Mario F Juruena - Profile on Academia.edu (original) (raw)

Papers by Mario F Juruena

Inserção de um hospital-dia na rede de atenção em saúde mental

Resumo - Objetivo: Descrever a insercao do Hospital-Dia do Hospital das Clinicas da Faculdade de ... more Resumo - Objetivo: Descrever a insercao do Hospital-Dia do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo, na rede de atencao em saude mental do Departamento Regional de Saude XIII, no Estado de Sao Paulo. Metodo: Estudo de caso associado as tecnicas da revisao documental. Foram visitadas 13 das 15 unidades de assistencia que compoem a rede de saude mental de Ribeirao Preto. Resultados: O Hospital-Dia e um dos equipamentos de saude especializado na estrutura de saude local e regional. O tratamento diferenciado entre os diversos servicos que referenciam o acesso para o Hospital-Dia e fator de tensao na gestao do sistema de saude. A falta de dialogo articulado com e entre as equipes de saude nos diferentes locais de assistencia nao permite o acompanhamento do itinerario terapeutico percorrido pelo paciente. Conclusoes: A capacidade instalada do hospital-dia pode deixar duvidas sobre o impacto produzido pela assistencia realizada. As evidencias da necessidade de acoes que considerem a integralidade e a intersetorialidade, pela restrita comunicacao entre os servicos e, a centralizacao dos atendimentos em um servico especializado em saude mental pode sugerir a fragilidade de uma rede de atencao em saude mental.

Psicologia, saúde & doenças, Nov 1, 2014

RESUMO-Revisar os estudos sobre hospital-dia em saúde mental no Brasil para conhecer as estratégi... more RESUMO-Revisar os estudos sobre hospital-dia em saúde mental no Brasil para conhecer as estratégias terapêuticas de inclusão social de seus usuários, as medidas de apoio e o grau de satisfação da família com o serviço de saúde mental. Revisão realizada em bases de dados eletrônicas (Lilacs e SciELO), em artigos nacionais publicados entre janeiro de 2001 e dezembro de 2012. Foram selecionadas 21 publicações em que o assunto principal indicado em cada artigo foi: ajuste social, apoio social, centro de reabilitação, centros comunitários de saúde mental, desinstitucionalização, família, hospital-dia, inclusão social, pessoas mentalmente doentes, psiquiatria, reforma de serviços de saúde, saúde mental, serviços comunitários de saúde mental, serviços de saúde mental, transtorno mental. Os estudos brasileiros sobre o funcionamento dos hospitais-dia em saúde mental mostraramse insuficientes levando-se em conta à importância da internação parcial em hospital-dia para o projeto de desospitalização em curso e o alcance do objetivo de reinserção social de seus usuários. As pesquisas correlacionando as abordagens terapêuticas para pacientes de hospital-dia e as estratégias de manejo com a família e/ou comunidade, ou as investigações que se ocuparam em estudar a inclusão social de usuários do hospital-dia-a partir da perspectiva da família e/ou do responsável-, apresentam-se ainda mais reduzidas no cenário científico nacional. Palavras-chave-apoio social; família; hospital-dia; psiquiatria comunitária.

InTech eBooks, Mar 14, 2012

When you are high, it is tremendous. Shyness goes, the right words and gestures are suddenly ther... more When you are high, it is tremendous. Shyness goes, the right words and gestures are suddenly there, the power to seduce and captivate others a felt certainty. Feelings of ease, intensity, power, well-being, financial omnipotence and euphoria now pervade one's marrow. But somehow, this changes. The fast ideas are far too fast and there are far too many, overwhelming confusion replaced by fear and concern. You are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of mind… It goes on and on and finally there are only other people's recollections of your behaviour -your bizarre, frenetic, aimless behaviour…" A patient's account from

Molecular mechanisms of glucocorticoid receptor sensitivity and relevance to affective disorders

