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Background: This study aimed to evaluate the effect of two different types of physical intervention on sedentary behavior and clinical changes in people with schizophrenia. Method: This is a clinical trial including people with schizophrenia in regular outpatient care who realized a 3-month exercise protocol and were separated into two groups: aerobic physical intervention (API) and postural physical intervention (PPI). All participants performed an assessment of (a) functional capacity through a 6 min walk test (6MWT), (b) flexibility using Well’s bench, (c) disease severity using the Brief Psychiatric Rating Scale (BPRS), (d) quality of life using the SF-36 Questionnaire and (e) physical activity using the Simple Physical Activity Questionnaire (SIMPAQ). Results: Thirty-eight patients with schizophrenia completed the intervention (24 patients in API and 14 patients in PPI). Regarding sedentary behavior, there was an improvement in the API group in the time exercising and in the PPI group concerning time in bed, time walking and exercising. Regarding quality of life, there was an improvement in the API group (functional capacity) and in the PPI group, there was an improvement in physical limitation, pain and emotional limitations. In the API group, there was an improvement in BMI (body mass index), diastolic blood pressure and systolic blood pressure. Functional capacity was improved only in the PPI group. There was no change in flexibility and disease severity. Conclusions: The study demonstrated a change response in the physical and mental aspects in people with schizophrenia after a change in sedentary behavior.

Background: Schizophrenia has disabling effects over mental and physical integrity involving changes in posture and flexibility, which reduce mobility, autonomy, and quality of life. Physical activity has been tested with uncertain effects in schizophrenia, mostly due to trial design, methodology, comparison groups, intervention length, and attrition. Inconsistency led to poor dissemination of active interventions in this population, which may benefit these individuals’ health. Objective: To evaluate the response of two different protocols: Aerobic and Functional exercises, in two groups of sedentary adults—patients with the diagnosis of schizophrenia and healthy controls.Methods: A clinical trial of two standardized physical interventions in adults diagnosed with schizophrenia and healthy controls. Posture was assessed by digital photogrammetry with the aid of a software and the flexibility by the Wells Fargo’s Test. Results: A total of 38 individuals completed the intervention, with 24 in Aerobic group and 14 in Functional group. The groups were homogeneous for gender, weight, and body mass index, with small differences in age and height. Posture and Flexibility changed according to group and intervention. In this study, guided physical activity improved posture and flexibility in both groups, with higher effect of the Functional protocol than the Aerobic protocol in cases and controls. Conclusions: Despite a preliminary and relatively small sample size, the study evidences the feasibility and clinical utility of physical intervention in schizophrenia. Additional data about specific adaptations in schizophrenia are needed to improve outcomes, such as individualized assistance, support, instructions and intensity. Trial registration: Clinical trial registration: Brazilian Registry of Clinical Trials (ReBEC) under No. RBR-2h2hjy; date: 09/29/2020, retrospectively registered (https://ensaiosclinicos.gov.br/rg/RBR-2h2hjy).

Objective: Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders. Methods: A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition. Results: In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05). Conclusions: These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines.

O transexualismo (CID-10) é uma condição caracterizada por forte e persistente dissociação com o gênero atribuído. A cirurgia de redesignação sexual (CRS) e a terapia hormonal (TH) permitem que indivíduos transexuais se sintam mais congruentes com seu gênero e, por isso, têm desempenhado papel importante nos últimos 70 anos. O fator neurotrófico derivado do cérebro (BDNF) parece desempenhar um papel fundamental na recuperação do trauma cirúrgico agudo e vulnerabilidade ambiental à psicopatologia. Nós hipotetizamos que o BDNF pode ser um biomarcador de alívio do sofrimento de incongruência de gênero pós-CRS. Objetivos: Mensurar os níveis séricos de BDNF no pré e pós-operatório em indivíduos transexuais como biomarcador de alívio de estresse relacionado à incongruência de gênero após a CRS. Métodos: Trinta e duas pessoas transexuais masculino para feminino submetidas a cirurgia e tratamento hormonal foram selecionadas de nossa amostra inicial. O nível sérico de BDNF foi avaliado antes e depois da CRS pela técnica ELISA. O tempo decorrido entre as coletas de sangue pré e pós-CRS foi medido. Resultados: Não houve diferença significativa nos níveis de BDNF pré e pós-CRS ou em relação ao tempo decorrido entre a CRS e a coleta. Conclusão: O alívio do sofrimento relacionado à incongruência de gênero pós-CRS não pode ser avaliado apenas pelo BDNF. Soluções cirúrgicas podem não fornecer uma solução rápida para o sofrimento associado ao transexualismo, e a CRS pode servir como um passo em direção à, em vez de conclusão da, construção da identidade de gênero de uma pessoa. Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one’s assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. Objectives: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Methods: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post- -SRS blood collections was also measured. Results: No significant difference was found in pre-SRS or post- -SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Conclusion: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person’s gender identity.

