Emetofobia: revisão crítica sobre um transtorno pouco estudado

INTRODUÇÃO: A emetofobia ou fobia de vômitos - que inclui o medo excessivo de vomitar ou de ver outras pessoas vomitando e pode ser desencadeado por estímulos internos e externos - é um transtorno mental complexo e pouco conhecido. OBJETIVO: Este estudo teve como objetivo levantar os conhecimentos disponíveis sobre diversos aspectos do quadro. MÉTODO: Revisão convencional da literatura dos últimos 30 anos utilizando como estratégia de busca as seguintes palavras-chave: emetofobia, emetofóbico, medo de vomitar, fobia de vomitar efobia de vômito. Foram incluídos artigos sobre epidemiologia, fenomenologia, diagnóstico diferencial e tratamento da emetofobia, assim como artigos referidos nestes. RESULTADOS: Não há dados de prevalência na população geral e pouco se sabe sobre a etiologia da emetofobia. A maioria dos estudos aponta predominância no sexo feminino, início precoce e curso crônico. Os comportamentos de esquiva podem impactar negativamente a vida ocupacional, social e familiar. Os principais diagnósticos diferenciais são: transtorno de pânico com agorafobia, fobia social, anorexia nervosa e transtorno obsessivo-compulsivo. Estudos de tratamento se resumem a relatos de casos e não há ensaios clínicos controlados, mas intervenções cognitivo-comportamentais parecem ser promissoras. CONCLUSÃO: Mais estudos são necessários para melhor compreensão sobre a epidemiologia, o quadro clínico, a etiologia, a classificação e o tratamento da emetofobia.

Tratamento do transtorno de pânico com terapia psicodramática de grupo

INTRODUÇÃO/OBJETIVOS: Há poucos trabalhos publicados sobre psicoterapia grupal para pacientes com transtorno de pânico (TP); além disso, esses estudos geralmente são restritos a abordagens cognitivo-comportamentais. O objetivo deste trabalho é relatar uma experiência de atendimento psicoterápico psicodramático grupal para portadores de TP, iniciada em 1996 na Faculdade de Medicina de Botucatu/Unesp, e discutir aspectos psicodinâmicos desse transtorno. MÉTODOS: Atende-se uma média de oito a dez pacientes em sessões mensais de duas horas de duração, nas quais se utilizam técnicas psicodramáticas. O uso associado de psicofármacos é a regra. A temática é aberta, centrando-se tanto em aspectos próprios do TP (sintomas mais comuns; peregrinação em serviços médicos até o diagnóstico; preocupações hipocondríacas; limitações e dependência; reações dos familiares; estratégias de exposição e enfrentamento; efeitos e reações dos medicamentos) quanto em problemas individuais específicos. RESULTADOS: A abordagem psicodramática favorece a identificação e a elaboração de aspectos psicodinâmicos. Entre estes, destacaram-se os sentimentos de desamparo e seus desdobramentos: insegurança; fragilidade e medo; raiva e culpa; sentimentos de desamor e rejeição; vergonha e inferioridade; isolamento e dificuldade de pedir ajuda; dificuldade de identificar e de expressar sentimentos - manifestados somaticamente -; e dificuldade de assumir o papel de cuidador e outras responsabilidades. CONCLUSÕES: Aspectos valiosos para o tratamento do TP, como apoio mútuo, companheirismo, confiança, modelo e estímulo, são favorecidos pelo contexto grupal homogêneo. O compartilhar de experiências e sofrimentos comuns propiciou rápida coesão e suporte grupal, melhora da capacidade de expressar sentimentos e da auto-estima e o aprimoramento de papéis sociais. Além da melhora dos sintomas, possibilitou-se a melhor compreensão e elaboração destes, que passam a ser integrados significativamente no contexto existencial.

Diagnóstico diferencial do transtorno obsessivo-compulsivo

Obsessive-compulsive disorder (OCD) has clinical features that overlap in various degrees with many other mental disorders. As a result, the differential diagnosis sometimes can be difficult. This review briefly summarizes the phenomenologic similarities and differences between OCD and the following disorders: depression, phobias, hypochondriasis and body dysmorphic disorder, Tourette syndrome and tic disorder, obsessive-compulsive personality disorder, impulse control and eating disorders, generalized anxiety, panic and post-traumatic stress disorders, and delusional and schizophrenic disorders. The accurate diagnosis is essential for adequate treatment planning and management.

