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Few studies have assessed biomarkers for the differentiation of major depressive disorder (MDD) and bipolar disorder (BD). However, some elements of depression such as hormones and receptors of the renin–angiotensin–adrenal system (RAAS), the hypothalamus–pituitary–adrenal (HPA) axis, and history of early-life stress (ELS) could be considered for differential diagnosis. Therefore, this study aimed to assess aldosterone and cortisol levels, MR and GR gene polymorphisms, and ELS as potential biomarkers for differentiating MDD and BD. This study presents a case–control design. Groups comprised samples for genetic, cortisol, and aldosterone analysis: healthy control (HC; n = 113/97/103), MDD (n = 78/69/67) and BD (n = 82/68/65) subjects. Furthermore, all subjects were assessed for diagnostic screening, the severity of depression, and history of ELS by applying MINI-PLUS, GRID-HDRS, and CTQ, respectively. In addition, genotype and allelic frequencies of GR (N363S, R22/23K and BclI) and MR (MI180V and -2G/C) polymorphisms were evaluated via PCR. Our findings demonstrate that basal aldosterone levels may be a biomarker for differentiating BD and MDD. Furthermore, ELS affects the HPA axis in BD, cortisol may be considered a biomarker for distinguishing BD and MDD, but only in the absence of ELS, and, finally, history of ELS and MR-2G/C variant alleles are factors that contribute to the severity of depressive symptoms in MDD and BD.

ResumoO estudo tem como objetivo discutir, com suporte em estudos já realizados, o Transtorno de Personalidade Borderline (TPB) em seus diversos aspectos, com o intuito de conhecer melhor as possíveis intervenções para esta doença. Tal transtorno vem se apresentando em evidência na contemporaneidade, principalmente devido a oscilação de humor presente nas pessoas que são acometidas, exigindo dos profissionais da saúde, uma maior atenção e preparo para identificação desta desordem mental. Para tanto, procedeu-se a uma busca em bases de dados eletrônicas -CAPES, BVS -Psi, Scielo, Google Acadêmico -onde foram identificados 85 artigos, dos quais se analisaram dados como título, autoria, resumo e conteúdos. A pesquisa ocorreu de agosto a outubro de 2013. Com base em estudos revisados, foi possível entender a correlação significativa entre abusos sexuais sofridos na infância e os índices de prevalência do TPB. Observou-se, ainda, a prevalência de outros tipos de desregulação em pacientes borderlines, gerando, por exemplo, comportamentos de parassuicídio e distorções cognitivas relevantes. Constatou-se a escolha da Terapia Cognitivo-Comportamental Dialética (TCD) como intervenção psicoterápica mais apropriada, pois o uso de metáforas e o Treino de Habilidades Sociais (THS) foram considerados de exume relevância para o prognóstico. Os avanços neurocientíficos apontaram o uso de psicofármacos como essencial para a evolução do tratamento do TPB. Conclui-se, com base nos estudos referendados neste artigo, que os traumas podem apresentar grande contribuição para o desenvolvimento do TPB. Ainda com o apoio em tais estudos, notou-se que os comportamentos de automutilação podem estar diretamente relacionados à necessidade dos pacientes em buscar alívio das dores emocionais presentes em decorrência dos traumas cultivados. AbstractThe study aims to discuss, supported on studies already carried out, the Borderline personality disorder (TPB) in its various aspects, in order to better understand the possible interventions for this disease. This disorder has been showing in evidence in contemporary times, mainly due to oscillation of humor present in the people who are involved, demanding of health professionals, greater attention and preparation to identification of this mental disorder. For this purpose, a search of electronic databases-CAPES, VHL-Psi, Scielo, Google Scholarwhere 85 articles were identified, which analyzed data such as title, author, summary and contents. The survey took place from August to October 2013. On the basis of studies reviewed, it was possible to understand the significant correlation between sexual abuse suffered in childhood and the prevalence rates of the TPB. It was noted the prevalence of other types of deregulation in patients borderlines, generating, for example, parasuicide behaviors and cognitive distortions that are relevant. It was noted the choice of cognitive-behavioral therapy Dialectic (TCD) as most appropriate psychotherapeutic intervention, because the use of metaphors and the Social S...

Consequências da personalidade borderline na adesão ao tratamento de dores crônicas