Objective: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. Methods: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS) between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. Results: A moderate decreasing trend (p < 0.001) in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768) and in admissions for organic mental disorders (R2 = 0.823), disorders due to psychoactive substance use (R2 = 0.767), schizophrenia (R2 = 0.680), and other diagnoses (R2 = 0.770), but not for mood disorders (R2 = 0.472). Most admissions (60 to 65%) were due to schizophrenia. Conclusion: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

Objective To describe the case of a patient with schizophrenia on clozapine treatment who had an episode of heat stroke. Case description During a heat wave in January and February 2014, a patient with schizophrenia who was on treatment with clozapine was initially referred for differential diagnose between systemic infection and neuroleptic malignant syndrome, but was finally diagnosed with heat stroke and treated with control of body temperature and hydration. Comments This report aims to alert clinicians take this condition into consideration among other differential diagnoses, especially nowadays with the rise in global temperatures, and to highlight the need for accurate diagnosis of clinical events during pharmacological intervention, in order to improve treatment decisions and outcomes.

ObjectiveMany studies have documented the high rates of functional impairment among patients with schizophrenia. The majority of the available instruments used to assess functioning, however, focus on global measures of functional recovery rather than specific domains of psychosocial functioning. Most of these instruments have important limitations regarding use in psychiatry. The aim of the present study was to evaluate the psychometric properties of the Brazilian version of the Functioning Assessment Short Test (FAST) in patients with schizophrenia.MethodsA convenience sample of 107 chronic outpatients with schizophrenia and 108 controls was assessed in a university hospital (Hospital de Clínicas de Porto Alegre, Brazil). Psychometric properties of FAST (internal consistency, concurrent validity, and test-retest reliability) were analyzed.ResultsThe internal consistency obtained was high; the Cronbach’s alpha was 0.89. FAST total score was higher in patients than in the control group (Z = 11.95; P

Background: Schizophrenia is associated with psychotic experiences and cognitive deficits. Therefore, cognitive function is one of the most critical determinants of quality of life in this pathology. Resveratrol has been related with neuroprotective action but there are no studies evaluating resveratrol in schizophrenia. The objective of this study was to determine the efficacy of resveratrol supplementation on cognition in individuals with schizophrenia. Methods: This is a 1-month randomized, double-blind controlled trial (NCT 02062190), in which 19 men with diagnosis of schizophrenia, aged 18 to 65 years, were assigned to a resveratrol supplement group (200mg) or placebo group (200mg), with a 1-month follow-up. Applying a series of cognitive tests assessed neuropsychology performance (Hopkins Verbal Learning Test, Stroop Color and Word Test, Weschler Adult Intelligence Scale) and Brief Psychiatric Rating Scale assessed psychopathology severity. Results: There were no significant improvement in neuropsychology performance (episodic memory, working memory, attention and concentration capacity, inhibitory control, interference measures, selective attention and mental flexibility) and psychopathology severity after 1-month of resveratrol supplementation (p>0.05). Conclusion: In conclusion, we have shown that 1-month of a resveratrol supplementation (200 mg/day) did not improve episodic memory, working memory, attention and concentration capacity, inhibitory control, interference measures, selective attention and mental flexibility as compared with placebo in patients with schizophrenia.

Introduction: Schizophrenia is a severe, debilitating mental disorder that affects both the physical health and the functional capacity of patients, causing great impairment throughout the life course. Although physical and cognitive impairments may represent different expressions of a single systemic inflammatory process, little is known about the relationship between motor function and schizophrenia. Objective: To evaluate physical functional capacity in patients with schizophrenia and ascertain whether it correlates with markers of inflammation, disease severity, and pharmacotherapy. Methods: Cross-sectional study using a convenience sampling strategy. Forty patients with stable schizophrenia, undergoing treatment, were recruited from the Outpatient Program of Hospital de Clinicas de Porto Alegre, University Hospital linked to Public Health System. Physical functional capacity was assessed by the 6-minute walk test (6MWT), and inflammatory markers were measured by C - reactive protein (CRP) and Von Willebrand Factor (VWF). Results: Mean functional capacity and clinical variables differed among patients and Brazilian population regarding heart rate (p=0.004), diastolic (p=0.001) and systolic (p

Background: Patients with schizophrenia (SZ) are generally overweight or obese and have several metabolic disorders. Additionally, such patients have a lower life expectancy and the main cause of their increased mortality is cardiovascular disease (CVD). The objective of this study was to determine the efficacy of resveratrol supplementation on serum glucose and CVD risk factors in individuals with SZ. Methods and Results: This is a four-week randomized, double-blind controlled trial (registration No.: NCT 02062190) in which 19 men with a diagnosis of SZ, aged 18 to 65, were assigned to either a resveratrol supplement group (200 mg/day) or a placebo group (200 mg/day). In short, we did not observe significant changes after resveratrol supplementation. In the placebo group, we found a significant increase in total cholesterol levels (p = 0.024) and in LDL-cholesterol (p = 0.002), as well as a decrease in body fat percentage (p = 0.038). The placebo group also showed an increase in triglycerides (9.19%) and a reduction in HDL-cholesterol (4.88%). In the resveratrol group, triglycerides decreased (7.64%). Conclusion: In summary, oral resveratrol in reasonably low dosages (200 mg daily) brought no differences to body weight, waist circumference, glucose, and total cholesterol. It was possible to note that the lipid profile in the placebo group worsened and, although no significant differences were found, we can assume that resveratrol might prevent lipid profile damage and that the intervention affected the lipoprotein metabolism at various levels.

