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 3, Volume 34 - Jul/Aug/Sep/2012


 

COVER NOTES
1 - Cover note
Sônia Salztein Goldberg
Pages:   -  

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EDITORIALS
2 - Driving while intoxicated in Brazil: Tougher laws are a first step, but further challenges remain
Aruna Chandran; Ricardo Pérez-Núñez
Pages: 237 - 240

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3 - Opportunity and challenge: the situation of child and adolescent mental health in Brazil
Christian Kieling; Myron Belfer
Pages: 241 - 244

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4 - Why is Brazil losing the race against youth suicide?
José Manoel Bertolote
Pages: 245 - 248

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ORIGINAL ARTICLES
5 - Lifetime Prevalence, Age and Gender Distribution and Age-of-Onset of Psychiatric Disorders in the São Paulo Metropolitan Area, Brazil: Results from the São Paulo Megacity Mental Health Survey
Maria Carmen Viana; Laura Helena Andrade
Pages: 249 - 260
Abstract

OBJECTIVES: To estimate prevalence, age-of-onset, gender distribution and identify correlates of lifetime psychiatric disorders in the São Paulo Metropolitan Area (SPMA).
METHODS: The São Paulo Megacity Mental Health Survey assessed psychiatric disorders on a probabilistic sample of 5,037 adult residents in the SPMA, using the World Mental Health Survey Version of the Composite International Diagnostic Interview. Response rate was 81.3%.
RESULTS: Lifetime prevalence for any disorder was 44.8%; estimated risk at age 75 was 57.7%; comorbidity was frequent. Major depression, specific phobias and alcohol abuse were the most prevalent across disorders; anxiety disorders were the most frequent class. Early age-of-onset for phobic and impulse-control disorders and later age-of-onset for mood disorders were observed. Women were more likely to have anxiety and mood disorders, whereas men, substance use disorders. Apart from conduct disorders, more frequent in men, there were no gender differences in impulse-control disorders. There was a consistent trend of higher prevalence in the youngest cohorts. Low education level was associated to substance use disorders.
CONCLUSIONS: Psychiatric disorders are highly prevalent among the general adult population in the SPMA, with frequent comorbidity, early age-of-onset for most disorders, and younger cohorts presenting higher rates of morbidity. Such scenario calls for vigorous public health action.

Descriptors: São Paulo Megacity Mental Health Survey; World Mental Health Surveys; Psychiatric Epidemiology; Population-Based Studies; Cross-Sectional Surveys; Developing Countries.


6 - Spatial distribution of suicide incidence rates in municipalities in the state of Espírito Santo (Brazil), 2003-2007: spatial analysis to identify risk areas
Luciene Bolzam Macente; Eliana Zandonade
Pages: 261 - 269
Abstract

OBJECTIVE: To analyze the spatial distribution of suicide incidence rate in a residential municipality of the state of Espírito Santo (ES), Brazil, from 2003 to 2007.
METHODS: Ecologic study of the exploratory kind, based on secondary data. Deaths per suicide, which took place in each municipality of ES, were included in the data according to information provided by the Mortality Information System. For the spatial data analysis, a Bayesian approach was used (Global empirical and Local Bayesian ones) to correct epidemiological rates. Moran's I index was calculated to a worldwide spatial level dependence, and Local Moran (LISA) to a local spatial correlation. The following software applications were used: Excel; R 2.6.2; SPSS 11.5 and TerraView 3.3.1.
RESULTS: The geographical localization of the municipalities that showed an incidence rate characterized as the average for suicide after adjustment (EBest Global) forms a corridor in the countryside. Some common characteristics among these municipalities are: a) immigration (Italians, Pomeranians/ Germans); b) rural population (average of 53%); c) supporting economy (agriculture, husbandry and livestock). A global and local spatial correlation was found among the municipalities (p < 0.05).
CONCLUSION: The study identified the spatial context where the greatest death incidence rate per suicide occurred in the state of ES, during the mentioned period.

Descriptors: Suicide; Residence Characteristics; Spatial Bayesian Analysis; Statistical Analysis; Incidence.


