Rev Bras Psiquiatr. 2006;28(1):80-5 83 Cartas aos editores consagram o lítio como primeira escolha terapêutica em pra-ticamente todas as fases e apresentações do TB. 5 Conclui-se que os psiquiatras (principalmente aqueles em formação) de-vem ser estimulados a conhecer de forma precisa as indica-ções do lítio e aprenderem a utilizar esta medicação, que tem auxiliado tantos pacientes. O legado do brilhante professor e pesquisador Mogens Schou, falecido recentemente, permanece mais atual do que nunca. Alegre (RS), Brasil Referências 1. Fieve RR. Lithium therapy at the millennium: a revolutionary drug used for 50 years faces competing options and possible demise. Bipolar Disord. 1999;1(2):67-70. 2. Schou M, Juel-Nielsen N, Stromgren E, Voldby H. The treatment of manic psychoses by the administration of lithium salts. J Neurol Neurosurg Psychiatry. 1954;17(4):250-60. 3. Schlagenhauf G, Tupin J, White RB. The use of lithium carbonate in the treatment of manic psychoses. Am J Psychiatry. 1966;123(2):199-207. 4. Sr. Editor, Nos últimos anos, a psiquiatria brasileira avançou muito no sentido de declarar todo e qualquer potencial conflito de interesse. No último congresso da Associação Brasileira de Psiquiatria (ABP), em Belo Horizonte (MG), todos os partici-pantes foram solicitados a declarar qualquer envolvimento comercial que pudesse, mesmo que remotamente, influen-ciar as suas apresentações. A própria Revista Brasileira de Psiquiatria (RBP) tem orientações muito claras para os auto-res quando da submissão dos artigos. Por isso, foi com grande surpresa que li, na última edição da RBP, o artigo do grupo do GREA-USP, 1 no qual não consta o reconhecimento de conflitos de interesse. É fato público que pelo menos dois dos autores desse artigo trabalham ou trabalharam na época da submissão do artigo numa ONG com financiamento da indústria do álcool (CISA). Na área da dependência química, várias das principais re-vistas internacionais têm códigos muito bem definidos sobre fontes de potencial conflitos de interesse, especialmente quan-do se trata de profissionais que aceitam financiamento da in-dústria do cigarro e do álcool. A declaração de haver, por parte dos profissionais, o envolvimento com a indústria do álcool ou do cigarro, lógico que não coloca necessariamente sob suspeita todo o eventual trabalho sério do ponto de vista científico. No entanto, acho que é um direito dos leitores da RBP saberem as eventuais fontes de conflitos de interesse para desenvolverem a sua própria opinião sobre a influência dessas indústrias na qualidade dos artigos publicados. Espero que os editores da RBP possam corrigir essa falta de informação.
Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute mania. Although continuation of atypical antipsychotic adjunctive therapy after mania remission reduces relapse of mood episodes, the optimal duration is unknown. As many atypical antipsychotics cause weight gain and metabolic syndrome, they should not be continued unless the benefits outweigh the risks. This 52-week double-blind placebo-controlled trial recruited patients with bipolar I disorder (n=159) who recently remitted from a manic episode during treatment with risperidone or olanzapine adjunctive therapy to lithium or valproate. Patients were randomized to one of three conditions: discontinuation of risperidone or olanzapine and substitution with placebo at (i) entry (‘0-weeks' group) or (ii) at 24 weeks after entry (‘24-weeks' group) or (iii) continuation of risperidone or olanzapine for the full duration of the study (‘52-weeks' group). The primary outcome measure was time to relapse of any mood episode. Compared with the 0-weeks group, the time to any mood episode was significantly longer in the 24-weeks group (hazard ratio (HR) 0.53; 95% confidence interval (CI): 0.33, 0.86) and nearly so in the 52-weeks group (HR: 0.63; 95% CI: 0.39, 1.02). The relapse rate was similar in the 52-weeks group compared with the 24-weeks group (HR: 1.18; 95% CI: 0.71, 1.99); however, sub-group analysis showed discordant results between the two antipsychotics (HR: 0.48, 95% CI: 0.17; 1.32 olanzapine patients; HR: 1.85, 95% CI: 1.00, 3.41 risperidone patients). Average weight gain was 3.2 kg in the 52-weeks group compared with a weight loss of 0.2 kg in the 0-weeks and 0.1 kg in the 24-weeks groups. These findings suggest that risperidone or olanzapine adjunctive therapy for 24 weeks is beneficial but continuation of risperidone beyond this period does not reduce the risk of relapse. Whether continuation of olanzapine beyond this period reduces relapse risk remains unclear but the potential benefit needs to be weighed against an increased risk of weight gain.
The effect of cholesteryl sulfate, a natural membrane component, on the physical state of dipalmitoyl phosphatidylcholine multilamellar vesicles was investigated using fluorescence polarization and differential scanning calorimetry techniques. Cholesteryl sulfate increased the order of acyl chains for those temperatures higher than the gel‐to‐liquid crystalline transition temperature while it decreased the order for those temperatures below the phase transition temperature. At equimolar concentrations, cholesteryl sulfate suppressed the crystal liquid‐to‐gel phase transition of dipalmitoyl phosphatidylcholine. These data suggest that sterol sulfates may provide new tools for the elucidation of molecular mechanisms involved in sterollipid interactions.
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