Objective: To review current data concerning the management of agitated or aggressive patients. Method: A search was performed in the PubMed and Web of Science databases and empirical articles and reviews about pharmacological and non-pharmacological interventions for the management of agitation and/or violence were selected and analyzed. Results: The non-pharmacological management of agitation/aggression involves the physical organization of the emergency department and the adequacy of the behavior and attitudes of health professionals. The main goal of pharmacological management is rapid tranquilization, aimed at reducing symptoms of agitation and aggression without inducing deep or prolonged sedation, keeping the patient calm but fully or partially responsive. Polypharmacy should be avoided and medication doses should be as low as possible, adjusted according to clinical requirements. Intramuscular administration of drugs should be considered as a last option. Available options related to the use of antipsychotics and benzodiazepines are described and discussed. The physical management by means of mechanical restraint may be necessary in violent situations involving risks for the patient or staff and must be performed according to strict criteria. Conclusion: Procedures must be carefully implemented to avoid physical and emotional complications for patients and staff. Descriptors

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Converging evidence indicates that dysfunctions in glutamatergic neurotransmission and in the glutamate-glutamine cycle play a role in the pathophysiology of schizophrenia. Here, we investigated glutamate and glutamine levels in the blood of patients with recent onset schizophrenia or chronic schizophrenia compared to healthy controls. Compared with healthy controls, patients with recent onset schizophrenia showed increased glutamine/glutamate ratio, while patients with chronic schizophrenia showed decreased glutamine/glutamate ratio. Results indicate that circulating glutamate and glutamine levels exhibit a dual behavior in schizophrenia, with an increase of glutamine/glutamate ratio at the onset of schizophrenia followed by a decrease with progression of the disorder. Further studies are warranted to elucidate the mechanisms and consequences of changes in circulating glutamate and glutamine in schizophrenia.

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The main objective of this study was to promote the evaluation of an educational method to identify health risks among adolescents exposed to mercury by their work in gold mining production.The project was carried out with adolescents from a public school from the District of Monsenhor Horta, Municipality of Mariana, state of Minas Gerais. Statistical evaluation of the results revealed a significant increase in the amount of correct answers between the first and fifth stage concerning the definition of work accidents and its importance in relation to work-related diseases, accidents on route to and from the work place and violence at work site itself.

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O objetivo desta revisão é verificar, na literatura, uma relação entre níveis plasmáticos aumentados de corticosteróides e sintomas psiquiátricos, identificar as manifestações clínicas mais comuns e os tratamentos propostos. Alterações no eixo hipotálamo-hipófise-supra-renal levando a hipercortisolemia estariam associadas a distúrbios do humor, sobretudo depressão, enquanto que o uso de drogas glicocorticóides estaria relacionado ao aparecimento de sintomas psiquiátricos, como mania, depressão, labilidade afetiva e psicose. O levantamento bibliográfico foi realizado através dos indexadores Medline e Bireme no período de 1993 a 2003, em inglês, francês e espanhol, utilizando-se o cruzamento das seguintes palavras-chave: cortisol, corticosteróides, depressão, transtorno bipolar e psicose. Foram incluídos artigos originais (33) e de revisão (22) e excluídos relatos de caso. Alguns estudos sugerem que altas concentrações plasmáticas de cortisol, em longo prazo, podem levar à depressão, propondo que a utilização de drogas antiglicocorticóides teria efeito antidepressivo. Outros estudos, por outro lado, indicam não haver associação entre hipercortisolemia e episódios depressivos.

This paper evaluates the levels of exposure to and health effects of metallic mercury emissions into the atmosphere by gold dealers in the town of Poconé, Mato Grosso State, Brazil. The project was based on the comparison of referred morbidity, clinical examination, and metallic mercury urinary concentrations in three population groups. The first group consisted of downtown residents who were exposed to metallic mercury emissions. The second group resided on the outskirts of the town and the third in an agricultural area. Urinary concentrations of metallic mercury showed highly significant differences between groups from downtown and the outskirts as compared to the control group. Investigation of individuals with high concentrations showed that exposure in the downtown area might have come from gold dealers' establishments. In the group from the town outskirts, exposure might have been from amalgam-smelting done inside homes. Referred morbidity data showed an increased proportion of complaints and alterations in clinical examinations by downtown residents as compared to the other groups.It was concluded that there was a possibility of exposure and health effects caused by metallic mercury for residents from the first two groups.