Distúrbios do sono em pacientes com transtorno depressivo

To evaluate sleep disorder complaints in outpatients with depressive disorder from a general hospital. Methods: An observational, cross-sectional study was carried out with a study sample composed of 70 patients (44 women and 26 men) with diagnosis of depressive disorder, according to the DSM-IV criteria. The patients were interviewed and evaluated by the Identification Questionnaire, the Sleep Habits Questionnaire and the Beck Depression Inventory (BDI). Results: In this study, 50 (71.3%) patients had recurrence of sleep disorder complaints. Mean BDI score was 35.83+8.85, with significant differences between patients with (38.50+8.70) and without (29.60+7.80) recurrence (p<0.05) and among patients with 1, 2, 3 and >3 episodes (p<0.05). In this study, 49 (70%) patients had insomnia and 21 (30%) had subjective excessive sleepiness. Significant differences were observed between the mean duration in months of the sleep disorders (7.16+2.10) and the depressive disorder (6.12+1.90) (p<0.05). Discussion: In the study sample, recurrence of sleep disorder complaints was high and significantly associated with severe depression. Insomnia was prevalent and the mean duration of sleep disorders was higher in relation to depressive disorder

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.

Caracterização de aspectos da cognição social, habilidades sociais e funções executivas de crianças diagnosticadas com transtorno autista e transtorno de asperger

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A relação entre transtorno da insônia e funções executivas em adultos

The insomnia disorder is defined as a difficulty initiating or maintaining sleep or waking up earlier than expected unable to return to sleep, followed by a feeling of nonrestorative and poor quality sleep, present for at least three months, with consequences on daytime functioning. Studies have shown that insomnia affects cognitive function, especially executive functions. However, researches that sought to investigate the relationship between primary insomnia and executive functioning were quite inconsistent from a methodological point of view, especially in regard to the variability of the used methods, the heterogeneity of diagnostic criteria for insomnia and the control of sleep altering drugs. In this sense, the present study aimed to investigate the relationship between insomnia and executive functions in adults. The participants were 29 people, from both genders, aged 20-55 years old. Participants were divided into three groups, one composed of 10 people with primary insomnia who used sleep medication (GIM), nine people with primary insomnia who did not use medication (GInM) and 10 healthy people who composed the control group (CG). The research was conducted in two stages. The first one involved a diagnostic evaluation for insomnia disorder through a clinical interview and the application of the following protocols: the Athens Insomnia Scale, the Insomnia Severity Index, Sleep Journal (for 14 days), Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Test, depression and anxiety Beck inventories, and Lipp’s Iventory of stress symptoms for adults. After this stage, the evaluation of executive functions was performed by applying a battery of neuropsychological tests composed by the following tests: Wisconsin, Stoop Test, Colored trails Test, the Tower of London Test, Iowa Gambling Task (IGT) and WAIS III subtest digit span, which measured selective attention, inhibitory control, cognitive flexibility, planning, problem solving, decision making and working memory, respectively. The results showed that insomniacs (GIM and GInM) showed higher sleep latency, shorter sleep duration and lower sleep efficiency compared to the CG. In regard to the performance in executive functions, no statistically significant difference between groups was observed in the evaluated modalities. However, the data show evidence that, compared to GInM and GC, the performance of GIM was lower on tasks that required quick responses and changes in attention focus. On the other hand, GInM, when compared to GIM and GC, showed a better performance on tasks involving cognitive flexibility. Furthermore, impaired sleep measures were correlated with the worst performance of insomniacs in all components evaluated. In conclusion, people with the insomnia disorder showed a performance similar to healthy people’s in components of the executive functioning. Thus, one can infer that there is a relationship between primary insomnia and executive functions in adults.

O teatro do oprimido e sua contribuição na formação da criança com transtorno do déficit de atenção com hiperatividade

This research investigates and reports the contributions of the Theatre of the Oppressed and its techniques as a therapeutic resource in the education of children with Attention Deficit Disorder with Hyperactivity. In the first chapter organize one studying theoretical seeking to conceptualize and understand the Learning, Attention Deficit Hyperactivity Disorder, seeking to better understand the behavior and the behavior of children with ADHD. Researching on the symptoms, causes and effects of this syndrome. Trace a relationship between familyschool- specialists in an attempt to prove the importance of family support in the teachinglearning process and treatment of these children. In the second chapter start conceptualizing theater, the relationship between work-Theatre-Education Therapy, explain the difference between the theatrical stage and the therapeutic stage. Account the importance of theater games in the classroom and its contribution to social and educational training of the child. Justify the choice of the Theatre of the Oppressed recognizing him as the primary method for this research, because it is a set of exercises, games and techniques that help the child regain equilibrium relations, developing autonomy, encourages creativity and spontaneity, freeing them from their oppression. Besides being an efficient transformation behavior, improving behavior, allowing the inclusion of children in society. It is verified the effectiveness of the method and techniques in their work with children Municipal School Professor. Antonio Severiano in Natal / RN, allowing these children develop body awareness, working senses, thought, memory, inhibition, teaching to expose your point of view, understand and deal with their emotions, respecting its limits and develop their motor and cognitive skills

