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Purpose Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. Methods Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb–Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan–Meier. Results From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease’s first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76–82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05–2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22–2.64, P = 0.003), age (HR 1.03, 95% CI 1.01–1.04, P

Made available in DSpace on 2021-06-25T11:03:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-03-01. Added 1 bitstream(s) on 2021-07-15T14:36:02Z : No. of bitstreams: 1 S0066-782X2021000400516.pdf: 3972880 bytes, checksum: b9bdbad26f21c4bcb57e0ea9683f5e70 (MD5) Universidade Federal de Goiás Liga de Hipertensão Arterial Pontifícia Universidade Católica de São Paulo Faculdade de Ciências Médicas e da Saúde Instituto do Coração (InCor) Centro Universitário CESMAC, AL - Brasil Universidade Federal de Pernambuco Pronto Socorro Cardiológico de Pernambuco (PROCAPE) Pontifícia Universidade Católica do Rio Grande do Sul Universidade Federal de São Paulo (UNIFESP) Hospital das Clínicas da Faculdade de Medicina da USP Serviço Hipertensão e Cardiometabolismo da Santa Casa de Porto Alegre Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo Hospital São Francisco Universidade Federal da Bahia (UFBA) BA - Brasil Faculdade Estadual de Medicina de São José do Rio Preto Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS) Universidade Federal do Paraná (UFPR) Hospital Agamenom Magalhães Hospital Alemão Oswaldo Cruz Universidade de São Paulo (USP) Universidade Estadual de Campinas (UNICAMP) Cardiocentro Universidade Federal do Rio de Janeiro (UFRJ) Universidade Estadual de Santa Cruz BA - Brasil Instituto de Cardiologia Fundação Universitária de Cardiologia (IC/FUC) Centro Universitário da Serra Gaúcha (FSG) Universidade Federal do Pará (UFPA) Ministério da Saúde Departamento de Cardiogeriatria da Sociedade Brazileira de Cardiologia Hospital Nossa Senhora da Conceição (HNSC) SC - Brasil Universidade Estácio de Sá (UNESA) Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR) Universidade Iguaçu (UNIG) Faculdade de Ciências Farmacêuticas de Ribeirão Preto da Universidade de São Paulo Associação Ribeirãopretana de Ensino Pesquisa e Assistência ao Hipertenso (AREPAH) Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo MT - Brasil Programa de Pós-Graduação em Medicina da Universidade Nove de Julho (UNINOVE) Instituto Dante Pazzanese de Cardiologia Hospital de Clínicas de Porto Alegre Escola Bahiana de Medicina e Saúde Pública BA - Brasil Universidade Santo Amaro (UNISA) SC - Brasil, Universidade Federal de Santa Catarina (UFSC) Hospital Israelita Albert Einstein Centro de Ciências da Saúde Universidade Federal do Espírito Santo Faculdade Ciências Médicas de Minas Gerais MG - Brasil Hospital Felício Rocho MG - Brasil Hospital do Coração (HCor) Instituto Estadual de Cardiologia Aloysio de Castro Centro Universitário de Tecnologia e Ciência (UniFTC) BA - Brasil Universidade Estadual Paulista (UNESP) Faculdade de Medicina da Universidade Federal de Mato Grosso MT - Brasil Sociedade Brazileira de Nefrologia Pontifícia Universidade Católica do Paraná Pontifícia Universidade Católica de Goiás Cardios Vita Centro de Medicina Cardiológica Hospital Pró-Cradíaco MG - Brasil, Universidade Federal de Juiz de Fora Avancor Cardiologia Universidade Estadual de Maringá Faculdade de Ciências Médicas da Santa Casa de São Paulo Universidade Federal de Uberlândia MG - Brasil Hospital Getúlio Vargas Universidade Estadual Paulista (UNESP)

