Desempenho de escolares com transtorno de déficit de atenção e hiperatividade em tarefas metalinguisticas e de leitura

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Epidemiologia do transtorno obsessivo-compulsivo: uma revisão

Os inquéritos populacionais são importantes, pois amostras clínicas tendem a apresentar vieses de seleção. Aspectos sociodemográficos e relacionados à própria condição mórbida podem interferir na procura por tratamento. Pela natureza egodistônica do transtorno obsessivo-compulsivo, seus portadores tendem a ocultar o problema, podendo não procurar ou demorar a procurar tratamento. Porém, a maior parte do conhecimento atual sobre o transtorno obsessivo-compulsivo advém de amostras clínicas, que não representam a totalidade dos casos. Foi feita uma revisão convencional da literatura através do Medline, PsicoInfo e Lilacs de inquéritos populacionais sobre o transtorno obsessivo-compulsivo, cobrindo o período de 1980 a 2004, utilizando-se como palavras-chave epidemiologia, transtorno obsessivo-compulsivo, inquéritos populacionais e prevalência. Estudos realizados em diferentes países indicam para o transtorno obsessivo-compulsivo uma prevalência atual em torno de 1,0% e ao longo da vida de 2,0 a 2,5%. Diferentemente de amostras clínicas, em quase todas as amostras populacionais há predomínio de mulheres e portadores que têm apenas obsessões. A freqüente comorbidade com outros transtornos mentais, particularmente depressão e outros transtornos ansiosos, repete-se em casos da população geral, que apresentam ainda uma associação com abuso de substâncias. Muitos portadores não estão em tratamento, particularmente os casos puros. Indicadores de incapacitação funcional demonstram um considerável impacto negativo do transtorno obsessivo-compulsivo. É preciso melhorar o conhecimento da população e dos profissionais de saúde sobre os sintomas do transtorno obsessivo-compulsivo para aumentar a procura de atendimento, assim como a correta identificação e abordagem terapêutica deste grave problema de saúde.

The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results

OBJETIVO: Descrever o recrutamento de pacientes, instrumentos de avaliação, métodos para o desenvolvimento de estudos colaborativos multicêntricos e os resultados preliminares do Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, que inclui sete centros universitários. MÉTODO: Este estudo transversal incluiu entrevistas semi-estruturadas (dados sociodemográficos, histórico médico e psiquiátrico, curso da doença e diagnósticos psiquiátricos comórbidos) e instrumentos que avaliam os sintomas do transtorno obsessivo-compulsivo (Escala para Sintomas Obsessivo-Compulsivos de Yale-Brown e Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown), sintomas depressivos (Inventário de Depressão de Beck), sintomas ansiosos (Inventário de Ansiedade de Beck), fenômenos sensoriais (Escala de Fenômenos Sensoriais da Universidade de São Paulo), juízo crítico (Escala de Avaliação de Crenças de Brown), tiques (Escala de Gravidade Global de Tiques de Yale) e qualidade de vida (questionário genérico de avaliação de qualidade de vida, Medical Outcome Quality of Life Scale Short-form-36 e Escala de Avaliação Social). O treinamento dos avaliadores consistiu em assistir cinco entrevistas filmadas e entrevistar cinco pacientes junto com um pesquisador mais experiente, antes de entrevistar pacientes sozinhos. A confiabilidade entre todos os líderes de grupo para os instrumentos mais importantes (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale ) foi medida após seis entrevistas completas. RESULTADOS: A confiabilidade entre avaliadores foi de 96%. Até março de 2008, 630 pacientes com transtorno obsessivo-compulsivo tinham sido sistematicamente avaliados. A média de idade (±SE) foi de 34,7 (±0,51), 56,3% eram do sexo feminino e 84,6% caucasianos. Os sintomas obsessivo-compulsivos mais prevalentes foram os de simetria e os de contaminação. As comorbidades psiquiátricas mais comuns foram depressão maior, ansiedade generalizada e transtorno de ansiedade social. O transtorno de controle de impulsos mais comum foi escoriação neurótica. CONCLUSÃO: Este consórcio de pesquisa, pioneiro no Brasil, permitiu delinear o perfil sociodemográfico, clínico e terapêutico do paciente com transtorno obsessivo-compulsivo em uma grande amostra clínica de pacientes. O Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo estabeleceu uma importante rede de colaboração de investigação clínica padronizada sobre o transtorno obsessivo-compulsivo e pode abrir o caminho para projetos semelhantes destinados a integrar outros grupos de pesquisa no Brasil e em todo o mundo.

