Abstract: BACKGROUND: The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR), designed to evaluate the effectiveness of a six-months regimen, assessed the adverse effects caused by the drugs. OBJECTIVE: Describe adverse effects due to MDT in U-MDT/CT-BR, comparing the uniform regimen (U-MDT) to the current WHO regimen (R-MDT). Patients and methods: After operational classification, patients were randomly allocated to the study groups. U-MDT PB and U-MDT MB groups, received the U-MDT regimen, six doses of MB-MDT (rifampicin, dapsone and clofazimine). R-MDT PB and R-MDT MB groups, received the WHO regimens: six doses (rifampicin and dapsone) for PB and 12 doses (rifampicin, dapsone and clofazimine) for MB. During treatment, patients returned monthly for clinical and laboratorial evaluation. Patients with single lesion were not included in this trial. RESULTS: Skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients. Laboratory exams showed hemoglobin concentration lower than 10g/dL in 23.3% of the patients, glutamic oxaloacetic transaminase (GOT) above 40U/L in 29.5% and glutamic pyruvic transaminase (GPT) above 40U/L in 28.5%. Twenty-four patients (3.2%) stopped dapsone intake due to adverse effects, of whom 16.6% due to severe anemia. One case of sulfone syndrome was reported. STUDY LIMITATIONS: Loss of some monthly laboratory sample collection. CONCLUSIONS: There was no statistical difference regarding adverse effects in the R-MDT and U-MDT groups but anemia was greater in patients from R-MDT/MB group, therefore adverse effects do not represent a constraint to recommend the six-month uniform regimen of treatment for all leprosy patients.

Resumo A interrogação que move este trabalho é se a herança estruturalista na clínica lacaniana das psicoses estaria ultrapassada devido aos desdobramentos dos últimos ensinamentos de Lacan. Nessa direção, este artigo tem como objetivo apresentar algumas contribuições do estruturalismo à clínica lacaniana da psicose, tendo como chave de análise o chamado “diagnóstico estrutural”. Foi com o ensino de Lacan que o diagnóstico diferencial, herdeiro de Freud, passou a ser qualificado como “estrutural” ao destacar a distinção das três grandes estruturas: neurose, perversão e psicose. A justificativa para a escolha da tônica do diagnóstico estrutural para a proposta de investigação do legado estruturalista em Lacan tem como base a evidência de duas vertentes que acabariam por impor alguns questionamentos à validade do diagnóstico apoiado na distinção estrutural atualmente: os chamados novos sintomas e o movimento de pluralização do Nome-do-Pai. Nesse sentido, admite-se que um breve retorno às principais contribuições do diálogo lacaniano com o estruturalismo na década de 1950 forneça considerações importantes para enriquecer o debate e esclarecer se essa herança estruturalista na clínica das psicoses estaria ultrapassada, ensejando, assim, o valor epistêmico da discussão para o campo da Psicologia como ciência. Não obstante, destaca-se a importância das questões atuais que circunscrevem o campo diagnóstico para a abordagem do sofrimento psíquico.

Abstract The question that moves this work is whether the structuralist inheritance in the Lacanian clinic of psychoses would be overtaken due to the unfolding of Lacan’s later teachings. In this sense, this article aims to present some of the structuralism’s contributions to the Lacanian clinic of psychosis, by the analysis of the so-called ‘structural diagnosis’. It was with Lacan’s teachings that the differential diagnosis, heir to Freud, was described as “structural” to highlight the distinction of three major structures: neurosis, perversion and psychosis. The reason for choosing structural diagnosis for the research proposal of the structuralist legacy in Lacan is based on the evidence of two aspects that would eventually impose some questions on the validity of the diagnosis based on the current structural distinction: the so-called new symptoms and the pluralization of the Name-of-the-Father. In this sense, it is accepted that a brief return to the main contributions of Lacanian dialogue with structuralism in the 1950s provides important considerations to enrich the debate and to clarify if this structuralist heritage in the clinic of psychoses would be overtaken, justifying the value of the epistemic discussion for the field of Psychology as a science. Nevertheless, the importance of the current issues that circumscribe the diagnostic field for the approach to psychic suffering is highlighted.

Resumen La interrogación que mueve este trabajo es si la herencia estructuralista en la clínica lacaniana de las psicosis estaría sobrepasada debido a los desdoblamientos de las últimas enseñanzas de Lacan. En esta dirección, este artículo tiene como objetivo presentar algunas contribuciones del estructuralismo a la clínica lacaniana de la psicosis, teniendo como clave de análisis el llamado ‘diagnóstico estructural’. Con la enseñanza de Lacan, el diagnóstico diferencial, heredero de Freud, pasó a ser calificado como “estructural” al destacar la distinción de las tres grandes estructuras: neurosis, perversión y psicosis. La justificación de la elección de la tónica del diagnóstico estructural para la propuesta de investigación del legado estructuralista en Lacan tiene como base la evidencia de dos vertientes que acabaría por imponer algunos cuestionamientos a la validez del diagnóstico apoyado en la distinción estructural actualmente: los llamados nuevos síntomas y el movimiento de pluralización del Nombre-del-Padre. En ese sentido, se admite que un breve retorno a las principales contribuciones del diálogo lacaniano con el estructuralismo en la década de 1950 proporciona consideraciones importantes para enriquecer el debate y aclarar si esa herencia estructuralista en la clínica de las psicosis estaría sobrepasada, dando así el valor epistémico de la discusión al campo de la Psicología como ciencia. No obstante, se destaca la importancia de las cuestiones actuales que circunscriben el campo diagnóstico para el abordaje del sufrimiento psíquico.