Background Resistant (HR) and refractory hypertension (HRef) are associated with increased cardiovascular events and target-organ damage. However, appropriate HR and HRef diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake in clinical practice. Purpose To evaluate whether hospitalization for confirming anti-hypertensive adherence in patients with HR and HRef may impact blood pressure (BP) control after hospital discharge in patients with HR or HRef suspicious at a tertiary outpatient clinic. Methods We recruited consecutive patients with HR or HRef suspicious admitted to the Hospital for confirming treatment adherence. HR was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. HRef was defined as no BP control despite using ≥5 antihypertensive drugs. Patients with suspected HRef who did not meet the criteria but full field the HR definition were named HRNoRef. During hospitalization, all patients used low sodium diet and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and HF/HRef status but also BP and number of antihypertensive drugs at hospital discharge and in the two first return outpatient's visits. Results We studied a total of 83 patients with suspected HR/HRef (age 53±14 years; 76% females; pre-hospitalization systolic and diastolic BP: 177±28 and 106±21mmHg, respectively). Of these, 68.7% (57 patients) had suspected HRef in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of HR fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p Conclusion Supervised medication intake during hospitalization may help not only to define the HR and HRef status but also to have impact on the number of antihypertensive drugs and lower BP values at short and mid-term follow-up. Funding Acknowledgement Type of funding source: None

Obstructive Sleep Apnea (OSA) is a common condition characterized by intermittent collapse of the upper airway during sleep, resulting in partial (hypopnoeas) and total obstructions (apneas). These respiratory events observed in OSA may trigger multiple pathways involved in the blood pressure (BP) instability during the night and potentially influencing daytime BP as well (carry-over effects). This review provides an update about the impact of OSA and its treatments on 24-h BP control. Overall, there is growing evidence suggest that OSA is associated with higher frequency of nondipping BP pattern and nocturnal hypertension in a dose-dependent manner. The presence of nondiping BP (especially the reverse pattern) is independently associated with OSA regardless of sleep-related symptoms suggesting a potential tool for screening OSA in patients with clinical indication for performing ABPM. Beyond dipping BP, preliminary evidence associated OSA with white-coat effect and higher frequency of masked hypertension and BP variability than the control group (no OSA). Unfortunately, most of the evidence on the evidence addressing the impact of OSA treatment on BP was limited to office measurements. In the last years, data from observational and randomized studies pointed that CPAP is able to promote 24-h BP decrease especially in patients with resistant and refractory hypertension. A randomized trial suggests that CPAP is able to decrease the rate of masked hypertension as compared to no treatment in patients with severe OSA. Interestingly, nondipping BP is a good predictor of BP response to CPAP making ABPM an interesting tool for better OSA management.

Purpose of Review There is increasing evidence indicating an association between several risk factors and worse prognosis in patients with coronavirus disease 2019 (COVID-19), including older age, hypertension, heart failure, diabetes, and pulmonary disease. Hypertension is of particular interest because it is common in adults and there are concerns related to the use of renin-angiotensin system (RAS) inhibitors in patients with hypertension infected with COVID-19. Levels of angiotensin-converting enzyme 2 (ACE2), a protein that facilitates entry of coronavirus into cells, may increase in patients using RAS inhibitors. Thus, chronic use of RAS inhibition could potentially lead to a more severe and fatal form of COVID-19. In this review, we provide a critical review to the following questions: (1) Does hypertension influence immunity or ACE2 expression favoring viral infections? (2) Are the risks of complications in hypertension mediated by its treatment? (3) Is aging a major factor associated with worse prognosis in patients with COVID-19 and hypertension? Recent Findings Despite the potential involvement of immune responses in the pathogenesis of hypertension, there is no evidence supporting that hypothesis that hypertension or RAS inhibitors contributes to unfavorable outcomes in viral infections. Future investigations adopting a strict protocol for confirming hypertension status as well as assessing associated comorbidities that may influence outcomes are necessary. From the therapeutic perspective, recombinant ACE2 may serve as a potential therapy, but relevant studies in humans are lacking. Definitive evidence regarding the use of RAS inhibitors in patients with COVID-19 is needed; 5 randomized trials examining this issue are currently underway. Summary There is no current scientific support for claiming that hypertension or its treatment with RAS inhibitors contribute to unfavorable outcomes in COVID-19.