Since approximately 70% of adult patients with attention-deficit/hyperactivity disorder (ADHD) have at least one comorbid disorder, rating of impairment specifically attributable to ADHD is a hard task. Despite the evidence linking environmental adversities with negative outcomes in ADHD, life events measures have not been used to rate the disorder impairment. The present study tested for the first time the hypothesis that increased ADHD severity is associated with an increase in negative recent life events, independently of comorbidity status. The psychiatric diagnoses of 211 adult ADHD outpatients were based on DSM-IV criteria assessed through structured interviews (K-SADS-E for ADHD and ODD, MINI for ASPD and SCID-IV-R for other comorbidities). ADHD severity was evaluated with the Swanson, Nolan and Pelham rating scale (SNAP-IV) and recent life events with the Life Experience Survey. Higher SNAP-IV inattention and hyperactivity scores, female gender, lower socioeconomic status and the presence of comorbid mood disorders were associated with negative life events. Poisson regression models with adjustment for possible confounders confirmed the effect of inattention and hyperactivity severity on negative life events. Our results suggest that the negative life events experienced by these patients are associated to the severity of ADHD independently from comorbid psychiatric disorders.

A obesidade mórbida está relacionada a muitos transtornos psiquiátricos e possui como opção terapêutica a cirurgia bariátrica. Objetivo: caracterizar a prevalência de transtornos depressivos e de ansiedade em pacientes submetidos à cirurgia bariátrica no Hospital Universitário Regional de Maringá e do Centro de Cirurgia de Obesidade de Maringá. Métodos: o estudo foi realizado com 50 pacientes obesos mórbidos submetidos à Cirurgia Bariátrica em diferentes períodos: pré-operatório, um mês de pós-operatório, três meses de pós-operatório e seis meses de pós-operatório. A avaliação do Transtorno Depressivo foi realizada pela aplicação do Inventário de Depressão de Beck, sendo outro instrumento utilizado neste trabalho a Escala Hospitalar de Ansiedade e Depressão (HAD). Resultados: a prevalência de quadros sugestivos de ansiedade foi: 40% (20 pacientes) no pré-operatório, 18% no primeiro mês pós-operatório, 8% no terceiro mês pós-operatório e 14% no sexto mês pós-operatório. Quadros sugestivos de depressão foram encontrados em: 26% (13 pacientes) no pré-operatório, 10% no primeiro mês pós-operatório e no terceiro mês pós-operatório e 8% no sexto mês pós-operatório. Conclusão: Os níveis de Ansiedade foram altos no pré-operatório, diminuíram no 1º e 3º mês pós-operatório e voltaram a subir no sexto mês, atingindo níveis mais altos que no terceiro mês.Morbid obesity is associated to several psychiatric disorders and bariatric surgery is a therapeutic option. Current research characterizes the prevalence of depression and anxiety disorders in patients who underwent bariatric surgery at the Regional Hospital of Maringá and at the Obesity Surgery Center of Maringá, Maringá PR Brazil. Study was undertaken with 50 morbid obese patients who underwent bariatric surgery and comprised different periods, namely, pre-surgery, one month after surgery, three months after surgery and six months after surgery. Depressive disorder was evaluated by Beck’s Depression Inventory and by the Hospital Scale of Anxiety and Depression (HAD). Results show prevalence of anxiety in 40% (20) of patients during the pre-surgery period; 18% during the 1st post-surgery month; 8% during the 3rd post-surgery month and 14% during the 6th post-surgery month. High rates of depression were found in 26% (13) of patients in the pre-surgery period; 10% in the 1st and 3rd post-surgery month and 8% in the 6th post-surgery month. Levels of anxiety were actually high in the pre-operative period but they decreased in the 1st and 3rd months after surgery. However, a rise during the 6th month was reported which reached higher levels than that during the 3rd month.

