RESUMOO atendimento a pacientes que procuram serviços primários de saúde deveria compreender uma avaliação global, tanto física como psicológica. Diversos estudos internacionais sobre prevalência de transtornos mentais entre pacientes atendidos em serviços de saúde que prestam cuidados primá-rios (1) mostram que de 10 a 31% dos pacientes apresentam pelo menos um tipo de diagnóstico psiquiátrico (principalmente depressão e ansiedade). Além disso, sabe-se que as dificuldades nas interações sociais podem manifestar-se sob a forma de doenças psicossomáticas, problemas emocionais ou de relacionamento, de forma isolada ou em combinação (2, 3).O desenvolvimento de problemas psiquiátricos é influenciado pelas particularidades do indivíduo e de suas interações com a família, sendo que as dificuldades são maiores quando já há outros membros da família com doença psiquiátrica. O processo de adoecimento também é afetado pelas relações de vizinhança, de trabalho e pelas relações do indivíduo com instituições como a escola e os centros de saúde.Para muitos pacientes, o sucesso do tratamento depende do entendimento da dinâmica familiar e da função que a doença assume na família e na vida do próprio paciente. O envolvimento da família no tratamento de todas as manifestações de uma doença, sejam elas de caráter psiquiátrico ou não, freRev Panam Salud Publica/Pan Am J

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

In this prospective study, a sample of 86 postpartum women was compared with a sample of 75 women from a random period of 8 consecutive days out of puerperium. Symptoms were evaluated each day using the Blues Questionnaire. Postpartum women and women out of puerperium showed a different distribution of percentile scores on the scale on the third, fourth and fifth days. The postpartum symptom peak occurred on the fifth day. Symptoms more significantly associated with the third, fourth and fifth postpartum days were overemotionalism and oversensitivity. It is concluded that maternity blues in Brazilian women appear to be characterized by maternal mental state alterations occurring on the third, fourth and fifth days postpartum. MB seems to be better defined as an emotional oversensitivity syndrome of cross-cultural dimension than as depression.

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Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.