Acute psychotic disorders induced by topiramate: report of two cases

Relatamos dois pacientes epilépticos que manifestaram quadro psicótico agudo induzido por topiramato (TPM). Um paciente apresentou agitação psicomotora grave, heteroagressividade, alucinações auditivas e visuais, e delírios de conteúdo paranóide e místico. O outro paciente apresentou agitação psicomotora, despersonalização, desrealização, ansiedade intensa e delírio de que estava perdendo a memória. Ambos os pacientes foram conduzidos ao serviço de emergência e, após a interrupção do TPM em um deles e redução da droga em outro, houve remissão total dos sintomas psicóticos sem necessidade de medicação antipsicótica. Alertamos os clínicos para o risco de surgimento de sintomas psicóticos em pacientes em uso do TPM.

A oficina terapêutica como intercessão em problemáticas de sujeitos constituídos por foraclusão

O presente estudo é uma reflexão crítica sobre um estágio realizado para pensar o dispositivo Oficina na Atenção Psicossocial (CAPS), levantando, a partir da teoria psicanalítica lacaniana, questões que permitiram desenvolver um trabalho sobre o laço social de Lacan para refletir a posição de estagiários e usuários dentro da oficina e problematizar a melhor maneira de trabalhar quando tratamos de sujeitos constituídos pela foraclusão. A forma de trabalhar o sofrimento mental também é discutida a partir da clínica ampliada, que coloca a doença entre parênteses para enxergar o sujeito. A criação de uma oficina, destinada a sujeitos constituídos pela foraclusão, trabalha com a hipótese de reestruturação psíquica através da criação artística. Funcionaria como delírio para a saída do desmoronamento foraclusivo e na diminuição do gozoOutro. Considera-se a dimensão da enunciação, sempre atenta ao surgimento de significantes, com o objetivo de dar maior suporte aos usuários da instituição. O Dispositivo Oficina seria o lugar onde se realizaria esta importante forma de subjetivação.

Um caso de delirio de infestacao parasitaria tratado com clomipramina

The article describes a clinical case of primary delusional parasitosis responsive to clomipramine, that had not previously respond to neuroleptic treatment. Clinical similarities of this disorder with obsessive-compulsive disorder are discussed. In conclusion, the article suggests that serotonergic antidepressants may be usefull in the treatment of patients with somatic delusional disorder.

Um transtorno delirante somático atípico

This paper describes the case of a 38 year-old single man with a previous history of social phobia and alcoholism, who presented an unusual pathological belief during the last 9 years. He believe that the muscles of his arms were loose, separated from the bones, and that a green fluid flowed from his shoulders, running under the skin towards his fingers, and returning to the shoulders. He also reported pain, weakness and sensations of loose and fluffy muscles, besides having visual and kinesthetic hallucinations and judgement impairment. No other psychopathological manifestations were observed. There was a worsening of the complaints and depressive symptoms with the use of pimozide and no improvement with fluoxetine, venlafaxine or risperidone. He is presently taking sulpiride. Psychopathological issues and difficulties in diagnosis and treatment are discussed.

The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

Background: Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). Methods: Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. Results: Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. Conclusion: Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies. Copyright © 2010 International Psychogeriatric Association.

The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity in dementia

ABSTRACT Background: Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort. Methods: Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI). Results: Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS. Conclusion: The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains. © International Psychogeriatric Association 2013.

