-Background: Hemodialysis (HD)-related headaches are a common complaint of patients undergoing this procedure. Objective: To determine the frequency and clinical characteristics of headache in patients undergoing HD and to discuss their diagnostic criteria. Method: The present study assessed, in a prospective manner, a series of patients consulting at a HD center in Aracaju, Sergipe, Brazil, from November 2007 to January 2008. Only patients with HD-related headaches without previous history of primary headache were diagnosed as isolated HD headache (HDH). Results: Headache was reported by 76.1% of the patients studied. Prior to beginning dialysis, 47.9% had migraine without aura, 6.7% migraine with aura, 0.6% hemiplegic migraine, 5% episodic tension-type headache, and 2.5% migraine and tension-type headache. HDH was diagnosed in 6.7% of the patients, the most prevalent features being diffuse or temporal region location, bilateral headache, throbbing nature, and moderate severity. Seven patients with headaches between the sessions were not classified. Conclusion: While the pathophysiology of HDH is unknown, to diagnose patients with HDH or other possible HD-related headaches remains a challenge.Key WOrDS: hemodialysis headache, end-stage renal, clinical description, diagnostic criteria. Caracterização clínica da cefaléia da diálise em pacientes renais crônicosResumo -Cefaléias relacionadas ao programa de hemodiálise é uma queixa comum. Objetivo: Determinar freqüência e características clínicas das cefaléias em pacientes em regime de hemodiálise e discutir critérios diagnósticos. Método: Foi feita uma avaliação clínica prospectiva de pacientes cefalêicos em um serviço de hemodiálise em Aracaju, Sergipe, Brasil, de novembro de 2007 a janeiro de 2008. Apenas pacientes sem antecedente de cefaléia primária receberam diagnóstico de cefaléia da diálise isolada. Resultados: Cefaléia esteve presente em 76,1% dos pacientes estudados. Como antecedente de cefaléia, 47,9% tinham migrânea sem aura, 6,7% migrânea com aura, 0,6% migrânea hemiplégica, 5,5% cefaléia tensional episódica, e 2,5% associação de migrânea e cefaléia tensional. A cefaléia da diálise isolada foi diagnosticada em 6,7% dos pacientes e as localizações difusas e temporais, cefaléia bilateral, pulsátil, e intensidade moderada foram as características mais prevalentes. Conclusão: enquanto a fisiopatologia da cefaléia da diálise for desconhecida, o diagnostico da cefaléia da diálise ou de outras possíveis cefaléias relacionadas à diálise permanecerá um desafio.PAlAvrAS-CHAve: cefaléia da diálise, insuficiência renal terminal, características clínicas, critérios diagnósticos.

rESUMo objetivo: Determinar a frequência de sintomas depressivos em crianças e adolescentes com anemia falciforme, bem como caracterizar e associar tal sintomatologia aos dados individuais. Métodos: Realizou-se um estudo transversal com portadores de anemia falciforme dos 7 aos 17 anos, atendidos em um ambulatório de Hematologia Pediátrica, os quais preencheram o Inventário de Depressão Infantil (CDI). resultados: Foram avaliados 76 pacientes, estabelecendo-se em 13 o ponto de corte. Vinte e seis pacientes (34,2%) apresentavam sintomas sugestivos de depressão. "Não ser tão bom quanto os outros colegas" foi o item mais pontuado, além de ter predominado significativamente naqueles com escore de CDI maior ou igual a 13, assim como as variáveis: ter pais separados ou viúvos e renda familiar mensal menor ou igual a R$ 510,00. O item "preocupação com dores" foi bem pontuado, independentemente da presença de sintomas depressivos (p = 0,1). Conclusão: A depressão em crianças e adolescentes com anemia falciforme ainda é pouco estudada. Os dados obtidos indicam frequência elevada de sintomas depressivos nessa população. Possivelmente, conviver precocemente com a separação dos pais e pertencer a uma família com baixa renda esteja relacionado ao desenvolvimento desses sintomas.

