Although lithium’s efficacy in affective illness has been well proven (1), the mechanisms of acti... more Although lithium’s efficacy in affective illness has been well proven (1), the mechanisms of action responsible for its therapeutic effect remain unknown, especially when one considers its long lasting dual antimanic and antidepressant properties. Several hypotheses have been formulated to explain how lithium exerts its action. Chronic lithium in clinically equivalent concentrations, inhibits differentially adenylate cyclases in animals and humans. Considering that these actions seem to be the most consistent findings of the lithium neurochemica1 studies, Belmaker and coworkers (2, 3) suggested that it might be the mechanism of lithium action. Another hypothesis was raised by Bunney and coworkers. They first speculated that manic depressive illness might be caused, at least partially, by oscillations in catecho1 amine receptor sensitivity, in an attempt to further develop the original catecho1 ami ne hypothesis, thus extending it to the receptor level (4). Their idea was based on clinical observation that dopamine receptor antagonists (neuro1epties) acutely suppress manic symptomatology, while dopamine agonists (such as piribedil and 1-Dopa) can precipitate manic episodes in certain depressed patients. These findings led to the idea that receptor sensitivity changes underlie the behavioral signs in bipolar illness: mania being a consequence of an abnormal increase and depression from an abnormal decrease.
Mood is the overall affective quality that is based on how the individual experiences the world a... more Mood is the overall affective quality that is based on how the individual experiences the world and themselves in a given time or period. It is the affective tone of this experience. Typically, the states of mood fluctuate according to internal or external, objective or subjective events within a certain range compatible with such events, and these oscillations are inherent to events. Therefore, mood swings can be considered normal. However, they can also occur for pathological reasons and represent a significant change in the functioning of the affected person. When mood swings are pathological, they lose the quantitative and qualitative proportionality in relation to the events that would have promoted them and are no longer explained by them. Furthermore, these oscillations can arise spontaneously, without association with any event; they can be durable and disruptive and can destabilize the individuals and their relationship with the world. Mood disorders can occur in several mental disorders but are more common in depressive and bipolar disorders.
Studies investigating a possible relationship between the plasma concentration of tricyclic antid... more Studies investigating a possible relationship between the plasma concentration of tricyclic antidepressants and clinical response have measured only the tertiary and secondary amine forms of these drugs. The present study shows that the hydroxy metabolites of tricyclic antidepressants might also be active. Hydroxylated imipramine, desipramine, chlorimipramine, and nortriptyline inhibit the uptake of norepinephrine and serotonin into synaptosomes to the same extent as do their parent compounds. Hydroxylated nortriptyline and imipramine reverse or prevent reserpine-induced motor retardation and ptosis. Following chronic imipramine, significant steady-state concentrations of unconjugated hydroxylated metabolites are present in rat tissues including the cerebrospinal fluid. Accounting for steady-state concentrations of hydroxylated metabolites of tricyclic antidepressants in man may help to clarify whether there is a relationship between active drug concentration and clinical effect.
The authors review the use of ECT with nine seriously depressed patients at the National Institut... more The authors review the use of ECT with nine seriously depressed patients at the National Institute of Mental Health over the past 8 years. Despite the patients' poor prior response to a variety of pharmacological treatments, only one patient failed to show a complete response to ECT. With most patients, improvement was quite rapid and dramatic, and all of the ECT responders were free of depression for at least 1 year after treatment. These results are consistent with previous studies; they deserve reemphasis now in light of recent controversies over ECT, including legislative and judicial attempts to restrict its use.
Plasma prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and cortisol were repeated... more Plasma prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and cortisol were repeatedly measured during the morning over a 4-hour period in patients who received single or chronic doses of desipramine (DMI) or zimelidine (ZIM). Preclinical studies had suggested that DMI, an uptake inhibitor specific for norepinephrine, would have different effects than ZIM, a selective serotinin uptake inhibitor. The GH response to DMI was blunted in the depressed patients. Neither DMI nor ZIM produced changes in LH or cortisol. DMI acutely increased plasma PRL, whereas ZIM had an effect only after chronic pretreatment. Chronic DMI but not ZIM increased baseline PRL. The patterns and magnitude of responses raise questions concerning the role of serotonin and norepinephrine in PRL release in man and the applicability of current preclinical models.
