e sua influência na qualidade de vida dos pacientes

Schizophrenia is a severe and persistent mental illness; diagnosis occurs mainly during adolescence. The pharmacological treatment is done with typical and atypical antipsychotics. Atypical have the advantage of reduced extrapyramidal effects, which make them promising for the treatment of schizophrenia, furthermore, they have shown significant metabolic and hormonal changes. The objective of this study was to evaluate the influence of atypical antipsychotics, olanzapine and risperidone on the quality of life and on their adverse effects in schizophrenic patients. For this we analyzed the quality of life of patients with implementation of EuroQol-5D-3L instrument and performing biochemical and hormonal tests, blood pressure measurement, and measurement of anthropometric indices, besides the application of Ugvalg scales for Kliniske Undersgelser (UKU) and Simpson-Angus, who evaluated the side effects caused by drugs. Data were analyzed using the Student t test and chi-square test, with 5% significance level. The results showed that the EuroQol the antipsychotic olanzapine causes significant losses associated with personal care (p <0.001). Comparing the two groups of antipsychotics, the average years of quality-adjusted life, known per QALY was favorable for the risperidone group (p <0.032). The results of olanzapine and risperidone groups were compared. In terms of socioeconomic, it was observed that men used, the prevalent form, olanzapine (p <0.008); this same group showed the following results significantly unfavorable, related to anthropometric variables: waist circumference (p <0.01), hip circumference (p <0.02), weight (p <0.02) and blood pressure (p <0.04). The biochemical and hormonal analyzes showed that olanzapine resulted in losses related to the following variables: triglycerides (p <0.04), HDL cholesterol in men (p < 0.02) and cortisol (p < 0.01). In risperidone users, the only negative value was prolactin (p < 0.04). Regarding the analysis of the Simpson-Angus scale, the group treated with olanzapine was handicapped because the average total scores for olanzapine was 0.38, while for risperidone was 0.11 (p < 0.02). In the UKU scale, the following results were obtained also unfavorable for the olanzapine group: fatigue (P <0.02), dystonia (p <0.01) and tremor (p <0.03). According to the UKU scale, the side effects present in the risperidone group included: gynecomastia (p <0.01), ejaculatory dysfunction (p <0.02) and erectile dysfunction (p <0.02). It was concluded that olanzapine users had the worst score of quality of life, higher metabolic risks associated with overweight and inadequate lipid profile and greater tendency to extrapyramidal manifestations. However, risperidone users were more likely to adverse reactions due to hormonal changes.

Indicadores e fatores preditivos de uso abusivo de álcool em adultos jovens

The abusive use of alcohol is closely related to dependence and to social and work damages. The main focus of this thesis is to create an instrument about alcohol abuse, in order to differentiate the degree of commitment of the symptomatology, considering its psychosocial factors of prediction. As specific goals: I) characterize the state of the art about assessment related to the abuse and dependence to alcohol; II) investigate and systematize aspects related to the predictive psychosocial factors for alcohol dependence; III) build an instrument for the assessment of alcohol abuse and protection and risk factors for the development of an alcohol dependence; and IV) verify validity evidence of the instrument built for the Brazilian population. In Study I, it was possible to observe the prevalence of articles related to the use of alcohol in a problematic way, without a classification dependence, it is lower than the one of articles that investigate the disease when it is already manifested, not to mention a few systematic studies about the theme of alcohol abuse in the scientific environment. In Study II, focus groups (FGs) were conducted, the analysis about the discourses of the focus groups were made through the ALCESTE software and it was possible to observe a response pattern that existed among the participants in different groups, with the generation of five classes. In Study III, we developed an instrument that contemplated aspects of the Alcohol Dependence Syndrome of the Millon Clinical Multiaxial Inventory-III, in addition to the characteristics defined in Study I and in Study II. The final version of the instrument had 59 items assessed through the likert scale of five points. In Study IV, the administration of the instrument was performed in an online format with university students ranging from 18 to 24 years old, residents in Brazilian metropolitan cities. The results evidenced that the internal consistency of the instrument is considered satisfactory (α = 0,882) and in what it refers to classes, the most significant data was the one related to financial loss and criteria for the diagnosis of alcohol abuse. It is important to consider the evaluative potential of risk and protective factors for the development of alcohol dependence of the instrument as a whole. Once the indicators of abuse and the profile of the abusers has been modified, the patient may have his/her treatment/intervention focused on the trouble and/or specific syndrome, thus having a clear and fast improvement.