Background The boundary between Dermatology and Psychiatry has increasing recognition. Psoriasis is a common psychophysiological skin disease with a major impact on patient's quality of life and a paradigmatic example of a pathology in that boundary. Studies are needed to exactly point out the prevalence of specific psychopathology and mental disorders associated with psoriasis. This work intends to analyse the prevalence of psychopathology and psychiatric comorbidities in patients with psoriasis. Methods A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the "5S" model proposed by Haynes. From all the papers retrieved by this search, a total of 34 papers met the inclusion criteria and were then deeply analysed. Results The most prevalent mental disorders in these patients are sleep disorders (average prevalence: 62.0%), sexual dysfunction (45.6%), personality (35.0%), anxiety (30.4%), adjustment (29.0%), depressive (27.6%) and substance-related and addictive disorders (24.8%). Other mental disorders have been less described, namely somatic symptoms and related disorders, schizophrenia and other psychoses, bipolar disorder and eating disorders. Conclusions This updated research shows that the prevalence of psychiatric conditions in psoriasis may range from 24% to 90%. The study of the mind-skin connection in psoriasis may improve the knowledge about psoriasis and its psychiatric comorbidities. The link between psoriasis and associated mental disorders is frequently forgotten or not considered in the clinical practice. Psychiatric disorders in patients with psoriasis may be underdiagnosed. These patients would really benefit from psychiatric assessment, with therapeutic relevance.

ContextPrimary aldosteronism (PA) is the most common cause of endocrine hypertension (HT). HT remission (defined as blood pressure ObjectiveTo determine clinical and molecular features associated with HT remission after adrenalectomy in patients with unilateral PA.MethodsWe retrospectively evaluated 100 patients with PA (60 women; median age at diagnosis 48 years with a median follow-up of 26 months). Anatomopathological analysis revealed 90 aldosterone-producing adenomas, 1 carcinoma, and 9 unilateral adrenal hyperplasias. All patients had biochemical cure after unilateral adrenalectomy. KCNJ5 gene was sequenced in 76 cases.ResultsKCNJ5 mutations were identified in 33 of 76 (43.4%) tumors: p.Gly151Arg (n = 17), p.Leu168Arg (n = 15), and p.Glu145Gln (n = 1). HT remission was reported in 37 of 100 (37%) patients. Among patients with HT remission, 73% were women (P = 0.04), 48.6% used more than three antihypertensive medications (P = 0.0001), and 64.9% had HT duration ConclusionThe presence of a KCNJ5 somatic mutation is an independent predictor of HT remission after unilateral adrenalectomy in patients with unilateral PA.

The authors developed a method for measuring the telic sensitivity of individual members in a group, derived from the sociometric test, which has to be previously performed. Such a measure is subdivided into 4 indices: composite indices of Positive and Negative Perception , and composite indices of Positive and Negative Mutuality . Each index scores from 0 to 100. The indices have a normal distribution and, whenever the choices are randomized, an expected mean of 50 ( SD = 11.3), irrespective of the size of the groups and the number of the received preferences and rejections. Young girls and boys (mean age 12 years) in actual school groups tend to have higher scores, especially for Positive Perception and Positive Mutuality , as opposed to randomized virtual groups. The authors identify other results in order to exemplify future research in clinical and organizational psychology settings.

Resistant hypertension (RH) is a growing clinical condition worldwide associated with target-organ damage and poor prognosis compared to non-resistant counterparts. The purpose of this review is to perform a critical evaluation of preferable drug choices for managing RH highlighting the evidence that significant proportion of patients remained uncontrolled despite using four anti-hypertensive drugs. Until recently, the fourth drug therapy was main derived from personal opinion or small interventional studies. The recent data derived from two multicentric randomized trials, namely PATHWAY-2 and ReHOT, pointed spironolactone as the preferable fourth drug therapy in patients with confirmed RH as compared to bisoprolol and doxazosin (PATHWAY-2) as well as clonidine (ReHOT). However, significant proportion of patients (especially observed in ReHOT trial that used 24-h ambulatory blood pressure monitoring) did not achieve optimal blood pressure with the fourth drug. This finding underscores the need of new approaches and treatment options in this important research area. The current evidence pointed that significant proportion of RH patients are requiring more than four drugs for controlling BP. This statement is particularly true considering the new criteria proposed by the 2017 Guidelines for diagnosing RH (> 130 × 80 mmHg). New combinations, drugs, or treatments should be tested aiming to reduce the RH burden. Based on the aforementioned multicentric trials, we proposed the first five preferable anti-hypertensive classes in the overall context of RH.