A Revista Brasileira de Psiquiatria (RBP) foi criada no mesmo ano que a Associação Brasileira de ... more A Revista Brasileira de Psiquiatria (RBP) foi criada no mesmo ano que a Associação Brasileira de Psiquiatria (ABP), há 50 anos. Entretanto, a revista sofreu solução de conti nuidade, provocando mudança de seu nome para Revista da ABP e, posteriormente, para Revista ABP-APAL, assim persisti ndo durante 20 anos, mas sempre sendo órgão ofi cial da ABP. Como a história da revista se confunde com a da ABP, vários presidentes da associação, responsáveis por alterações substanciais na revista, são mencionados, assim como os vários editores que contribuíram com seus trabalhos na consolidação da RBP, hoje com expressivo reconhecimento nacional e internacional.
A review of fluoxetine's safety profile, especially during long-term treatment, is presented.... more A review of fluoxetine's safety profile, especially during long-term treatment, is presented. Key safety advantages for fluoxetine include lower adverse events and dropout rates compared with tricyclic antidepressants and other selective serotonin reuptake inhibitors (SSRIs), safety in overdose, and safe use in special population groups such as women in pregnancy. Prospectively ascertained pregnancy outcomes following exposure to SSRIs, mainly fluoxetine, consistently show no teratogenic effects as assessed in the postnatal period and in comparison with controls. An additional advantage of fluoxetine is the absence or mildness of discontinuation symptoms following treatment interruption, probably a consequence of fluoxetine's long half-life in comparison with other SSRIs. The available data on these topics confirm the suitability of long-term fluoxetine treatment.
Cymbopogon citratus is one of the most used plants in Brazilian folk medicine for the treatment o... more Cymbopogon citratus is one of the most used plants in Brazilian folk medicine for the treatment of nervous and gastrointestinal disturbances. It is also used in many other places to treat feverish conditions. The usual way to use it is by ingesting an infusion made by pouring boiling ...
Total and ionized calcium decreased with increasing blood alcohol concentration in both alcoholic... more Total and ionized calcium decreased with increasing blood alcohol concentration in both alcoholics and nonalcoholics. Alcohol consumption caused no significant differences between alcoholics and nonalcoholics in plasma protein and ionized calcium but caused higher plasma phosphate levels in alcoholics.
Although lithium’s efficacy in affective illness has been well proven (1), the mechanisms of acti... more Although lithium’s efficacy in affective illness has been well proven (1), the mechanisms of action responsible for its therapeutic effect remain unknown, especially when one considers its long lasting dual antimanic and antidepressant properties. Several hypotheses have been formulated to explain how lithium exerts its action. Chronic lithium in clinically equivalent concentrations, inhibits differentially adenylate cyclases in animals and humans. Considering that these actions seem to be the most consistent findings of the lithium neurochemica1 studies, Belmaker and coworkers (2, 3) suggested that it might be the mechanism of lithium action. Another hypothesis was raised by Bunney and coworkers. They first speculated that manic depressive illness might be caused, at least partially, by oscillations in catecho1 amine receptor sensitivity, in an attempt to further develop the original catecho1 ami ne hypothesis, thus extending it to the receptor level (4). Their idea was based on clinical observation that dopamine receptor antagonists (neuro1epties) acutely suppress manic symptomatology, while dopamine agonists (such as piribedil and 1-Dopa) can precipitate manic episodes in certain depressed patients. These findings led to the idea that receptor sensitivity changes underlie the behavioral signs in bipolar illness: mania being a consequence of an abnormal increase and depression from an abnormal decrease.
Mood is the overall affective quality that is based on how the individual experiences the world a... more Mood is the overall affective quality that is based on how the individual experiences the world and themselves in a given time or period. It is the affective tone of this experience. Typically, the states of mood fluctuate according to internal or external, objective or subjective events within a certain range compatible with such events, and these oscillations are inherent to events. Therefore, mood swings can be considered normal. However, they can also occur for pathological reasons and represent a significant change in the functioning of the affected person. When mood swings are pathological, they lose the quantitative and qualitative proportionality in relation to the events that would have promoted them and are no longer explained by them. Furthermore, these oscillations can arise spontaneously, without association with any event; they can be durable and disruptive and can destabilize the individuals and their relationship with the world. Mood disorders can occur in several mental disorders but are more common in depressive and bipolar disorders.