Aspectos cognitivos do transtorno obsessivo-compulsivo

This paper describes the most important cognitive models for obsessive-compulsive disorder, i. e., the inference processes (thoughts and believes) underlying the patients'feelings and behaviors. The major models formulated in this area emphasize the following aspects: exacerbated perception of danger (risk evaluation), overimportance of intrusive thoughts, excessive sense of personal responsibility (blame for harm self and others), perfectionism, psychological fusion of thought and action, and illogical inference processes involving confusion between imagination and reality. The knowledge of cognitive aspects brings new perspectives for the psychological treatment of this 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.

Psicoterapia grupal no transtorno obsessivo-compulsivo

There are few published papers about group psychotherapy for patients with obsessive-compulsive disorder (OCD), and usually restricted psychoeducational, support or cognitive-behavioral approaches. This article describes the experience of group psychotherapy for OCD patients started in 1996 in Botucatu Medical School - Unesp, São Paulo, Brazil. The two-hour sessions occur once a month, with 6 to 10 female patients, and are based on psychodramatic techniques. Psychotropic prescriptions are given after the sessions. In the beginning, aggressive obsessions were more prominent and were reported with much anguish and shame. Gradually, the themes changed from OCD specific issues (symptoms, pharmacological treatment, outcome, need of exposure and response prevention) to deeper and more personal psychodynamic aspects. The psychodramatic approach (techniques of double, mirror, role inversion, search for prymary scenes) has mostly shown: difficulty in accepting their own human mistakes or negative emotions due to excessive personal demands. This seems to generate guilt, low self-esteem, idealization of others, difficulty in enjoying pleasant situations, fear of taking responsibilities and of losing control (madness/aggressiveness). The group has been considered very important by the patients, since sharing experiences helps to diminish feelings of isolation, shame and guilt, stimulates the exposure to feared situations and enhances self-esteem. The fact that all participants have the same disorder favors group cohesion and provides relief, as they see in the others some of their afflictions and are able to share similar feelings and experiences. Many times the burden of the symptoms are dealt with humor. The confidence in such therapeutic setting is helping the identification and resolution of personal conflicts and contributing to the adherence to pharmacological treatment. The group also provides valuable training experiences for resident physicians in psychiatry.

O espectro médio de longo termo na pesquisa e na clínica fonoaudiológica.

BACKGROUND: One of the great difficulties in evaluating a voice is the judgment of quality through the perceptual auditive analysis--although frequently used--, as it is influenced by socioeconomic and cultural aspects as well as individual preferences. Many are the adjectives and methods used in this assessment, especially because of the subjectivity involved in the process, leading to incompatibilities between listeners and difficulties in reaching a consensus on the use of this or that terminology. In such a context, the voice laboratory and more specifically the acoustic computerized analysis, has guided and complemented speech-language treatments. Among the several possibilities of spectrographic analysis, the (Long-Term Average Spectrum--LTAS) quantifies the quality of voices, pointing differences between gender, age, professional--spoken and sang--and dysphonic voices. The LTAS has been used a lot in researches that investigate voice. As it evidences the contribution of the glottic source and of resonance to the quality of voice, it provides objective parameters for the evaluation of this aspect which usually depends on our auditive perception. AIM: to demonstrate how LTAS can be applied in voice research and in the speech-language therapy practice, describing both the technical aspects required for the production and interpretation of results, and its limitations. CONCLUSION: The area of voice research has developed a lot in these last two decades especially because of the advent of the voice and speech laboratory. For this reason, the knowledge about the applicability of more tools for voice analysis, as the LTAS, as well as the existing need for more studies in this area, will most certainly contribute for the creation of new research areas not only in the field of professional voice but also in the field of therapy.