Brain-derived neurotrophic factor (BDNF) plays a critical role in neurodevelopment and neuroplasticity. Altered BDNF signaling is thought to contribute to the pathogenesis of schizophrenia (SZ) especially in relation to cognitive deficits. Clozapine (CLZ) has been shown a beneficial effect on cognition in SZ in some studies and a detrimental effect in others. To examine serum BDNF, two groups of chronically medicated DSM-IV SZ patients (n = 44), on treatment with clozapine (n = 31) and typical antipsychotics (n = 13) had 5 ml blood samples collected by venipuncture. Serum BDNF levels were significantly correlated with CLZ daily dose (r = 0.394, p = 0.028), but not with typical antipsychotic daily dose (r = 0.208, p = 0.496). This study suggests that serum BDNF levels are correlated with CLZ daily dose, and this may lead to the cognitive enhancement as seen in patients with SZ under CLZ. Despite the strong evidence that chronic administration of CLZ is effective for patients with SZ, it is still unknown whether atypical antipsychotic drugs regulate BDNF expression. Serum BDNF levels concentration in SZ merits further investigations with regard to the role of neurotrophins in the cognitive response to treatment with CLZ and other atypical antipsychotics.

OBJETIVO: A eficácia da eletroconvulsoterapia em tratar sintomas depressivos está estabelecida por meio de inúmeros estudos desenvolvidos durante as últimas décadas. A eletroconvulsoterapia é o tratamento biológico mais efetivo para depressão atualmente disponível. O objetivo deste estudo foi demonstrar o papel da eletroconvulsoterapia no tratamento da depressão e destacar aspectos atuais relativos à sua prática. MÉTODO: Foram revisados na literatura estudos de eficácia, remissão de sintomas, fatores preditores de resposta, assim como aspectos atuais acerca da qualidade de vida, percepção dos pacientes, mecanismo de ação, técnica e prejuízo cognitivos. RESULTADOS: Os principais achados desta revisão foram: 1) a eletroconvulsoterapia é mais efetiva do que qualquer medicação antidepressiva; 2) a remissão da depressão com a eletroconvulsoterapia varia, em geral, de 50 a 80%; 3) Ainda é controverso o efeito da eletroconvulsoterapia nos níveis de fator neurotrófico derivado do cérebro (acho que aqui pode colocar entre parenteses o "BNDF"); 4) a eletroconvulsoterapia tem efeito positivo na melhora da qualidade de vida; 5) os pacientes submetidos à eletroconvulsoterapia, em geral, têm uma percepção positiva do tratamento. CONCLUSÃO: A eletroconvulsoterapia permanece sendo um tratamento altamente eficaz em pacientes com depressão resistente. Com o avanço da sua técnica, a eletroconvulsoterapia tornou-se um procedimento ainda mais seguro e útil tanto para a fase aguda, quanto para a prevenção de novos episódios depressivos. OBJECTIVE: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice. METHOD: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients' perception, mechanism of action, technique and cognitive impairment. RESULTS: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment. CONCLUSION: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes.

OBJETIVO: Descrever a construção e o teste de rotina para análise das interna-ções psiquiátricas pelo Sistema Único de Saúde, a partir de seu banco de dados (Datasus), e analisar as características e tendências dessas internações. MÉTODOS: Foram extraídos dados das autorizações de internação hospitalar dos anos de 2000 a 2004, no Rio Grande do Sul. Os dados referentes a 91.233 internações foram processados por meio de sintaxes pelo programa SPSS, tendo sido testada a confiabilidade das rotinas. Foram descritas as freqüências das internações em hospitais gerais e psiquiátricos, e os principais diagnósticos, com análise de tendências por modelos de regressão polinomial. RESULTADOS: As confiabilidades intra e interavaliador foram de 100%. Observou-se tendência de crescimento na proporção das internações por transtornos de humor e de diminuição naquelas por esquizofrenia e por transtornos orgânicos. A proporção de internações por transtorno por uso de substâncias manteve-se estável. Houve tendência crescente na proporção do número de internações psiquiátricas em hospitais gerais, apresentando um crescimento de 97,7% no período. CONCLUSÕES: Foram evidenciadas a confiabilidade e a viabilidade das rotinas apresentadas, sugerindo o uso dos arquivos do Sistema de Informações Hospitalares como fonte de dados para a avaliação contínua das internações psiquiátricas pelo Sistema Único de Saúde. As alterações observadas nas proporções de internações psiquiátricas podem ter sido devido às mudanças: no tipo de pacientes; no padrão de diagnósticos, conhecido como viés de diagnóstico orientado pelo tratamento; e na legislação.OBJECTIVE: To describe the construction and testing of a routine to assess psychiatric hospitalizations in the Brazilian Health System based on its database (DATASUS), and to assess characteristics and trends of these hospitalizations. METHODS: Data were extracted from hospital admission authorizations in the state of Rio Grande do Sul, Southern Brazil, from 2000 to 2004. Data from 91,233 admissions were processed through a routine (syntaxes) using SPSS program and their reliability was tested. Hospitalization rates in general and psychiatric hospitals and main diagnoses were described, and trends were analyzed using polynomial regression models. RESULTS: Intra and inter-rater reliabilities were 100%. There was seen a trend of increasing hospitalization rates due to mood disorders and decreasing rates due to schizophrenia and organic disorders. Hospitalization rates due to substance use disorders remained stable. There was an increasing trend in the number of psychiatric hospitalizations in general hospitals with a 97.7% growth in the period studied. CONCLUSIONS: Routines proved to be reliable and feasible, suggesting the use of data from Hospital Information System database as a source of information for continuous evaluation of psychiatric hospitalizations in Brazilian Health System. Psychiatric hospitalization rates may have changed due to changes in the type of patients; diagnostic patterns, known as treatment-oriented diagnostic bias; and legislation.

