Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
JCR IF 2017: 2.093
Fully open access
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Current issue 2, Volume 41 - Mar/Apr/2019


2 - Epidemiological research in psychiatry: acting glocally
Thiago M. Fidalgo; Andre R. Brunoni
Pages: 99 - 100


3 - Topography of 11C-Pittsburgh compound B uptake in Alzheimer's disease: a voxel-based investigation of cortical and white matter regions
Daniele de P. Faria; Fabio L. Duran; Paula Squarzoni; Artur M. CoutinhO; Alexandre T. Garcez; Pedro P. Santos; Sonia M. Brucki; Maira O. de Oliveira; Eduardo S. Trés; Orestes V. Forlenza; Ricardo Nitrini; Carlos A. Buchpiguel; Geraldo Busatto Filho
Pages: 101 - 111

OBJECTIVE: To compare results of positron emission tomography (PET) with carbon-11-labeled Pittsburgh compound B (11C-PIB) obtained with cerebellar or global brain uptake for voxel intensity normalization, describe the cortical sites with highest tracer uptake in subjects with mild Alzheimer's disease (AD), and explore possible group differences in 11C-Pib binding to white matter.
METHODS: 11C-PIB PET scans were acquired from subjects with AD (n=17) and healthy elderly controls (n=19). Voxel-based analysis was performed with statistical parametric mapping (SPM).
RESULTS: Cerebellar normalization showed higher 11C-PIB uptake in the AD group relative to controls throughout the cerebral cortex, involving the lateral temporal, orbitofrontal, and superior parietal cortices. With global uptake normalization, greatest cortical binding was detected in the orbitofrontal cortex; decreased 11C-PIB uptake in white matter was found in the posterior hippocampal region, corpus callosum, pons, and internal capsule.
CONCLUSION: The present case-control voxelwise 11C-PIB PET comparison highlighted the regional distribution of amyloid deposition in the cerebral cortex of mildly demented AD patients. Tracer uptake was highest in the orbitofrontal cortex. Decreased 11C-PIB uptake in white-matter regions in this patient population may be a marker of white-matter damage in AD.

Descriptors: Amyloid PET imaging; Alzheimer's disease; statistical parametric mapping

4 - Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique
María de la Paz Maino; Susana Morales; Orietta Echávarri; Jorge Barros; Arnol García; Claudia Moya; Tita Szmulewicz; Ronit Fischman; Catalina NUnez; Alemka Tomicic
Pages: 112 - 121

OBJECTIVE: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care.
METHOD: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster.
RESULTS: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one's own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships.
CONCLUSIONS: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

Descriptors: Suicide; mood disorders; adolescents; adult development; community mental health

5 - Psychometric properties of the Liebowitz Social Anxiety Scale in a large cross-cultural Spanish and Portuguese speaking sample
Vicente E. Caballo; Isabel C. Salazar; Victor Arias; Stefan G. Hofmann; Joshua Curtiss; CISO-A Research Team
Pages: 122 - 130

OBJECTIVE: To examine the psychometric properties of the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) based on a large sample recruited from 16 Latin American countries, Spain, and Portugal.
METHODS: Two groups of participants were included: a non-clinical sample involving 31,243 community subjects and a clinical sample comprising 529 patients with a diagnosis of social anxiety disorder (SAD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used in order to determine the psychometric properties of the LSAS-SR.
RESULTS: EFA identified five factors with eigenvalues greater than 1.00 explaining 50.78% of the cumulative variance. CFA and ESEM supported this 5-factor structure of the LSAS-SR. The factors included: 1) speaking in public; 2) eating/drinking in front of other people; 3) assertive behaviors; 4) working/writing while being observed; and 5) interactions with strangers. Other psychometric properties such as interfactor correlations, invariance, reliability, and validity of the scale were also found.
CONCLUSION: Psychometric data support the internal consistency and convergent validity of the LSAS-SR. It seems to be a valid and reliable measure of global social anxiety for Spanish and Portuguese-speaking countries, although when considering a multidimensional approach (factor-based assessment) it seems to be lacking some relevant social situations that are feared in those countries.

Descriptors: Social anxiety disorder; questionnaires; psychometrics; cross-cultural comparison

6 - Alcohol misuse among women in Brazil: recent trends and associations with unprotected sex, early pregnancy, and abortion
Luciana T.S. Massaro; Renata R. Abdalla; Ronaldo Laranjeira; Raul Caetano; llana Pinsky; Clarice S. Madruga
Pages: 131 - 137

OBJECTIVE: This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households.
METHODS: This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed.
RESULTS: A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion.
CONCLUSION: Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Descriptors: Brazil; alcohol abuse; binge drinking; female; abortion

7 - Child and Adolescent Psychosocial Care Center service use profile in Brazil: 2008 to 2012
Grey Y. Ceballos; Cristiane S. Paula; Edith L. Ribeiro; Darci N. Santos
Pages: 138 - 147

OBJECTIVE: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012.
METHODS: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12.
RESULTS: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%).
CONCLUSIONS: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.

