Objective: There is strong evidence that family-based treatment is effective in cases of adolescent anorexia nervosa. Although family-based treatment has been studied in English-speaking countries, there is a need to examine the generalizability of this approach to non-English speaking cultures. This pilot-study aimed to examine the feasibility, acceptability, and effectiveness of family-based treatment in Brazil. Method: Observational study of adolescents with anorexia nervosa (excluding menstrual criteria), as determined with the Diagnostic and Well-Being Assessment, referred for treatment at a specialized center in São Paulo, Brazil. The following data were collected at baseline, at the end of treatment, and after six months of follow-up: weight; height; body mass index; menstrual status; Eating Disorder Examination Questionnaire score; and Children Global Assessment of Functioning Scale score. Results: Of 11 eligible patients/families, 9 (82%) enrolled in the study, and 7 (78%) completed the treatment. The mean patient age was 14.64 ± 1.63 years (range, 12.33-17.00 years). The Wilcoxon signed rank test showed statistically significant improvement in weight and body mass index at the end of treatment, as well as after six months of follow-up, at which point none of the patients met the diagnostic criteria for any eating disorder. Conclusion: The results suggest that family-based treatment is acceptable and feasible for Brazilian families. Outcomes suggest that the approach is effective in this cultural context, leading to improvements similar to those reported in previous studies conducted in other cultures. (DP = 1,63;12,00 Descriptors IntroductionAnorexia nervosa (AN) is a serious psychiatric disorder with a prevalence rate of 0.3% in adolescent females.1 AN is associated with a high mortality rate and is often complicated by psychiatric and medical comorbidity. The accumulated evidence supports the hypothesis that outcomes are better when adolescent patients and their parents are treated together. Studies suggest that family-based treatment (FBT), a method developed and described in a manual written specifically for AN by Lock (J.L.), is an effective treatment for AN.2-4 However, those studies were all conducted in Englishspeaking countries. The purpose of the current study is to examine the feasibility, acceptability, and effectiveness of this approach in Brazil.To date, there have been no studies examining FBT for AN in Brazil. Specialized clinical treatment for adolescent AN in Brazil in public care is limited to a multidisciplinary program either as an inpatient or outpatient in the hospital where this study was conducted and other outpatient programs in university hospitals. The alternative is treatment at private clinics, which are not accessible for most of the population. There is a need to examine treatment alternatives for AN in Brazil because of high costs, long waiting lists, and limited public resources. For example, the estimated average waiting time for treatment in a specialized ...

Objective: The prevalence of psychiatric disorders in childhood and adolescence ranges between 10% and 15%. The most frequent causes requiring psychiatric emergency care at this age are behavioral disturbances, suicidal behavior, and depression. The objective of this study is to present the most relevant clinical issues and to guide the initial procedures in psychiatric emergency care in childhood and adolescence. Method: This was a non-systematic review. Results: Relevant clinical issues for the evaluation of children and adolescents in psychiatric emergency settings are presented. Clinical presentations are divided in relevant groups of symptoms according to their frequency and impact on patients and their families. The following syndromes are presented: aggressive behavior, intoxications, suicidal behavior, psychosis, anxiety disorders, eating disorders, and abuse against children and adolescents. The initial procedures recommended for each of these conditions are described. Conclusion: Psychiatric emergencies in childhood and adolescence include relapse of pre-existing conditions and first episodes of psychiatric disorders. The objectives of emergency assessment are: establishment of the diagnosis, assessment of risks factors for the child/ adolescent, and identification of triggering and maintaining factors and of the presence of familiar and social support. Descriptors

Objective: The purpose of this study was to test the efficacy of clomipramine and fluoxetine, controlled by placebo, and compare their action in children and adolescents with anxiety disorders. Method: Thirty subjects (ages 7-17 years), who were diagnosed with generalized anxiety disorder and/or separation anxiety disorder and/or social phobia, were submitted to a 12 week double-blind, randomized, placebo-controlled trial of clomipramine and fluoxetine. The instruments included: the Schedule for Affective Disorders and Schizophrenia, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, the Clinical Global Impressions, and the Children's Global Assessment Scale. Results: All groups (clomipramine [n = 9], fluoxetine [n = 10], placebo [n = 11]) showed a significant improvement after 12 weeks of treatment. There were significant differences between the fluoxetine and placebo groups in some ratings of anxiety severity and impairment. No significant differences were observed between clomipramine and placebo groups or between fluoxetine and clomipramine groups. Conclusions: Treatment with placebo showed an unusual high response rate. Clomipramine showed similar efficacy compared with fluoxetine, although it was not superior to placebo.