Palavras-chaves TDAH, adultos, transtorno de oposicao e desafio, transtorno de conduta, transtorno de personalidade anti-social. RESUMO Os autores examinam a influencia dos transtornos de oposicao e desafio (TOD), de conduta (TC) e de personalidade anti-social (TPAS) ao longo da vida do individuo com TDAH. Os principais achados mostram que o TDAH e modulado por essas comorbidades e que seu prognostico e modificado dependendo da presenca ou nao desses transtornos. O transtorno de oposicao e desafio intensificaria as caracteristicas de impulsividade e isolacionismo do TDAH, porem nao acarretaria em um aumento na incidencia de TPAS na vida adulta. Ja o TC associado ao TDAH implica um aumento significativo na impulsividade e agressividade, estando associado significativamente a TPAS e um pior prognostico. A diferenciacao entre os diferentes transtornos e seu correto diagnostico e essencial para o tratamento adequado do TDAH. Futuros estudos precisam determinar se o tratamento do TDAH produziria uma mudanca significativa no prognostico desse grupo de pacientes.

CONTEXTO: Após cinco décadas de síntese e disseminação de uso de drogas para o tratamento da esquizofrenia, foi possível observar a disponibilidade de drogas com diferentes perfis farmacológicos e um largo perfil de efeitos adversos que se estendem além dos originalmente descritos em área endocrinológica e neurológica, se expandindo para aumento de peso, transtornos metabólicos, transtornos cardiovasculares e morte prematura associada a doenças comuns. Estas evidências, agravadas com a relativa ausência de diretrizes e orientações para o clínico, apontam para a necessidade de se produzir orientações claras e sintéticas para uso pelo clínico, orientando para a seleção de drogas e medidas de prevenção e tratamento de transtornos de peso e metabolismo. OBJETIVO: Identificar a freqüência e o tipo de alterações de peso e metabolismo em pessoas diagnosticadas com esquizofrenia, antes e depois do uso de diferentes antipsicóticos, e sintetizar as medidas preventivas e paliativas adequadas para a redução desses desfechos desfavoráveis. MÉTODOS: Efetuada breve revisão em PubMed e Scielo nos últimos cinco anos com os descritores weight, metabolic syndrome AND schizophrenia, e a partir dos artigos encontrados, selecionados artigos com dados clínicos. RESULTADO: Foram identificados aumento de peso, dislipidemia e síndrome metabólica em pacientes portadores do diagnóstico de esquizofrenia, antes, durante e após o uso de antipsicóticos, especialmente em drogas de nova geração, com taxas perto de duas vezes maiores do que na população geral, que resultam de redução de cerca de 20% na expectativa de vida desses pacientes. CONCLUSÃO: Devido a estes riscos elevados e à inexistência de critérios claros de definição de risco de ganho de peso antes da exposição a antipsicóticos (apesar do maior risco associado a uso de clozapina e olanzapina), recomenda-se seguimento ativo de pacientes em regime de drogas antipsicóticas, com troca logo que observado aumento em 5% ou mais no peso corporal, com manutenção do cuidado ativo, com orientação nutricional e de estilo de vida e nível de atividade. Adicionalmente, existe a necessidade de revisões sistemáticas para controlar possíveis vieses de seleção com o tipo de metodologia empregada.BACKGROUND: Five decades after use and dissemination of use of drugs for the treatment of schizophrenia, with different pharmacologic profiles, it has been evidenced that these drugs display a large profile of adverse events other than endocrinological and neurological, including weight gain, metabolic disorders, increased frequency of cardiovascular disorders and premature death associated to common disorders. These evidences, aggravated by the lack of synthetic and clear description of guidelines for the clinical practitioner, points to the need of comprehensive studies about weight gain and metabolic disturbances followed by clear and simple guidelines orienting drug selection and measures for prevention and treatment of weight and metabolic disturbances. OBJECTIVE: Identification of frequency and type of weight and metabolic disturbances in people diagnosed with schizophrenia, before and after the use of different antipsychotics. METHODS: A PubMed and Scielo review of the last 5 years using descriptors such as weight, metabolic syndrome AND schizophrenia, and after that, the authors selected articles with clinical data. RESULT: Increased weight, dislipidemia and metabolic syndrome in subjects with schizophrenia, before, was evidenced during and after drug use, especially new-generation drugs, with overall rates around 2 times the general population, resulting in a 20% reduction of life expectancy in these patients. CONCLUSION: The evidence of elevated risk for overweight and metabolic syndrome and the lack of defined criteria for risk assessment for weight gain before drug use (despite of increased pre-drug use risk with clozapine and olanzapine) it is recommended active follow-up of patients under antipsychotic drug use, with drug change when observed 5% or more weight gain, with maintenance of active care of nutritional, lifestyle and activity level. There is also a need of systematic reviews for controlling selection biases associated to the type of methodology of the present review.

