Para estimar a prevalência de transtornos do humor, foram utilizadas a entrevista estruturada, "Clinical Interview Schedule" (CIS-R), e a escala "Hospital Anxiety and Depression" (HAD) em 78 pacientes internados em uma enfermaria geral de adultos (43 homens e 35 mulheres, média de idade = 43,2 anos). Foi encontrada prevalência instantânea de 39% de transtornos do humor. Dezesseis (20,5%) pacientes preencheram critérios para ansiedade, a maioria dos casos sendo de gravidade leve. Vinte e seis (33%) casos de depressão foram detectados, 7 dos quais de gravidade moderada. Observou-se uma combinação de sintomas de preocupação, depressão, ansiedade e insônia. A HAD mostrou-se de fácil compreensão pelos pacientes. As subescalas de ansiedade e de depressão tiveram consistência interna de 0,68 e 0,77, respectivamente. A correlação dos itens com as respectivas subescalas sugere que essas possuem validades convergentes, não discriminantes. Com ponto de corte 8/9, a sensibilidade e a especificidade foram 93,7% e 72,6%, para ansiedade, e 84,6% e 90,3%, para depressão. Na prática clínica, a utilização da HAD poderia auxiliar na detecção de casos de transtornos do humor que necessitam de tratamento. Depressão, epidemiologia. Ansiedade, epidemiologa. Entrevista psiquiátrica padronizada. Pacientes internados. IntroduçãoA freqüência global de transtornos do humor em pacientes internados no hospital geral varia de 20% a 60% 11,13 . A variação nessas cifras depende da população estudada (características sociodemográficas, tipo de enfermidade, gravidade, cronicidade) e de definições metodológicas (critérios de inclusão, instrumentos de pesquisa, ponto de corte, definição de "caso" e outros).Dentre os transtornos do humor, as reações de ajustamento constituem o grupo mais prevalente. A exemplo do observado na assistência primária, o padrão mais comum de sintomas é de natureza indiferenciada, compreendendo uma combinação de preocupações excessivas, ansiedade, depressão e insônia 11,13 .Apesar de causarem considerável sofrimento e implicações clínica 15,19,21 , pelo menos um terço dos pacientes acometidos por transtornos do humor não são reconhecidos como tais pelos seus médi-cos 7 . Além disso, certos sintomas 'vegetativos' (fadiga, insônia, taquicardia, falta de ar, anorexia, diminuição da libido, e outros) podem ser decorrentes tanto de patologia orgânica quanto mental, confundindo o diagnóstico.Os citados sintomas encontram-se presentes na maioria das escalas de ansiedade e depressão. Em pesquisas epidemiológicas, tal fato pode superestimar a freqüência dos transtornos afetivos às custas de pacientes que, sem se encontrarem mentalmente enfermos, apresentem sintomas ocasionados pela patologia física. Outra dificuldade é que em hospital geral torna-se difícil diferenciar Separatas/Reprints: Neury J. Botega -Caixa Postal 6111 -13081-970 -Campinas -SP -Brasil -Fax: (0192) 53.1856 E.mail: Botega@ccvax. Unicamp.br. Edição subvencionada pela FAPESP. Processo 95/2290