O quixotesco em Fogo morto e O coronel e o lobisomen

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations

Background: One reason for the decision to delay the introduction of an Attenuated Psychosis Syndrome in the main text of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders was the concern that attenuated psychotic symptoms (APS) might in fact be common features in adolescents and young adults from the general population of no psychopathological significance in themselves. This concern was based on reports of high prevalence rates of psychotic-like experiences (PLEs) in the general population and the assumption that PLEs are a good estimate of APS. Although the criterion validity of self-reported PLEs had already been studied with respect to clinician-rated psychotic symptoms and found insufficient, it had been argued that PLEs might in fact be more comparable with mild, subclinical expressions of psychotic symptoms and, therefore, with APS. The present paper is the first to specifically study this assumption. Sampling and Methods: The sample consisted of 123 persons seeking help at a service for the early detection of psychosis, of whom 54 had an at-risk mental state or psychosis, 55 had a nonpsychotic mental disorder and 14 had no full-blown mental disorder. PLEs were assessed with the Peters Delusion Inventory and the revised Launay-Slade Hallucination Scale, and psychotic symptoms and APS were assessed with the Structured Interview for Prodromal Syndromes. Results: At a level of agreement between the presence of any PLE (in 98.4% of patients) and any APS (in 40.7%) just exceeding chance (κ = 0.022), the criterion validity of PLEs for APS was insufficient. Even if additional qualifiers (high agreement or distress, preoccupation and conviction) were considered, PLEs (in 52.8%) still tended to significantly overestimate APS, and agreement was only fair (κ = 0.340). Furthermore, the group effect on PLE prevalence was, at most, moderate (Cramer's V ≤ 0.382). Conclusions: The prevalence of APS cannot be deduced from studies of PLEs. Thus, the high population prevalence rate of PLEs does not allow the conclusion that APS are common features of no pathological significance and would lack clinical validity as an Attenuated Psychosis Syndrome in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Rather, the population prevalence rate of APS has to be assumed to be largely unknown at present but is likely lower than indicated by epidemiological studies of PLEs. Therefore, dedicated studies are warranted, in which APS are assessed in a way that equates to their clinical evaluation.

Estudio de los criterios de calidad, expectativas y satisfacción de los usuarios de las cartas de servicio de la Administración General del Estado aplicados al sector marítimo. Análisis de las necesidades de desarrollo de futuro

