Rafaela Zorzanelli

This descriptive and ecological study estimated the prevalence of clonazepam consumption in Rio de Janeiro State2009 to 2013. Consumption was measured using Defined Daily Dose by total population and by population 18 or more years old. Calculations were performed using standard DDDs of 8 mg (indication as anticonvulsant) and 1 mg (indication as hypnosedative). The municipalities of the Metropolitan Region were grouped by Human Development Index (HDI) and by GINI coefficient, subjected to cluster analysis by Ward’s hierarchical method, and ranked by mean and median clonazepam consumption. In Rio de Janeiro State, clonazepam consumption increased0.35 to 1.97 DDD per 1000 population. The values are higher when only individuals over 18 years of age are considered. When the calculation formula is applied to a dose of 1 mg rather than 8 mg, the result, in 2013, is 21 DDD per 1000 population over 18 years old. In 2013 Rio de Janeiro and Niterói, which boast the highest HDIs, returned the highest consumption estimates, 3.38 DDD and 4.52 DDD, respectively. The data suggest that up to 2% of the adult population are users of clonazepam, possibly as a hypnosedative. Hence consideration must be given to the fact of extended use beyond therapeutic indications.

Objectives. To present and discuss recent patterns of prescription opioid sales throughout Brazil. Methods. We graphed linear trends of opioid prescriptions sold from registered pharmacies across Brazil from 2009 to 2015. We then calculated the change in rate of prescriptions sold per 1000 persons in 2015 compared with 2009. Results. Opioid sales increased across Brazil from 1 601 043 prescriptions in 2009 to 9 045 945 prescriptions in 2015, corresponding to a 465% increase in 6 years. The largest absolute increase was for codeine products (rate ratio (RR) = 5.30; 95% confidence interval [CI] = 5.29, 5.31), accounting for more than 98% of prescriptions in both years. Oxycodone had the largest relative increase (RR = 11.39; 95% CI = 11.19, 11.59), and fentanyl products had the smallest absolute and relative increase (RR = 2.91; 95% CI = 2.78, 3.03). Conclusions. Given rapid increases in opioid sales across Brazil, it is critical to introduce effective prescribing and monitoring methods that allow patients to access necessary medications without escalating risk of opioid misuse and related consequences. Careful surveillance of supply and subsequent outcomes are needed to prevent the development of another devastating opioid epidemic in the Americas. (Am J Public Health. Published online ahead of print March 22, 2018: e1–e3.

Resumen El trabajo tiene como objetivo ofrecer un análisis sistemático de algunos resultados de investigaciones realizadas en Argentina y Brasil relacionadas con el uso del metilfenidato, su prescripción y la regulación de la venta. También examinamos las discusiones entre investigadores y profesionales que asisten a personas diagnosticadas con TDAH en ambos países. El artículo integra dos campos de investigación. En Argentina se analizaron artículos de prensa, datos numéricos de organizaciones oficiales y profesionales y entrevistas semiestructuradas de profesionales de salud individuales y grupales realizadas entre 2007 y 2011. En Brasil se analizaron las revistas científicas, la observación participante y los profesores de las escuelas y los profesionales de la salud. Las conclusiones incluyen que los movimientos sociales en ambos países se han organizado y articulado, en un intento de promover el debate sobre la medicalización de la infancia y su despliegue en la sociedad.
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O artigo apresenta um debate sobre a natureza do objeto da psiquiatria. Apresentam-se duas perspectivas de abordagem da questão — o realismo e o pragmatismo. Segundo o realismo, as condições deno-minadas transtornos mentais existiriam de forma autônoma, a despeito da conceitualização humana. Já as perspectivas pragmáticas pressupo-riam que transtornos mentais não são suficientemente explicados como tipos naturais, porque normas e interesses humanos sempre estariam presentes em classificações psiquiátricas. São descritas as caracterís-ticas, diferenças e pontos de limitação dessas abordagens.

From a critical analysis of medicalization studies, and as a contribution to these perspectives, we describe and analyze the ways in which the transnational pharmaceutical industry penetrates diverse social spaces, with different marketing strategies, to consolidate medicalized processes in Argentina and Brazil. We analyzed two expansion methods of medicalization processes and specific ADHD diagnostic and treatment aspects and trends were developed in both countries: the impact of the pharmaceutical industry on advocacy groups in Brazil and pharmaceutical marketing strategies aimed at non-medical actors in Argentina. These two methods are characterized by involving other actors than medical professionals. The methodology includes data from research conducted in Argentina and Brazil between 1998 and 2014, based in the University of Buenos Aires and in the State University of Rio de Janeiro, focused on the study of ADHD diagnostic and treatment processes and methylphenidate consumption in both countries. We used individual and group semi-structured interview techniques with professors and health professionals, official and professional organization statistics, and national and international general and specialized literature. We concluded that the phenomena documented in Argentina and Brazil highlight the importance of conducting investigations that covers specific aspects of empirical cases and their multiple connections with broader and intense knowledges networks, dispositives, normatives and actors involved in the medicalization in the 21st century.