Hunger suppresses the onset and the freezing component of the antipredator response to conspecific skin extract in pintado catfish

Although the skin of an injured conspecific releases alarm substance in some fish species, it has been shown that such damage induces feeding behaviour rather than an alarm reaction under conditions of food scarcity. We studied chemical communication associated with this paradox in a Brazilian catfish, the pintado (Pseudoplatystoma coruscans). In preliminary tests pintado were confirmed to demonstrate an alarm reaction to conspecific skin extract. In the experiment we investigated whether skin extract of pintado induces either alarm response (panic or alert component) or feeding in hungry conspecifics. Fish feed-deprived for eight days and fed control fish were exposed to either conspecific skin extract or distilled water (as a control). Alarm reaction was restricted to the skin extract treatment and occurred in the fish irrespective of their hunger state, but the components of this response were significantly affected by hungry. Fed fish showed a complete alarm reaction (dashing and freezing behaviours). Feed-deprived fish exhibited only part of this biphasic response, the dashing component. We conclude that chemicals from injured fish elicit an alarm reaction, which is partially inhibited by feeding motivation.

Correlação entre a degradação in vitro e digestibilidade in vivo de feno de duas gramíneas tropicais

Realizou-se um estudo para comparar a técnica de degradação in vitro e digestibilidade in vivo, para a qual foram utilizados oito ovinos capões que receberam feno de capim-de-rhodes (Chloris gayana Kunt.) e capim-green panic (Panicum maximum Jacq. var. Trichoglume cv. Petrie),em quatro estágios de maturação. No estudo da digestibilidade in vivo não se verificaram diferenças significativas entre os diferentes coeficientes de digestibilidade dos alimentos. Para a degradação in vitro da fibra em detergente neutro com 24 a 48 horas, não houve diferenças significativas (P > 0,05) para os mesmos nutrientes. Determinaram-se as equações de regressão e os coeficientes de correlação. Os valores de r foram considerados de médios a elevados, e os erros padrões da estimativa, satisfatórios a elevados. O maior valor de correlação foi obtido entre a taxa de degradação relativa de 24 a 48 horas, e o teor de NDT das forragens (r= 0,84), com erro-padrão da estimativa satisfatório (Sy’x = 3,92).

Role of 5-HT in stress, anxiety, and depression

There are conflicting results on the function of 5-HT in anxiety and depression. To reconcile this evidence, Deakin and Graeff have suggested that the ascending 5-HT pathway that originates in the dorsal raphe nucleus (DRN) and innervates the amygdala and frontal cortex facilitates conditioned fear, while the DRN-periventricular pathway innervating the periventricular and periaqueductal gray matter inhibits inborn fight/flight reactions to impending danger, pain, or asphyxia. To study the role of the DRN 5-HT system in anxiety, we microinjected 8-OH-DPAT into the DRN to inhibit 5 HT release. This treatment impaired inhibitory avoidance (conditioned fear) without affecting one-way escape (unconditioned fear) in the elevated T-maze, a new animal model of anxiety. We also applied three drug treatments that increase 5-HT release from DRN terminals: 1) intra-DRN microinjection of the benzodiazepine inverse agonist FG 4172, 2) intra-DRN microinjection of the excitatory amino acid kainic acid, and 3) intraperitoneal injection of the 5-HT releaser and uptake blocker D-fenfluramine. All treatments enhanced inhibitory avoidance in the T-maze. D-Fenfluramine and intra-DRN kainate also decreased one-way escape. In healthy volunteers, D-fenfluramine and the 5-HT agonist mCPP (mainly 5-HT2C) increased, while the antagonists ritanserin (5-HT2A/(2C)) and SR 46349B (5-HT2A) decreased skin conductance responses to an aversively conditioned stimulus (tone). In addition, D-fenfluramine decreased, whereas ritanserin increased subjective anxiety induced by simulated public speaking, thought to represent unconditioned anxiety. Overall, these results are compatible with the above hypothesis. Deakin and Graeff have suggested that the pathway connecting the median raphe nucleus (MRN) to the dorsal hippocampus promotes resistance to chronic, unavoidable stress. In the present study, we found that 24 h after electrolytic lesion of the rat MRN glandular gastric ulcers occurred, and the immune response to the mitogen concanavalin A was depressed. Seven days after the same lesion, the ulcerogenic effect of restraint was enhanced. Microinjection of 8-OH-DPAT, the nonselective agonist 5-MeO-DMT, or the 5-HT uptake inhibitor zimelidine into the dorsal hippocampus immediately after 2 h of restraint reversed the deficits of open arm exploration in the elevated plus-maze, measured 24 h after restraint. The effect of the two last drugs was antagonized by WAY-100135, a selective 5-HT1A receptor antagonist. These results are compatible with the hypothesis that the MRN-dorsal hippocampus 5-HT system attenuates stress by facilitation of hippocampal 5-HT1A-mediated neurotransmission. Clinical implications of these results are discussed, especially with regard to panic disorder and depression.