No abstract

Objectives: To investigate the sociodemographic and clinical profile of patients receiving treatment at a specialized service for children and adolescents with eating disorders (ED) in São Paulo, Brazil, and to compare data with the relevant literature. Methods: This cross-sectional study assessed male and female patients with ED up to 18 years of age. All data were collected upon admission. Results: A total of 100 subjects were assessed. Mean age was 15.41±0.18 years, and mean age at ED onset was 13.5±0.19 years. Mean disease duration was 21.06 ±1.67 months. Of the total sample, 82% of the patients were female, 84% were Caucasian, 64% came from A and B economic tiers. Moreover, in 60% ED started at 14 years of age or less, and 74% had psychiatric comorbidities. Anorexia nervosa was the most prevalent diagnosis (43%). Hospitalized patients had lower body mass index, longer ED duration, and more severe scores on the Children's Global Assessment Scale than outpatients (p < 0.05). Conclusions: Our young Brazilian patients with ED present epidemiological and symptomatic characteristics very similar to those found in the scientific literature, including a high prevalence of psychiatric comorbidities. The higher frequency of full syndrome ED, the predominance of cases with an early onset, the delay in beginning specialized treatment, and the more severe state of inpatients provide grounds for concern because these factors differ from what has been reported in reference studies and indicate greater ED severity.

Background: Delusional misidentification syndromes are conditions in which the patients pathologically misidentify people, places, objects or events. They have been categorized in four subtypes: Capgras, Frégoli, intermetamorphosis and subjective double syndromes. Such syndromes may be present in patients with psychiatric disorders such as schizophrenia and mood disorders, and with neurological diseases such as Alzheimer, Parkinson and brain injury (trauma, vascular). Objectives: To describe and discuss a case of coexistent between Capgras and Frégoli syndromes in a female patient with paranoid schizophrenia and brain MRI findings. Methods: Psychiatric interview and brain MRI scanning. Results: The patient presented structural magnetic resonance imaging periventricular and subcortical white matter hyperintensities on flair images mainly concentrated in the right frontotemporal region and bilateral frontotemporal volume loss. Discussion: The described neuroimaging findings may represent an organic substrate to the delusional misidentification syndromes of the present case. The delusional symptoms in Capgras and Frégoli syndromes could be the result of a right temporolimbic-frontal disconnection which results in impossibility to associate previous memories to new information and consequently misidentifying symptoms. Moreover a volume loss of such cerebral regions, as observed in the present case, may also play a significant role in the development of delusional misidentification syndromes. G, et al. / Rev Psiq Clín. 2009;36(6):240-3 Keywords: Schizophrenia, neuroimaging, magnetic resonance imaging, pathophysiology, psychosis. Turkiewicz ResumoContexto: Transtornos delirantes de identificação são condições nas quais os pacientes identificam de maneira patologicamente equivocada pessoas, lugares, objetos ou eventos. Esses transtornos têm sido categorizados em quatro diferentes subtipos: Capgras, Frégoli, intermetamorfose e síndrome do duplo subjetivo. Tais síndromes podem estar presentes em diferentes transtornos psiquiátricos, como esquizofrenia e transtornos do humor, bem como em diferentes doenças neurológicas, como Alzheimer, Parkinson, lesões cerebrais traumáticas ou vasculares. Objetivos: Descrever e discutir um caso de coexistência entre as síndromes de Capgras e Frégoli em uma paciente com esquizofrenia paranoide e com alterações cerebrais. Métodos: Entrevista psiquiátrica e ressonância magnética de crânio. Resultados: A paciente apresentava hiperintensidades periventriculares em aquisição flair e de substância branca subcortical concentradas principalmente na região frontotemporal direita, bem como perda do volume da região frontotemporal bilateral. Discussão: As alterações descritas podem representar substrato orgânico das síndromes dos transtornos delirantes de identificação. Os delírios nas síndromes de Capgras e Frégoli podem ocorrer como reCoexistence of Capgras and Frégoli syndromes associated to frontotemporal volume reduction and cerebral white matter hyperintensities Coexistência das sín...

No abstract

A elaboração deste trabalho começou em 2007, com o estudo do método, tratamento familiar, e a definição do projeto de pesquisa, que posteriormente foi colocado em prática e executado com a participação de uma equipe de profissionais. Todo este percurso só foi possível com a colaboração de algumas pessoas que estiveram ao meu lado, às quais sou imensamente grata. Meu marido Marcelo, por sua admiração e respeito pelo meu trabalho, e por estar ao meu lado em todos os momentos. Minha orientadora e amiga, Bacy Fleitlich-Bilyk, por acreditar que este projeto seria possível, por sua parceria e orientação, e pela confiança que teve e tem em meu trabalho. James Lock, autor do manual de tratamento familiar para anorexia nervosa, por compartilhar conosco sua experiência clínica e em pesquisa, pela parceria e pela oportunidade de aplicarmos este método no Brasil. A equipe do PROTAD, com quem aprendi o significado de um verdadeiro trabalho em equipe. O grupo de terapeutas responsáveis pelo atendimento das famílias, por seu envolvimento e dedicação, e por acreditarem que estes pais seriam capazes de ajudar suas filhas. Sem este time, este trabalho não teria sido possível. Minhas queridas amigas Alicia Cobelo, Ana Paula Gonzaga e Manoela Nicoletti, terapeutas da primeira fase do estudo, que estiveram comigo desde o primeiro treinamento e leitura do manual, pelos atendimentos das primeiras famílias, e por tudo que me ensinaram com sua experiência e dedicação.