Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
JCR IF 2018: 2.440
Fully open access
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Current issue 3, Volume 41 - May/Jun/2019


 

EDITORIAL
1 - Childhood maltreatment and health outcomes
Rodrigo Grassi-Oliveira
Pages: 193 - 193

Descriptors:


ORIGINAL ARTICLES
2 - Telomere length and childhood trauma in Colombians with depressive symptoms
Karen M. Jiménez; Angela J. Pereira-Morales; Ana Adan; Diego A. Forero
Pages: 194 - 198
Abstract

OBJECTIVE: Childhood trauma and telomere length (TL) are important risk factors for major depressive disorder. We examined whether there was an association between childhood trauma and TL in a sample of Colombians who were assessed for depressive symptoms.
METHODS: We applied the Center for Epidemiologic Studies Depression scale, the Patient Health Questionnaire-9, the Hospital Anxiety and Depression scale and the Childhood Trauma Questionnaire to 92 Colombian subjects (mean age = 21). TL was measured with quantitative PCR. Spearman's correlation coefficient (rs) was used to analyze the relationship between childhood trauma scores and TL.
RESULTS: We found a significant correlation between tL and sexual abuse scores (rs = 0.428, p = 0.002) in individuals with higher depressive symptom scores.
CONCLUSION: This is the first report of a significant association between TL and sexual abuse in a Latin American sample and provides additional evidence about the role of childhood trauma and TL in neuropsychiatric disorders.

Descriptors: Childhood trauma; depression; Latin America; sexual abuse; telomere length


3 - Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence
Alessandra Diehl; Jales Clemente; Sandra C. Pillon; Paulo R.H. Santana; Claudio J. da Silva; Jair de J. Mari
Pages: 199 - 207
Abstract

OBJECTIVE: To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users.
METHODS: A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated.
RESULTS: The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36).
CONCLUSION: Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

Descriptors: Adult survivors of child abuse; child maltreatment; substance-related disorders; sexual behavior


4 - Prevalence of self-reported trauma In a sample of Iranian children Is low and unrelated to parents' education or current employment status
Morteza Shamohammadi; Maryam Salmanian; Mohammad-Reza Mohammadi; Dena Sadeghi Bahmani; Edith Holsboer-Trachsler; Serge Brand
Pages: 208 - 212
Abstract

OBJECTIVE: In Western countries, the prevalence of childhood trauma (CT) ranges from 15 to 25%. CT might be indirectly associated with lower parental socioeconomic status and educational attainments. The aims of this cross-sectional study were fourfold: to assess prevalence of CT in a large sample of Iranian children; to compare the Iranian prevalence rates with those of Western countries; to explore gender-specific patterns; and to explore possible socioeconomic predictors.
METHOD: The sample comprised 608 children (mean age 11.49 years, 51.5% females). All completed the Farsi version of the Trauma Symptoms Checklist for Children. Additionally, parents reported on their current employment status and highest educational level.
RESULTS: Trauma symptoms were reported by 20 of 295 boys and 23 of 313 girls. The overall prevalence was 7.1%. Child-reported trauma symptoms were not associated with parents' socioeconomic status or highest educational level. Compared to prevalence findings from U.S. national surveys (ranging from 15-25% of children and adolescents), the prevalence among 11- and 12-year-olds in the present study was considerably lower.
CONCLUSIONS: The overall prevalence of reported trauma symptoms among a large sample of Iranian children was unrelated to parents' socioeconomic status, and was lower than that reported in U.S. surveys.

Descriptors: Trauma symptoms; prevalence; socioeconomic status; education


5 - PTSD in mental health outpatient settings: highly prevalent and under-recognized
Herika C. da Silva; Maísa M. Furtado da Rosa; William Berger; Mariana P. Luz; Mauro Mendlowicz; Evandro S.F. Coutinho; Carla M. Portella; Pamela I.S. Marques; Daniel C. Mograbi; Ivan Figueira; Paula Ventura
Pages: 213 - 217
Abstract

OBJECTIVES: To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training.
METHODS: We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records.
RESULTS: Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals.
CONCLUSIONS: These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.

