Experience With Lacosamide in a Series of Children With Drug-Resistant Focal Epilepsy

We report our pediatric experience with lacosarnide, a new antiepileptic drug, approved by the US Food and Drug Administration as adjunctive therapy in focal epilepsy in patients more than 17 years old. We retrospectively reviewed charts for lacosamide use and seizure frequency outcome in patients with focal epilepsy (Wilcoxon signed rank test). Sixteen patients (7 boys) were identified (median dose 275 mg daily, 4.7 mg/kg daily; mean age 14.9 years, range 8-21 years). Patients were receiving a median of 2 antiepileptic drugs (interquartile range [IQR] 1.7-3) in addition to having undergone previous epilepsy surgery (n = 3), vagus nerve stimulation (n = 9), and ketogenic diet (n = 3). Causes included structural (encephalomalacia and diffuse encephalitis, 1 each; stroke in 2) and genetic abnormalities (Aarskog and Rett syndromes, 1 each) or cause not known (n = 10). Median seizure frequency at baseline was 57 per month (IQR 7-75), and after a median follow-up of 4 months (range 1-13 months) of receiving lacosamide, it was 12.5 per month (IQR 3-75), (P < 0.01). Six patients (37.5%; 3 seizure free) were classified as having disease that responded to therapy (>= 50% reduction seizure frequency) and 10 as having disease that did not respond to therapy (<50% in 3; increase in 1; unchanged in 6). Adverse events (tics, behavioral disturbance, seizure worsening, and depression with suicidal ideation in 1 patient each) prompted lacosamide discontinuation in 4/16 (25%). This retrospective study of 16 children with drug-resistant focal epilepsy demonstrated good response to adjunctive lacosamide therapy (median seizure reduction of 39.6%; 37.5% with >= 50% seizure reduction) without severe adverse events. (C) 2011 Elsevier Inc. All rights reserved.

Obsessive-compulsive disorder: Prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000

Objective: There is little information about obsessive-compulsive disorder in large representative community samples. The authors aimed to establish obsessive-compulsive disorder prevalence and its clinical typology among adults in private households in Great Britain and to obtain generalizable estimates of impairment and help-seeking.Method: Data from the British National Psychiatric Morbidity Survey of 2000, comprising 8,580 individuals, were analyzed using appropriate measurements. The study compared individuals with obsessive-compulsive disorder, individuals with other neurotic disorders, and a nonneurotic comparison group. ICD-10 diagnoses were derived from the Clinical Interview Schedule-Revised.Results: the authors identified 114 individuals (74 women, 40 men) with obsessive-compulsive disorder, with a weighted 1-month prevalence of 1.1%. Most individuals (55%) in the obsessive-compulsive group had obsessions only. Comorbidity occurred in 62% of these individuals, which was significantly greater than the group with other neuroses (10%). Co-occurring neuroses were depressive episode (37%), generalized anxiety disorder (31%), agoraphobia or panic disorder (22%), social phobia (17%), and specific phobia (15%). Alcohol dependence was present in 20% of participants, mainly men, and drug dependence was present in 13%. Obsessive-compulsive disorder, compared with other neurotic disorders, was associated with more marked social and occupational impairment. One-quarter of obsessive-compulsive disorder participants had previously attempted suicide. Individuals with pure and comorbid obsessive-compulsive disorder did not differ according to most indices of impairment, including suicidal behavior, but pure individuals were significantly less likely to have sought help (14% versus 56%).Conclusions: A rare yet severe mental disorder, obsessive-compulsive disorder is an atypical neurosis, of which the public health significance has been underestimated. Unmet need among individuals with pure obsessive-compulsive disorder is a cause for concern, requiring further investigation of barriers to care and interventions to encourage help-seeking.

Suicidality in Obsessive-Compulsive Disorder: Prevalence and Relation to Symptom Dimensions and Comorbid Conditions

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

Prevention of mental ill-health and suicide: Public health perspectives

According to the World Health Organization (WHO) estimates for the year 2020, approximately 1.5 million people will commit suicide, and at least 10 times that many will make an attempt. This paper offers a brief overview of the current state of the epidemiology of suicide, a burgeoning public health problem. The information provided is based in large measure on reports of suicide mortality from 130/193 countries. In order to contextualize these data, this paper explores the contribution of both individual and sociocultural factors that influence suicidal behavior, from which much has been learned. Outlining the history of attempts by international and national organizations like WHO, United Nations, member states in the European community and other countries to regularize identification and suicide reporting procedures, this paper also demonstrates that serious knowledge gaps remain. Minimal requirements for successful evidence-based interventions are presented. (C) 2010 Published by Elsevier Masson SAS.

Alcohol use disorders in patients with obsessive-compulsive disorder: The importance of appropriate dual-diagnosis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

BODY DYSMORPHIC DISORDER IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE and CLINICAL CORRELATES

Background The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.

Qualidade de vida no transtorno obsessivo-compulsivo: uma revisão

CONTEXTO: O transtorno obsessivo-compulsivo (TOC) foi considerado pela Organização Mundial da Saúde como a 10ª causa de anos vividos com incapacidade, mas pesquisas sobre qualidade de vida (QV) nesse transtorno ainda são relativamente raras. OBJETIVOS: O objetivo deste trabalho foi fazer uma revisão convencional da literatura a respeito de estudos sobre qualidade de vida no TOC, publicados em português e inglês. MÉTODOS: A busca de artigos foi feita pelos sistemas MEDLINE, PsicoInfo e LILACS, cobrindo o período de 1980 a 2007, utilizando-se como palavras-chave: qualidade de vida, transtorno obsessivo-compulsivo, prejuízo funcional e incapacidade. RESULTADOS: Estudos populacionais apresentam indicadores indiretos de comprometimento na QV em pessoas com TOC, como mais desemprego, menor renda e menor índice de união conjugal estável, além de taxas relativamente altas de ideação e tentativas de suicídio. Estudos clínicos encontraram mais comprometimento na QV no TOC em comparação com algumas doenças clínicas crônicas, outros transtornos de ansiedade, quadros depressivos e mesmo esquizofrenia, em alguns aspectos. CONCLUSÃO: O impacto negativo do TOC sobre a QV de seus portadores pode ser grande, afetando vários domínios da vida e repercutindo também nos familiares. A reabilitação psicossocial deve ser vista como parte integrante essencial do tratamento e é preciso aumentar a conscientização da população sobre o problema, assim como o acesso a tratamentos adequados, para minimizar tal impacto, por vezes devastador.