Anxiety levels and wild running susceptibility in rats: assessment with elevated plus maze test and predator odor exposure

It is reported in the literature that nearly 20% of rats are susceptible to displays of wild running (WR) behavior when submitted to high intensity acoustic stimulation. Some characteristics of WR suggest that it can be viewed as a panic-like reaction. This work aimed to test whether WR-sensitive rats show higher levels of anxiety in elevated-plus-maze (EPM) and predator-odor exposure paradigms in comparison with WR-resistant ones. Male adult Wistar rats were submitted to two trials of acoustic stimulation (104 dB, 60 s) in order to assess WR susceptibility. Seven WR-sensitive and 15 WR-resistant rats were evaluated by the EPM test. Other 13 WR-sensitive and 18 WR-resistant animals were submitted to the predator-odor exposure test which consisted of a 10 min-session of free exploration in a specific apparatus containing two odoriferous stimuli: cotton swab imbedded with snake cloacal gland secretion or with iguana feces (control). WR-sensitive rats presented a significantly higher closed-to open-ann-entry ratio in the EPM test. All rats responded with anxiety-like behaviors to the predator odor exposure, although the WR-sensitive ones showed a marked behavioral inhibition regardless of the odor condition. We conclude that WR-sensitive rats present elevated levels of anxiety manifested by means of passive behavioral strategies. (C) 2004 Elsevier B.V. All rights reserved.

Diagnóstico diferencial da fobia social: Uma revisâo

Social phobia is a common mental disorder that can cause considerable distress and impairment in functioning and quality of life but it is still an underdiagnosed and undertreated disorder. The differential diagnosis is not always simple. because its clinical features overlap with many other mental and non-mental disorders characterized by social avoidance. The aim of this study was to review the literature and discuss the differential diagnosis of social phobia with the following conditions. normal social anxiety (shyness), depressive disorders, alcoholism, body dysmorphic disorder, panic disorder and agoraphobia, simple phobias, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, delusional disorders and avoidant and schizoid personality disorders. A Medline and Lilacs search was conducted between 1990 and 2002, using the key words social phobia, social anxiety disorder, diagnosis and defferential diagnosis. The accurate diagnosis is very important for the appropriate treatment approach.

Role of stressful and traumatic life events in obsessive-compulsive disorder

Whilst genetic factors are thought to contribute to the development of obsessive-compulsive disorder (OCD), the role of environmental factors in OCD is only beginning to be understood. In this article, we review the influence of stress-related factors in OCD. Overall, studies indicate that: patients with OCD frequently report stressful and traumatic life events before illness onset, although these rates do not seem to be significantly different from those described in other disorders; the association between OCD and post-traumatic stress disorder (PTSD) might result from symptom overlap, although cases of patients developing OCD after PTSD and showing obsessive-compulsive symptoms that were unrelated to trauma have been described fairly consistently; it is unclear whether patients with OCD and a history of stress-related factors (including stressful life events, traumatic life events or comorbid PTSD) may respond better or worse to the available treatments; and comorbid PTSD may modify the clinical expression of OCD-although controlled studies comparing pre-versus post-traumatic OCD patients are still unavailable. In conclusion, there is a growing evidence to suggest a role for stress-related factors in OCD. Although the available literature does not confirm the existence of a post-traumatic subtype of OCD, it does call for further systematic research into this topic. © 2011 Future Medicine Ltd.

Towards a post-traumatic subtype of obsessive-compulsive disorder

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS. © 2011 Elsevier Ltd.

Ethopharmacological evaluation of the rat exposure test: A prey-predator interaction test

The rat exposure test (RET) is a prey (mouse)-predator (rat) situation that activates brain defensive areas and elicits hormonal and defensive behavior in the mouse. Here, we investigated possible correlations between the spatiotemporal [time spent in protected (home chamber and tunnel) and unprotected (surface) compartments and frequency of entries into the three compartments] and ethological [e.g., duration of protected and unprotected stretched-attend postures (SAP), duration of contact with the rat's compartment] measures (Experiment 1). Secondly, we investigated the effects of systemic treatment with pro- or anti-aversive drugs on the behavior that emerged from the factor analysis (Experiment 2). The effects of chronic (21 days) imipramine and fluoxetine on defensive behavior were also investigated (Experiment 3). Exp. 1 revealed that the time in the protected compartment, protected SAP and rat contacts loaded on factor 1 (defensive behavior), while the total entries and unprotected SAP loaded on factor 2 (locomotor activity). Exp. 2 showed that alprazolam (but not diazepam) selectively changed the defensive factor. Caffeine produced a mild proaversive-like effect, whereas yohimbine only decreased locomotor activity (total entries). Fluoxetine (but not imipramine) produced a weak proaversive-like effect. 5-HT1A/5-HT2 receptor ligands did not change any behavioral measure. In Exp. 3, chronic fluoxetine (but not imipramine) attenuated the defensive behavior factor without changing locomotion. Given that the defensive factor was sensitive to drugs known to attenuate (alprazolam and chronic fluoxetine) and induce (caffeine) panic attack, we suggest the RET as a useful test to assess the effects of panicolytic and panicogenic drugs. © 2012 Elsevier B.V.