Descriptors: Mental health problems; children/adolescents; epidemiology; mental health service

8 - Investigating the Spectra constellations of the Hierarchical Taxonomy of Psychopathology (HiTOP) model for personality disorders based on empirical data from a community sample
Giselle Pianowski,; Lucas de F. Carvalho,; Fabiano K. Miguel
Pages: 148 - 152

OBJECTIVE: The Hierarchical Taxonomy of Psychopathology (HiTOP) posits that psychopathology is hierarchically structured. For personality disorder (PD) traits, there are five spectra: internalizing, thought disorder, disinhibited externalizing, antagonistic externalizing, and detachment. Empirical findings suggest a sixth group, compulsivity. In this research, we tried to recover the five HiTOP spectra, plus compulsivity, specifically for PD traits.
METHODS: The sample was composed of 4,868 Brazilians (54.9% women, age ranging from 18 to 70; mean = 25.7; SD = 9.64). All participants answered the Dimensional Clinical Personality Inventory 2 (IDCP-2), a self-report inventory for adults, developed in Brazil, for assessment of pathological personality traits.
RESULTS: Parallel analysis yielded up to nine factors. On exploratory structural equation modeling (E-SEM), the balance between interpretability and fit index suggested the six-factor solution as the best solution. The fit indexes for the confirmatory factor analysis were slightly less adjusted in comparison to the empirical model.
CONCLUSION: The hypothesis was confirmed, as we did find the groups proposed at the spectrum level of the HiTOP. We also found a compulsivity factor, encompassing the main traits from the conscientiousness dimension of IDCP-2, which is related to obsessive-compulsive PD. Finding the six groupings of traits in the HiTOP model contributes to the validity of this model, and confirms the existence of proposed spectra.

Descriptors: Keywords: Personality disorders; internal structure; diagnostic classification

9 - Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach
Leonardo Baldaçara; Flávia Ismael; Verônica Leite; Lucas A. Pereira; Roberto M. dos Santos; Vicente de P. Gomes JUnior; Elie L.B. Calfat; Alexandre P. Diaz; Cintia A.M. Perico; Deisy M. Porto; Carlos E. Zacharias; Quirino Cordeiro; Antonio Geraldo da Silva; Teng C. Tung
Pages: 153 - 167

OBJECTIVE: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil.
METHODS: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools.
RESULTS: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient's appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree.
CONCLUSION: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint.

Descriptors: Environmental health; psychomotor agitation; aggression; emergency; mental disorders; patient care team; risk assessment; physical restraint; immobilization

10 - Anxiolytic properties of compounds that counteract oxidative stress, neuroinflammation, and glutamatergic dysfunction: a review
Patrícia Santos; Ana P. Herrmann; Elaine Elisabetsky; Angelo Piato
Pages: 168 - 178

OBJECTIVE: Anxiety disorders are highly prevalent and the efficacy of the available anxiolytic drugs is less than desired. Adverse effects also compromise patient quality of life and adherence to treatment. Accumulating evidence shows that the pathophysiology of anxiety and related disorders is multifactorial, involving oxidative stress, neuroinflammation, and glutamatergic dysfunction. The aim of this review was to evaluate data from animal studies and clinical trials showing the anxiolytic effects of agents whose mechanisms of action target these multiple domains.
METHODS: The PubMed database was searched for multitarget agents that had been evaluated in animal models of anxiety, as well as randomized double-blind placebo-controlled clinical trials of anxiety and/or anxiety related disorders.
RESULTS: The main multitarget agents that have shown consistent anxiolytic effects in various animal models of anxiety, as well in clinical trials, are agomelatine, N-acetylcysteine (NAC), and omega-3 fatty acids. Data from clinical trials are preliminary at best, but reveal good safety profiles and tolerance to adverse effects.
CONCLUSION: Agomelatine, NAC and omega-3 fatty acids show beneficial effects in clinical conditions where mainstream treatments are ineffective. These three multitarget agents are considered promising candidates for innovative, effective, and better-tolerated anxiolytics.

Descriptors: Anxiety; agomelatine; N-acetylcysteine; omega-3 fatty acids

11 - Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis
Amanda P. Trindade; Jose C. Appolinario; Paulo Mattos; Janet Treasure; Bruno P. Nazar
Pages: 179 - 187

OBJECTIVE: To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED.
METHODS: The procedures followed the Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO).
RESULTS: Thirty-three studies were included in the analysis, of which 14 were included in the metaanalysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively).
CONCLUSION: Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.

Descriptors: Eating disorders; epidemiology; nutrition; women; statistics

12 - Suicide by hanging in Brazil: challenges to mitigating its escalation
Danilo Borges-Santos; Yuan-Pang Wang
Pages: 188 - 192


13 - Treating nightmares in PTSD with doxazosin: a report of three cases
Vitor Crestani Calegaro; Pedro Henrique Canova Mosele; Isabela Duarte e Souza; Emanuelly Martins da Silva; Julia Pinto Trindade
Pages: 189 - 190


14 - Life-threatening hypoglycemia attributable to haloperidol in a patient with schizophrenia
Joana Couto; Luís Pontes dos Santos; Tiago Mendes; Raquel López
Pages: 190 - 191


15 - Institutional factors in the medical burnout epidemic
Simone Hauck; Glen O. Gabbard
Pages: 191 - 192