Psiquiatria

Major depressive disorder (MDD) is an incapacitating mental disorder associated with significant personal, social, and economic impairment. Patients with MDD present lower quality of life and higher prevalence of medical conditions, including epilepsy. Noninvasive brain stimulation (NIBS) is a technique that might aid in overcoming some of the current challenges related to pharmacotherapy. Trigeminal nerve stimulation is an incipient, simple, low-cost interventional strategy based on the application of an electric current over a branch of the trigeminal nerve with further propagation of the stimuli toward brain areas related to mood symptoms. We performed an open-label proof-of-concept trial using TNS for MDD. To the best of our knowledge, we present a TNS interventional protocol that has not been evaluated for MDD hitherto. A total of 11 patients were studied, with a mean age of 50.36 years (sd: 11.8 from 30 to 60). Only one patient was male. Regarding the main outcome, there was a reduction of depressive symptoms with a mean score of 5.72 (sd: 2.24) (p<0.001) on the HDRS-17. Considering a categorical analysis, all patients presented clinical response defined as a reduction of scores of at least 50%. Only one patient did not reach a remission score (defined as an HDRS score lower than 8). In the current neuromodulation scenario, clinical results have been working as truly hypothesis-driven forces, i.e., empirical observation and data analysis from different studies have been highlighting possible mechanisms related to the neurobiological functioning of neuromodulation strategies. The present results, however significant, need to be taken as hypothesis-driven given the study design. Data generalization is jeopardized due to the present study lacking a control group. Our results, therefore, may be overestimated due to intrinsic characteristics such as the placebo effect and Hawthorne effect. We present a proof-of-concept trial evaluating a new TNS protocol for depression. Data analysis underscores a significant participation of TNS in ameliorating depressive symptoms of patients with moderate or severe depressive episode. Further controlled studies will contribute to establish the clinical relevance of this new strategy for MDD.

This article develops a phenomenological contribution to biological psychiatry. Grounded in the principles of transformation, heterogeneity, proportionality and particularity, a paradigm of phenomenological orientation allocates to biology a role different from that assumed by official Cartesian psychiatry. First, no clear definition of what is biological may be established a priori—as a general application, and useful to each and every studied phenomenon. Biology may be understood only as the experience of ununderstandable elements within consciousness, and as belonging necessarily to a whole unity of conscious experience. Second, the research agenda in biological psychiatry necessarily intersects with the investigation of the particularities of each individual clinical case with its unique characteristics. Without this, the very notion of biological psychiatry becomes merely a theoretical abstraction. Finally, the continuity of the biological agenda needs to resume the construction and investigation of psychopathological categories that cohere with the reality of the mental universe.

This essay aims to examine the essence of drunkenness in its temporal and spatial dimensions. Despite the interest shown by phenomenological literature in the study of psychopathological consequences of acute and chronic drunkenness, the essential characteristics of drunkenness have not yet been addressed in depth. This essay claims that the temporal essence of drunkenness is the overwhelming, disintegrator of temporality's condition, which converges to its own extinction in a temporality, thus encompassing a distinct ability of assimilatory magnetization of the temporal dimensions. From the spatial standpoint, the essential manifestation of the condition of drunkenness is increased materiality, expressed by means of compression and exclusivity. At last, we show how the essence of drunkenness gradually leads to instability and decrease in the consciousness' ability of temporalization, which are both typical of a general condition of addiction.

The article explores the evolution of the Brazilian republic's laws and norms on mental illness during three periods. The first (1890-1910) saw the topic of mental pathology introduced into the State's realm of interest, with the main concern being to recognize and preserve the rights of those displaying such pathologies. During this period, mental alterations were understood in terms of neuropathology. The following period (1911-1945) saw expansion of government initiatives, with the same concerns as the previous period. The interpretation of mental illness did not undergo any major changes, although it broadened in scope. Marked by a discontinuity in relation to previous times, Brazil's developmentalist period (1946-1982) saw an economic developmentalist spirit hold sway, underpinned by humanist thought of conservative propensity. It brought a vigorous growth in the number of Brazilian hospitals, while interest in protecting the mentally ill continued.

This article investigates the existential conditions of possibility of a population of crack cocaine abusers in Brazil. This work initially describes the essence of the drug intoxication; after that, it identifies the anthropological situations at risk of crack abuse. It argues that an anthropological form denominated fusional existence, is specially vulnerable to the acute and transitory effect of the substance. This vulnerability occurs because of the pre- reflexive dominance of the present in relation to the other dimensions of the temporality. The article examines the ways of development of this existential form, concluding that the essence of crack dependence is a funneling, motivated by the condensation of the existence into a sole point of insertion in the world. This condition is accompanied by a rigid keeping of stabilized role identities, and even a reinforcement of colective values, that justifies the frequent psychopathogical findings in this group.