This article focuses on Canadian stem cell researchers working on therapeutic applications of autologous stem cells for heart disease. Building on the concept of 'multiverse' – coined by William James and then further developed by Ernst Bloch – we are interested in the simultaneity of the certain and uncertain, sometimes contradictory arguments articulated by these scientists. In the first part of the article we illustrate some of the factors that provide certainty for researchers and clinicians. The second part analyzes the ways in which uncertain elements become integrated into a discourse of certainty. What we would like to show, using the concept of multiverse, is that a relatively new biotechnology such as stem cell treatments generally relies on both certain and uncertain reasoning. However, uncertainty has to give way to a platform of partial certainty, if crucial action is to be taken on issues as diverse as treatments and grant applications. The principle mechanisms we found that can make this kind of transformation possible target future developments (what we call 'if only arguments'), including past encouraging results in need of further research.

Um panorama sobre as variações em torno do conceito de medicalização entre 1950-2010 An overview of the variations surrounding the concept of medicalization between 1950 and 2010 Resumo Este artigo analisa a pertinência do con-ceito de medicalização, para a análise sóciocultu-ral, partindo de críticas na literatura internacio-nal surgidas na década de 2000. Essas críticas apon-tam a excessiva generalidade do termo, que pas-sou a abranger situações diversas, perdendo parte de sua acurácia analítica. Analisaremos alguns dos sentidos possíveis do termo medicalização, tais como: 1) as estratégias massivas de sanitarização da população; 2) a transformação de comporta-mentos considerados desviantes em doenças; 3) a ação do controle e imperialismo médico; 4) a par-ticipação de atores fora do campo da medicina. A partir desses diferentes usos, apontaremos a ne-cessidade de uma transitividade do conceito, ou seja, que se especifiquem os sentidos que são a ele atribuídos por ocasião de sua utilização – do con-trário, haveria uma perda de precisão teórica que retiraria do conceito sua possível utilidade para a análise social. Abstract This article examines the pertinence of the concept of medicalization for socio-cultural analysis. The study is based on the criticism which emerged in the international literature between 2000 and 2010. The criticism stressed the excessive generality of the expression that encompasses different situations and thereby loses its analytical precision. The main meanings of the term medicalization are examined, namely 1) the major strategies of hygienization of the population; 2) the transformation of behavior considered deviant into disorders; 3) control strategies and the medical imperative; 4) the participation of non-medical actors. Based on the different meanings of the notion of medicalization, the transient nature of the concept needs to be stressed, i.e. the need to specify the different meanings attributed to the notion depending on the different contexts in which it is used. If this is not done, the concept will lose its theoretical accuracy and will possibly no longer be useful for social analysis.

This article explores the epistemological underpinnings of the Research Domain Criteria (RDoC), launched by the National Institute of Mental Health (NIMH) - USA. The project has the objective of empirically investigating mental disorders in a biological framework. We discuss the sharp criticism received by the DSM shortly before its fifth edition came out, based as it was on the neuroscientific approach adopted by the RDoC. The preference for pathophysiology, combined with the exclusion of first-person experience, points to a scenario where research and clinical work are irrevocably divorced, and runs the risk of fostering an odd psychiatry with neither psyche nor pathos.

Key words: RDoC; classification systems; mental disorders; DSM; psychiatric clinics

The periodic revisions of psychiatric classificatory systems always draw sharp criticism that put at stake the very nature of the objects they classify. The recurrent question is: do psychiatric disorders in fact exist or are they merely socially constructed? In this article, our aim is to clarify the underlying assumptions of both the essentialist and the social constructionist positions. We also show that there are conceptual alternatives, such as the practical-kinds model, that move the center of gravity of the nosological discussion away from the nature-versus-social-construction argument.

as a concept to approach the
actual subjectivity processes and also the emergence of biotechnologies instruments to approach mental disorders,
behaviors and human attitudes. It analyses the use of neuroimages and the new issues they bring to psychological
research field that has to face the biologization of mind.

This article presents preliminary results
from ongoing research about autism in
Brazilian virtual communities. We
investigated public opinion about autism
in the virtual communities dedicated to
this issue. Public opinion about a medical
condition directly influences the sick
person’s experience and the experiences
of her caregivers and family. The results
describe the social representations of the
users – mainly parents and caregivers of
autistic children – about the supposed
causes of autism, the forms of treatment,
the forms of activism and the rights
of autistics and the ambivalent use of
medical knowledge, which is frequently
endowed with the capacity of disclosing
the disease, but which is also resisted in
favor of lay knowledge of parents and
caregivers based on their daily experience
with the autistic people.
Keywords: Autistic Disorder. Public
opinion. Social networking. Psychiatric
disorders

Based on a review of the literature published in the early twenty-first century by Brazilian researchers, the article offers an overview of stem cell research in Brazil. Three central topics were detected in these papers: (1) the funding of stem cell research in Brazil; (2) preclinical and clinical trials in Brazil; and (3) social anthropological analysis focused on ethical and legal matters. Our review identifies controversial questions in the construction of this scientific field, especially issues involving the media as a disseminator of values and
of certain social representations, where new kinds of hope figure large. Within this climate of uncertainty, we find patients and their families energized by the promises of the “medicine of the future.”