7 - Prevalence of suicide risk and comorbidities in postpartum women in Pelotas
Daniele Tavares; Luciana Quevedo; Karen Jansen; Luciano Souza; Ricardo Pinheiro; Ricardo Silva
Pages: 270 - 276
Abstract

OBJECTIVES: To evaluate the prevalence of suicide risk and comorbidities in postpartum women.
METHODS: This is a cross-sectional study of postpartum women. The sample comprised mothers who have received prenatal care from the Brazilian National System of Public Heath in the city of Pelotas. Suicide risk and other mental disorders were evaluated using the Mini International Neuropsychiatric Interview (MINI). A yes answer on one of the six interview questions was considered a sign of suicide risk.
RESULTS: The sample consisted of 919 postpartum women. The 11.5% suicide prevalence was 4.62 (CI 2.45, 8.73) times higher in women with low educational levels. Women with comorbid depression or an anxiety disorder showed a 17.04 (CI 2.27; 19.96) times greater risk of suicide than those who did not suffer from any mood disorder.
CONCLUSION: Lower education levels and psychiatric disorders are associated with suicide risk. Bipolar disorder is the psychiatric disorder with the highest impact on suicide risk.

Descriptors: Postpartum Depression; Suicide Risk; Maternal Depression; Anxiety Disorders; Woman.


8 - Predictors of positive Blood Alcohol Concentration (BAC) in a sample of Brazilian drivers
Flavio Pechansky; Paulina do Carmo Arruda Vieira Duarte; Raquel De Boni; Carl G. Leukefeld; Lisia von Diemen; Daniela Benzano Bumaguin; Fernanda Kreische; Juliana Balbinot Hilgert; Mary Clarisse Bozzetti; Daniel Fernando Paludo Fuchs
Pages: 277 - 285
Abstract

OBJECTIVE: To verify the frequency of positive Blood Alcohol Concentration (BAC) among drivers and to examine associated factors in a cross-sectional study of Brazilian state capitals.
METHODS: 3,398 drivers were approached on highways crossing all 27 Brazilian capitals from 12 p.m. to 12 a.m. (Fridays and Saturdays). They were breathalyzed and data on their driving characteristics and alcohol consumption were collected. Multivariate logistic regression following a hierarchical conceptual framework was used to evaluate associated factors.
RESULTS: The overall weighted prevalence of positive BAC (> 0.1 mg/L) was 4.2%. The multivariate analysis showed that education up to 8 years (OR = 2.0; 95% CI: 1.4-3.0), age > 30 years (OR = 2.6; 95% CI: 1.8-3.8), type of vehicle (cars: OR = 3.0; 95% CI: 1.7-5.1; motorcycles: OR = 3.7; 95% CI: 2.1-6.4), binge drinking (OR = 1.7; 95% CI: 1.3-2.4), having been breathalyzed before (OR = 2.6; 95% CI: 1.8-3.7), and purpose of the trip (coming from a party: OR = 1.9; 95% CI: 1.3-3.0; leisure trip: OR = 1.7; 95% CI: 1.32.4; driving after 8 p.m.: OR = 1.7; 95% CI: 1.3-2.3) were independently associated with DUI.
CONCLUSION: Study findings suggest that selected external environmental factors, such as socioeconomic and demographic characteristics as well as personal characteristics like alcohol consumption and the relationship between drinking and driving were associated with positive BAC among Brazilian drivers. Results can help to inform drinking and driving policy and preventive approaches.

Descriptors: Epidemiology; DUI; Alcohol; Traffic.


9 - Suicide rates and trends in São Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis
Daniel H. Bando; André R. Brunoni; Tiótrefis G. Fernandes; Isabela M. Benseñor; Paulo A. Lotufo
Pages: 286 - 293
Abstract

OBJECTIVE: To evaluate suicide rates and trends in São Paulo by sex, age-strata, and methods.
METHODS: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide.
RESULTS: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (> 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners.
CONCLUSIONS: Specific epidemiological trends for suicide in the city of São Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention.

Descriptors: Suicide; Brazil; Epidemiology; Regression Analysis; Public Health; High-Risk Group.