AIMTo identify factors associated with depressive symptoms among inpatients with cardiovascular disease (CVD).METHODSThis is a cross-sectional study performed in a subsample of a large cross-sectional research that investigated affective disorders and suicide behaviour among inpatients hospitalized in non-surgical wards of the University Hospital of the Federal University of Minas Gerais from November 2013 to October 2015. Sociodemographic and clinical data were obtained through a structured interview and medical record review. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Scale, with scores ≥ 8 considered as positive screening for depression. We used the Fageström Test for Nicotine Dependence to characterize nicotine dependence. For assessing resilience and early-life trauma, we used the raw scores of the Wagnild and Young Resilience Scale and Childhood Trauma Questionnaire, respectively.RESULTSAt endpoint, we included 137 subjects. Thirty-eight (27.7%) subjects presented depressive symptoms and nine (23.7%) of those were receiving antidepressant treatment during hospitalization. The female sex; a lower mean educational level; a greater prevalence of previous suicide attempts; a higher level of pain; a higher prevalence of family antecedents of mental disorders; a lower resilience score; and higher childhood trauma score were the factors significantly associated with screening positive for major depression (P < 0.05). Multivariate analysis demonstrated that the factors independently associated with the depressive symptoms were a higher childhood trauma severity (OR = 1.06; P = 0.004); moderate to severe nicotine dependence (OR = 8.58; P = 0.008); and the number of previous hospital admissions (OR = 1.11; P = 0.034). The obtained logistic model was considered valid, indicating that the three factors together distinguished between having or not depressive symptoms, and correctly classified 74.6% of individuals in the sample.CONCLUSIONOur results demonstrate that inpatients presenting both CVD and a positive screening for depression are more prone to have antecedents of childhood trauma, nicotine dependence and a higher number of previous hospitalizations.

Objective: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management. Case description: We describe the case of a patient with anti--NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia. Comments: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis. Keywords: Anti-NMDAR encephalitis, consultation-liaison psychiatry, behavioral symptoms. ResumoObjetivo: Sintomas psiquiátricos surgem em estágios precoces da encefalite antirreceptor N-metil-D-aspartato (NMDAR), o que faz muitos pacientes procurarem tratamento em serviços de psiquiatria antes de se dirigirem a unidades de clínica geral. Embora muitos artigos sobre encefalite anti-NMDAR venham sendo publicados na comunidade científica internacional, poucos enfatizam o papel do psiquiatra no seu manejo sintomatológico. Descrição do caso: O presente artigo relata o caso de um paciente que desenvolveu encefalite anti-NMDAR em nosso serviço e discute manejo de alterações comportamentais com base na literatura científica atual. Altas doses de antipsicóticos atípicos e benzodiazepínicos foram usados para controle de agitação, e trazodona foi utilizada para tratar insônia. Comentários: A interconsulta psiquiátrica pode ajudar no ajuste de condutas de toda a equipe assistente para as complicações neuropsiquiátricas que possam surgir na evolução de pacientes internados por encefalite anti-NMDAR. Descritores: Encefalite anti-NMDAR, interconsulta psiquiátrica, sintomas comportamentais.

Associações entre doença autoimune e psicose sugerem papel importante do sistema imune na fisiopatologia dos sintomas psicóticos em pacientes com esquizofrenia e outras desordens psicóticas. São observados sintomas psicóticos com maior frequência no lúpus eritematoso sistêmico (LES), especialmente associado ao uso imunossupressores. Este relato descreve paciente com LES em atividade e a dificuldade no diagnóstico diferencial de sintomas psicóticos em concomitância à corticoterapia. Palavras-chave: Transtornos Psicóticos; Lúpus Eritematoso Sistêmico;Corticosteroides. RESUMOAssociations between autoimmune disease and psychosis suggest an important role of the immune system in the pathophysiology of psychotic symptoms in patients with schizophrenia and other psychotic disorders system. Psychotic symptoms are more frequently observed in patients with autoimmune diseases such as systemic lupus erythematosus (SLE). As well as, there is also an increased risk of psychotic symptoms during treatment with immunosuppressants. We report a case of a patient with SLE and discuss its difficulties in the differential diagnosis of psychotic symptoms in the presence of indicators of autoimmune activity and concomitant use of corticosteroids. ABSTRACTDiagnóstico diferencial de sintomas psicóticos em paciente com lúpus eritematoso sistêmico em uso de corticosteroides: relato de caso Rev Med Minas Gerais 2016; 26:e-1810

Chronic migraine is recognized as a migraine complication and is characterized by frequency of attacks up to 15 days/ month for more than three months, in absence of painkiller abusive usage. Studies indicate that magnesium ion plays a role in migraine pathophysiology but, until now, they have never included only patients with chronic migraine as their population. Objective: To compare serum magnesium levels etween treated and non-treated chronic migraineurs. Methods: Twenty-two patients with chronic migraine were selected and divided in two groups (treated and non-treated), matched by sex and age, and submitted to serum dosage of magnesium ion for latter comparison. Result: The non-treated chronic migraineurs presented serum magnesium ion level within normal limits, but lower than those found in the treated group with a statistically significant difference. Conclusion: Similarly to other studies in the literature, this study stresses the importance of magnesium ion in the migraine pathophysiology, but studying only the chronic migraine patients.