Descriptors: Prevalence; PTSD; underdiagnosis; outpatient psychiatry


6 - Cost-effectiveness analysis of the treatment of mild and moderate Alzheimer's disease in Brazil
Luciana R. da Silva; Cid M.M. Vianna; Gabriela B.G. Mosegui; Antônio A.F. Peregrino; Valeska Marinho; Jerson Laks
Pages: 218 - 224
Abstract

OBJECTIVE: To perform a cost-effectiveness analysis of donepezil and rivastigmine therapy for mild and moderate Alzheimer's disease (AD) from the perspective of the Brazilian Unified Health System.
METHOD: A hypothetical cohort of 1,000 individuals of both sexes, aged >65 years, and diagnosed with AD was simulated using a Markov model. The time horizon was 10 years, with 1-year cycles. A deterministic and probabilistic sensitivity analysis was performed.
RESULTS: For mild AD, the study showed an increase in quality-adjusted life years (QALYs) of 0.61 QALY/21,907.38 Brazilian reais (BRL) for patients treated with donepezil and 0.58 qAlY/BRL 24,683.33 for patients treated with rivastigmine. In the moderate AD group, QALY increases of 0.05/BRL 27,414.96 were observed for patients treated with donepezil and 0.06/BRL 34,222.96 for patients treated with rivastigmine.
CONCLUSIONS: The findings of this study contradict the standard of care for mild and moderate AD in Brazil, which is based on rivastigmine. A pharmacological treatment option based on current Brazilian clinical practice guidelines for AD suggests that rivastigmine is less cost-effective (0.39 QALY/BRL 32,685.77) than donepezil. Probabilistic analysis indicates that donepezil is the most cost-effective treatment for mild and moderate AD.

Descriptors: Alzheimer's disease; economic issues; administration; geriatric psychiatry


7 - The validity and reliability of the CAMDEX-DS for assessing dementia in adults with Down syndrome in Brazil
Luciana M. Fonseca; Glenda G. Haddad; Guilherme P. Mattar; Melaine C. de Oliveira; Sharon S. Simon; Laura M. Guilhoto; Geraldo F. Busatto; Shahid Zaman; Anthony J. Holland; Marcelo Q. Hoexter; Cassio M. Bottino
Pages: 225 - 233
Abstract

OBJECTIVE: Alzheimer's disease occurs at a higher prevalence and an earlier age in individuals with Down syndrome (DS) than typically developing individuals. However, diagnosing dementia in individuals with intellectual disability remains a challenge due to pre-existing cognitive deficits. The aim of this study was to investigate the validity and reliability of the Brazilian version of the Cambridge Examination for Mental Disorders of Older People with Down's syndrome and Others with Intellectual Disabilities (CAMDEX-DS) for individuals with DS.
METHODS: Two psychiatrists, working independently, evaluated 92 adults with DS ≥ 30 years of age. The concurrent validity of the CAMDEX-Ds was analyzed in relation to the gold standard of established international criteria. In a subgroup of 20 subjects, the concurrent validity of the CAMDEX-DS was analyzed in relation to an independent objective assessment of cognitive decline over three years. We analyzed the inter-rater reliability of cognitive assessment.
RESULTS: The diagnostic accuracy of the CAMDEX-DS compared to the gold standard was 96.7%. CAMDEX-DS-based diagnosis was considered consistent with cognitive decline. The probability of a participant with dementia having cognitive decline was 83%. Inter-rater reliability for the participant assessment was good, with a kappa of > 0.8 for 93% of the CAMDEX-DS items.
CONCLUSION: The CAMDEX-DS can be considered the first valid and reliable instrument for evaluating dementia in adults with DS in Brazil. Its use in such individuals could improve clinical practice and research.

Descriptors: Alzheimer disease; Down syndrome; diagnosis; dementia; intellectual disability


8 - Does cyberbullying occur simultaneously with other types of violence exposure?
Marlene A. Vieira; John A. Ronning; Jair de J. Mari; Isabel A. Bordin
Pages: 234 - 237
Abstract

OBJECTIVE: Our study aimed to verify whether cyberbullying victimization among adolescents occurs concomitantly with other forms of violence exposure (at home, at school and in the community).
METHODS: A collaborative longitudinal study by Norwegian and Brazilian researchers was conducted in Itaboraí, a low-income city in southeast Brazil. At baseline, trained interviewers applied a semi-structured questionnaire to a population-based sample of 669 in-school adolescents (11-15 years old). The investigated types of violence exposure included cyberbullying, traditional bullying, severe physical punishment by parents and community violence (victimization and eye-witnessed violent events outside the home and school).
RESULTS: In the previous six months, 1.9% of the adolescents had been victims of cyberbullying, and 21.9% had been victims of physical aggression, verbal harassment and/or social manipulation by peers. However, only 5.5% of the adolescents considered themselves bullying victims. In the previous 12 months, 12.4% of adolescents had suffered severe physical punishment, 14.0% had been victims of community violence, and 20.9% eye-witnessed community violence. Multivariable regression analysis showed that victimization by multiple types of traditional bullying and self-perceived bullying victimization were correlates of cyberbullying victimization, while suffering violence at home and in the community were not.
CONCLUSION: This study provides evidence of an association between cyberbullying, traditional bullying and self-perceived bullying among low-income Brazilian adolescents.