Acta Neuropsychiatrica, Dec 1, 2003

Changes in the hypothalamic–pituitary–adrenocortical (HPA) system are characteristic of depressio... more Changes in the hypothalamic–pituitary–adrenocortical (HPA) system are characteristic of depression, and in the majority of these patients these result in HPA axis hyperactivity. This is further supported by the reduced sensitivity to the inhibitory effects of the glucocorticoid, dexamethasone (DEX), on the production of adrenocorticotropic hormone (ACTH) and cortisol, during the DEX suppression test and the DEX-corticotropin-releasing hormone (DEX/CRH) test. Because the effects of glucocorticoids are mediated by intracellular receptors including, most notably, the glucocorticoid receptor (GR), several studies have examined the number and/or function of GRs in depressed patients. These studies have consistently demonstrated that GR function is impaired in major depression, resulting in reduced GR-mediated negative feedback on the HPA axis and increased production and secretion of CRH in various brain regions postulated to be involved in the causality of depression. This article summarizes the literature on GR in depression and on the impact of antidepressants on the GR in clinical and preclinical studies, and supports the concept that impaired GR signaling is a key mechanism in the pathogenesis of depression, in the absence of clear evidence of decreased GR expression. The data also indicate that antidepressants have direct effects on the GR, leading to enhanced GR function and increased GR expression. Hypotheses regarding the mechanism of these receptor changes involve non-steroid compounds that regulate GR function via second messenger pathways, such as cytokines and neurotransmitters. Moreover, we present recent evidence suggesting that membrane steroid transporters such as the multidrug resistance (MDR) p-glycoprotein, which regulate access of glucocorticoids to the brain, could be a fundamental target of antidepressant treatment. Research in this field will lead to new insights into the pathophysiology and treatment of affective disorders.

Depresäo na infância

Acta méd. (Porto Alegre), 1985

Biological Psychiatry, May 1, 2011

Increased neuronal oxidative stress (OxS) induces deleterious effects on signal transduction, str... more Increased neuronal oxidative stress (OxS) induces deleterious effects on signal transduction, structural plasticity and cellular resilience, mainly by inducing lipid peroxidation in membranes, proteins and genes. Major markers of OxS levels include the thiobarbituric acid reactive substances (TBARS) and the enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase. Lithium has been shown to prevent and/or reverse DNA damage, free-radical formation and lipid peroxidation in diverse models. This study evaluates OxS parameters in healthy volunteers prior to and following lithium treatment. Healthy volunteers were treated with lithium in therapeutic doses for 2-4 weeks. Treatment with lithium in healthy volunteers selectively altered SOD levels in all subjects. Furthermore, a significant decrease in the SOD/ CAT ratio was observed following lithium treatment, wich was associated with decreased OxS by lowering hydrogen peroxide levels. This reduction in the SOD/CAT ratio may lead to lower OxS, indicated primarily by a decrease in the concentration of cell hydrogen peroxide. Overall, the present findings indicate a potential role for the antioxidant effects of lithium in healthy subjects, supporting its neuroprotective profile in bipolar disorder (BD) and, possibly, in neurodegenerative processes.

HPA Axis in Depression and Type 2 Diabetes. Oxford University Press

Prednisolone Suppression Test Predicts Outcome in Treatment Resistant Depression, but not Dexamethasone

Early life stress in bipolar patients: HPA axis response to GR and MR challenges

Bipolar Disorders, Jul 1, 2016

medRxiv (Cold Spring Harbor Laboratory), Feb 9, 2023

Debates em Psiquiatria, Aug 19, 2022

Sinestesia espelho-toque em esquizofrenia, uma condição patológica? Mirror-touch synesthesia in s... more Sinestesia espelho-toque em esquizofrenia, uma condição patológica? Mirror-touch synesthesia in schizophrenia, a pathological condition? La sinestesia tacto-espejo en la esquizofrenia, ¿una condición patológica?