Detecção do risco de suicídio nos serviços de emergência psiquiátrica

OBJETIVO: Auxiliar o profissional de saúde na identificação dos fatores de risco e de proteção, e no manejo de pacientes com risco de suicídio, por meio de entrevista clinica, no contexto de emergência médica. MÉTODO: Revisão seletiva da literatura para identificar achados clínicos relevantes e ilustrativos. RESULTADO: A entrevista clinica é o melhor método para avaliar o risco suicida e tem dois objetivos: 1) apoio emocional e de estabelecimento de vínculo; 2) coleta de informações. Existe um número considerável de informações a serem coletadas durante a entrevista: fatores de risco e proteção (predisponentes e precipitantes), dados epidemiológicos, caracterização do ato, aspectos psicodinâmicos, antecedentes pessoais e familiares, modelos de identificação, dados sobre saúde física e rede de apoio social. Dificuldades ao longo da entrevista serão encontradas, mas com conhecimento e treinamento adequado, o profissional poderá abordar e ajudar adequadamente o paciente. Embora várias escalas tenham sido propostas, nenhuma delas demonstrou eficiência para a detecção de risco de suicídio. CONCLUSÃO: Não há como prever quem cometerá suicídio, mas é possível avaliar o risco individual que cada paciente apresenta, tendo em vista a investigação detalhada e empática da entrevista clinica. Impedir que o paciente venha a se matar é regra preliminar e fundamental.

Repetition of Suicide Attempts Data from Emergency Care Settings in Five Culturally Different Low- and Middle-Income Countries Participating in the WHO SUPRE-MISS Study

Background: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. Aims: To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Methods: Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure has been reported in a previous paper. Results: Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites. Conclusions: This study from five low-and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

A new interpretation of the defense glands of neotropical Ruptitermes (Isoptera, Termitidae, Apicotermitinae)

Suicidal altruism has been reported for some species of eusocial insects, in which the individual dies in defense of the society. The termites of the genus Ruptitermes are known for the suicidal behavior of the workers which liberate a sticky defensive secretion by body bursting. In the present paper it is given a new interpretation of the defense glands of Neotropical Ruptitermes based on the morphological analysis of three species collected at Rio Claro, SP, Brazil. Before the current study, the suicidal defensive behavior was attributed to the dehiscence of the salivary gland reservoirs. The defense or dehiscent glands of Neotropical Ruptitermes are pair structures rounded in shape that are independent of the salivary glands. The dehiscent glands consist of multiple secretory units that are kept together by thin connective tissue. Each secretory unit is composed of one cell generally with one peripheral nucleus and characteristic secretion. The three species studied here present some histological differences in the secretory units, probably related to the chemical composition of the secretion.

An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: A multicentre study

Objective: In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD. Methods: This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown Obsessive-Compulsive Scale, as well as with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results: We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR. =1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001). Conclusion: Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels. © 2012 Elsevier Inc.

Clinical features of pure obsessive-compulsive disorder

Objective Psychiatric comorbidity is the rule in obsessive-compulsive disorder (OCD); however, very few studies have evaluated the clinical characteristics of patients with no co-occurring disorders (non-comorbid or pure OCD). The aim of this study was to estimate the prevalence of pure cases in a large multicenter sample of OCD patients and compare the sociodemographic and clinical characteristics of individuals with and without any lifetime axis I comorbidity. Method A cross-sectional study with 955 adult patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Assessment instruments included the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, The USP-Sensory Phenomena Scale and the Brown Assessment of Beliefs Scale. Comorbidities were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses were followed by logistic regression. Results Only 74 patients (7.7%) presented pure OCD. Compared with those presenting at least one lifetime comorbidity (881, 92.3%), non-comorbid patients were more likely to be female and to be working, reported less traumatic experiences and presented lower scores in the Y-BOCS obsession subscale and in total DY-BOCS scores. All symptom dimensions except contamination-cleaning and hoarding were less severe in non-comorbid patients. They also presented less severe depression and anxiety, lower suicidality and less previous treatments. In the logistic regression, the following variables predicted pure OCD: sex, severity of depressive and anxious symptoms, previous suicidal thoughts and psychotherapy. Conclusions Pure OCD patients were the minority in this large sample and were characterized by female sex, less severe depressive and anxious symptoms, less suicidal thoughts and less use of psychotherapy as a treatment modality. The implications of these findings for clinical practice are discussed. © 2013 Elsevier Inc. All rights reserved.

Avaliação das atividades ansiolítica e antidepressiva dos óleos essenciais de Mentha piperita L. e Cananga odorata (Lam.) Hook. f. & Thomson em camundongos, por via inalatória

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito do gliconato de cálcio e do fluoreto de fenilmetilsulfonil (PMSF) no tratamento da intoxicação aguda por organofosforado neuropático em galinhas, utilizando como protótipo do TRI-ORTO-CRESIL fosfato (TOCP)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)