Descriptors: Adolescence; cyberbullying; bullying; child abuse; community violence


9 - Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina
Alfredo H. Cia; Juan C. Stagnaro; Sergio Aguilar-Gaxiola; Sebastián Sustas; Edith Serfaty; Martin Nemirovsky; Ronald C. Kessler; Corina Benjet
Pages: 238 - 244
Abstract

OBJECTIVE: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE).
METHODS: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization.
RESULTS: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income.
CONCLUSIONS: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

Descriptors: Epidemiology; mental disorders; health services; Argentina


10 - Efficacy of adjunctive Garcinia mangostana Linn (mangosteen) pericarp for bipolar depression: study protocol for a proof-of-concept trial
Melanie M. Ashton; Michael Berk; Chee H. Ng; Malcolm Hopwood; Seetal Dodd; Alyna Turner; Ellie Brown; Felice N. Jacka; Susan M. Cotton; Jon-Paul Khoo; Mary Lou Chatterton; Bianca E. Kavanagh; Sarah E. Nadjidai; Samantha L. Lo Monaco; Brian H. Harvey; Jerome Sarris; Gin S. Malhi; Nathan L. Dowling; Olivia M. Dean
Pages: 245 - 253
Abstract

OBJECTIVE: Bipolar depression is characterized by neurobiological features including perturbed oxidative biology, reduction in antioxidant levels, and a concomitant rise in oxidative stress markers. Bipolar depression manifests systemic inflammation, mitochondrial dysfunction, and changes in brain growth factors. The depressive phase of the disorder is the most common and responds the least to conventional treatments. Garcinia mangostana Linn, commonly known as mangosteen, is a tropical fruit. The pericarp's properties may reduce oxidative stress and inflammation and improve neurogenesis, making mangosteen pericarp a promising add-on therapy for bipolar depression.
METHODS: Participants will receive 24 weeks of either 1,000 mg mangosteen pericarp or placebo per day, in addition to their usual treatment. The primary outcome is change in severity of mood symptoms, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), over the treatment phase. Secondary outcomes include global psychopathology, quality of life, functioning, substance use, cognition, safety, biological data, and cost-effectiveness. A follow-up interview will be conducted 4 weeks post-treatment.
CONCLUSION: The findings of this study may have implications for improving treatment outcomes for those with bipolar disorder and may contribute to our understanding of the pathophysiology of bipolar depression.
CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry, ACTRN12616000028404.

Descriptors: Garcinia mangostana; bipolar disorder; treatment; clinical trial; depression


BRIEF COMMUNICATIONS
11 - Smaller left anterior cingulate cortex in non-bipolar relatives of patients with bipolar disorder
Marsal Sanches; Edilberto Amorim; Benson Mwangi; Giovana B. Zunta-Soares; Jair C. Soares
Pages: 254 - 256
Abstract

OBJECTIVE: Bipolar disorder (BD) is highly heritable. The present study aimed at identifying brain morphometric features that could represent markers of BD vulnerability in non-bipolar relatives of bipolar patients.
METHODS: In the present study, structural magnetic resonance imaging brain scans were acquired from a total of 93 subjects, including 31 patients with BD, 31 non-bipolar relatives of BD patients, and 31 healthy controls. Volumetric measurements of the anterior cingulate cortex (ACC), lateral ventricles, amygdala, and hippocampus were completed using the automated software FreeSurfer.
RESULTS: Analysis of covariance (with age, gender, and intracranial volume as covariates) indicated smaller left ACC volumes in unaffected relatives as compared to healthy controls and BD patients (p = 0.004 and p = 0.037, respectively). No additional statistically significant differences were detected for other brain structures.
CONCLUSION: Our findings suggest smaller left ACC volume as a viable biomarker candidate for BD.

Descriptors: Bipolar disorder; cingulate cortex; magnetic resonance imaging; endophenotypes


12 - No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder
Michele Skinazi, Maria A. de Mathis, Tatiana Cohab, Marina de Marco e Souza, Roseli G. Shavitt, Euripedes C. Miguel, Marcelo Q. Hoexter, Marcelo C. Batistuzzo
Pages: 257 - 260
Abstract

OBJECTIVE: Although attentional bias (AB) toward angry faces is well established in patients with anxiety disorders, it is still poorly studied in obsessive-compulsive disorder (OCD). We investigated whether OCD patients present AB toward angry faces, whether AB is related to symptom severity and whether AB scores are associated with specific OCD symptom dimensions.
METHOD: Forty-eight OCD patients were assessed in clinical evaluations, intelligence testing and a dot-probe AB paradigm that used neutral and angry faces as stimuli. Analyses were performed with a one-sample t-test, Pearson correlations and linear regression.
RESULTS: No evidence of AB was observed in OCD patients, nor was there any association between AB and symptom severity or dimension. Psychiatric comorbidity did not affect our results.
CONCLUSION: In accordance with previous studies, we were unable to detect AB in OCD patients. To investigate whether OCD patients have different brain activation patterns from anxiety disorder patients, future studies using a transdiagnostic approach should evaluate AB in OCD and anxiety disorder patients as they perform AB tasks under functional neuroimaging protocols.