Articles in Press, Schizophrenia (SZ) and bipolar disorder (BD) are severe psychiatric conditions with a neurodevelopmental component. Genetic findings indicate the existence of an overlap in genetic susceptibility across the disorders. Also, image studies provide evidence for a shared neurobiological basis, contributing to a dimensional diagnostic approach. This study aimed to identify the molecular mechanisms that differentiate SZ and BD patients from health controls but also that distinguish both from health individuals. Comparison of gene expression profiling in post-mortem brains of both disorders and health controls (30 cases), followed by a further comparison between 29 BD and 29 SZ revealed 28 differentially expressed genes. These genes were used in co-expression analysesthat revealed the pairs CCR1/SERPINA1, CCR5/HCST, C1QA/CD68, CCR5/S100A11 and SERPINA1/TLR1 as presenting the most significant difference in co-expression between SZ and BD. Next, a protein-protein interaction (PPI) network using the 28 differentially expressed genes as seeds revealed CASP4, TYROBP, CCR1, SERPINA1, CCR5 and C1QA as having a central role in the diseases manifestation. Both co-expression and network topological analyses pointed to genes related to microglia functions. Based on this data, we suggest that differences between SZ and BP are due to genes involved with response to stimulus, defense response, immune system process and response to stress biological processes, all having a role in the communication of environmental factors to the cells and associated to microglia., Stanley Medical Research Institute for providing the tissue samples and the patients for donating the samples, info:eu-repo/semantics/publishedVersion

Considerando-se as dificuldades atuais do diagnóstico do transtorno do déficit de atenção/hiperatividade em adultos, foram reunidos especialistas brasileiros que fazem pesquisas nesta área, de modo a produzir diretrizes de consenso para uso no país. Foi realizada uma revisão não-sistemática preliminar e concebido um texto inicial, que foi repetidamente avaliado e editado pelos autores, com acréscimos e correções ao longo de 6 meses, através de correio eletrônico e de uma reunião posterior, patrocinada pela Associação Brasileira do Déficit de Atenção. A versão preliminar foi apresentada publicamente durante o congresso anual da Associação Brasileira de Psiquiatria, com comentários e sugestões dos participantes, para a redação da versão final.Considerándose las dificultades actuales del diagnóstico del trastorno del déficit de atención/hiperactividad en adultos, se reunieron especialistas brasileños que investigan en esa área, de modo a producir directrices de consenso para uso en el país. Se realizó una revisión no-sistemática preliminar y se concibió un texto inicial, que ha sido repetidamente evaluado y editado por los autores, con acrecimos y correcciones a lo largo de 6 meses, a través de correo electrónico y de una reunión posterior, patrocinada por la Asociación Brasileña del Déficit de Atención. La versión preliminar ha sido presentada públicamente durante el congreso anual de la Asociación Brasileña de Psiquiatría, con comentarios y sugerencias de los participantes para la redacción de la versión final.Present difficulties in the diagnosis of attention-deficit/hyperactivity disorder in adults have prompted Brazilian specialists involved in research in this area to make a consensus to be used in the country. A non-systematic preliminary review was repeatedly evaluated by all authors, who added new material, commented and corrected parts of the text for 6 months through electronic mail and a further meeting sponsored by the Brazilian Association of Attention-Deficit Disorder. The preliminary version was publicly presented during the annual congress of the Associação Brasileira de Psiquiatria (Brazilian Association for Psychiatry) for appraisal and suggestions from participants in order to prepare the final version.

A eletroconvulsoterapia (ECT) consiste em tratamento biológico ainda não amplamente utilizado na prática psiquiátrica, devido aos inúmeros fatores que contribuem para uma resistência acerca do método. Objetivando sustentar, com embasamento científico, o emprego da ECT, agregamos evidências de sua eficácia, indicações, contra-indicações e efeitos adversos, advindas dos principais ensaios clínicos randomizados e meta-análises disponíveis na literatura médica atual sobre o tema (PubMed/MEDLINE, Cochrane).La electroconvulsoterapia (ECT) consiste en tratamiento biológico todavía no ampliamente utilizado en la práctica psiquiátrica, debido a los innúmeros factores que contribuyen a una resistencia al método. Objetivando sostener, con embasamiento científico, el empleo de la ECT, añadimos evidencias de su eficacia, indicaciones, contraindicaciones y efectos secundarios, advenidos de los principales ensayos clínicos aleatorios y meta-análisis disponibles en la literatura médica actual sobre el tema (PubMed/MEDLINE, Cochrane).The electroconvulsive therapy is a biological treatment not widely used in the psychiatric practice. A number of factors contribute to resistance concerning this method. The goal of the present article is to provide scientific support to the use of electroconvulsive therapy by showing its effectiveness, indications, contraindications and adverse effects. Such factors were searched in the major randomized clinical trials and meta-analyses available in the current medical literature on the subject (PubMed/MEDLINE, Cochrane).