Interações comunicativas entre uma professora e um aluno com transtorno invasivo do desenvolvimento na escola regular

Inclusion of students with autism in regular education settings is a topic that has not been much explored by the national scientific literature. This matter is complex and, due to the extent of various aspects involved, it is essential to delimitate a focus of investigation. The direction taken by this study was to evaluate the effects of an intervention program in the communicative interactions between a student with autism and his teacher in a regular classroom. Data were collected in an elementary private school, located in the city of Natal, Rio Grande do Norte during the 2010 academic school year. The study included a teacher and a non-vocal, 10-year-old student diagnosed with autism. A quasi-experimental A-B research design was employed. During the intervention program the teacher was trained to use Naturalistic Teaching Strategies and Alternative and Augmentative Communication (AAC) resources to increase the frequency of interactions with the student during three classroom routines (entry time, snack and pedagogical activity). The results indicated qualitative and quantitative changes in the interactions of the dyad after the implementation of the intervention program. The student began to use pictograms to communicate with the teacher in two of the three routines investigated. The frequency of AAC use was also observed in the teacher‟s repertoire, especially when the student failed to understand gestures and words. The teacher positively evaluated the intervention program

Análise dos efeitos de um plano educacional individualizado no desenvolvimento acadêmico e funcional de um aluno com transtorno do espectro do autismo

Given the paradigm of inclusive education, the presence of students with autism spectrum disorder in regular schools has become more significant in recent years. Studies have revealed, however, deficits in academic participation of these students in these settings. Among the factors contributing to this phenomenon include poor teacher training and the lack of strategies to promote curriculum access. The aim of this study was to develop an instrument that would promote academic inclusion of a student with autism through procedures that could simultaneously empower the teacher. In this perspective, the study aimed to analyze the effects of an Individualized Educational Plan (IEP), developed collaboratively with teachers, on the academic and functional development of a student with autism in an early childhood education setting. Data were collected in a private school located in the city of Natal in Rio Grande do Norte, in the course of the academic year 2012. In addition to the student with autism, one teacher, a specialized educator, and four teacher aides participated in the study. The research used a single subject quasi-experimental design (AB) as well as qualitative methods of data analysis. The study was conducted in three phases: characterization, baseline and intervention. The first comprised interviews with the child´s parents and teachers, as well as the identification of two routines focus of intervention. In the second phase, the amount of time the student spent engaged in the selected routines during baseline was analyzed. In the third phase, the researcher prepared, collaboratively with the teachers, an individualized educational plan (IEP) for the student. Finally, the IEP was implemented by the teachers. The results indicated qualitative and quantitative changes in student´s participation in academic and functional tasks after the intervention program

A prática pedagógica de professores de alunos com transtorno de déficit de atenção/hiperativadade

This study is inserted at the Line of Strategical Research of Thinking and Knowledge production which scientific projects about the relation of thinking and knowledge production are realized. The accomplishment of this dissertation involved an empiric research at a school of the municipal district of Natal RN. Our purpose was to investigate the practice of the staff working with students who present Disabilities and Attention Deficit Hyperactivity (DADH) at regular classes due to the organization of thinking in pedagogical strategies. The object of this study is presented at the center of the questions which involves the conscious analysis of the problems and needs that emerge at the school. Considering the specialty of the theme, we choose a methodology whose focus is the dialogue and the sharing of meanings with the partners of this research through the observation of the activities developed at class/school and interviews/conversations with six teachers of first and second cycles of primary education. According with the study, some theoretician presumptions of Mr. Freire (2001), Mr. Nóvoa (1995), Mr. Bohm (2005) and son on. The results reveled at the research indicate the fragility of a continuous formation directed to the development of critical-reflexive thinking of the teachers.The teachers revel conceptions due to formation, pedagogical practices and the relation with the parents and coordinators, through their performances and speeches, allowing us to identify some pedagogical strategies used. We identified some negative response about the process of learning-developing of these pedagogical strategies such as the one we call unconcern . The strategy of sitting the student at the front row chairs can have positive and negative responses depending on the way the teacher act and follow the student. Other strategies identified as positive response bringers at the learning-developing process and that should be reinforced by the staff are the playful and the group assignments . At this perspective, the school needs to develop a collective project between the pedagogical team and teachers to overcome the needs of all students, and as a consequence, of the staff and improve the positive strategies, minimizing the negative ones and allowing the organizations of new strategies that promotes the improvement of learning-teaching process of the students with DADH

