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Metabolic, toxic or structural brain changes may present as psychotic symptoms. Organic delusional disorders are characterized by the presence of delusional ideas with evidence of brain dysfunction. Iatrogenesis may be a cause of this dysfunction. We present a case of neuropsychiatric symptoms, including delusional disorder, secondary to the use of herbal products. The patient's perception regarding the safety of natural products might result in an omission to report their use during clinical history taking, and thus its use should be actively questioned.Sintomas psicóticos podem constituir a forma de apresentação de alterações estruturais, metabólicas ou tóxicas. As perturbações delirantes orgânicas são caraterizadas pela presença de ideias delirantes com evidência de disfunção cerebral. A iatrogenia pode ser uma causa desta disfunção. Apresentamos um caso de sintomas neuropsiquiátricos, incluindo perturbação delirante, secundária ao uso de produtos de ervanária. A noção de inocuidade associada a estes produtos origina que o consumo dos mesmos não seja referido espontaneamente pelo doente na recolha da história clínica, pelo que a sua utilização deve ser ativamente questionada.

This international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300–600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75–150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175–300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100–200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250–400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150–300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300–600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.

This research aimed to know the concepts and didactic-pedagogical practices related to experimentation developed by professors in the area of Natural Sciences (Biology, Physics and Chemistry) who are masters of the Postgraduate Program in Teaching of Natural Sciences of the University as. A qualitative approach was followed whose methodological design consisted of four stages: exploratory (bibliographic review), elaboration of the research tools, application of the questionnaire and interview, analyzes and conclusions. Three categories of experimentation (investigative, demonstrative and verification) can be identified in the pedagogical practices of the participating teachers, as well as two different theoretical approaches to learning (behavioral and constructivist). Finally, it was possible to perceive that there was a possible re-signification, especially after entering the professional master's degree course, many of the conceptions about experimental activities and learning theories that underlie them, mainly on the idea of the role of the teacher and students in the process of construction of scientific knowledge. Com esta pesquisa, objetivou-se compreender as concepções e práticas didático-pedagógicas relacionadas à experimentação desenvolvidas por professores da área de Ciências Naturais (Biologia, Física e Química) que são mestrandos do Programa de Pós-Graduação em Ensino de Ciências Naturais da Universidade Federal de Mato Grosso. Seguiu-se uma abordagem qualitativa, cujo percurso metodológico consistiu em quatro etapas: exploratória (revisão bibliográfica), elaboração dos instrumentos de pesquisa, aplicação de questionários e entrevistas e análises e conclusões. Como resultado, identificou-se três categorias de experimentação (investigativa, demonstrativa e de verificação) presentes nas práticas pedagógicas dos professores participantes, bem como duas abordagens teóricas de aprendizagem (comportamentalista e construtivista). Desta forma, foi possível perceber que houve uma possível ressignificação, sobretudo após ingresso no curso de mestrado profissional, de muitas das concepções sobre atividades experimentais e teorias de aprendizagem que as subjazem, principalmente sobre a ideia do papel do professor e dos estudantes no processo de construção do conhecimento científico.

Hashimoto's encephalopathy is an unusual condition that is associated with Hashimoto's thyroiditis. Myoclonus, epileptic seizures, dementia, and disturbances of consciousness are the most common features.We present an atypical case of Hashimoto's encephalopathy in a 33-year-old woman who presented with several brief and acute psychotic episodes. After treatment with steroids, there was an improvement in the patient's psychiatric symptoms and electroencephalogram, and antithyroglobulin antibody titers returned to normal levels.It is our opinion that Hashimoto's encephalopathy should be considered in the differential diagnosis of atypical psychosis, especially because this is a treatable syndrome. This is particularly important in patients with a previous history of thyroid disease, despite current normal thyroid function.

The authors present a case report on a eighteenth months old male white, who was admitted at the Nephrology Unit with nephrotic syndrome--first episode. Considering the age of the patient, the laboratorial results and the negative result of the immunologic study, the first diagnostic hypothesis was the minimal lesions nephrotic syndrome and was initiated treatment with corticosteroid in the dosis of 60 mg per square meter, per day. The generalized oedema and the massive proteinuria persisted although the corticosteroid and additional therapy. At the sixth week the renal biopsy revealed membranous glomerulonephropathy with mesangial deposits of IgG, IgA, IgM, C3, C4, C1q, compatible with an immunologic disease and suggestive of lupus nephritis. Then, was initiated the therapeutic protocol with 6 menstrual pulses of intravenous cyclophosphmide. After the 4th pulse of cyclophosphamide the proteinuria was negative, and the patient remains in clinical and laboratorial remission since the end of the 6 pulses, and after 14 months of follow-up.