Peritraumatic dissociation has been considered an important feature for the development of post-traumatic stress disorders, but this concept remains widely unclear. To explore the peritraumatic experience, we interviewed eight victims of urban violence shortly after their traumatic events. The data collected were compared and analyzed according to the systematic set of procedures of Grounded Theory (GT). The alterations reported by participants were coded and categorized according to their perceptions of their inner and outer world, and the impressions of others involved, including the examiner's observations. The theoretical perspective for interpreting this study has parallels with Jaspers' psychopathology. Peritraumatic dissociation was conceived as a failure of synthesis among emerging stimuli from the internal and the external world, including the time-space flow structure, even when cognitive-perceptual tools remain intact. This synthesis qualifies the totality of the perceptual experience as coherent and meaningful to conscience, enabling possibilities for being/existing.

The domains of retardation and interest/fatigue are the most relevant for the diagnosis of major depressive episode after stroke.

The frequencies of coarctation and dilation of the aorta detected on magnetic resonance imaging were similar to those reported in the literature (5.5% to 20%, and 6.3% to 29%, respectively). This confirmed the adjuvant role of magnetic resonance imaging to Doppler echocardiography for diagnosing cardiovascular alterations in patients with Ullrich-Turner's syndrome.

ResumoContexto: A depressão pós-AVC (DPAVC) possui uma prevalência elevada. Apesar disso, ela é pouco detectada e tratada. Muitos fatores de risco e repercussões negativas na recuperação dos pacientes estão associados à DPAVC. Objetivo: Revisar alguns aspectos da DPAVC como: qualidade de vida, prejuízos cognitivos, eixo HHA, localização do AVC e tratamento. Métodos: Pesquisa dos últimos 10 anos da base de dados MedLine/PubMed usando as palavraschave post-stroke depression, stroke, quality of life, hypercortisolism, cogntitive dysfunction e treatment. Resultados: A prevalência de DPAVC é de 23% a 60%. Há poucos estudos sobre a incidência de DPAVC. A DPAVC está associada a pior prognóstico e evolução, agravo das disfunções cognitivas e redução da qualidade de vida. O hipercortisolismo está associado à DPAVC que ocorre tardiamente ao AVC. AVC em gânglios da base, região frontal esquerda e estruturas do circuito prefrontosubcortical está relacionado à frequência e à gravidade da DPAVC. Conclusões: É necessário melhoria na metodologia dos estudos para maior esclarecimento sobre a fisiopatologia da incidência da DPAVC. Programas objetivando o aumento das taxas de detecção dos pacientes deprimidos se fazem necessários inclusive para a redução dos impactos negativos na recuperação desses pacientes.Terroni LMN, et al. / Rev Psiq Clín. 2009;36(3):100-8 Palavras-chave: depressão pós-AVC, acidente vascular cerebral, qualidade de vida, disfunção cognitiva, hipercortisolismo, tratamento. AbstractBackground: The prevalence of post-stroke depression (PSD) is elevated. Some risk factors and poor outcome have been associated with PSD. The treatment of PSD reduced the negative impact in patients recovery. Appart from these data the PSD has been under diagnosed and under treated. Objective: Review some aspects such as quality of life, cognitive dysfunction, hypercortisolism, stroke localization and treatment of PSD. Methods: MedLine/PubMed database search using the terms post-stroke depression, stroke, quality of life, hypercortisolism, cognitive dysfunction and treatment, published in MedLine in the last 10 years. Results: PSD has a high rate of prevalence, from 23% to 60%. Few incidence rates are investigated. PSD is associated with poor outcome, increase of cognitive dysfunction and reduced quality of life. The hypercortisolism seems to be associated with PSD in the latter period of stroke. Stroke in the left frontal region, basal ganglia and some structures of prefrontosubcortical circuits have been related with

Objective: Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD. Methods: PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event.Results: The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQI-A-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD. Conclusion:The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings.

Background: Topiramate might be effective in the treatment of posttraumatic stress disorder (PTSD) because of its antikindling effect and its action in both inhibitory and excitatory neurotransmitters. Open-label studies and few controlled trials have suggested that this anticonvulsant may have therapeutic potential in PTSD. This 12-week randomized, double-blind, placebo-controlled clinical trial will compare the efficacy of topiramate with placebo and study the tolerability of topiramate in the treatment of PTSD.

BackgroundAnhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume.Patients and methodsA psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program according to the Brodmann Map to calculate the lesion volume.ResultsPatients with anhedonia had significantly larger diurnal variation (P-value =0.017) and higher morning levels of salivary cortisol (1,671.9±604.0 ng/dL versus 1,103.9±821.9 ng/dL; P-value =0.022), and greater stroke lesions in the parahippocampal gyrus (Brodmann area 36) compared to those without anhedonia (10.14 voxels; standard deviation ±17.72 versus 0.86 voxels; standard deviation ±4.64; P-value =0.027). The volume of lesion in the parahippocampal gyrus (Brodmann area 36) was associated with diurnal variation of salivary cortisol levels (rho=0.845; P-value =0.034) only in anhedonic patients.ConclusionOur findings suggest that anhedonia in stroke patients is associated with the volume of stroke lesion in the parahippocampal gyrus and with dysfunction of the hypothalamic–pituitary–adrenal axis.

Background: Peritraumatic dissociation has become increasingly important for both the diagnosis and the prognosis of Post-traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD). Changes in inflammatory mediators, immune-related genes and alterations of the hypothalamic-pituitary adrenal axis are suggestive findings that support the role of stress and neurodegeneration that might result in negative cognitive outcomes, such as dementia and other comorbidities. This study aims to describe an ASD case with persistent peritraumatic dissociation, its evolution to PTSD and the concomitant early onset demential syndrome. Methods and Findings: The patient, a woman, victim of urban violence, experienced peritraumatic dissociation; she was diagnosed with ASD and later developed PTSD and concomitant EOD, the latter being an unexpected and devastating outcome. Dissociative symptoms and cognitive impairment persisted throughout the patient's clinical status evolution. Moreover, the patient underwent a full psychiatric interview and was assessed through a battery of neuropsychological tests, neuroimage studies and a complementary examination. Over two years, no proposed treatment was satisfactory for improving her symptoms of PSTD and the neuropsychological evaluation confirmed EOD. Conclusion: This case illustrates that peritraumatic and persistent dissociation can be a possible psychopathological marker of neurodegeneration and an important factor for causing irreversible functional impairment.