Civilização suficientemente boa? Do princípio do desamparo humano ao desamparo como princípio humano

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The United States subprime mortgage crisis and its implications for the Caribbean

The bursting of the property bubble – subprime mortgage crisis – in 2007 in the United States has engendered panic, recession fears and turmoil in the global financial system. Although the United States economy grew by 0.6 per cent in the last quarter of 2007, down from 4.9 per cent in the previous quarter, day by day worsening scenarios emerge, from escalating oil prices, to a depreciating dollar and financial institutions’ bailout by the Federal Reserve. Many economists and policy makers share the view that a subprime-led recession – i.e. two consecutive quarters with negative growth – is inevitable and will be much deeper and longer than the 2001 dot-com downturn. Moreover, the critical situation of the financial system has driven some analysts to argue that should the monetary policy response fails to restore confidence among investors, the outcome would be the worst crisis seen since the Great Depression. This pessimism is not only among specialists. Indeed, in late March 2008 the Consumer Confidence Index in the United States recorded its lowest level since February 1992. A recession in the United States will undoubtedly have an important impact on the world economy, despite the continuous rapid growth experienced by emerging economies, particularly China and India. The purpose of this article is threefold: first, to characterize the current situation in the United States economy; second, to discuss the economic policy responses; and finally, to elaborate on how Caribbean economies may be affected.

The effects of diazepam on the elevated T-maze are dependent on the estrous cycle of rats

In order to determine the modulation of anxiolytic and panicolytic-like effects of diazepam by the hormonal cycle of female rats, male and female rats – the latter divided per estrous cycle phase (estrus, diestrus, metaestrus and proestrus) – were tested in the elevated T-maze, a behavioral model of panic and anxiety. Diazepam (0.5, 1.0 and 2.0 mg/kg) or saline solution was injected in individual animals that were submitted to one session in the elevated T-maze 25 min after drug/saline administration. The test consisted of three avoidance trials and one escape trial, separated by a 30 s interval, during which the animals were isolated in individual cages. The avoidance trials began with the animal being placed at the end of the maze's enclosed arm. The time necessary for the animal to leave the central square was considered as the response's latency. The trials that exceeded 300 s were considered as failures. Results demonstrate a decrease in the effects of diazepam in inhibitory avoidance (anxiety) trials in females in diestrus and proestrus, but no relation of gender or estrous cycle on diazepam effects on escape trials (fear). The results support the hypothesis that down-regulation of GABAA receptors by activation of nuclear estrogen receptors and induction of PKC-mediated GABAA receptor phosphorylation by activation of surface estrogen receptors in raphe neurons underlie the modulation of diazepam sensitivity by estrogen.

Murilo Mendes: pânico, amor e poesia: uma leitura de A Poesia em Pânico à luz do surrealismo

Esta pesquisa privilegia, a priori, cinco aspectos importantes concernentes à influência do Surrealismo na produção literária de Murilo Mendes, especialmente em A Poesia em Pânico, tais como: a poética da construção por vias da negação; a conciliação de objetos e idéias divergentes que acena para a busca da totalidade; o duplo, indiretamente ligado aos temores da repressão; a mulher e o amor, como confluências necessárias para o estabelecimento do projeto de construção surrealista; e a poesia como espaço da palavra salvadora. Tais aspectos estão em consonância com os estudos propostos por André Breton, Ferdinand Alquié, Chénieux-Gendron, Walter Benjamin e outros. Relacionada à produção de poetas simbolistas e surrealistas, a obra em foco deixa-se ilustrar por alguns trabalhos artísticos do pintor paraense Ismael Nery ¾ com quem Murilo Mendes estabelece grande amizade ¾ e fragmentos de textos de poetas tais como Artur Rimbaud, Charles Baudelaire, Lautréamont, Stéphane Mallarmé, André Breton. Murilo Mendes, para quem as idéias não tem fronteiras, foi um dos autores mais representativos da escrita surrealista no Brasil que, embora notificada aqui em apenas uma de suas obras, constitui traço permanente em toda a sua trajetória poética.