One hundred years after the publication of the first edition of KarlJaspers´ General Psychopathology, it is relevant an evaluation of its value. This article examines one section of this work, the phenomenology. In order to understand the meaning of a partial science in General Psychopathology, it is necessary the global aprehension of the work, i.e. its emphasis on the dialetical relationship between parts and totality. This article demonstrates that the notion of hermeneutic circle is the main principle of the General Psychopathology. As a consequence, phenomenology as an empirical science is, for Jaspers, only a
particular investigation method, separated from philosophical reflections on existence

ABSTRACT Estudos epidemiológicos em esquizofrenia estabeleceram que a idade de início para o gênero masculino precede em alguns anos aquela para o feminino. No entanto, tal efeito de gênero não vem sendo observado para os casos de esquizofrenia familiar, em que pelo menos dois membros de uma mesma família recebam o mesmo diagnóstico. Nosso estudo examina pela primeira vez esta questão em uma população brasileira. Estudamos 31 pacientes com diagnóstico de esquizofrenia pelos critérios RDC, provenientes de 13 famílias com dois ou mais afetados. Nossos resultados confirmam os da literatura internacional, não encontrando diferenças entre gênero masculino e feminino na idade de aparecimento dos sintomas. Estes resultados indicam a possibilidade da existência de influência genética na idade de início do transtorno e devem receber atenção de estudos em genética molecular.

Genetic factors play a role in the vulnerability to cocaine dependence. The reinforcing properties of cocaine are related to the dopaminergic system, and, in particular, the dopamine receptors have been linked to the reward mechanisms. The present study examines the role of the variants TaqI A of the dopamine D2 receptor gene and BalI of the dopamine D3 receptor gene in a Brazilian sample consisting of 730 cocaine dependents and 782 healthy controls. The studied polymorphisms did not show any difference in allelic frequencies or genotypic distribution between the groups. Our data do not support a role for the dopamine D2 receptor gene TaqI A and dopamine D3 receptor gene BalI gene polymorphisms in the susceptibility to cocaine dependence in a Brazilian sample.

Defendendo que o passado recebe seu sentido a partir da perspectiva de um pensamento presente em ato, este ensaio propõe uma orquestra de múltiplas tradições. Em harmonia com a observação das singularidades concretas e com uma programática desconfiança contra as generalizações, o que o paradigma antigo apresenta é o primado das relações de proporção como alternativa à hegemonia das classificações universais e abstratas. Nesse quadro teórico, o próprio discernimento entre o saudável e o patológico se faz em termos de uma distinção entre, respectivamente, um devir pessoal que não se deixa paralisar e um enrijecimento que compromete a aptidão do indivíduo para a multiplicidade simultânea - o espaço - e sucessiva - o tempo. Assim sendo, a estabilidade do objeto, que é uma condição epistêmica incontornável, poderia coincidir, no caso do conhecimento da vida psíquica, com a caracterização mesma da doença, de sorte que o psiquismo saudável, que não se fixa em nenhuma forma definitiva, tornar-se-ia incognoscível. A busca da solução para esse paradoxo é uma das principais linhas de força deste ensaio.

Este livro parte do princípio de que a diversidade de orientações psicopatológicas observadas ao longo da história seja devida a distintas posições epistemológicas assumidas por seus autores. Uma psicopatologia, seus conceitos e suas conclusões de dependem, portanto, do paradigma que a sustenta, declarada ou tacitamente. Optando por um paradigma da transformação (como pólo oposto de um paradigma da estabilidade) a reflexão contida neste livro examina as conseqüências da radicalização da opção voluntária na construção de uma ciência psicopatológica. 'Psicopatologia e transformação' retoma, relê e redimensiona certa tradição. Partindo de uma análise epistemológica dos antecedentes históricos dessa psicopatologia, apresenta propostas para a categorização fundamental de uma psicopatologia da transformação, desdobrada empiricamente em estudos sobre a consciência, sobre o movimento psíquico, sobre a interpessoalidade e em uma análise formal das transformações.

