Objective: To provide a description of our transsexual population. Method: This descriptive observational study included 138 patients with a diagnosis of Transsexualism in Brazil, between March 1998 and September 2005. Demographic, clinical and psychiatry data were collected.Results: Age ranged from 16 to 54 years; 88.4% were male. The prevalence of sexually transmitted diseases was 19.5%, and 17.6% were HIV-positive. Hormone therapy was reported by 91.2%, and 47.4% referred drug and alcohol use; 14.2%, attempted suicide; and 12.5%, history of sexual abuse. Self-mutilation was reported by 5.2%s. Fifty-nine patients (42.7%) had at least one currently psychiatric comorbidity (axis I or II).Conclusions: Mental health professionals have a central role in coordinating the multidisciplinary care of transsexuals.

Objective: To evaluate the impact of sex reassignment surgery on the defense mechanisms of 32 transsexual patients at two different points in time using the Defensive Style Questionnaire. Method: The Defensive Style Questionnaire was applied to 32 patients upon their admission to the Gender Identity Disorder Program, and 12 months after they had undergone sex reassignment surgery. Results: There were changes in two defense mechanisms: anticipation and idealization. However, no significant differences were observed in terms of the mature, neurotic and immature categories. Discussion: One possible explanation for this result is the fact that the procedure does not resolve gender dysphoria, which is a core symptom in such patients. Another aspect is related to the early onset of the gender identity disorder, which determines a more regressive defensive structure in these patients. Conclusion: Sex reassignment surgery did not improve the defensive profile as measured by the Defensive Style Questionnaire.

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Rev Bras Psiquiatr. 2005;27(4):341-8 346 Cartas aos editores escala, o propranolol (aproximadamente seis meses). Efeitos colaterais e tóxicos impediram o aumento delas e parece que, com o tempo, M. desenvolveu certa tolerância ao seu efeito. Com a introdução de 150 mg de topiramato/dia (50 mg 3x/dia), os níveis de irritabilidade e agressividade caíram muito, o que permitiu a redução e a retirada de outras medicações concomitantes. Já temos hoje um seguimento de nove meses e não houve, até o momento, o desenvolvimento de tolerância, como ocorreu com a clorpromazina e com o propranolol. O paciente, no momento, está em monoterapia com topiramato, 50 mg, 3x/dia. Eventualmente, quando necessita de um hipnótico, utiliza-se lorazepam 3 mg ao deitar. Assim, o topiramato mostrou-se uma medicação muito efetiva na redução da agressividade, irritabilidade auto e heterodirigida em uma criança autista. Ao nosso conhecimento, este é o primeiro relato da utilização exitosa do topiramato na agressividade/irritabilidade de pacientes com autismo automutilatório severo.