A psicopatologização da infância no contemporâneo: um estudo sobre a expansão do diagnóstico de transtorno de déficit de atenção e hiperatividade

The expansion of psychiatric labeling does not reach only the adult population, but also the problematic related to childhood have been captured by the speeches and practices of the medical-psychiatric knowledge and turned into psychopathologies which tend to be treated with the main resource made available by psychiatrics in the present times: the psychotropic drugs. This work presents a critical thinking on the expansion of the diagnoses of “attention deficit disorder and hyperactivity” (ADHD) both in children and teenagers and on the conduction of drug therapies. It follows that the processes of childhood psycho-pathologization and the trivializing of psychotropic drug prescription are related to the overvaluation of the biological conception of psychic suffering and to the economic interests of the great pharmaceutical laboratories which by means of several strategies influence the medical practices, factors that lead to exposure of these patients to possible side effects and the risks of stigmatization that must be considered.

O trabalho como dispositivo de atenção em saúde mental: trajetória histórica e reflexões sobre sua atual utilização

The partnership between Mental Health (MH) and work is present throughout the history of psychiatry. Capitalist society has used and uses the fitness or unfitness for work not only as one of the elements to the definition of "normality", but also as a treatment strategy. In this perspective, one can find a position healing and, more recently, a different proposal put forward by the psychiatric reform that considers also make / produce, the construction of meaning in the work as crucial for subjectivity. This sense is present in therapeutic workshops that seek to value the uniqueness, not to override the differences. The objective of this paper is to reflect on the relationship between Attention in SM / Work. Initially presents three theses, from which this relationship is built historically: 1 - Work as a means of avoiding idleness returning productively to society; 2 - Work as a healing practice, from the prescription, and 3 - Work as a strategy for care and social inclusion. Below, we discuss some questions about therapeutic workshops and income generation in the mental health care as a device for attention and social inclusion.

A explosão do consumo de Ritalina

A sociedade atual vive desde a década de 50 uma “revolução psicofarmacológica”, em que os avanços tecnológicos da psiquiatria e da neurologia possibilitam a criação de dispositivos que conseguem ter uma melhor visualização do funcionamento físico-químico do cérebro, onde o paradigma de tratamento de sofrimento psíquico passou a ser baseado na utilização de psicotrópicos. Dessa forma, a medicina buscou tratar neurocientificamente comportamentos desviantes da norma social. Nesse cenário, o diagnóstico do Transtorno de Déficit de Atenção e Hiperatividade (TDAH) desponta com certa freqüência e com uma constância ainda maior o uso de Ritalina, nome comercial do metilfenidato, no tratamento do suposto transtorno, principalmente em crianças. Esse presente trabalho faz uma reflexão, a partir de uma revisão bibliográfica, a cerca do aumento do consumo de Ritalina nos últimos anos, procurando problematizar a forma indiscriminada de diagnosticar e tratar o TDAH.

A banalização da prescrição de psicofármacos em um ambulatório de saúde mental

The development of modern psychiatric medications coupled with the wide range currently gained by preventive emphasis in mental health changed the practices of psychiatry, which is no longer focused on treating insanity but is also dedicated to treat any psychiatric suffering through the prescription of psychopharmacos. This study discusses the current process in which medication has been generalized, and presents the results of an exploratory study aimed to examine the patients' medical files, the trajectory of users since they enter the service to the prescription of psychiatric medication in the scope of a Mental Health Outpatient Clinic, in a town in the west of the São Paulo state, Brazil. Results revealed that most (65%) users already arrive at the service with previous prescription of psychiatric medications, and nearly all (99%) of them receive prescriptions of psychiatric medication once forwarded to psychiatric consultations.

Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months. Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC). Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively. Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

Cortical correlates of affective syndrome in dementia due to Alzheimer’s disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aspects correlates with Scandinavian Stroke Scale for predicting early neurological impairment

Objective: To investigate the correlation between the Alberta Program Early CT Score (ASPECTS) and the Scandinavian Stroke Scale (SSS) for the evaluation of neurological impairment in patients with acute stroke. Method: 59 patients with a first acute ischemic stroke were evaluated. The ASPECTS were evaluated by 2 neurologists at admission and by another neurologist after 48 hours. The NIHSS and SSS was applied to determinate stroke severity. Correlations and agreements were analysed statistically by Spearman and Kappa tests. Results: ASPECTS was correlated with National Institute of Health Stroke Scale (NIHSS) at admission (r = -0.52; p < 0.001) and SSS (r = 0.50; p < 0.001). The ASPECTS and SSS items were most correlated with arm (r = 0.52; p < 0.001) and hand (r = 0.49; p < 0.001) motor power, and speech (r = 0.51; p < 0.001). The SSS of 25.5 shows sensitivity (68%) and specificity (72%) when associated with ASPECTS <= 7. Conclusion: The SSS can predict worst neurological impairment when associated with lower values of ASPECTS.