Transtorno bipolar do humor e gênero

Although the bipolar disorder (BD) occurs almost with the same frequency in both genders, the phenomenology and the outcome of the illness differ between them. Nevertheless, there is evidence that women with BD show, more than men, delayed beginning, especially in their fifth decade, more rapid cycling outcome, more depressive episodes, more dysphoric mania, more mixed states and more BD type II. Even so, the findings are not always consistent. Although the risk of comorbidities in BD includes, for both the sorts, excessive alcoholic consumption and drugs, bipolar men would have greater probability of being alcohol dependent, of not seeking treatment and of committing suicide. Suggested hypotheses to explain such differences vary from those centered in cultural or psychological aspects to those that focus on the steroids hormones, and other hormones such as cortisol, thyroid hormones and even on the cerebral anatomy. The reproductive cycle (menstrual cycle, pregnancy and menopause) influences on the BD phenomenology and its relevance to the therapeutical options in the treatment of the BD in women are presented in the last part of this review. Further investigations must to be done in order to clarify this controversy. However, up to now the data indicate that estrogen therapy is not to be primarily indicated to prevent depression, Alzheimer disease or cognition impairment.

Espectro de agentes etiológicos associados a surtos de doenças transmitidas por alimentos em núcleos receptores turísticos de três regiões geográficas do Estado de São Paulo

Foodborne and waterborne diseases are spread by the consumption of food or water contaminated with bacteria and/or their toxins, viruses, parasites or chemicals. The aim of the research reported here was to establish the spectrum of etiologic agents of foodborne outbreaks at 15 tourist resorts in three geographic regions of the State of Sao Paulo (Brazil). The study was based on the cases reported to the Epidemic Surveillance Center (CVE) of the Public Health Authority of the State of São Paulo (SES), from 2002 to 2005. The tourist centers were chosen at random in three regions of the state (Capital, Interior and Coast) and offered the following attractions: events, agribusiness, cultural history, shopping, town center, gastronomy, health and leisure, sun and sea. Among the bacteria, the results showed that Salmonella spp. were most frequently associated with outbreaks, followed by Shigella spp., enterotoxigenic Escherichia coli, Staphylococcus aureus, Clostridium perfringens, Bacillus cereus and Campylobacter spp. Viruses (Rotavirus and Hepatitis A) played a part in many of the cases, while the frequency of parasites and worm infestations was low in the foodborne disease outbreaks at these resorts. The mixed foods (rice, beans, liver, potatoes, barbecue, juice), fish and poultry were the three commonest vehicles implicated in the outbreaks.

Enfermeiros e a família do portador de transtorno mental.

This qualitative study aimed at investigating how mental health nurses acquired knowledge about the theme family during their academic training, how they see families in their daily practice, and how should professional training be considering the presence of the family in the care setting. Data were collected using semistructured questionnaires. Six nurses were interviewed. Data analysis allowed the establishment of three theme categories: Academic and professional training absence of the family theme; the nurses' perception of the family with a mentally ill member; and a new vision of the family the role of teaching. During undergraduate education, nurses acquired little knowledge about the theme family; in the institutional routine, they praise the family as a participant of care; and indicate that the need for knowledge about families is based on the interdisciplinary character of education.

Perfusão cerebral e análise individual automatizada utilizando SPECT em uma população com transtorno obsessivo-compulsivo

Objective: To make individual assessments using automated quantification methodology in order to screen for perfusion abnormalities in cerebral SPECT examinations among a sample of subjects with OCD. Methods: Statistical parametric mapping (SPM) was used to compare 26 brain SPECT images from patients with OCD individually with an image bank of 32 normal subjects, using the statistical threshold of p < 0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). The maps were analyzed, and regions presenting voxels that remained above this threshold were sought. results: Six patients from a sample of 26 OCD images showed abnormalities at cluster or voxel level, considering the criteria described above, which represented 23.07%. However, seven images from the normal group of 32 were also indicated as cases of perfusional abnormality, representing 21.8% of the sample. Conclusion: The automated quantification method was not considered to be a useful tool for clinical practice, for analyses complementary to visual inspection.

Detecção de beta-lactamase de espectro estendido em membros da família Enterobateriaceae

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Efeito da prática no controle de torque isométrico em crianças com transtorno de desenvolvimento de coordenação

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Processamento auditivo comportamental e eletrofisiológico em crianças com Transtorno de Déficit de Atenção com Hiperatividade (TDAH)

Pós-graduação em Fonoaudiologia - FFC

A interação professor-aluno em classe inclusiva: um estudo exploratório com criança autista

Pós-graduação em Educação - FFC