Esquizofrenia: se a morte acontece sem aviso prévio, o que devemos propor para o futuro próximo?

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaNational Institutes of Health National Institute of Mental HealthUNIFESP, EPMSciEL

SHAPS-C: the Snaith-Hamilton pleasure scale modified for clinician administration

Anhedonia, a diminished or lack of ability to experience and anticipate pleasure represents a core psychiatric symptom in depression. Current clinician assessment of anhedonia is generally limited to one or two all-purpose questions and most well-known psychometric scales of anhedonia are relatively long, self-administered, typically not state sensitive, and are unsuitable for use in clinical settings. A user-friendly tool for a more in-depth clinician assessment of hedonic capacity is needed. The present study assessed the validity and reliability of a clinician administered version of the Snaith-Hamilton Pleasure Scale, the SHAPS-C, in 34 depressed subjects. We compared total and specific item scores on the SHAPS-C, SHAPS (self-report version), Montgomery-Åsberg Depression Rating Scale (MADRS), and the Inventory of Depressive Symptomatology-Self Rating version (IDS-SR). We also examined construct, content, concurrent, convergent, and discriminant validity, internal consistency, and split-half reliability of the SHAPS-C. The SHAPS-C was found to be valid and reliable. The SHAPS and the SHAPS-C were positively correlated with one another, with levels of depression severity, as measured by the MADRS, and the IDS-SR total scores, and with specific items of the MADRS and IDS-SR sensitive to measuring hedonic capacity. Our investigation indicates that the SHAPS-C is a user friendly, reliable, and valid tool for clinician assessment of hedonic capacity in depressed bipolar and unipolar patients

Bioconcentration of Triclosan, Methyl-Triclosan, and Triclocarban in the Plants and Sediments of a Constructed Wetland

Triclosan and triclocarban are antimicrobial compounds added to a variety of consumer products that are commonly detected in waste water effluent. The focus of this study was to determine whether the bioconcentration of these compounds in wetland plants and sediments exhibited species specific and site specific differences by collecting field samples from a constructed wetland in Denton, Texas. The study showed that species-specific differences in bioconcentration exist for triclosan and triclocarban. Site-specific differences in bioconcentration were observed for triclosan and triclocarban in roots tissues and sediments. These results suggest that species selection is important for optimizing the removal of triclosan and triclocarban in constructed wetlands and raises concerns about the long term exposure of wetland ecosystems to these compounds

Construcción y validez, una prueba rápida para determinar la funcionalidad familiar

Introducción: Tanto las familias de la antigüedad como aquellas de las sociedades mo- dernas son dinámicas y evolutivas, sus funciones van acorde con alguna etapa de la sociedad. Con el paso del tiempo y el apoyo de intervenciones diversas, la familia mo- derna tiene cinco funciones principales: cuidado, afecto, expresión de la sexualidad y regulación de la fecundidad, socialización y estatus o nivel social.Objetivo: Elaborar y Determinar la validez de una prueba rápida para medir la funciona- lidad familiar.Diseño: Validación de instrumentos.Participantes: Jefes de familia que acudieran a consulta externa de la unidad de Medi- cina Familiar.Mediciones principales: Se diseñó un cuestionario con 5 preguntas para evaluar de forma rápida la funcionalidad familiar, cada una de éstas con 3 opciones de respuesta. El pilotaje fueron 40 jefes de familia.Resultados: Posterior a la evaluación de 3 expertos se modificaron las preguntas porque éstas utilizaban términos técnicos para el lector, las familias; finalmente, hubo una sola pregunta para cada una de las funciones de la familia propuestas por el consenso mexi- cano de medicina familiar de 2005. La confiabilidad se obtuvo con la determinación de un Alfa de Cronbach de .73, para la validez se realizó una correlación de Pearson ítem-test obteniendo un valor significativo con una r > .35 para cada ítem.Conclusión: Esta prueba es una opción válida y confiable para determinar la funcionali- dad familiar aplicable en la consulta del primer nivel de atención

Construcción y validez, una prueba rápida para determinar la funcionalidad familiar

Introducción: Tanto las familias de la antigüedad como aquellas de las sociedades mo- dernas son dinámicas y evolutivas, sus funciones van acorde con alguna etapa de la sociedad. Con el paso del tiempo y el apoyo de intervenciones diversas, la familia mo- derna tiene cinco funciones principales: cuidado, afecto, expresión de la sexualidad y regulación de la fecundidad, socialización y estatus o nivel social.Objetivo: Elaborar y Determinar la validez de una prueba rápida para medir la funciona- lidad familiar.Diseño: Validación de instrumentos.Participantes: Jefes de familia que acudieran a consulta externa de la unidad de Medi- cina Familiar.Mediciones principales: Se diseñó un cuestionario con 5 preguntas para evaluar de forma rápida la funcionalidad familiar, cada una de éstas con 3 opciones de respuesta. El pilotaje fueron 40 jefes de familia.Resultados: Posterior a la evaluación de 3 expertos se modificaron las preguntas porque éstas utilizaban términos técnicos para el lector, las familias; finalmente, hubo una sola pregunta para cada una de las funciones de la familia propuestas por el consenso mexi- cano de medicina familiar de 2005. La confiabilidad se obtuvo con la determinación de un Alfa de Cronbach de .73, para la validez se realizó una correlación de Pearson ítem-test obteniendo un valor significativo con una r > .35 para cada ítem.Conclusión: Esta prueba es una opción válida y confiable para determinar la funcionali- dad familiar aplicable en la consulta del primer nivel de atención