Small calcified lesions suggestive of neurocysticercosis are associated with mesial temporal sclerosis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nicotine dependence and levels of depression and anxiety in smokers in the process of smoking cessation

Background: Depression and anxiety are psychiatric disorders that are related to tobacco use and associated with dependence, the process of cessation, lapses and relapses after quitting smoking. Objective: To analyze the association of nicotine dependence with the level of anxiety and depression in patients who are in the process of smoking cessation. Methods: Cross-sectional study conducted with patients who sought the smoking cessation program in Cuiabá/MT. All the smokers enrolled from May to August 2012, participated in this study. Four instruments were applied: Socio-demographic Questionnaire, Fagerstrom test, Beck Anxiety Inventory and Beck Depression Inventory. Following bivariate analysis, using the crude prevalence ratio, with level of significance lower than 5% (p < 0.05), having as variable outcome the nicotine dependence >= 5 (Fagerstrom). The associations with p < 0.20 were selected for robust Multiple Poisson Regression (RPa). Results: Associations of Fagerstrom >= 5 with the male sex (RP = 1.15 CI 95% 1.03-1.28); number of cigarettes/day (RP = 1,33; CI 95% 1.19-1.48); and moderate/severe level of depression (RP = 1.15; CI 95% 1.04-1.28) were found. In the final model (RPa), the following variables remained associated: male gender (RPa 1.12; CI 95% 1.01-1.24), number of cigarettes/day (RPa 1.28; CI 95% 1.15-1.43) and high level of depression (RPa 1.12; CI 95% 1.01-1.23). Discussion: High level of nicotine dependence was associated significantly with the level of depression, emphasizing the association between smoking and psychiatric comorbidities.

Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

Vascular lesions can be serious complications resulting of blunt or penetrating trauma(1,2). Internal carotid artery lesion is one of most serious and relatively frequent in all mechanisms of craniofacial trauma. Several clinical manifestations can occur as central neurologic and cranial nerves deficits as well as several degrees of bleeding (from mild symptomatic to fatal). Recurrent and massive epistaxis can occur after trauma due to pseudaoneurysms of the external and internal carotid artery (ICA)(3,4). Considering its life-threatening course, the assisting physician has a relatively narrow time to detect and treat these lesions.We present two cases of recurrent and massive epistaxis secondary to ICA pseudoaneurysm following blunt and perforating trauma. Evolution was fatal in the first case with delayed treatment and uneventfully in the second which was treated by occlusion of the pseudoaneurysm and ICA via endovascular intervention.

A configuração de forças na constituição histórica do trabalho como estratégia de cuidado em saúde mental: problematizações foucaultianas

Investigated in this paper, as contributions to Foucault's genealogy of knowledge, the historical constitution of the joint activities between Work and Care in Mental Health (called Therapeutic Workshops, among other names) in their different purposes and dimensions that contributed to the production care of patients with psychological distress at different times. History is here understood as a multiplicity (and nonlinearity) of time series and various blending and shuffleforming speeches as truths. In conjunction we have discussed, we conclude that the work as a therapeutic modality in nursing homes, there emerged in the world of psychiatry, but of capitalism. Associated with measures of occupation "empty minds" of misfits, later earned the position of an instrument of discipline and social regulation. With the Psychiatric Reform, activities Work in Mental Health have been re-invented as spaces enablers of access to citizenship and contractuality social network users.

Editando vidas: focos do DSM na medicalização social

Pós-graduação em Educação - IBRC

Knowledge of nursing undergraduate students about the use of contact precautions measures

To assess knowledge of nursing undergraduate students about the use of contact precautions. Methodology. There were 106 nursing undergraduate students from three universities within the state of Sao Paulo. The data collection was done between April and May 2012. A questionnaire was elaborated with questions assessing knowledge regarding contact precautions. The data were submitted to statistical procedures in the package MINITAB version 16. The knowledge were rated as adequate, partially adequate and inadequate. Results. There was a predominance of females (86%) and age group between 20 and 29 years (70%). Regarding the definition of contact precaution of diseases in which these measures are used, undergraduate’s knowledge was partially adequate (92% and 44%, respectively). The knowledge was considered adequate for the preventive measures used during assistance (86%). As difficulties mentioned in the use of these measures were discomfort, lack of material, personnel and time. Conclusion. Although undergraduate students know what measures to be used in contact precaution, they do not have adequate knowledge about which diseases they should use them. The three participating universities should reflect on the quality of training for nursing students regarding biosecurity and contact precautions.

Experience of family members as a result of children's hospitalization at the Intensive Care Unit

Objective. To describe the experience of family members as a result of children’s hospitalization at the Intensive Care Unit (ICU). Methodology. Descriptive and cross-sectional study. A structured interview was held with 20 relatives of patients hospitalized at two clinics of the Botucatu Medical School at Universidade Estadual Paulista “Júlio de Mesquita Filho”. Information was collected between July and September 2010. Results. The main characteristics of the participating relatives were: 80% mothers of the children; 70% low education level and 70% married. Sixty percent of the children were hospitalized at the ICU for the first time. Eighty percent of the interviewees believe that the children’s behavior changes inside the unit and 85% consider that visiting hours are sufficient. The predominant negative feelings are fear (50%) and insecurity (20%), while the predominant positive feelings are hope (50%) and the expectation of discharge (25%). The professional who most supported the relatives was the nurse (35%). Conclusion. The family members’ experience as a result of the children’s hospitalization at the ICU involves positive and negative aspects, which also affect the child’s behavior at the unit.

Bacteria on the hands of school-age children at a Pediatric Hospitalization Unit

Objective. To estimate the prevalence of bacteria isolated in samples from the hands of school-age children at a hospitalization unit. Methodology. In 2009, strains were cultured from the hands of 90 school-age children at the pediatric hospitalization unit of Hospital Estadual Bauru (São Paulo, Brazil). After culture of the samples, the isolated bacteria were identified. Results. In 98% of the samples taken from the children, bacteria were isolated. Coagulase-negative Staphilococcus was isolated in 64% of the samples, followed by Staphilococcus aureus (5%) and Pseudomonas aeruginosa (1%). Conclusion. In most of the samples from the children’s hands, bacteria were isolated. Therefore, educative actions about hygiene habits in- and outside the hospital environment should be reinforced, aimed at children and their companions.