Background. Salt sensitivity is associated with an increased cardiovascular risk, but the gold standard method (diet cycles) requires 24-h urine samples and has poor patient compliance. Objectives. Test the hypothesis that oral fludrocortisone (0.4 mg per day for 7 days) is a good alternative in identifying salt-sensitive patients. Methodology. We conducted a randomized crossover study with 30 hypertensive individuals comprising the following steps: (1) washout; (2) phase A (low- and high-sodium diet cycles); (3) washout 2; (4) phase B (fludrocortisone test). Phase A and B steps were performed in a random way. Consistent with the literature, we found that 53.3% were salt-sensitive according to the reference test. Using the ROC curve, the fludrocortisone test defined salt sensitivity by a median blood pressure increase of ≥3 mmHg. A good accuracy of fludrocortisone in detecting salt sensitivity was observed (AUC: 0.732±0.065; p Conclusion. The fludrocortisone test is a good option for screening salt sensitivity in hypertensive patients. However, the low specificity prevents this test from being an ideal substitute to the labor-intensive diet cycles exam in the definition of salt sensitivity. This clinical trial is registered with NCT01453959.

Meaning is a concept which is discussed everywhere. Besides being a common word, it is relevant for cognitive and linguistic studies. Nevertheless, translation problems and the specific definition of similar concepts by different disciplines hamper the discussion. In this paper, the authors discard some popular ideas about meaning (as being an image, an object or the relationship between signs), and highlights its relation with intentions, and the new concept of “embodied meaning”. Following a suggestion by Timothy Crow, who studied schizophrenia and brain lateralization, the authors conclude that the right hemisphere (in right handed people) processes intentions and meanings, whereas the left hemisphere processes the signifier part of signs, including words, and their relationship to each other (the sense). This vision can elucidate some problems of Psychopathology and Philosophy of Mind.

A psicose puerperal (PP) é um quadro clínico exuberante, com uma frequência estimada de 1 caso por cada 1.000 puerpérios, e que tem sido associado com maior consistência ao espectro bipolar. A evidência científica disponível é escassa, nomeadamente no respeitante à orientação terapêutica. Os autores apresentam o caso clínico de uma mulher primípara de 28 anos, sem antecedentes psiquiátricos, que iniciou nas primeiras semanas de puerpério um quadro psicótico florido, composto por agitação psicomotora, confusão, desorganização do pensamento e comportamento, sintomatologia psicótica e insônia grave. Por ausência de resposta ao tratamento farmacológico, houve recurso à eletroconvulsoterapia (ECT), com melhoria clínica rápida e evidente. Nesse contexto, os autores realizaram uma apreciação da literatura e evidência referentes ao uso de ECT na psicose puerperal. Puerperal psychosis (PP) is an exuberant clinical syndrome with an estimated frequency of 1 case per 1,000 childbirths that has been most consistently associated with the bipolar disorders spectrum. Available evidence is scarce, namely regarding management and treatment. The authors present the clinical case of a 28 year-old first-time mother, with no psychiatric history, who developed a florid psychotic syndrome in the first weeks of puerperium. Due to lack of improvement following pharmacological treatment, electroconvulsive therapy (ECT) was applied, with substantial and quick response. In this context, the authors reviewed current literature on the use of ECT for the treatment of puerperal psychosis.

Objective: Conversion, dissociation and somatization are historically related in the long established concept of hysteria. Somewhere along the way they were separated due to the Cartesian dualistic view. The aim of the present study was to compare these pathologies and investigate whether symptoms of these pathologies overlap in their clinical appearance in a Portuguese sample. Method: Twenty-six patients with conversion disorder, 38 with dissociative disorders, 40 with somatization disorder, and a comparison group of 46 patients having other psychiatric disorders answered questions about dissociation (Dissociative Experiences Scale), somatoform dissociation (Somatoform Dissociation Questionnaire), and psychopathological symptoms (Brief Symptom Inventory). Results: Dissociative and somatoform symptoms were significantly more frequent in dissociative and conversion disorder than in somatization disorder and controls. There were no significant differences between dissociative and conversion patients. Conclusions: Conversion disorder is closely related to dissociative disorders. These results support the ICD-10 categorization of conversion disorder among dissociative disorders and the hypothesis of analogous psychopathological processes in conversion and dissociative disorders versus somatization disorder.

