Cartas aos Editores 394
Rev Bras Psiquiatr. 2009;31(4):387-95 Case report: S. is a 21-year-old single woman who came to office
asking for help to get a job. She applied for a selection process and asked for a prescription of methylphenidate to improve her chances. She became aware of this drug through a friend that was studying with her and reported an important improvement in academic test performance. The friend was using pills from his sister. S. had already taken this medication once, noticing a discrete improvement in her capabilities. There was no current or lifetime diagnosis of ADHD or any other psychiatric disorders. The performance in ASRS4 test was within the normal range. The risks and benefits of using stimulants in this manner were explained to her. General orientation about study, sleep, diet, leisure and relationships with others were highlighted. Methylphenidate was not prescribed. The patient seemed dissatisfied at the end of the appointment. A new appointment was scheduled, but the patient did not show up.
Discussion: Changing cultural values may put pressures on clinicians’ decisions in order to prescribe performance enhancing drugs. We may be facing a paradigm shift towards Cosmetic
References
1. Greely H, Sahakian B, Harris J, Kessler RC, Gazzaniga M, Campbell P, Farah MJ. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature. 2008;456(7223):702-5. Erratum in: Nature.
2008;456(7224):872.
2. Smart drugs: Drugs to make you cleverer are in the test-tube. Good Economist. 2008;24 May:22.
3. Gould MS, Walsh BT, Munfakh JL, Kleinman M, Duan N, Olfson M, Greenhill L, Cooper T. Sudden death and use of stimulant medications in youths. Am J Psychiatry. 2009;166(9):992-1001.
4. Mattos P, Segenreich D, Saboya E, Louzã M, Dias G, Romano M. Transcultural adaptation of the adult self-report scale into Portuguese for evaluation of adult attention-deficit/hyperactivity disorder (ADHD).
Rev Psiquiatr Clin. 2006;(33):188-94.
5. Chatterjee A. The promise and predicament of cosmetic neurology.
J Med Ethics. 2006;32(2):110-3.
Psychiatry. To go beyond therapy seems inevitable.5 Dermatology and plastic surgery have already changed. Society has evolved to accept the risks if the benefits are culturally valued. However, there are serious concerns; we don’t know the risks of long term treatments both in patients and in healthy people.
The treatment of ADHD for all ages in the public health system in Brazil is far from ideal. Most patients do not receive any support. There has been an increased interest in using these drugs as enhancers in some social strata. We need to identify and define ethical issues raised by recent discussions and social pressures in order to anticipate and respond to clinical changes and public concerns. This may lead, where necessary, to the formulation of new guidelines or rules by the appropriate regulatory agencies.
Marcelo Victor ADHD Outpatient Program – Adult Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre (RS), Brazil
The impact of marital status in
hospitalized patients with bipolar
disorder
O impacto da situação conjugal em
paci-entes internados com transtorno do humor
bipolar
Dear Editor,
Cartas aos Editores 395
Rev Bras Psiquiatr. 2009;31(4):387-95
to 50% that are medically justified.3 In addition, hospitalization is considered an important indicator of greater severity and poorer outcomes for manic and mixed states in our country and in other regions of the world.4
Therefore, we conducted a retrospective case-control chart review study of patients that were hospitalized from January 1st 2004 to December 31st 2008, at the Psychiatric Unit of Santa Maria’s University Hospital (a community public hospital). Of the 294 charts reviewed, we included 178 that fulfilled the inclusion criteria: 1) DSM-IV-TR diagnostic of BD, most recent episode manic with psychotic features; detailed descriptions about: 2) marital status, 3) length of disease, 4) number of mood episodes, 5) number of hospitalizations due to BD and 6) time of hospitalization due to BD. Subjects were divided into two groups: with (n = 43) or without spouse (n = 135). Results were analyzed using ANCOVA. Ethics committee approval was given.
The presence of a spouse was related to a lower total time of hospitalization, in days, in the patient’s lifetime. Similarly, there were fewer hospitalizations in those patients that lived with a spouse. Curiously, disease related variables like total number of mood episodes and number of mood episodes per year of disease
were not related to the presence of a spouse (Table 1). Confounding factors, such as adherence to treatment, were not evaluated, being limitations of the study.
We can conclude, then, that for this particular type of BD patient, the presence of a spouse can reduce hospitalization rates, though does not reduce the number of episodes of the disease. Future studies should investigate whether brief hospitalizations are associated with the pattern of coping skills of caregivers.
Pedro Domingues Goi Laboratório de Pesquisa em Psiquiatria (LaPP), Hospital Universitário de Santa Maria (HUSM), Santa Maria (RS), Brazil
Bruno Paz Mosqueiro School of Medicine, Universidade Federal de Santa Maria
(UFSM), Santa Maria (RS), Brazil
Angelo Batista da Cunha Psychiatric Unit, Laboratório de Pesquisa em Psiquiatria (LaPP),
Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria (RS), Brazil
References
1. Goossens PJ, Van Wijngaarden B, Knoppert-van Der Klein EA, Van Achterberg T. Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress. Int J Soc Psychiatry. 2008;54(4):303-16.
2. Hoblyn JC, Balt SL, Woodard SA, Brooks JO 3rd. Substance use disorders as risk factors for psychiatric hospitalization in bipolar disorder. Psychiatr Serv. 2009;60(1):50-5.
3. Hallak JE, Crippa JA, Vansan G, Zuardi AW. Diagnostic profile of inpatients as a determinant of length of stay in a general hospital psychiatric unit. Braz J Med Biol Res. 2003;36(9):1233-40.