This article focuses on Canadian stem cell researchers working on therapeutic applications of autologous stem cells for heart disease. Building on the concept of 'multiverse' – coined by William James and then further developed by Ernst Bloch – we are interested in the simultaneity of the certain and uncertain, sometimes contradictory arguments articulated by these scientists. In the first part of the article we illustrate some of the factors that provide certainty for researchers and clinicians. The second part analyzes the ways in which uncertain elements become integrated into a discourse of certainty. What we would like to show, using the concept of multiverse, is that a relatively new biotechnology such as stem cell treatments generally relies on both certain and uncertain reasoning. However, uncertainty has to give way to a platform of partial certainty, if crucial action is to be taken on issues as diverse as treatments and grant applications. The principle mechanisms we found that can make this kind of transformation possible target future developments (what we call 'if only arguments'), including past encouraging results in need of further research.

This article focuses on Canadian stem cell researchers working on therapeutic applications of autologous stem cells for heart disease. Building on the concept of 'multiverse' – coined by William James and then further developed by Ernst Bloch – we are interested in the simultaneity of the certain and uncertain, sometimes contradictory arguments articulated by these scientists. In the first part of the article we illustrate some of the factors that provide certainty for researchers and clinicians. The second part analyzes the ways in which uncertain elements become integrated into a discourse of certainty. What we would like to show, using the concept of multiverse, is that a relatively new biotechnology such as stem cell treatments generally relies on both certain and uncertain reasoning. However, uncertainty has to give way to a platform of partial certainty, if crucial action is to be taken on issues as diverse as treatments and grant applications. The principle mechanisms we found that can make this kind of transformation possible target future developments (what we call 'if only arguments'), including past encouraging results in need of further research.

Medicalización más allá de los médicos: marketing farmacéutico en torno al trastorno por déficit de atención e hiperactividad en Argentina y Brasil (1998-2014) Abstract From a critical analysis of medicalization studies, and as a contribution to these perspectives, we describe and analyze the ways in which the transnational pharmaceutical industry penetrates diverse social spaces, with different marketing strategies, to consolidate medicalized processes in Argentina and Brazil. We analyzed two expansion methods of medicalization processes and specific ADHD diagnostic and treatment aspects and trends were developed in both countries: the impact of the pharmaceutical industry on advocacy groups in Brazil and pharmaceutical marketing strategies aimed at non-medical actors in Argentina. These two methods are characterized by involving other actors than medical professionals. The methodology includes data from research conducted in Argentina and Brazil between 1998 and 2014, based in the University of Buenos Aires and in the State University of Rio de Janeiro, focused on the study of ADHD diagnostic and treatment processes and methylphenidate consumption in both countries. We used individual and group semi-structured interview techniques with professors and health professionals, official and professional organization statistics, and national and international

Although autism is not a contagious
disease, the term “autism epidemic” is
used in allusion to the dramatic increase in
the number of new cases in only a short
period of time. This paper provides an
overview of the socially shared conceptions
surrounding autism in Brazil, through the
narratives that have given visibility to this
topic in the Brazilian press between 2000
and 2012. We regard these narratives
not as representations of a reality a priori,
but through their function of structuring
human experience. On the one hand,
such narratives shape and give content
to the issues and controversies that
surround autism in Brazil, while on the
other hand, they also actively contribute
to such debates, given that they affect the
meaning that readers place on them.

ORTEGA, F. J. G.; ZORZANELLI, RAFAELA TEIXEIRA ; GONÇALVES, VALÉRIA PORTUGAL . Academic and Professional Tensions and Debates around ADHD in Brazil.In: Meredith R. Bergey; Angela M. Filipe; Peter Conrad; Ilina Singh. (Org.). Global Perspectives on ADHD: Social Dimensions of Diagnosis and Treatment in Sixteen Countries. 1ed.Baltimore: Johns Hopkins University Press, 2017, v. , p. 306-329.

The Life-world of Hysteria explores the fundamental anthropological features of the hysterical person. Two essential elements for the understanding of the hysterical persons are described: relational hypo-sufficiency and anthropological fragmentation. Relational hypo-sufficiency reveals the central characteristic of hysterical interpersonality, namely the subjugation of the I of the hysterical person to the other. Relational hypo-sufficiency is understood in terms of its temporality, spatiality, corporeality, and social identity. Anthropological fragmentation has puzzle corporeality as its main characteristic. In it, the body of the hysterical person is transformed into a passive stage of heteronomous life-projects.  The chapter draws points of contrast with other disorders and sets out a dialectics of hysterical existence, presenting a fruitful face of this life-world.