La aproximación de las organizaciones a la mejora de sus procesos ha venido por distintos caminos. Muchas Administraciones Públicas se acercaron a este universo a través del modelo EFQM de calidad y excelencia que surgió en la década de los 80 y que sirvió como referente en el ámbito de la Unión Europea como vía de autoevaluación y determinación de procesos de mejora continua. Está basado en la identificación de los puntos fuertes y débiles aplicados a diferentes ámbitos de la organización, siendo éstos el punto de partida para el proceso de mejora continua. Se trata de un modelo en el que puedes decir que estás en calidad aunque tu puntuación sea muy pequeña, por lo que, por imagen, muchas empresas públicas empezaron a implantarlo. La empresa privada sin embargo se decantó por los sistemas de calidad basados en normas ISO. En estos sistemas has de tener un nivel mínimo para poder exhibir una certificación o acreditación del sistema de calidad. La más extendida es la ISO 9001:2008 ya que es válida para todo tipo de empresa. Este sistema se centra en la satisfacción del cliente y está basada en gran medida en el PDCA, acrónimo de Plan, Do, Check, Act (Planificar, Hacer, Verificar y Actuar). Al tratarse de sistemas documentados, pasados los años se llega a la misma conclusión, aquellas empresas que simplemente tienen un certificado colgado en la pared y que arreglan los papeles antes de la auditoría no tienen nada que aporte valor añadido a la empresa y se autoengañan. La potencia de todo sistema de gestión de calidad reside en aprovechar el potencial de sus recursos humanos dirigiendo los recursos de la empresa de forma eficiente y haciendo participe de los objetivos de la organización a su personal para que se impliquen y sepan que se espera de cada uno. La formación de ingeniero siempre nos hace ser críticos con los modelos existentes y tratar de buscar caminos alternativos que sean más eficientes. Para ello es necesario tener un conocimiento muy preciso de la organización. Por ello, después de más de cinco años trabajando en la Organización, desempeñando diversos cometidos, analizando diferentes esferas de actuación y tras estudiar informes de diferentes organizaciones que supervisan el funcionamiento de la empresa me di cuenta que la Dirección General de la Marina Mercante podía cambiar de forma de actuar para modernizarse y ser más transparente, eficaz y eficiente. Esta tesis versa sobre la posibilidad de implantar un nuevo servicio en la Dirección General de la Marina Mercante que le permita mejorar su competitividad a nivel mundial, como estado de abanderamiento, y que, dentro de nuestras fronteras, haga que sus servicios se reorienten aprovechando el conocimiento de su personal, teniendo en cuenta las necesidades de sus usuarios y los recursos de la Organización. Las cartas de servicio permiten acercar al ciudadano al funcionamiento de la organización. Le informa de las condiciones en las que se presta el servicio, los compromisos de la empresa y la forma en la que puede participar para mejorarlos, entre otros. Por otra parte, la empresa no necesita previamente tener ningún sistema de calidad implantado, aunque, como veremos en el capítulo tres y cuatro siempre ayuda a la hora de tener sistemas de aseguramiento implantados. En el capítulo seis se detallan los objetivos que se lograrían con la implantación de las cartas de servicio en la DGMM y en el capítulo siete se discuten dichos resultados y conclusiones. ABSTRACT Different ways have been used by organizations to approach process improvement. Many Public Administrations chose quality and excellence EFQM model for that approachment. This quality program began in 80 decade and that it was the Europe Unión reference to continuous improvement autoevaluation and determination. It is based on strong and weak points of different organization fields, and they are considered as starting point for continuous improvement. This model allows enterprises to say that they are working on a quality scheme even though their score is very little, and this was why a lot of Public Administrations began using it. Nevertheless private enterprises chose quality management systems based on ISO standards. In these systems there is a threshold you must have to be able to have a certification or an accreditation of quality management system. ISO 9001:2008 is the standard most used because of it can be applied to a great range of enterprises. This system is focused on customer satisfaction and it is based on PDCA, Plan, Do, Check, Act. All these systems are documented ones, so once time goes by the same conclusion is reached: enterprises that have the certificate hung on the wall and that papers are fixed for audits have nothing that give them added value and they self-delusion. Quality management system power is related to the usage of human resources potential to lead enterprise resources efficiently and to make them participate in organization objectives. Naval architect training makes them to be critic with existing models and to try to find alternative ways to be more efficient. To achieve this goal, a precise knowledge of the organization is needed. That is the reason why, after five years in quality related issues in the Organization, in different chores, analyzing our scope and reports of organizations that supervise our operation, I realized that Merchant Marine Directorate could change the way of operation to modernize and be more transparent, efficient and effective. This thesis is about the possibility of implantation of a new service in Merchant Marine Directorate that will make it possible to improve their worldwide competitiveness as Flag State, and that to reorient all services taking into account citizens needs and Organization resources. Citizen’s charters able approachment to organization operation. It gives the following information: which are terms in which service is given, enterprise compromises, ways in which citizen can collaborate to improve them, and etc. Additionally, no quality management system is needed to be implemented. Although we’ll see in chapter three and four that having it is of great help. In chapter six are detailed goals achieved if citizen’s charters are implemented in Merchant Marine Directorate, and in chapter seven conclusions and results are discussed.

International delusions,

Printed in Great Britain.

The Cotard syndrome. Report of two patients: with a review of the extended spectrum of 'délire des négations'

The Cotard syndrome is characterized by the delusion where an individual insists that he has died or part of his body has decayed. Although described classically in schizophrenia and bipolar disorder, physical disorders including migraine, tumour and trauma have also been associated with the syndrome. Two new cases are described here, the one associated with arteriovenous malformations and the other with probable multiple sclerosis. The delusion has been embarrassing to each patient. Study of such cases may have wider implications for the understanding of the psychotic interpretation of body image, for example that occurring in anorexia nervosa.