IntroductionWernicke's encephalopathy is an acute, potentially fatal, neuropsychiatric syndrome resulting from thiamine deficiency. The disorder is still greatly under-diagnosed, and failure to promptly identify and adequately treat the condition can lead to death or to the chronic form of the encephalopathy - Korsakoff's syndrome. Wernicke's encephalopathy has traditionally been associated with alcoholism but, in recent years, there has been an increase in the number of clinical settings in which the disorder is observed.Case presentationWe report the case of a 45-year-old Caucasian woman who arrived at the emergency room presenting signs of marked malnutrition and mental confusion, ataxic gait and ophthalmoplegia. Main laboratory test findings included low serum magnesium and megaloblastic anemia. Brain magnetic resonance imaging revealed increased T2 signal in the supratentorial paraventricular region, the medial regions of the thalamus and the central and periaqueductal midbrain. The diagnosis of Wernicke's encephalopathy was made at once and immediate reposition of thiamine and magnesium was started. The patient had a long history of recurrent thoughts of being overweight, severe self-imposed diet restrictions and self-induced vomiting. She had also been drinking gin on a daily basis for the last eight years. One day after admittance the acute global confusional state resolved, but she presented severe memory deficits and confabulation. After six months of outpatient follow-up, memory deficits remained unaltered.ConclusionIn this case, self-imposed long-lasting nutritional deprivation is thought to be the main cause of thiamine deficiency and subsequent encephalopathy, but adjunct factors, such as magnesium depletion and chronic alcohol misuse, might have played an important role, especially in the development of Korsakoff's syndrome. The co-morbidity between eating disorders and substance abuse disorders has emerged as a significant health issue for women, and the subgroup of patients with anorexia nervosa who also misuse alcohol is probably at a particular risk of developing Wernicke-Korsakoff syndrome. The present case report highlights this relevant issue.

The 12-item General Health Questionnaire (GHQ-12) and the revised Clinical Interview Schedule (CIS-R) were used to estimate the prevalence of psychiatric morbidity among 78 consecutive admissions to a general medical ward in a Brazilian university hospital (43 males and 35 females; mean age = 43.2 years). The CIS-R was administered by three 5th-year medical students after a brief training. A prevalence rate of 36% was found for psychiatric disorders. The most frequent symptoms were sleep disorders (48.7%), worry (35.9%), depression (28.2%) and anxiety (26.9%). The sensitivity and specificity of the GHQ-12 were 71% and 76%, respectively. The CIS-R was simple to administer and acceptable both to patients and interviewers. Misunderstanding was most likely to occur with the poorly educated (20% were illiterate) in questions involving time calculation. Alternative options might be used to specify the length of time in future studies. The findings support the feasibility of the CIS-R and the use of 'lay' interviewers to produce epidemiological information on psychiatric disorders in developing countries at lower costs.

Positron emission tomography using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used in breast cancer. The new generation cameras integrate PET and CT within the same camera, allowing the simultaneous assessment of the structural and metabolic aspects of disease. There is presently a controversy on the clinical significance of osteoblastic bone metastases in breast cancer which are not detected on FDG-PET. It has been suggested that these radiologically dense lesions represent the result of successful treatment of initially osteolytic lesions. We report a case of a 65-year-old woman with a suspicion of recurrent breast cancer based on an increasing serum tumor marker. Serial PET/CT showed progressive blastic bone metastases on the CT without FDG uptake. These lesions were confirmed by bone single photon emission computed tomography. This case report shows: first, that progressive osteoblastic lesions can lack FDG-avidity, leading to a false-negative PET; and secondly, that bone scintigraphy should not be replaced by FDG-PET/CT for the detection of bone metastases in breast cancer.

The Functional Assessment of Cancer Therapy-Bone Marrow Transplant measures quality of life (QOL) in SCT patients. Prior reports found mixed results regarding QOL differences among autologous and allogeneic SCT patients. In addition, there is a paucity of literature examining differences in QOL patterns over time between autologous and allogeneic patients. The present study examines differences in QOL between patients free of clinical depression undergoing autologous (n ¼ 41) and allogeneic (n ¼ 64) SCT during early stages of treatment. Despite clinical differences, autologous and allogeneic patients demonstrated similar changes in QOL. The exception was the Functional subscale which indicated worse QOL for allogeneic patients at discharge (F test ¼ 4.61, df ¼ 1, Po0.05); allogeneic patients (Mean ¼ 13.06, s.d. ¼ 5.36) indicated they were less able to function at work and were less accepting of their illness than autologous patients (Mean ¼ 16.02, s.d. ¼ 6.73). There was a significant main effect for time on nearly all QOL subscales (Po0.05) demonstrating decline during treatment and return to baseline by discharge; only the Social Well-Being scale did not significantly change over time. These results help to understand patients' response to SCT in the earliest stages and ultimately help identify patients at risk who could benefit from therapeutic interventions.