10 - Use of alcohol and other drugs among Brazilian college students: effects of gender and age
Arthur Guerra de Andrade; Paulina do Carmo Arruda Vieira Duarte; Lucia Pereira Barroso; Raphael Nishimura; Denis Guilherme Alberghini; Lúcio Garcia de Oliveira
Pages: 294 - 305
Abstract

OBJECTIVE: To assess the frequency of drug use among Brazilian college students and its relationship to gender and age.
METHODS: A nationwide sample of 12,721 college students completed a questionnaire concerning the use of drugs and other behaviors. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) criteria were used to assess were used to assess hazardous drug use. A multivariate logistic regression model tested the associations of ASSIST-WHO scores with gender and age. The same analyses were carried out to measure drug use in the last 30 days.
RESULTS: After controlling for other sociodemographic, academic and administrative variables, men were found to be more likely to use and engage in the hazardous use of anabolic androgenic steroids than women across all age ranges. Conversely, women older than 34 years of age were more likely to use and engage in the hazardous use of amphetamines.
CONCLUSIONS: These findings are consistent with results that have been reported for the general Brazilian population. Therefore, these findings should be taken into consideration when developing strategies at the prevention of drug use and the early identification of drug abuse among college students.

Descriptors: Epidemiology; Cross-Sectional Study; Ethanol; Illicit Drugs; Students.


11 - Regional differences associated with drinking and driving in Brazil
Raquel De Boni; Lisia von Diemen; Paulina do Carmo Arruda Vieira Duarte; Daniela Benzano Bumaguin; Juliana Balbinot Hilgert; Mary Clarisse Bozzetti; Anne Sordi; Flavio Pechansky
Pages: 306 - 313
Abstract

OBJECTIVE: To evaluate regional differences and similarities associated with drinking and driving (DUI) in the five Brazilian macro-regions.
METHOD: A roadside survey was conducted in the 27 Brazilian state capitals. A total of 3,398 drivers were randomly selected and given a structured interview and a breathalyzer test. To determine the predictors of positive blood alcohol concentration (BAC) in each region, a MANOVA was performed, and 3 groups were used as follows: 1) North and Northeast, 2) South and Midwest, and 3) Southeast. A Poisson robust regression model was performed to assess the variables associated with positive BAC in each group.
RESULTS: Of all surveyed drivers, 2,410 had consumed alcohol in the previous 12 months. Most were male, with a median age of 36. Leisure as the reason for travel was associated with positive BAC in all 3 groups. Low schooling, being older than 30, driving cars or motorcycles and having been given a breathalyzer test at least once in their lives predicted DUI in at least two different groups.
CONCLUSIONS: Factors , especially low schooling and leisure as a reason for travel, associated with drinking and driving were similar among regions, although certain region-specific features were observed. This information is important for aiming to reduce DUI in the country.

Descriptors: Alcohol drinking; Traffic accidents; Geographic locations.


12 - Psychiatric disorders among individuals who drive after the recent use of alcohol and drugs
Sibele Faller; J. Matthew Webster; Carl G. Leukefeld; Daniela Benzano Bumaguin Paulina do Carmo Arruda Vieira Duarte; Raquel De Boni; Flavio Pechansky
Pages: 314 - 320
Abstract

INTRODUCTION: This cross-sectional study assessed the prevalence of psychiatric disorders among drivers and their association with recent use of alcohol and drugs using telephone interviews.
METHODS: Drivers (n = 1,134) from a roadside survey from 25 Brazilian state capitals were breathalyzed and had their saliva tested for psychoactive drugs. A telephone interview was performed to obtain psychiatric disorders data through MINI. The association was analyzed with a Poisson regression model.
RESULTS: The prevalence of any psychiatric disorder was 40.5% among drivers with recent use, compared to 12.9% in the other drivers. Alcohol/drug-positive drivers reported a higher prevalence of depression (19.4%), mania (6.5%), hypomania (5.4%), post-traumatic stress disorder (8.6%), antisocial personality (7.8%), and substance/alcohol abuse or dependence (48.1%) when compared to other drivers (3.5%, 2.5%, 2.1%, 0.5%, 1.3% and 18.3% [p < 0.001], respectively). Drivers with recent use were 2.5 times more likely to have any psychiatric diagnosis (CI: 1.8-3.6, p < 0.001).
DISCUSSION: This is the first study in Low/Middle-Income Countries (LAMIC) that aims to evaluate psychiatric disorders of drivers with recent use of alcohol and drugs using telephone interviews. Psychiatric disorders were associated with this use. This type of epidemiological information is vital to plan strategies aimed at curtailing related problems, since these psychiatric conditions are diagnosable.
FINAL REMARKS: Results can help design interventions, treatment programs and focused psychiatric evaluation, both in Brazil and abroad.

