Objetivos: mensurar e comparar os indicadores de prazer-sofrimento em enfermeiros brasileiros e portugueses de cuidados primários à pessoa/família no contexto do transtorno mental. Método: estudo quantitativo, descritivo-correlacional, multicêntrico, com 500 enfermeiros de Portugal e Brasil. Coleta realizada via Google forms de abril a agosto de 2018, com questionário sociodemográfico e escala de indicadores de prazer-sofrimento no trabalho. Resultados: nos dois países, o domínio gratificação-realização profissional foi avaliado como satisfatório; insegurança/falta de reconhecimento e desgaste/esgotamento como graves. Os enfermeiros portugueses avaliaram a liberdade de expressão como satisfatória, os brasileiros como crítica. Em ambos os países houve correlação da liberdade de expressão com tempo de atuação no serviço, carga horária de trabalho e gênero; insegurança com tempo de formação, atuação no serviço e carga horária de trabalho; desgaste-esgotamento com tempo de atuação no atual serviço e tempo de formação. Conclusão: os enfermeiros de ambos os países apresentaram níveis críticos de sofrimento no trabalho. Avaliam com gratificação e com possibilidade de realização profissional a condução de cuidado à pessoa e famílias no contexto do transtorno mental, mas sua liberdade de expressão está comprometida.
BackgroundThe corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).Case reportA 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.ConclusionThis case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionFertility and fecundity are usually considered signs of social and emotional well-being. Bipolar disorder (BD) is a prevalent psychiatric disease that influences the individual's life style and behaviours. Some studies have addressed the issue of fecundity among women with bipolar disorder but few have focused on determining the differences between disease subtypes, which is expected, taking into account the studied differences in demographic measures.ObjectivesTo examine the fecundity of a population of women with bipolar disorder.AimThe aim of this study is to compare the fecundity among women diagnosed with subtypes I to IV of BD, according to Akiskal's bipolar spectrum disorder classification.MethodsA total of 108 female outpatients were divided into four groups. We analyzed number of offspring and demographic features between patients with different subtypes of BD using multivariate analyses.ResultsOur results showed a significantly higher average number of children for BD IV patients when compared with BD I patients. Although not reaching statistical significance, BD I patients had less offspring than BD II and BD III patients. BD I patients had lower marriage rates compared to the other groups.ConclusionsOur results suggest that the subtype of bipolar disorder influences fecundity and behaviours, as is expressed by the lower number of marriages seen in BD I patients. We found that fecundity is significantly impaired among BD I patients, which may imply that female with more severe disorders are less likely to become parents. Fecundity is higher among BD IV patients, which makes a way to speculate about the adaptive role of hyperthimic temperamental traits.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Objetivo: Analisar presença de sofrimento psíquico em mulheres em situação de rua. Método: Estudo descritivo, exploratório, de abordagem qualitativa, com uso do referencial teórico da análise de conteúdo temático. Realizado em centro de acolhida tipo II de São Paulo. Feita entrevista com instrumento sobre perfil sociodemográfico e de morbidade e questões norteadoras. Entrevistas foram áudio gravadas, transcritas na íntegra e interpretadas conforme análise de conteúdo. Resultados: Dezesseis mulheres em situação de rua participaram do estudo, todas experienciavam sofrimento psíquico antes da situação de rua e uma vez nela, ele foi agudizado pelas adversidades na tentativa de sobrevivência, em meio a cotidiano permeado por condições subumanas, preconceitos, ociosidade, invisibilidade social, impedimentos para reinserção no mercado de trabalho, graves violações aos direitos humanos e as violências sofridas, incluindo a do Estado. Principais manifestações identificadas foram alterações de humor, de sono e apetite, estresse emocional, tentativas de suicídio, choros constantes, ansiedade, nervosismo e sintomas psicossomáticos. Conclusão: presença do sofrimento psíquico, deu-se em decorrência de um sistema capitalista, sexista e patriarcal que corrobora para a vulnerabilidade social por meio da desigualdade e exclusão sociais.
IntroductionPsychiatric disorders are frequent among patients with epilepsy. The association between epilepsy and mood disorders is recognized since the classical antiquity. Recent studies demonstrated that the prevalence of bipolar symptoms in epilepsy patients is more significant than previously expected. In the first half of the twentieth century, Kraeplin and Bleuler were the first to describe a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy and recently Blumer coined the term interictal dysphoric disorder to identify this condition. Although for some authors, the existence of this condition as a diagnostic entity is still doubtful, for others, it represents a phenotypic copy of bipolar disorder.ObjectivesIn this work, we start from the phenomenological similarities between the interictal dysphoric disorder and the bipolar disorder, to explore the neurobiological underpinnings that support a possible link between epilepsy and bipolar disorder.MethodsResearch of articles published in PubMed and other databases.ResultsInterictal dysphoric patients have features that resemble the more unstable forms of bipolar II disorder and benefit from the same therapy used in bipolar depression. Epilepsy and bipolar disorder share features like episodic course, the kindling phenomenon as possible pathogenic mechanisms and the response to antiepileptic drugs. The study of possible common biological processes like neurogenesis/neuroplasticity, inflammation, brain-derived-neurotrophic-factor, hypothalamus pituitary adrenal axis, provided promising but not consensual results.ConclusionsFurther efforts to understand the link between epilepsy and bipolar disorder could provide the insight needed to find common therapeutic targets and improve the treatment of both illnesses.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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