Previous studies have shown that circulating levels of cytokines are increased in patients with congestive heart failure (CHF), resulting in myocardial depression. In this work, we have determined serum levels of TNF-α and IFN-γ by ELISA, detected sTNFR-I by dot ELISA, as well as TNFα, IL-6, IL-10 and granulysin mRNA in unstimulated peripheral blood mononuclear cells (PBMC) by RT-PCR in CHF patients. Such patients were classified using New York Heart Association criteria and compared to a control group of volunteers without CHF. The performed echocardiographic evaluations showed a significant difference between the control group and the patients. Additionally, the ejection fraction and the left ventricular fractional shortening showed a direct relation with functional classes, varying in inverse proportion. Generally, the studied cytokines in serum or PBMC did not correlate either to functional classes or to the presence/absence of CHF. However, the granulysin mRNA was detected in most of the patients tested as compared to controls. Moreover, the qualitative detection of the sTNFR-I also made it possible to discriminate between patients and the control group. Functional classes could be separated because of a direct association between CHF severity and elevated levels of sTNFR-I, defined by intensity of signal in dot-ELISA. Our results suggest that detection of granulysin mRNA as well as the detection of sTNFR-I appear to have a clinical relevance as markers of immune activation in CHF.

To compile data on Tourette's syndrome (TS), tics and associated disorders. METHODS: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included. RESULTS: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders. CONCLUSIONS: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance.

Objective: To compile data on Tourette's syndrome (TS), tics and associated disorders.Methods: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included.Results: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders.Conclusions: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance. Objetivo: Compilar o conhecimento existente sobre a síndrome de Tourette (ST), tiques e patologias associadas.Metodologia: Foi realizada uma revisão sistemática da literatura usando os níveis 5S (sistemas, sumários, sinopses, sínteses e estudos) de organização de evidência de pesquisa em saúde, com base no modelo proposto por Haynes. Os termos de busca foram Tourette, tiques e comorbidades, completados por pesquisa por referência cruzada. Os artigos fornecidos pelos editores e aqueles a serem processados para publicação em 31 de julho de 2013 também foram incluídos.Resultados: De todos os artigos encontrados durante a pesquisa, 64 foram selecionados porque analisavam a epidemiologia, as características clínicas e a etiopatogenia da ST. A ST define-se como um distúrbio hipercinético do movimento, e pelo menos 90% dos pacientes apresentam comorbidades neuropsiquiátricas, das quais as mais comuns são a perturbação de déficit de atenção com hiperatividade e a perturbação obsessivo- -compulsiva. Esta síndrome é clinicamente heterogênea e tem sido relacionada com a disfunção dos circuitos córtico-estriado- -tálamo-corticais envolvendo vários neurotransmissores. Apesar de sua etiologia genética ter sido amplamente estudada, outros fatores podem ser importantes para entender esta síndrome e as perturbações relacionadas.Conclusões: A ST resulta de uma perturbação do desenvolvimento neurológico causado pelo impacto de fatores de estresse num substrato biológico vulnerável durante os períodos críticos do desenvolvimento neurológico. O estudo da ST e das suas comorbidades poderá contribuir, em diferentes níveis, para o entendimento de várias perturbações neuropsiquiátricas com relevância clínica e terapêutica.

The author begins by commenting on the difficulty of the semantic delimitation between concepts of affect, emotion, sentiment, feeling, mood, and passion. This difficulty becomes greater when the terms are translated into different languages. He then foccuses on the concept of emotion, which has benefited from recent research, and its distinction from mood, a concept which is at the base of the psychopathology of bipolar disorders. Much more complex is the Portuguese concept of affect (different from the English concept), which has an interpersonal dimension and can be developed from recent discoveries of “mirror neurons” and “theory of mind”., O autor começa por comentar a dificuldade de delimitação semântica entre os conceitos de afecto, emoção, sentimento, estado de ânimo, humor, paixões e aparentados, dificuldade esta que se agrava quando os termos são traduzidos em línguas diferentes. Centra-se depois no conceito de emoção, que tem beneficiado de investigação recente, e da sua distinção do humor, um termo que fundamenta a psicopatologia das perturbações bipolares. Muito mais complexo se revela o conceito de afecto, que tem uma dimensão interpessoal e que se pode elaborar a partir das recentes descobertas dos “neurónios-espelho” e da “Teoria da Mente”.

Three decades after J. L. Moreno's death, psychodrama has expanded around the world. During this time, it has often been observed that psychodrama does not appear to have its own underlying theory, and a range of psychological theories has been used to augment the theoretical basis of psychodrama. Moreno himself may be partly responsible for this, as he proposed action instead of theoretical 'cultural conserves'. It is also true that external theories may be purposefully and beneficially adapted to psychodrama practice. In this chapter we explore these and related issues and describe how theory is embedded in the psychodramatic method.