Descriptors: Drivers; Alcohol; Drugs; Psychiatric Disorders; Telephone.


13 - Is there an association between perinatal complications and attention-deficit/hyperactivity disorder-inattentive type in children and adolescents?
Carla Ruffoni Ketzer; Carolina Gallois; Ana Luiza Martinez; Luis Augusto Rohde; Marcelo Schmitz
Pages: 321 - 328
Abstract

OBJETIVO: O objetivo desse estudo é investigar a associação entre complicações perinatais (complicações ocorridas nos períodos pré, peri e pós-natal imediato - CPPs) e transtorno de déficit de atenção/hiperatividade (TDAH) do subtipo desatento (TDAH-D).
MÉTODO: Em um estudo de casos e controles, foram avaliadas 124 crianças e adolescentes (6-17 anos) com TDAH-D e 124 controles sem a doença, provenientes tanto de uma amostra populacional (n = 200), quanto de uma amostra clínica (n = 48). Casos e controles, pareados por gênero e idade, foram sistematicamente avaliados através de entrevistas diagnósticas estruturadas. Informações sobre as complicações ocorridas durante os períodos pré, peri e pós-natal imediato (CPPs), assim como sobre potencias confundidores, foram obtidas através de entrevistas realizadas diretamente com as mães biológicas.
RESULTADOS: A análise de regressão logística condicional mostrou que para as crianças e adolescentes cujas mães apresentaram maior número de CPPs, o risco de TDAH-D foi significativamente mais elevado (p = 0.005; OR = 1.25; IC 95%: 1.1-1.5).
CONCLUSÕES: Em um estudo de caso-controle, foi possível expandir, para o TDAH predominantemente desatento, os achados prévios que sugeriam a associação entre complicações perinatais e TDAH sem um subtipo específico. Em virtude da possibilidade de prevenção de algumas dessas complicações, nossos resultados podem exercer impacto sobre políticas públicas de saúde.

Descriptors: Attention-Deficit Hyperactivity Disorder - predominantly inattentive type; Prenatal, Delivery and Early Postnatal Complications; Environmental Factors.


BRIEF COMMUNICATIONS
14 - Effects of pregabalin on behavioral alterations induced by ketamine in rats
Emerson Arcoverde Nunes; Leila Canever; Larissa de Oliveira; Renata D'altoe de Luca; João Quevedo; Alexandra Zugno; Antonio Peregrino; José Alexandre S. Crippa; Serdar M. Dursun; Glen B. Baker; Jaime Eduardo C. Hallak
Pages: 329 - 333
Abstract

OBJECTIVE: The aim of this study is to investigate the effects of pregabalin on the behavior of rats under the influence of ketamine, an NMDA receptor antagonist that mimics the symptoms of schizophrenia.
METHODS: Rats were injected with saline or 25 mg/kg ketamine intraperitoneally. After that, behavior modifications were investigated by the evaluation of stereotypy and hyperlocomotion, after treating rats with pregabalin (at doses of 30 mg/kg or 100 mg/kg) or placebo (saline solution).
RESULTS: The administration of pregabalin reduced ketamine-induced hyperlocomotion. However, neither doses of pregabalin had a significant effect on ketamineinduced stereotypy.
CONCLUSION: This is the first study to investigate the effects of pregabalin using an animal model of psychosis. Furthermore, our results indicate that behavioral changes induced by ketamine in rats can be reversed with the use of pregabalin, suggesting its potential to treat psychotic symptoms.