The paradox of social resilience:how cognitive strategies and coping mechanisms attenuate and accentuate resilience

This paper examines two concepts, social vulnerability and social resilience, often used to describe people and their relationship to a disaster. Social vulnerability is the exposure to harm resulting from demographic and socioeconomic factors that heighten the exposure to disaster. Social resilience is the ability to avoid disaster, cope with change and recover from disaster. Vulnerability to a space and social resilience through society is explored through a focus on the elderly, a group sometimes regarded as having low resilience while being particularly vulnerable. Our findings explore the degree to which an elderly group exposed to coastal flood risk exhibits social resilience through both cognitive strategies, such as risk perception and self-perception, as well as through coping mechanisms, such as accepting change and self-organisation. These attenuate and accentuate the resilience of individuals through their own preparations as well as their communities' preparations and also contribute to the delusion of resilience which leads individuals to act as if they are more resilient than they are in reality, which we call negative resilience. Thus, we draw attention to three main areas: the degree to which social vulnerability can disguise its social resilience; the role played by cognitive strategies and coping mechanisms on an individual's social resilience; and the high risk aspects of social resilience. © 2014 Elsevier Ltd. All rights reserved.

Mundos prohibidos: El poder en el discurso epistolar de Gertrudis Gómez de Avellaneda y Juana Borrero

This dissertation analyses, through a theoretical framework and a critical approach, letters of Cuban writers Gertrudis Gómez de Avellaneda and Juana Borrero. While love letters have captured the interest of some scholars, such as Claudio Guillén, Cintio Vitier and Alexander Roselló Selimov, the conflict that the analysis of non-literary texts poses has prevented further research in this field. Therefore, I propose a systematic method of analysis encompassing but not limited to evaluating letters based on their purpose, intent, interpretation, and temporal and spatial composition; analyzing the perspective and function of epistolary entities, and examining the textual signs that distinguish the epistolary forms from the literary forms. With this analytical tool, I examine a selection of letters of Gómez de Avellaneda and demonstrate that the writer displaces her identify from the autobiographic self to the epistolary self, in order to manipulate the perspective of her addressee. Caught between the Neoclassical way of thinking and the Romantic aesthetics, her assertive discourse, also reflected in her epistolary work, contributed to the incursion of women writers into the social and professional life of the nineteen century. Following the same method of investigation, an analysis of letters written by Borrero proves that, by building a world of delusion, hallucination and fantasy the writer brings to prose what first generation of female modernistas had done in poetry. In both cases, my focus is on the strategies that turn these letters into instruments of power, process that transformed the love-letter paradigm and forever renovated the women epistolary genre. This dissertation further explores the possibility of initiating a cycle in the study of personal letters to uncover a forgotten genre, mission that might build a bridge to embrace the new forms of written communication that scholars have already begun to explore in contemporary literature.

The short reign of Sultan Osman and other stories

A character discovering and testing the limits of his emotional or psychological range most interests me. What will he choose to do? Stay within his old boundaries? Or try and go beyond them? What does he learn about himself in the process? And, finally, what price will be exacted, either for his staying where he is, or for his choosing a new level of self-knowledge? "The Short Reign Of Sultan Osman and Other Stories" is a collection of short stories set in either the United States, Greece, or Brazil, and ranging in time from 1972 to today. Each story presents its protagonist with challenges unique to a specific time and place. In most of these stories, the protagonists are driven by an urge for love or for mastery, and these urges send them across landscapes of delusion or folly before they can arrive at some sense of self-knowledge.

El declive de la memoria en "Tu rostro" mañana de Javier Marías: la escritura revivida

Este trabajo tiene como objetivo estudiar los diferentes estados mentales de los personajes de las novelas de Tu rostro mañana, de Javier Marías. Estudiando las reflexiones del narrador sobre J. Deza, Peter Wheeler o Francisco Rico observamos que su decadencia mental se muestra a través de una suerte de ―presciencia‖ o lucidez momentánea que puede servir para mostrar el silencio como única tendencia de todo discurso. Desde el momento en que toda historia de ficción se cimenta sobre un discurso –no importa su cauce de presentación, ni su fuente– este es falsificado por el tiempo, la gente y cualquier otra herramienta que pueda ser utilizada para contar nada. Las conclusiones de este trabajo muestran la quimera que implica tratar de mantener una contención absoluta sobre lo acaecido, pues dicho vacío de narrativas será ocupado por una suplantación que suele ser el reverso más infame de sus actores. Es por ello que el narrador J. Deza sigue conminado a explicar sus historias, incluso allí donde uno diría que ya no puede haber ni palabras suficientes para traducir un hecho en ficción.