Ações dos agentes comunitários de saúde diante do usuário da estratégia saúde da família com estados depressivos no Município de Abaiara-CE-BR

Brazilian health public assistance is going through two Reforms, Sanitary and Psychiatric, and through these the assistance is guaranteed in the three levels: primary, secondary and tertiary. Thus, mental health assistance should be offered since preventive cares until the ones that demand larger technological apparatus. Programs like Health Community Agent's Program (HCAP) and Family Health Strategy (FHS), besides increasing the services coverage, have been making possible the system reorientation in the meaning of integrality, universalization and equity. Thus, united intervention of mental health team and FHS can offer several benefits to the population, providing assistance and follow-up to patients with mental disorder. It was aimed to assess health community agents facing the user of Family Health Strategy in depressive state. This quanti-qualitative study took place in the municipal district of Abaiara-CE. Semi-structured interview was applied with health community agents and Beck Depression Inventory with the users registered in Family Health Strategy. It was verified that among the 64 users interviewed, 12.5% didn't present symptoms of depression, 10.9% presented symptoms of light depression, 14.1% symptoms of moderate depression and 62.5% symptoms of serious depression. For the 22 health community agents interviewed, they all reported the existence of people with symptoms of depression in their personal micro-areas, being difficult to work with them, once the FHS team is not qualified to work with mental health problems. It was verified that the Municipal district doesn't have specialized professionals, making difficult the routing and treatment. Based on these results, it was concluded that in spite of the articulation of mental health with FHS is necessary and benefactor to the population, it still doesn't exist, worsening the situation, mainly in small Municipal districts, once they don't have mental health services. Thus, the population is exposed and without follow-up, which allows the identification of installed diseases and with gravity, like depression, because there are no prevention and control activities. It is recommended, due the extreme need, the elaboration and implantation of a mental health program in these municipal districts, articulated with FHS

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

Análise de grafos aplicada a relatos de sonhos: ferramenta diagnóstica objetiva e diferencial para psicose esquizofrênica e bipolar

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Expressão imuno-histoquímica das integrinas a2ß1, a3ß1 e a5ß1 em adenoma pleomórfico de glândula salivar menor e maior e carcinoma adenóide cístico

Pleomorphic adenoma and adenoid cystic carcinoma (ACC) consist benign and malignant neoplasm from salivary gland, respectively. These neoplasms share some characteristics, such as cellular origin and considerable production of extracellular matrix, however, with distinct biological behavior. The aim of the present study was to compare the expression of D2E1, D3E1 e D5E1 integrins in pleomorphic adenoma from minor and major salivary glands and ACCs. Furthermore, it was investigated possible differences in the expression of these integrins according to histological subtypes of ACC. Fourteen cases of pleomorphic adenoma from major salivary gland, fourteen cases from minor salivary gland and ten cases of ACC were selected. It was taken into consideration the presence or absence, localization and intensity of integrin immunoexpression. The cases of pleomorphic adenoma were grouped in order to compare the expression between the distinct neoplasms. It was observed a highly significant difference (p<0,0001) in relation to D2E1 integrin between the neoplasms since pleomorphic adenoma showed a pronounced immunostaining. It was not possible to perform statistical tests considering the D2E1 integrin expression; nevertheless, it could be observed a tendency of higher staining in pleomorphic adenoma. For comparative reasons the cases ACCs were divided in two groups: solid and tubular/cribriform. It was not detected significant differences in regard to D2E1 integrin; and statistical analysis could not be realized in relation to D3E1 and D5E integrin expression. However, it was also verified a tendency of absence or reduced expression in the solid subtype. It can be concluded that the reduced D2E1 integrin expression observed in CACs may be related to a lesser degree of cell differentiation in this neoplasm and the reduced D5E1 integrin expression can be associated with aggressive biological behavior. Moreover, the absence and/or reduced expression of the studied integrins in solid ACC suggests a role in pathogenesis and more aggressive biological behavior of this histological subtype

Avaliação comportamental e neuroquímica de ratos em dessincronização forçada: possíveis implicações para um modelo animal de oscilações no humor