Descriptors: Anticonvulsants; Psychosis; Schizophrenia; Other Areas of Neuroscience and Other Aspects of Psychopharmacology.


SPECIAL ARTICLES
15 - How to improve the mental health care of children and adolescents in Brazil: Actions needed in the public sector
Cristiane S. Paula; Edith Lauridsen-Ribeiro; Lawrence Wissow; Isabel A. S. Bordin; Sara Evans-Lacko
Pages: 334 - 341
Abstract

INTRODUCTION: Child/adolescent mental health (CAMH) problems are associated with high burden and high costs across the patient's lifetime. Addressing mental health needs early on can be cost effective and improve the future quality of life.
OBJECTIVE/METHODS: Analyzing most relevant papers databases and policies, this paper discusses how to best address current gaps in CAMH services and presents strategies for improving access to quality care using existing resources.
RESULTS: The data suggest a notable scarcity of health services and providers to treat CAMH problems. Specialized services such as CAPSi (from Portuguese: Psychosocial Community Care Center for Children and Adolescents) are designed to assist severe cases; however, such services are insufficient in number and are unequally distributed. The majority of the population already has good access to primary care and further planning would allow them to become better equipped to address CAMH problems. Psychiatrists are scarce in the public health system, while psychologists and pediatricians are more available; but, additional specialized training in CAMH is recommended to optimize capabilities. Financial and career development incentives could be important drivers to motivate employment-seeking in the public health system.
CONCLUSIONS: Although a long-term, comprehensive strategy addressing barriers to quality CAMH care is still necessary, implementation of these strategies could make.

Descriptors: Child, Adolescent, Mental Health, Community Mental Health Services; Primary Health Care.


UPDATE ARTICLE
16 - Temperament and character dimensions and their relationship to major depression and panic disorder
Marina Dyskant Mochcovitch; Antonio Egidio Nardi; Adriana Cardoso
Pages: 342 - 351
Abstract

INTRODUCTION: Since the first publication of Cloninger´s psychobiological model of personality, the relationship between temperament and character dimensions and psychiatric disorders has been widely studied. The exact nature of this interaction, however, is still unclear. Different models have been proposed (state-dependency, vulnerability, continuous spectrum etc).
OBJECTIVE: To analyze the relationship between temperament and character dimensions with depression and panic disorder.
METHOD: Systematic review on interventional studies published up until December 2011 on MEDLINE and ISI databases. Also, a brief review on genetic studies is hereby undertaken, aiming to discuss the gene-environment interaction in relation to this topic.
RESULTS: Thirteen studies were included: 10 related to depression and 3 to panic disorder (or unspecific anxiety symptoms). All of them showed association between high harm avoidance (HA) and low self directedness (SD) with depression and anxiety symptoms. Longitudinal studies demonstrated that these traits may not be just state-dependent.
CONCLUSIONS: HA and SD dimensions are associated with both the occurrence of depressive and anxiety symptoms. There is also some evidence to suggest that high HA and low SD indicates susceptibility to depression. Longitudinal studies are not sufficient to affirm the same about panic disorder up to the present moment.

Descriptors: Temperament; Character; Depression; Panic Disorder; Temperament and Character Inventory.


LETTER TO THE EDITORS
17 - Rates of psychiatric readmission and public mental health policies
Régis Eric Maia Barros; Cristina Marta Del-Ben
Pages: 352 - 355

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18 - Lithium use during the first trimester of pregnancy followed by discontinuation, close follow-up and therapy focused on listening and support
Débora Bassitt; Walter Soares; Michel Haddad; Mariana Alberti; Marcela Bezerra
Pages: 356 - 359

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BOOK REVIEW
20 - Exploring frontiers of the mind-brain relationship
Neusa Sicca da Rocha
Pages: 364 - 365

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21 - Cinema e Loucura - conhecendo os transtornos mentais através dos filmes
Cristiane Reberte de Marque
Pages: 366 - 367

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ERRATUM
22 - The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study
Elie Leal de Barros Calfat; Pedro Mario Pan; Pedro Shiozawa; Ana Cristina Chaves
Pages: 368 - 368

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