A eletroconvulsoterapia (ECT) consiste em tratamento biológico ainda não amplamente utilizado na prática psiquiátrica, devido aos inúmeros fatores que contribuem para uma resistência acerca do método. Objetivando sustentar, com embasamento científico, o emprego da ECT, agregamos evidências de sua eficácia, indicações, contra-indicações e efeitos adversos, advindas dos principais ensaios clínicos randomizados e meta-análises disponíveis na literatura médica atual sobre o tema (PubMed/ MEDLINE, Cochrane). The electroconvulsive therapy is a biological treatment not widely used in the psychiatric practice. A number of factors contribute to resistance concerning this method. The goal of the present article is to provide scientific support to the use of electroconvulsive therapy by showing its effectiveness, indications, contraindications and adverse effects. Such factors were searched in the major randomized clinical trials and meta-analyses available in the current medical literature on the subject (PubMed/MEDLINE, Cochrane). La electroconvulsoterapia (ECT) consiste en tratamiento biológico todavía no ampliamente utilizado en la práctica psiquiátrica, debido a los innúmeros factores que contribuyen a una resistencia al método. Objetivando sostener, con embasamiento científico, el empleo de la ECT, añadimos evidencias de su eficacia, indicaciones, contraindicaciones y efectos secundarios, advenidos de los principales ensayos clínicos aleatorios y meta-análisis disponibles en la literatura médica actual sobre el tema (PubMed/MEDLINE, Cochrane).

O diagnóstico do transtorno de déficit de atenção e hiperatividade (TDAH) e do transtorno de oposição desafiante (TOD) em adultos carece de instrumentos adequados. Esta investigação visa avaliar a confiabilidade entre observadores das seções do K-SADS-E adaptadas para os diagnósticos destes transtornos em adultos. As adaptações realizadas se limitaram ao direcionamento das perguntas ao próprio paciente, investigação do início dos sintomas em um período mais tardio e abordagem de sintomas próprios de adultos. Seis avaliadores treinados pontuaram 16 entrevistas gravadas. Os coeficientes Kappa foram de 1,00 para o diagnóstico de TDAH no passado, 0,91 para o subtipo no passado, 1,00 para diagnóstico de TDAH atual e 0,95 para o subtipo atual. Os coeficientes Kappa para o TOD foram de 1,00 para o diagnóstico no passado e 0,89 para o diagnóstico atual. Todos os coeficientes tiveram um p

Os autores do presente artigo propõem, a partir do modelo pedagógico proposto por Antoni Zabala, uma abordagem psicoeducativa grupal para pacientes adultos portadores de Transtorno de Déficit de Atenção/Hiperatividade. Para tanto, adaptam esta estrutura pedagógica para fundamentar a abordagem de grupos psicoeducacionais. O presente trabalho adiciona uma nova técnica para o tratamento do TDAH no adulto a partir da interface entre a pedagogia e a psicoterapia.Los autores del presente artículo proponen, a partir del modelo pedagógico propuesto por Antoni Zabala, un abordaje psico-educativo grupal para pacientes adultos portadores del Tratamiento del Déficit de Atención/Hiperactividad. Para tanto, adaptan esta estructura pedagógica para fundamentar el abordaje de grupos psico-educacionales. El presente trabajo adiciona una nueva técnica para el tratamiento del TDAH en el adulto a partir de la interfase entre la pedagogía y la psicoterapia.TIn this paper the authors suggest a psycho-educative group approach to adult patients with Attention Deficit/Hyperactivity Disorder (ADHD) based on a pedagogic model proposed by Antoni Zabala. This paper intends to present this new technique for the treatment of adults with ADHD. The conceptualization is based on the interface between pedagogy and psychotherapy.

Schizophrenia is present in all human populations with approximately the same incidence. Why does such illness persist given that it is associated with a reproductive disadvantage? What is the balancing advantage? A possible explanation is linked to human language. According to this hypothesis schizophrenia occurs as a manifestation of genetic diversity associated with language--the function by which Homo sapiens has separated from other primate species. Language originated by a genetic mutation that allowed the cerebral hemispheres to develop with a degree of specialization (or lateralization) reflected in cerebral asymmetries. Individuals with schizophrenia show lesser structural and functional brain asymmetries than the population as a whole, and this finding can be interpreted as a delay, or failure in, establishing hemispheric dominance for language. We review recent evidence supporting this theory.

