Mario F Juruena | King's College London (original) (raw)
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Papers by Mario F Juruena
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.
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Psicologia, saúde & doenças, Nov 1, 2014
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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.
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Acta méd. (Porto Alegre), 1985
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Biological Psychiatry, May 1, 2011
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Bipolar Disorders, Jul 1, 2016
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medRxiv (Cold Spring Harbor Laboratory), Feb 9, 2023
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Debates em Psiquiatria, Aug 19, 2022
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European Neuropsychopharmacology, Oct 1, 2013
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Vitamins and hormones, 2023
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Neuropsychiatric Disease and Treatment, Feb 1, 2023
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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.
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Psicologia, saúde & doenças, Nov 1, 2014
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InTech eBooks, Mar 14, 2012
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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.
Bookmarks Related papers MentionsView impact
Acta méd. (Porto Alegre), 1985
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Biological Psychiatry, May 1, 2011
Bookmarks Related papers MentionsView impact
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Bipolar Disorders, Jul 1, 2016
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medRxiv (Cold Spring Harbor Laboratory), Feb 9, 2023
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Debates em Psiquiatria, Aug 19, 2022
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European Neuropsychopharmacology, Oct 1, 2013
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Medicina, Feb 4, 2017
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Vitamins and hormones, 2023
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Springer eBooks, 2022
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Neuropsychiatric Disease and Treatment, Feb 1, 2023
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Nutrients, May 19, 2022
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F1000Research, 2011
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Acta Psiquiatrica Y Psicologica De America Latina, 2000
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