Diagnóstico e tratamento do TDA/H: investigação dos critérios utilizados por diferentes categorias profissionais da cidade de Natal-RN

TDA/H is usually considered among the most frequent psychological malfunctions in both childhood and adolescence. It covers a complex combination of neurocognitive deficits leading to developmental troubles linked to attention failure, hyperactivity and impulsivity. On the other hand, diagnosis of TDA/H is frequently a hard task, since sociocultural aspects concerning the evaluation of symptoms lead to some etiologic vagueness. Additionally, the large extent of evaluation tools, together with the diversity of therapeutic approaches referred by specialized literature justify the interest of investigating the diverse ways of diagnosing and treating TDA/H by medical doctors, psychologists and psycho-pedagogues developing professional activities in Natal-RN (Brazil) in the assistance of children and teenagers with TDA/H diagnosis hypothesis. A sample of thirty-four professionals participated in this study in a convenience-basis, and submitted to a semi-directed interview. Information from this procedure was analyzed, categorized and submitted to a multidimensional descriptive analysis (cluster analysis procedure), allowing to verify the partition of the sample in two groups: Group 1, basically composed by medical professionals, and Group 2, composed by psychologists and psycho-pedagogues. The categorized variable “Number of sessions” – average time used for arriving to a diagnosis – was the partition-variable showing the larger amount of statistical contribution for the partition, followed by the variables “Professional formation” and “Use of diagnostic tools”. Variables such “Comorbidity”, “TDA/H Definition” and Modalities of Intervention” also showed contribution to the partition obtained, even though their lesser amount of statistical contribution. Despite some similarity between these two groups, data allowed to demonstrate specific association between academic source-formation of the professional concerned and diagnosis and intervention modalities shown by these professionals when dealing with TDA/H. These data confirm relevant heterogeneity in dealing with TDA/H due to professional formation of professionals involved in diagnosis and treatment tasks.

Diagnóstico e tratamento do TDA/H: investigação dos critérios utilizados por diferentes categorias profissionais da cidade de Natal-RN

TDA/H is usually considered among the most frequent psychological malfunctions in both childhood and adolescence. It covers a complex combination of neurocognitive deficits leading to developmental troubles linked to attention failure, hyperactivity and impulsivity. On the other hand, diagnosis of TDA/H is frequently a hard task, since sociocultural aspects concerning the evaluation of symptoms lead to some etiologic vagueness. Additionally, the large extent of evaluation tools, together with the diversity of therapeutic approaches referred by specialized literature justify the interest of investigating the diverse ways of diagnosing and treating TDA/H by medical doctors, psychologists and psycho-pedagogues developing professional activities in Natal-RN (Brazil) in the assistance of children and teenagers with TDA/H diagnosis hypothesis. A sample of thirty-four professionals participated in this study in a convenience-basis, and submitted to a semi-directed interview. Information from this procedure was analyzed, categorized and submitted to a multidimensional descriptive analysis (cluster analysis procedure), allowing to verify the partition of the sample in two groups: Group 1, basically composed by medical professionals, and Group 2, composed by psychologists and psycho-pedagogues. The categorized variable “Number of sessions” – average time used for arriving to a diagnosis – was the partition-variable showing the larger amount of statistical contribution for the partition, followed by the variables “Professional formation” and “Use of diagnostic tools”. Variables such “Comorbidity”, “TDA/H Definition” and Modalities of Intervention” also showed contribution to the partition obtained, even though their lesser amount of statistical contribution. Despite some similarity between these two groups, data allowed to demonstrate specific association between academic source-formation of the professional concerned and diagnosis and intervention modalities shown by these professionals when dealing with TDA/H. These data confirm relevant heterogeneity in dealing with TDA/H due to professional formation of professionals involved in diagnosis and treatment tasks.

Avaliação de duas variedades de Passiflora edulis sobre as respostas comportamentais de camundongos e um possível mecanismo de ação

The medicinal plants constitute a rich source of biologically active compounds used for the treatment of many psychiatric disorders, such as anxiety disorders and depression. Generalized anxiety disorder has increased significantly, being the second most prevalent disorder in care facilities to public health. Depression is considered a chronic and common psychiatric disorder that affects 350 million people of all ages around the world. In this context, the pharmacological intervention conduits have been employed, effective, although leave to be desired when observed adverse effects. The genus Passiflora is commonly commercially known by its fruit, but is also widely used in traditional Brazilian medicine. Passiflora edulis displays considerable morphological variability. This plant produces two types of fruit: Purple (Passiflora edulis Sims fo. edulis) and yellow (Passiflora edulis fo. flavicarpa Degener). This study investigated the central effects of aqueous extract of the leaves of the two varieties of the species Passiflora edulis in tests used to assess behavior related to anxiety and depression, as well as investigating the potential effect of the antidepressant-like fractions of edulis fo. edulis and neuropharmacological mechanisms responsible for this action. To conduct this study used male Swiss mice (2 months old, weighing 30-35 g). The animals received the aqueous extract of the leaves of the two species of Passiflora: edulis fo. edulis (100, 300, 1000 mg / kg) and fractions ethyl acetate, butanol and aqueous waste (25, 50, 75, 100 mg / kg) and edulis fo. flavicarpa (30, 100, 300, 1000 mg / kg) or saline by gavage 60 minutes prior to the maze tests at high cross the open field test, test forced swim test and sedation induced by thiopental. To investigate the mechanism of action of the activity of antidepressant type of fractions the following drugs were used: PCPA (inhibitor of 5-HT synthesis) AMPT (inhibitor of catecholamine synthesis), DSP-4 (noradrenergic neurotoxin) and Sulpiride (antagonist selective dopamine D2 receptor). They were used as a standard positive control, fluoxetine and nortriptyline. The results of the phytochemical profile show very different characteristics to the aqueous extract of the varieties of Passiflora edulis "flavicarpa" and "edulis". The aqueous extracts of both varieties of Passiflora edulis share anxiolytic activity type (edulis fo. edulis 300 mg/kg; edulis fo. flavicarpa 300 and 1000 mg/kg) and antidepressant (edulis fo. edulis 300 mg/kg; edulis fo flavicarpa 1000 mg/kg), while the effect hipolocomotor/sedative was only seen for edulis fo. edulis (1000 mg/kg). Both fractions ethyl acetate, butanol aqueous extract edulis fo. edulis showed activity type antidepressant at a dose of 50 mg/kg in the forced swim test. The data suggest that the effect of antidepressant-like fractions edulis fo. edulis involves catecholaminergic and serotonergic neurotransmission, particularly dopaminergic, there is seen that pre-treatment DSP-4 is not affected antidepressant action of fractions as was dependent activation of dopamine D2 receptors.