The authors review environmental and neurodevelopmental risk factors for schizophrenic disorders, with emphasis on minor physical anomalies, particularly craniofacial anomalies and dermatoglyphic variations. The high prevalence of these anomalies among schizophrenic subjects supports the neurodevelopmental theory of the etiology of schizophrenia, since they suggest either genetically or epigenetically controlled faulty embryonic development of structures of ectodermal origin like brain and skin. This may disturb neurodevelopment that in turn may cause these subjects to be at increased risk for the development of schizophrenia and related disorders. The precise confirmation of this theory, at least in some cases, will provide further understanding of these illnesses, allowing easy and inexpensive identification of subjects at risk and providing guidelines for the development of new pharmacological interventions for early treatment and even for primary prevention of the illness.

Estudos têm evidenciado o alto risco de osteoporose em pacientes esquizofrênicos. Alguns estudos têm demonstrado que os neurolépticos típicos e a risperidona podem induzir a osteoporose ou reduzir a densidade mineral óssea. Isso pode ser atribuído ao fato de estas drogas, em uso prolongado, induzirem a hiperprolactinemia a níveis acima do normal, em ambos os sexos, e a baixa dos níveis de estrogênio e de testosterona, aumentando o risco para osteopenia/osteoporose. Neste relato, será apresentado um caso de osteopenia em uma paciente mulher de 53 anos, em uso de antipsicóticos há 30 anos, sendo comentados os procedimentos recomendados para detecção dessa ocorrência e as diretrizes existentes para seu manejo.Studies have shown a high risk of osteoporosis in schizophrenic patients. Some studies have demonstrated that typical neuroleptics and risperidone may induce osteoporosis or reduce bone mineral density. This can be due to the fact that prolonged use of those drugs induces hyperprolactinemia to levels above normal in both genders, and reduces the levels of estrogen and testosterone, thus increasing the risk of osteopenia/osteoporosis. We report on a case of osteopenia in a 53-year-old female patient using antipsychotics for 30 years. We comment on the recommended procedures to detect osteopenia and on the existing guidelines for its management.

Estudos têm evidenciado o alto risco de osteoporose em pacientes esquizofrênicos. Alguns estudos têm demonstrado que os neurolépticos típicos e a risperidona podem induzir a osteoporose ou reduzir a densidade mineral óssea. Isso pode ser atribuído ao fato de estas drogas, em uso prolongado, induzirem a hiperprolactinemia a níveis acima do normal, em ambos os sexos, e a baixa dos níveis de estrogênio e de testosterona, aumentando o risco para osteopenia/osteoporose. Neste relato, será apresentado um caso de osteopenia em uma paciente mulher de 53 anos, em uso de antipsicóticos há 30 anos, sendo comentados os procedimentos recomendados para detecção dessa ocorrência e as diretrizes existentes para seu manejo.

Importance The treatment of schizophrenia remains a challenge, and the currently available antipsychotic drugs are slow acting and produce a number of adverse effects. Objective To examine the effectiveness and safety of a single intravenous administration of sodium nitroprusside (0.5 μg/kg/min for 4 hours) on the positive, negative, anxiety, and depressive symptoms in patients with schizophrenia. Design Single-center, randomized, double-blind, placebo-controlled trial performed from March 9, 2007, to March 12, 2009. Setting University teaching hospital in Sao Paulo, Brazil. Participants Twenty inpatients aged 19 to 40 years with a diagnosis of schizophrenia who were in the first 5 years of the disease who are taking antipsychotics. Intervention Sodium nitroprusside administration. Main Outcome Measures The 18-item Brief Psychiatric Rating Scale and the negative subscale of the Positive and Negative Syndrome Scale. Results After the infusion of sodium nitroprusside, a rapid (within 4 hours) improvement of symptoms was observed. The placebo and experimental groups had significant differences in the 18-item Brief Psychiatric Rating Scale total score and subscale scores, which persisted for 4 weeks after infusion. Conclusions The results clearly show a therapeutic effect of sodium nitroprusside. If this drug is approved for routine clinical use in patients with schizophrenia, this discovery will be an important advance in the pharmacologic treatment of this devastating disorder. Trial Registration clinicaltrials.gov Identifier:NCT01548612

To identify a classifier in schizophrenia, blood gene expression profiling was applied to patients with schizophrenia under different treatments and to controls. Expression of six genes discriminated patients with sensitivity of 89.3% and specificity of 90%, supporting the use of peripheral blood as biological material for diagnosis in schizophrenia., We thank Biobank of A.C. Camargo Hospital for RNA extraction of the samples. We also thank the Fundacao para a Ciencia e Tecnologia/FEDER (Portugal) grant POCI/SAU-ESP/58757/2004, the GRICES/CAPES International Collaborative Program (Portugal, Brazil) and the FIPE- HCPA for financial support.