Resumo A psicose é um dos poucos termos da psicopatologia clássica e da psicanálise que permanece nos sistemas classificatórios atuais, como o DSM (Manual Diagnóstico Estatístico de Transtornos Mentais) e a CID (Classificação Internacional de Doenças), o que nos dá condições para investigarmos as diversas maneiras de pensar o sofrimento psíquico. Desse modo, analisamos criticamente como o DSM-IV-TR, a sua atual edição (DSM-V) e a CID-10 definem e utilizam o termo “psicose”. A apropriação desse conceito ampara-se em definição meramente descritiva como estratégia de recusa ao debate etiológico. A alucinação, um dos critérios para a classificação dos “transtornos psicóticos”, é definida partindo-se de realismo ingênuo em que a realidade é tomada objetivamente como um dado. Assim, apresentamos o contraponto psicanalítico para essa apropriação: a psicanálise aponta para a relevância da estruturação simbólica dos fenômenos perceptivos e para a realidade como construção subjetiva.

Abstract Psychosis is one of the few terms in classical psychopathology and psychoanalysis that remain in the current classification systems, such as the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases), which allows to investigate the various ways of thinking about psychological distress. We discuss how the DSM-IV-TR, its current edition (DSM-V), and the ICD-10 define and use the term psychosis. The appropriation of this concept is based on a merely descriptive definition, as a refusal strategy towards etiological discussion. Hallucination, one of the criteria for the classification of “psychotic disorders”, is defined with a naive realism in which reality is taken as an objective construction. We present the psychoanalytic counterpoint to such appropriation: psychoanalysis points to the relevance of the symbolic structuring of perceptual phenomena and reality as a subjective construction.

Resumen La psicosis es uno de los pocos términos de la psicopatología clásica y el psicoanálisis que permanecen en los sistemas de clasificación actuales, tales como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM) y la Clasificación Internacional de Enfermedades (CID), que nos da las condiciones para investigar las distintas formas de pensar sobre la angustia psicológica. Por lo tanto, se discute cómo el DSM-IV-TR, su edición actual (DSM-V) y el CID-10 definen y utilizan el término psicosis. La apropiación de este concepto mantiene a sí misma como una definición puramente descriptiva de la negativa a la estrategia de debate etiológico. La alucinación, uno de los criterios para la clasificación de los “trastornos psicóticos” se define empezando con un realismo ingenuo donde la realidad se toma como un hecho objetivamente. Por lo tanto, presentamos el contrapunto psicoanalítica a esa apropiación: puntos psicoanálisis a la relevancia de la estructuración simbólica de los fenómenos de percepción y la realidad como una construcción subjetiva.

Résumé La psychose est l’un des rares termes de psychopathologie et de la psychanalyse classique qui restent dans les systèmes de classification actuels, tels que le Manuel diagnostique et statistique des troubles mentaux (DSM) et la Classification internationale des maladies (CID), qui nous donne les conditions pour enquêter sur les différents façons de penser la détresse psychologique. Ainsi, nous verrons comment le DSM-IV-TR, son numéro actuel (DSM-V) et la CID-10 définissent et utilisent le terme psychose. L’appropriation de ce concept se prend comme une définition purement descriptive de refus de stratégie de débat étiologique. L’hallucination, l’un des critères pour la classification des «troubles psychotiques» est définie à partir d’un réalisme naïf où la réalité est prise comme une donnée objective. Ainsi, nous présentons le contrepoint psychanalytique de cette appropriation: les points psychanalyse à la pertinence de la structuration symbolique des phénomènes de perception et la réalité comme une construction subjective.

A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.

This study sought to verify the correlation between leprosy types and the adverse effects of treatment drugs. This quantitative, prospective, nested study was developed at the Dona Libânia Dermatology Centre in Fortaleza, Brazil. Data were collected from November 2007-November 2008. During this period, 818 leprosy patients were diagnosed and began treatment. Forty patients with tuberculoid leprosy (TT) were selected. Twenty patients followed a standard therapy of dapsone and rifampicin and 20 were administered dapsone, rifampicin and clofazimine (U-MDT). Twenty patients with borderline lepromatous (BL) and lepromatous leprosy (LL) were also selected and treated with U-MDT. All of the subjects received six doses. With the exception of haemolytic anaemia, there was a low incidence of adverse effects in all the groups. We did not observe any differences in the incidence of haemolytic anaemia or other side effects across groups of patients with TT, BL or LL treated with U-MDT.

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.