RESUMOOs autores apresentam o caso de uma paciente de 61 anos, com antecedentes depressivos e história de síncopes, que desenvolve, no espaço de meio ano, alterações de comportamento pautadas por hiper-religiosidade, ideias delirantes de grandiosidade e fenômenos compatíveis com déjà vu. Nesse contexto, foi referenciada pelo médico de família para a urgência de psiquiatria, tendo sido realizada investigação orgânica e identificada epilepsia do lobo temporal após realização de eletroencefalograma. Foi medicada com valproato de sódio, na dose de 750 mg/dia, com esbatimento progressivo da sintomatologia psicótica. Com este trabalho, os autores pretendem sublinhar a importância da exploração orgânica dos sintomas neuropsiquiátricos, antes de atribuir um diagnóstico psiquiátrico ao paciente. ABSTRACTThe authors report the case of a 61 years-old woman, with history of depressive episodes and syncope, who developed hyperreligiosity, grandiose delusions and déjà vu. She was admitted to a psychiatry emergency and the electroencephalogram identified temporal lobe epilepsy. She was medicated with valproate sodium 750 mg/day with remission of psychotic symptoms and return to premorbid function. The purpose of this work is to highlight the importance of organic investigation in the assessment of neuropsychiatric symptoms.

Introdução: Objetivando comparar as predições de número de alunos no domínio do tempo através do processo de Markov e modelo linear em uma determinada academia de ginástica situada na Zona Oeste do Rio de Janeiro, foram analisados 367 alunos (179 mulheres e 188 homens) com idades entre 19 e 80 anos, freqüentadores regulares da academia entre julho/2004 e junho/2005. Materiais e Métodos: Os dados foram tomados do banco de dados da instituição, no qual a modalidade preferida era considerada como aquela com maior média de assiduidade em cada mês do período estudado. Inicialmente, foram estimadas as probabilidades condicionais para cada modalidade, as quais formaram a Matriz de Transição, após o que a teoria referente ao processo de Markov foi aplicada. Resultados: As predições assim obtidas foram comparadas àquelas do modelo linear (previamente existente na academia), em função do percentual médio de proximidade dos valores reais mensais, através do Teste de Mann-Whitney (α=0,05). Em todos os meses o modelo markoviano demonstrou maior proximidade signifi cativa dos valores reais. Discussão: Concluiu-se que esta aplicação estocástica, mantidas as condições iniciais, apresentava capacidade de predição do número de clientes externos por modalidade, superior à abordagem linear. Logo, cabe a extrapolação da aplicação, não dos resultados, por serem refl exos da organização do negócio da estudada academia.

Introduction: Genetic causes are responsible for half of the cases of hearing loss, most of them being the result of non-syndromic genetic changes resulting from autosomal recessive inheritance. Parental consanguinity might be an indicator to consider in the diagnosis of these cases. The aim of this study was to assess its importance as a risk factor for childhood hearing loss.Material and Methods: A retrospective cohort study conducted in a district hospital, between 2014 and 2018. We included all live births born during this period and excluded those with risk factors for childhood hearing loss other than parental consanguinity and those without hearing screening. We formed two study groups: newborns with parental consanguinity and newborns without risk factors. All the participants underwent hearing screening with the primary outcome of this study being the result of the screening. Those with a not normal result or with parental consanguinity also underwent diagnostic audiological evaluation.Results: Among 8513 live births, we studied 96 newborns with first-degree parental consanguinity and 96 newborns without risk factors. We found a statistically significant difference (p = 0.007) between the groups, with a ‘refer’ screening result rate of 24% in the group with parental consanguinity and 9.4% in the group without risk factors. We diagnosed one case of sensorineural hearing loss and another of mixed hearing loss in the first group andnone of these cases in the second.Conclusion: Parental consanguinity was associated with a higher risk of a refer screening result in newborns, which suggests the need to consider this as a risk factor for childhood hearing loss.

Suicide is the act of intentionally causing one's own death. It is often committed out of despair, the cause of which is attributed to a mental disorder, alcoholism, drug abuse or stress factors such as financial difficulties or troubles with interpersonal relationships. In the 20th century it is possible that more people have died from suicide than in the two great wars ocurred in the same century. The World Health Organization estimates that it is the 13th leading cause of death worldwide.This study aimed to describe the situation of different regions of central Portugal with regard to suicidal behavior in the general population, comparing different data from coastal and inland regions. The intention was also to compare these realities with nacional and european standards.The authors present a retrospective study of over 8000 forensic autopsies performed between 2006 and 2010 in the portuguese regions of Aveiro, Castelo Branco, Coimbra, Covilhã, Figueira da Foz, Leiria, Viseu and Tomar, of which around 15% were related to suicide. Several variables were characterized in order to establish the profile and circumstances of suicide in these regions.As the portuguese legislation predicts a forensic exam in cases of violent death, the continuous raise of the number of autopsies from suicides means that this trend shows an alarming increase. Data collected from forensic post mortem exams may prove essential to understand this phenomenon, which is a source of economical and social impoverishment.

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Suicide is the act of intentionally causing the one's own death and it can be explored by different studies using different methodologies, one of which is the statistical analysis of suicide, recognized by World Health Organization as very useful in research to gain a better understanding of the phenomenon.Research data from statistical analysis collected from various countries shows that there are gender-by-culture differences in rates of suicide completion and it has been reported that biological, social and psychological factors affect suicidal behavior differently in men and women.Several variables were characterized by the authors not only to establish the gender differences in suicide completion in the central Portugal but also to compare this reality with nacional and european patterns.The authors present a retrospective study of forensic autopsies performed between 2006 and 2010 in the central portuguese regions of Aveiro, Castelo Branco, Coimbra, Covilhã, Figueira da Foz, Guarda, Leiria, Viseu and Tomar. Among 8148 forensic autopsies 15% (N=1248) were due to suicide and data collected from these forensic post mortem exams helped to establish the profile and circumstances of suicide in men and women.Health care professionals must consider gender differences in treating patients who are at risk for suicide, although this field clearly deserves more research attention to generate information that can guide clinical practice and prevention strategies.

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Religious and spiritual experiences can appear in mental health practice as far as they often structure what aspects of psychopathological phenomena are present, sometimes making it difficult to determine whether some experiences should be classified as symptoms of a psychiatric disorder or crises within spiritual life.We present a clinical vignette of a 62-year-old sacristan who was admitted to the Psychiatric Emergency Room for suicidal thoughts in the context of physical sequelae of a cardiac episode. He confessed that, in the process of coping with his illness, he had a distressing experience of guilt and of losing his religious faith and shared the intention to take his own life by hanging himself.Themes that emerge in the discussion include issues related to the boundaries of psychiatric diagnosis, the spiritual dimension of mental health and the values that underlie clinical decision-making regarding a suicidal individual.Incorporating religious and spiritual perspectives in the clinical assessment of patients is essential to understand individual’s framework of cultural values and social attitudes on disease.