European Neuropsychopharmacology, Oct 1, 2013

the SDS-T analysis, and chronic pain and previous hospitalisation for depression in the WPAI-4 an... more the SDS-T analysis, and chronic pain and previous hospitalisation for depression in the WPAI-4 analysis. Results: The 947 analysable patients had a mean age of 43.6 years and 73% of them were women. Two-thirds (67%) were employed, 56% were married or in a stable relationship. At baseline consultation, 23% of the patients were already on antidepressants, and had a treatment switch prescribed by the physician. Patientreported MDD severity was moderate to severe (PHQ-9 mean total score = 17.7). Over 25% reported very frequent cognitive symptoms on the PDQ-5 (total score >15). Overall functioning was impaired (mean SDS-T = 19.3), as was overall activity (62% impairment, as assessed by the WPAI-4). In multivariate analyses, increased overall functional impairment (SDS-T) was associated with increased patient-reported depression severity (p < 0.001), increased patient-reported cognitive dysfunction (p < 0.001), switch of antidepressant at baseline (p = 0.004) and country (p = 0.006). Increased overall activity impairment (WPAI-4) was associated with increased patient-reported depression severity (p < 0.001) and increased patient-reported cognitive dysfunction (p < 0.001). Conclusions: In multivariate analyses, functional impairment in MDD is not only associated with the severity of depression, but is additionally impacted by patient-reported cognitive function, switching antidepressant, and country. These preliminary results need to be confirmed by analyses of the full dataset.

Medicina, Feb 4, 2017

Os Transtornos relacionados a traumas e a estressores são quadros psiquiátricos relacionados a ex... more Os Transtornos relacionados a traumas e a estressores são quadros psiquiátricos relacionados a exposição a um evento traumático ou estressante, resultando em sofrimento psicológico relevante, prejuízo social, profissional e em outras áreas importantes da vida do indivíduo. A apresentação clínica de tais transtornos é caracterizada por sintomas de ansiedade e de medo, anedonia, disforia, externalizações da raiva, agressividade e sintomas dissociativos. De acordo com a 5ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5), as categorias diagnósticas inclusas nesse espectro são

Early life stress, depression and epigenetics

Vitamins and hormones, 2023

The Role of Hypothalamic-Pituitary-Adrenal Axis in the Pathophysiology of Major Depression: A Translational Research Perspective of the Prednisolone Suppression Test

Springer eBooks, 2022

the Netherlands. He got his PhD degree in Psychiatry from the University of London, and training ... more the Netherlands. He got his PhD degree in Psychiatry from the University of London, and training in cognitive psychotherapy at Beck Institute for Cognitive Behavior Therapy-USA. He is a specialist in adult psychiatry in the UK according to the Medical Royal Colleges and has published over 80 original research articles, reviews and book chapters, editing four books. British Association for Psychopharmacology awarded him the "Senior Clinical Psychopharmacology Award 2007". He also received the "Robert W.

Neuropsychiatric Disease and Treatment, Feb 1, 2023

Treatment-resistant depression (TRD) is associated with profound morbidity for patients, placing ... more Treatment-resistant depression (TRD) is associated with profound morbidity for patients, placing a significant burden on those affected, the health service and wider society. Despite this, TRD remains chronically underserved in terms of viable treatment options. To address this gap, an advisory panel of psychiatrists and clinical researchers with experience in managing TRD convened to develop best practice statements on the use of esketamine nasal spray, one of the first TRD treatments to be licensed in 30 years. Methods: During a virtual meeting held on 12th November 2020, the advisory panel shared their experiences of using esketamine nasal spray in their clinical practice. The meeting focused on developing and refining recommendations for setting up and running an efficient esketamine nasal spray clinic for patients living with TRD. At the conclusion of the meeting, agreement was reached on all recommendation statements. Results: In setting up an esketamine nasal spray clinic, it is important to consider the logistical requirements involved and put measures in place to ensure it runs as efficiently as possible. Educating patients about the treatment and maintaining their well-being is paramount for preventing discontinuation. Putting in place checklists can be a useful strategy for ensuring treatment appointments run smoothly and safely. Conclusion: Providing additional treatment options for the management of TRD, such as esketamine nasal spray, is likely to be key to improving the long-term outcomes of this underserved patient population.

Nutrients, May 19, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

A vulnerability in depressed with family history of depression and history of autoimmune disease

F1000Research, 2011

Evaluación de las alteraciones estacionales en el humor y comportamiento en la ciudad de San Pablo

Acta Psiquiatrica Y Psicologica De America Latina, 2000