Descriptors: Threat; anxiety; cognition; reaction time; emotion; attention


SPECIAL ARTICLE
13 - From anatomy to function: the role of the somatosensory cortex in emotional regulation
Erika Kropf; Sabrina K. Syan; Luciano Minuzzi; Benicio N. Frey
Pages: 261 - 269
Abstract

Since the pioneering work of Penfield and his colleagues in the 1930s, the somatosensory cortex, which is located on the postcentral gyrus, has been known for its central role in processing sensory information from various parts of the body. More recently, a converging body of literature has shown that the somatosensory cortex also plays an important role in each stage of emotional processing, including identification of emotional significance in a stimulus, generation of emotional states, and regulation of emotion. Importantly, studies conducted in individuals suffering from mental disorders associated with abnormal emotional regulation, such as major depression, bipolar disorder, schizophrenia, post-traumatic stress disorder, anxiety and panic disorders, specific phobia, obesity, and obsessive-compulsive disorder, have found structural and functional changes in the somatosensory cortex. Common observations in the somatosensory cortices of individuals with mood disorders include alterations in gray matter volume, cortical thickness, abnormal functional connectivity with other brain regions, and changes in metabolic rates. These findings support the hypothesis that the somatosensory cortex may be a treatment target for certain mental disorders. In this review, we discuss the anatomy, connectivity, and functions of the somatosensory cortex, with a focus on its role in emotional regulation.

Descriptors: Somatosensory cortex; emotional regulation; mental disorders


LETTERS TO THE EDITORS
14 - Reduced functional bladder capacity associated with ketamine use
Sergio de P. Ramos; Tatiana K. Zambonato; Túlio M. Graziottin
Pages: 270 - 271

Descriptors:


15 - Long-term response to cathodal transcranial direct current stimulation of temporoparietal junction in a patient with refractory auditory hallucinations of schizophrenia
Nathalia Janovik; Victor H. Cordova; Bruna Chwal; Cintya Ogliari; Paulo Belmonte-de-Abreu
Pages: 271 - 272

Descriptors:


16 - First psychotic episode in an adult with Becker muscular dystrophy
Cátia Fernandes Santos
Pages: 272 - 273

Descriptors:


SPECIAL ARTICLE
43 - Biological bases for a possible effect of cannabidiol in Parkinson's disease
Nilson C. Ferreira-Junior; Alline C. Campos; Francisco S. Guimarães; Elaine Del-Bel; Patrícia M. da R. Zimmermann; Liberato Brum Junior; Jaime E. Hallak; José A. Crippa; Antonio W. Zuardi
Pages: -
Abstract

OBJECTIVE: Current pharmacotherapy of Parkinson's disease (PD) is palliative and unable to modify the progression of neurodegeneration. Treatments that can improve patients' quality of life with fewer side effects are needed, but not yet available. Cannabidiol (CBD), the major non-psychotomimetic constituent of cannabis, has received considerable research attention in the last decade. In this context, we aimed to critically review the literature on potential therapeutic effects of CBD in PD and discuss clinical and preclinical evidence supporting the putative neuroprotective mechanisms of CBD.
METHODS: We searched MEDLINE (via PubMed) for indexed articles published in English from inception to 2019. The following keywords were used: cannabis; cannabidiol and neuroprotection; endocannabinoids and basal ganglia; Parkinson's animal models; Parkinson's history; Parkinson's and cannabidiol.
RESULTS: Few studies addressed the biological bases for the purported effects of CBD on PD. Six preclinical studies showed neuroprotective effects, while three targeted the antidyskinetic effects of CBD. Three human studies have tested CBD in patients with PD: an open-label study, a case series, and a randomized controlled trial. These studies reported therapeutic effects of CBD on non-motor symptoms.
CONCLUSIONS: Additional research is needed to elucidate the potential effectiveness of CBD in PD and the underlying mechanisms involved.

Descriptors: Cannabidiol; CBD; Parkinson; neurodegeneration; neuroprotection.