Studies investigating a possible relationship between the plasma concentration of tricyclic antid... more Studies investigating a possible relationship between the plasma concentration of tricyclic antidepressants and clinical response have measured only the tertiary and secondary amine forms of these drugs. The present study shows that the hydroxy metabolites of tricyclic antidepressants might also be active. Hydroxylated imipramine, desipramine, chlorimipramine, and nortriptyline inhibit the uptake of norepinephrine and serotonin into synaptosomes to the same extent as do their parent compounds. Hydroxylated nortriptyline and imipramine reverse or prevent reserpine-induced motor retardation and ptosis. Following chronic imipramine, significant steady-state concentrations of unconjugated hydroxylated metabolites are present in rat tissues including the cerebrospinal fluid. Accounting for steady-state concentrations of hydroxylated metabolites of tricyclic antidepressants in man may help to clarify whether there is a relationship between active drug concentration and clinical effect.
The authors review the use of ECT with nine seriously depressed patients at the National Institut... more The authors review the use of ECT with nine seriously depressed patients at the National Institute of Mental Health over the past 8 years. Despite the patients' poor prior response to a variety of pharmacological treatments, only one patient failed to show a complete response to ECT. With most patients, improvement was quite rapid and dramatic, and all of the ECT responders were free of depression for at least 1 year after treatment. These results are consistent with previous studies; they deserve reemphasis now in light of recent controversies over ECT, including legislative and judicial attempts to restrict its use.
Plasma prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and cortisol were repeated... more Plasma prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and cortisol were repeatedly measured during the morning over a 4-hour period in patients who received single or chronic doses of desipramine (DMI) or zimelidine (ZIM). Preclinical studies had suggested that DMI, an uptake inhibitor specific for norepinephrine, would have different effects than ZIM, a selective serotinin uptake inhibitor. The GH response to DMI was blunted in the depressed patients. Neither DMI nor ZIM produced changes in LH or cortisol. DMI acutely increased plasma PRL, whereas ZIM had an effect only after chronic pretreatment. Chronic DMI but not ZIM increased baseline PRL. The patterns and magnitude of responses raise questions concerning the role of serotonin and norepinephrine in PRL release in man and the applicability of current preclinical models.
A Revista Brasileira de Psiquiatria (RBP) foi criada no mesmo ano que a Associação Brasileira de ... more A Revista Brasileira de Psiquiatria (RBP) foi criada no mesmo ano que a Associação Brasileira de Psiquiatria (ABP), há 50 anos. Entretanto, a revista sofreu solução de conti nuidade, provocando mudança de seu nome para Revista da ABP e, posteriormente, para Revista ABP-APAL, assim persisti ndo durante 20 anos, mas sempre sendo órgão ofi cial da ABP. Como a história da revista se confunde com a da ABP, vários presidentes da associação, responsáveis por alterações substanciais na revista, são mencionados, assim como os vários editores que contribuíram com seus trabalhos na consolidação da RBP, hoje com expressivo reconhecimento nacional e internacional.
A review of fluoxetine's safety profile, especially during long-term treatment, is presented.... more A review of fluoxetine's safety profile, especially during long-term treatment, is presented. Key safety advantages for fluoxetine include lower adverse events and dropout rates compared with tricyclic antidepressants and other selective serotonin reuptake inhibitors (SSRIs), safety in overdose, and safe use in special population groups such as women in pregnancy. Prospectively ascertained pregnancy outcomes following exposure to SSRIs, mainly fluoxetine, consistently show no teratogenic effects as assessed in the postnatal period and in comparison with controls. An additional advantage of fluoxetine is the absence or mildness of discontinuation symptoms following treatment interruption, probably a consequence of fluoxetine's long half-life in comparison with other SSRIs. The available data on these topics confirm the suitability of long-term fluoxetine treatment.
Cymbopogon citratus is one of the most used plants in Brazilian folk medicine for the treatment o... more Cymbopogon citratus is one of the most used plants in Brazilian folk medicine for the treatment of nervous and gastrointestinal disturbances. It is also used in many other places to treat feverish conditions. The usual way to use it is by ingesting an infusion made by pouring boiling ...
Total and ionized calcium decreased with increasing blood alcohol concentration in both alcoholic... more Total and ionized calcium decreased with increasing blood alcohol concentration in both alcoholics and nonalcoholics. Alcohol consumption caused no significant differences between alcoholics and nonalcoholics in plasma protein and ionized calcium but caused higher plasma phosphate levels in alcoholics.
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Papers by Helena Maria Calil