It is examined in this article the pertinence of the differential diagnosis between endogenous and exogenous psychoses, from a phenomenological point of view. Initially the author identifies the historical dualistic foundations of this distinction and then presents how a monistic ontology understands the theme of connection between phenomena. In order to disentangle the relations of connection in the phenomenological psychopathology it is necessary to replace the notions of cause and motivation – both referring to a dualistic point of view – by the notion of origin. The origin is determined by the meaning of the structure of the consciousness. Therefore, endogeneity and exogeneity may only be defined from the very innerness of this structure. A psychosis can be classified as endogenous if there is i. destruction of the primordial articulation of the structure, ii. hindering of resuming this articulation, and iii. autonomous actions of partial regions of the structure. Nevertheless, every non acute psychosis whose origin is external to the region of primordial articulation of the structure is exogenous. The limits and intertwining of these diagnoses are examined as well.

The aim of this work is the search for the best categories for the study of structure-materiality relationships, on which depends the coherent understanding of phenomenological psychopathology, psychology, and psychiatric practice. Structure is defined as a synthetic entity, relatively independent from its material components; materiality is defined - on an essentialist meaning - as solidity, intensity, and cyclical and mechanical modalities. The author supports the notion of a moderate structuralism. For the comprehension of such a structuralism it is necessary the simultaneous investigation of the logics of structure and materiality. Three modalities of typical relationships are examined and examples of each of them are offered.

A psicopatologia fenomenológica é uma ciência autônoma e independente, a psicopatologia fenomenológica teve, desde o seu início, a pretensão de fornecer fundamento epistemológico e empírico para o desenvolvimento mais acurado das práticas da psiquiatria e da psicologia clínica. Dentre as diversas correntes e acepções de psicopatologia fenomenológica, encontra-se a fenomenologia estrutural (termo cunhado por Eugène Minkowski), cuja visão de mundo inspira a maior parte dos autores dos artigos deste livro, reunidos sob a égide da Sociedade Brasileira de Psicopatologia Fenômeno-Estrutural (SBPFE). O intuito desta coletânea é apresentar à comunidade científica os caminhos contemporâneos que vem tomando essa escola clássica de psicopatologia no Brasil, em contínuo processo de renovação e recriação da tradição.

Aprendemos muito sobre a Dependência Química nos últimos 40 anos. No entanto, a área de psicopatologia não acompanhou todo esse avanço; permanecemos sem uma compreensão psicopatológica do adoecer psíquico que ocorre com o uso de substâncias. O livro do Prof. Dr. Guilherme Messas é uma grande contribuição nessa área. Desenvolve uma metodologia acerca de como a fenomenologia estrutural pode compreender toda a variedade do histórico das modificações produzidas na mente pelas intoxicações continuadas. Oferece um método, uma forma, uma estrutura para melhor observar esse fenômeno complexo. Mesmo para o não-iniciado em fenomenologia, esse método fica claro. Essa clareza é um componente essencial, uma característica do próprio método. A fenomenologia tem como objetivo primordial a investigação da psicopatologia tal e qual vivida pelo paciente. Seu procedimento é a análise, por via empática, das estruturas da vivência de cada paciente. Por esse motivo, sem deixar de lado a complexidade da experiência de cada indivíduo acometido por problemas com substâncias químicas, permite uma visão global e esclarecedora. Os casos clínicos expostos neste livro dão o testemunho dessa rica variabilidade de modos com que as substâncias obstruem uma vida

Even though psychopathology has consistently verified since its inception the coexistence of use/abuse of psychoactive substances and psychoses, the modalities of such association remain a psychiatric enigma. The epidemiological-semeiological literature, while investigating the relationships of causality, psychopathological typicality, and reasons for continued use even after psychological aggravation, is not conclusive. The aim of this paper is to offer a contribution from a phenomenological-psychopathological standpoint to the theme of relationships between psychosis and use/abuse of substances, allowing for a deeper anthropological understanding. The study defends that a phenomenological comprehension must have as an epistemological priority the investigation of the meanings of drug intoxication and the origins of psychosis. To do that, it is initially necessary that atemporalization be ackowledged as the essence of drug intoxication. Once existence is understood as a structured totality that evolves biographically, investigating the meanings of intoxication is synonymous with identifying how an atemporalizing influence acts upon a temporalized structure. From the meanings of intoxication it is then possible to determine two origins for psychotic outcomes: an endogenous origin, in which the primordial temporal meaning of existence is altered; and an exogenous origin, in which it is preserved. The two origins are not exclusive, and must be understood in terms of their proportional participation. Two clinical vignettes illustrate the use of such categories.