Avaliação de duas variedades de Passiflora edulis sobre as respostas comportamentais de camundongos e um possível mecanismo de ação

The medicinal plants constitute a rich source of biologically active compounds used for the treatment of many psychiatric disorders, such as anxiety disorders and depression. Generalized anxiety disorder has increased significantly, being the second most prevalent disorder in care facilities to public health. Depression is considered a chronic and common psychiatric disorder that affects 350 million people of all ages around the world. In this context, the pharmacological intervention conduits have been employed, effective, although leave to be desired when observed adverse effects. The genus Passiflora is commonly commercially known by its fruit, but is also widely used in traditional Brazilian medicine. Passiflora edulis displays considerable morphological variability. This plant produces two types of fruit: Purple (Passiflora edulis Sims fo. edulis) and yellow (Passiflora edulis fo. flavicarpa Degener). This study investigated the central effects of aqueous extract of the leaves of the two varieties of the species Passiflora edulis in tests used to assess behavior related to anxiety and depression, as well as investigating the potential effect of the antidepressant-like fractions of edulis fo. edulis and neuropharmacological mechanisms responsible for this action. To conduct this study used male Swiss mice (2 months old, weighing 30-35 g). The animals received the aqueous extract of the leaves of the two species of Passiflora: edulis fo. edulis (100, 300, 1000 mg / kg) and fractions ethyl acetate, butanol and aqueous waste (25, 50, 75, 100 mg / kg) and edulis fo. flavicarpa (30, 100, 300, 1000 mg / kg) or saline by gavage 60 minutes prior to the maze tests at high cross the open field test, test forced swim test and sedation induced by thiopental. To investigate the mechanism of action of the activity of antidepressant type of fractions the following drugs were used: PCPA (inhibitor of 5-HT synthesis) AMPT (inhibitor of catecholamine synthesis), DSP-4 (noradrenergic neurotoxin) and Sulpiride (antagonist selective dopamine D2 receptor). They were used as a standard positive control, fluoxetine and nortriptyline. The results of the phytochemical profile show very different characteristics to the aqueous extract of the varieties of Passiflora edulis "flavicarpa" and "edulis". The aqueous extracts of both varieties of Passiflora edulis share anxiolytic activity type (edulis fo. edulis 300 mg/kg; edulis fo. flavicarpa 300 and 1000 mg/kg) and antidepressant (edulis fo. edulis 300 mg/kg; edulis fo flavicarpa 1000 mg/kg), while the effect hipolocomotor/sedative was only seen for edulis fo. edulis (1000 mg/kg). Both fractions ethyl acetate, butanol aqueous extract edulis fo. edulis showed activity type antidepressant at a dose of 50 mg/kg in the forced swim test. The data suggest that the effect of antidepressant-like fractions edulis fo. edulis involves catecholaminergic and serotonergic neurotransmission, particularly dopaminergic, there is seen that pre-treatment DSP-4 is not affected antidepressant action of fractions as was dependent activation of dopamine D2 receptors.

Implementações metodológicas para o estudo eletrofisiológico e comportamental em um modelo animal de autismo

O autismo é um transtorno do desenvolvimento que se manifesta nos primeiros anos de vida e apresenta semiologia heterogênea. Esta patologia afeta a maturação do encéfalo e produz alterações sensoriais, de linguagem e de interação social no início na infância. O modelo experimental de autismo utilizando ácido valproico (VPA) durante o período gestacional tem sido demonstrado ter alta validade de face e permitir estudos tanto das bases neuropatológicas quanto neuro-funcionais durante o desenvolvimento. A despeito do recente interesse por este modelo como instrumento de compreensão dos aspectos básicos da fisiopatologia do autismo, a maioria dos estudos experimentais têm se concentrado nos aspectos comportamentais, histológicos e celulares. Neste trabalho, foram propostas estratégias experimentais de avaliação comportamental associadas a eletrofisiologia \textit{in vivo}, uma técnica que nunca fora utilizada para avaliação desse modelo. Animais controles e experimentais, submetidos previamente a um procedimento cirúrgico para implante de eletrodos crônicos, participaram de experimentos de livre exploração, interação social e condicionamento ao medo.