Bipolar disorder has been growing in several countries. It is a disease with high mortality and has been responsible by the social isolation of the patients. Bipolar patients have alterations in circadian timing system, showing a phase shift in various physiological variables. There are several arguments demonstrating alterations in circadian rhythms may be part of the bipolar disorder pathophysiology. Given the necessity for further elucidation, the goal of this study was to validate the forced desynchronization protocol as an animal model for bipolar disorder. To do this, Wistar rats were submitted to a forced desynchronization protocol which consists in a symmetrical light dark cycle with 22h. Under this protocol, rats dissociate the locomotor activity rhythm into two components: one synchronized to the light / dark cycle with 22h, and another component with period longer than 24 hours following the animal endogenous period. These rhythms with different periods sometimes there is coincidence, which we named CAP (Coincidence Active Phase) and the opposite phase, non-coincidence, called NCAP (Non-Concidence Active Phase). The hypothesis is that in CAP animals present a mania-like behavior and animals in NCAP depressive-like behavior. We found some evidence described in detail throughout this thesis. In sum, the animals under forced desynchronization protocol were more stressed, showed an increase in stereotypic behaviors such as grooming and reduction in other behaviors such as risk assessment and vertical exploration when compared to the control group. The CAP animals showed increased locomotor activity, especially during the dark phase when compared to controls (rats under T24) and less depressive behavior in the forced swim test. The animals in NCAP showed a higher anxiety in elevated plus maze, but they don t have ahnedonia. The animals under dissociation have more labeled 5HT1A cells at the amygdala area, which appoint that they have more amygdala inhibition. Taking these data together, we could partially validated the forced desynchronization protocol as an animal model for mood oscillations

Avaliação do cortisol, dehidroepiandrosterona sulfato e dos perfis lipídico e imunológico e suas correlações com a sensibilidade dolorosa, depressão e funcionalidade em mulheres com fibromialgia na pós-menopausa

Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome characterized by widespread musculoskeletal pain with palpable tender points, muscle stiffness, fatigue, and sleep disturbances. Patients with FM have hormonal changes that are directly correlated with symptoms of the syndrome. The neuroendocrine regulation may be impaired, with abnormalities in the hypothalamus-pituitary-adrenal (HPA) axis with various hormones showing changes in their levels. In women in fertile period, various gonadal hormones are associated with symptoms of the syndrome, but studies focusing only a population of women in post-menopausal period who do not use hormone replacement are rare. We developed an analytical cross sectional study to assess the plasma levels of cortisol and dehidroepiandrosterona sulfate (DHEA-S) with quimioluminescence method in a group of 17 women with FM and 19 healthy women in post-menopause who do not use hormone replacement and observe the correlation with the symptoms of pain through algometry, depression and physical functional capacity measured from the Beck Depression Index (BDI) and the Fibromyalgia Impact Questionnaire (FIQ). Three blood samples were collected in the morning (between 8:00 9:30) with an interval of 24 hours for the measurements of hormonal levels and biochemical profile. There were no immunological or lipid changes in patients with FM. Comparing the two groups, there is no difference in levels of cortisol and a tangential effect for DHEA-S (p=0,094) with the lowest levels in the FM. DHEA-S also correlated with pain threshold (r=0,7) and tolerance (r=0,65) in group FM. We found the presence of depressive state and low physical functional capacity in FM. It was also evident that women in post-menopausal period, DHEA-S should influence the symptoms of increased sensitivity to pain, but not the presence of depressive status and low physical functional

A doença como ponto de mutação :os processos de significação em mulheres portadores de lúpus eritematoso sistêmico

Systemic lupus erythematous (SLE) is a chronic and auto-immune disease that can affect several systems of one´s body, including the nervous system, causing several clinical evidences, which can put in risk the person´s life. Although the illness could manifest itself at any age or sex, studies indicate higher incidence among women. Its etiology points to the combination of genetic, hormonal and environmental factors. Due to the disease´s complexity, it is evident that it affects all the person´s life as a whole and not only its organic dimension. It is believed that the signification attributed to all the process of sickening influences its treatment, as well as the person´s capacity to cope with the difficulties and implicit profits involved in the process.In this study, eight women who were affected by SLE were interviewed, with the aim of examining carefully the processes of signification as well as the generation of meanings which permeate these women´s sickening processes. The analysis of their speeches evidences distinct forms of giving meaning to the process, regardless of the time of the diagnosis. The fact that the disease is incurable was shocking to all the participants, and it demanded changes in their lives, in order to detain a relative control of their condition. The majority of the participants were able to deal with these modifications, since strategies have been created to face the difficulties and thus to preserve their social life, without damaging their health. However, some of the participants did not obtain strenght to cope with the disease, eventually developing a depressive state. It is observed that not only SLE has innumerable ways of manifestation, but the experience of the illness is very subjective and dynamic. There are also several ways of expressing this experience, according to the implications in the social, cultural and economic context where the participants are inserted. This ratifies the necessity of a interdisciplinary approach to embrace SLE complexity. (310 words, 1.610 characters)