The Functional DRD3 Ser9Gly Polymorphism (rs6280) Is Pleiotropic, Affecting Reward as Well as Movement

Abnormalities of motivation and behavior in the context of reward are a fundamental component of addiction and mood disorders. Here we test the effect of a functional missense mutation in the dopamine 3 receptor (DRD3) gene (ser9gly, rs6280) on reward-associated dopamine (DA) release in the striatum. Twenty-six healthy controls (HCs) and 10 unmedicated subjects with major depressive disorder (MDD) completed two positron emission tomography (PET) scans with [11C]raclopride using the bolus plus constant infusion method. On one occasion subjects completed a sensorimotor task (control condition) and on another occasion subjects completed a gambling task (reward condition). A linear regression analysis controlling for age, sex, diagnosis, and self-reported anhedonia indicated that during receipt of unpredictable monetary reward the glycine allele was associated with a greater reduction in D2/3 receptor binding (i.e., increased reward-related DA release) in the middle (anterior) caudate (p<0.01) and the ventral striatum (p<0.05). The possible functional effect of the ser9gly polymorphism on DA release is consistent with previous work demonstrating that the glycine allele yields D3 autoreceptors that have a higher affinity for DA and display more robust intracellular signaling. Preclinical evidence indicates that chronic stress and aversive stimulation induce activation of the DA system, raising the possibility that the glycine allele, by virtue of its facilitatory effect on striatal DA release, increases susceptibility to hyperdopaminergic responses that have previously been associated with stress, addiction, and psychosis

Abnormality in glutamine-glutamate cycle in the cerebrospinal fluid of cognitively intact elderly individuals with major depressive disorder: a 3-year follow-up study

Major depressive disorder (MDD), common in the elderly, is a risk factor for dementia. Abnormalities in glutamatergic neurotransmission via the N-methyl-D-aspartate receptor (NMDA-R) have a key role in the pathophysiology of depression. This study examined whether depression was associated with cerebrospinal fluid (CSF) levels of NMDA-R neurotransmission-associated amino acids in cognitively intact elderly individuals with MDD and age- and gender-matched healthy controls. CSF was obtained from 47 volunteers (MDD group, N = 28; age- and gender-matched comparison group, N = 19) at baseline and 3-year follow-up (MDD group, N = 19; comparison group, N = 17). CSF levels of glutamine, glutamate, glycine, L-serine and D-serine were measured by highperformance liquid chromatography. CSF levels of amino acids did not differ across MDD and comparison groups. However, the ratio of glutamine to glutamate was significantly higher at baseline in subjects with MDD than in controls. The ratio decreased in individuals with MDD over the 3-year follow-up, and this decrease correlated with a decrease in the severity of depression. No correlations between absolute amino-acid levels and clinical variables were observed, nor were correlations between amino acids and other biomarkers (for example, amyloid-β42, amyloid-β40, and total and phosphorylated tau protein) detected. These results suggest that abnormalities in the glutamine–glutamate cycle in the communication between glia and neurons may have a role in the pathophysiology of depression in the elderly. Furthermore, the glutamine/glutamate ratio in CSF may be a state biomarker for depression

A wake-up call : Sleep physiology and related translational discrepancies in studies of rapid-acting antidepressants

Depression is frequently associated with sleep problems, and clinical improvement often coincides with the normalization of sleep architecture and realignment of circadian rhythm. The effectiveness of treatments targeting sleep in depressed patients, such as sleep deprivation, further demonstrates the confluence of sleep and mood. Moreover, recent studies showing that the rapid-acting antidepressant ketamine influences processes related to sleep-wake neurobiology have led to novel hypotheses explaining rapid and sustained antidepressant effects. Despite the available evidence, studies addressing ketamine's antidepressant effects have focused on pharmacology and often overlooked the role of physiology. To explore this discrepancy in research on rapid acting antidepressants, we examined articles published between 2009-2019. A keyword search algorithm indicated that vast majority of the articles completely ignored sleep. Out of the 100 most frequently cited pre clinical and clinical research papers, 89 % and 71 %, respectively, did not mention sleep at all. Furthermore, only a handful of these articles disclosed key experimental variables, such as the times of treatment administration or behavioral testing, let alone considered the potential association between these variables and experimental observations. Notably, in preclinical studies, treatments were preferentially administered during the inactive period, which is the polar opposite of clinical practice and research. We discuss the potential impact of this practice on the results in the field. Our hope is that this perspective will serve as a wake-up call to (re)-examine rapid-acting antidepressant effects with more appreciation for the role of sleep and chronobiology.Peer reviewe