Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
JCR IF 2017: 2.093
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Current issue 1, Volume 35 - Jan/Feb/Mar/2013


1 - Cover note
Cristina Freire
Pages: 0 - 0


2 - Biological mechanisms underlying neuroprogression in bipolar disorder
Josiane Budni; Samira S. Valvassori; João Quevedo
Pages: 1 - 2


3 - More than two dozen "autisms"
Marcos Tomanik Mercadante; James F. Leckman
Pages: 3 - 4


4 - Is positive affect in pregnancy protective of postpartum depression?
Sandra Carvalho Bos; António Macedo; Mariana Marques; Ana Telma Pereira; Berta Rodrigues Maia; Maria João Soares; José Valente; Ana Allen Gomes; Maria Helena Azevedo
Pages: 5 - 12

OBJECTIVE: To investigate the predictive/protective role of negative affect/positive affect in late pregnancy on the outcome of postpartum depression.
METHODS: A total of 491 pregnant women participated in the study. The participants were asked to fill out a series of questionnaires, which included the Profile of Mood States, the Beck Depression Inventory-II, psychosocial variables and socio-demographic characteristics and were asked to participate in a psychiatric interview. After delivery, 272 mothers participated again in the study and filled out a similar series of questionnaires.
RESULTS: Negative affect was associated with more intense depressive symptomatology, more self-perceived stress, lower self-reported social support, lower quality of life and perception of having a more difficult infant. By contrast, positive affect was negatively associated with these variables. Negative affect in late pregnancy increased the likelihood of experiencing postpartum depression (DSM-IV/OR = 2.1, 95%CI = 1.3-3.4, p = .003; ICD-10/OR = 2.1, 95%CI = 1.5-3.0, p < .001), while positive affect increased the odds of not having this condition (DSM-IV/OR = 2.0, 95%CI = 1.5-2.7, p = .042).
CONCLUSION: In pregnancy, negative affect was a predictor of postpartum depression, whereas positive affect showed a protective role. Future studies are required to explore whether psychotherapeutic strategies focusing on decreasing negative affect and enhancing positive affect in the last trimester of pregnancy can reduce the risk of postpartum depression.

Descriptors: Negative Affect; Positive Affect; Profile of Mood States; Pregnancy; Postpartum Depression.

5 - Chronic pain and quality of life in schizophrenic patients
Jouce Gabriela de Almeida; Patrícia Emilia Braga; Francisco Lotufo Neto; Cibele Andrucioli de Mattos Pimenta
Pages: 13 - 20

OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain.
METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia). Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief) data were collected between June and September 2008.
RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001). There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them.
CONCLUSION: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age) and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

Descriptors: Chronic Pain; Schizophrenia; Quality of Life.

6 - Effects of Panax ginseng extract in patients with fibromyalgia: A 12-week, randomized, double-blind, placebo-controlled trial
Alessandra S. Braz; Liana Clébia S. Morais; Ana Patríca Paula; Margareth F. F. M. Diniz; Reinaldo N. Almeida
Pages: 21 - 28

The purpose of the study was to evaluate the efficacy of an extract of Panax ginseng in patients with fibromyalgia. A randomized, double-blind, controlled clinical trial was carried out over 12 weeks to compare the effects of P. ginseng (100 mg/d) with amitriptyline (25 mg/d) and placebo in 38 patients with fibromyalgia: 13 in Group I (amitriptyline), 13 in Group II (placebo), and 12 in Group III (P. ginseng). Ratings on the Visual Analogue Scale (VAS) revealed a reduction in pain in the P. ginseng group (p < .0001), an improvement in fatigue (p < .0001) and an improvement in sleep (p < .001), with respect to baseline characteristics, but there were no differences between the three groups. With respect to anxiety, improvements occurred in the P. ginseng group compared to baseline (p < .0001); however, amitriptyline treatment resulted in significantly greater improvements (p < .05). P. ginseng reduced the number of tender points and improved patients' quality of life (using the Fibromyalgia Impact Questionnaire - FIQ); however, there were no differences between groups. The beneficial effects experienced by patients for all parameters suggest a need for further studies to be performed on the tolerability and efficacy of this phytotherapic as a complementary therapy for fibromyalgia.

Descriptors: Fibromyalgia; Panax ginseng; Pharmacological Treatment; Complementary Treatment; Phytotherapy.

7 - Religion as a protective factor against drug use among Brazilian university students: a national survey
Fernanda Carolina Gomes; Arthur Guerra de Andrade; Rafael Izbicki; Alexander Moreira Almeida; Lúcio Garcia de Oliveira
Pages: 29 - 37

OBJECTIVE: To investigate the relationship between religiosity and drug use among Brazilian university students.
METHODS: This manuscript is part of the "First Nationwide Survey on the Use of Alcohol, Tobacco and Other Drugs among College Students in the 27 Brazilian State Capitals". In this study, 12,595 university students were divided into two groups according to their attendance at religious services: frequent attenders (FR; 39.1%) and non-frequent attenders (NFR; 60.8%). Subsequently, we analyzed their responses to a structured, anonymous questionnaire on drug use and other behaviors. Individual multivariate logistic regression models tested the association between religiosity and drug use (alcohol, tobacco, marijuana and at least one illicit drug).
RESULTS: Drug use over the last 30 days was higher among NFR students even after controlling for demographic variables. NFR students were more likely to use alcohol OR = 2.52; 95% CI: 2.08- 3.06, tobacco (2.83; 2.09-3.83), marijuana (2.09; 1.39-3.11) and at least one illicit drug (1.42; 1.12-1.79) compared to FR students.
CONCLUSION: Religiosity was found to be a strongly protective factor against drug use among Brazilian university students. However, more studies are needed to identify the mechanisms by which religiosity exerts this protective influence.

Descriptors: Religion and Medicine; Street Drugs; Cross-Sectional Study; Students; Brazil.

8 - Cross-cultural adaptation, validation and reliability of the Brazilian version of the Richmond Compulsive Buying Scale
Priscilla Leite; Bernard Rangé; Monika Kukar-Kiney; Nancy Ridgway; Kent Monroe; Rodolfo Ribas Junior; J. Landeira Fernandez; Antonio Egidio Nardi; Adriana Silva
Pages: 38 - 43

OBJECTIVE: To present the process of transcultural adaptation of the Richmond Compulsive Buying Scale to Brazilian Portuguese.
METHODS: For the semantic adaptation step, the scale was translated to Portuguese and then back-translated to English by two professional translators and one psychologist, without any communication between them. The scale was then applied to 20 participants from the general population for language adjustments. For the construct validation step, an exploratory factor analysis was performed, using the scree plot test, principal component analysis for factor extraction, and Varimax rotation. For convergent validity, the correlation matrix was analyzed through Pearson's coefficient.
RESULTS: The scale showed easy applicability, satisfactory internal consistency (Cronbach's alpha=.87), and a high correlation with other rating scales for compulsive buying disorder, indicating that it is suitable to be used in the assessment and diagnosis of compulsive buying disorder, as it presents psychometric validity.
CONCLUSION: The Brazilian Portuguese version of the Richmond Compulsive Buying Scale has good validity and reliability © 2013 Associação Brasileira de Psiquiatria. Published by Elsevier Editora Ltda. All rights reserved.

Descriptors: Compulsive Behavior; Psychometrics; Psychiatric Status Rating Scales; Diagnosis.

9 - The Val66Met polymorphism at the BDNF gene does not influence Wisconsin Card Sorting Test results in children and adolescents with bipolar disorder
Cristian Patrick Zeni; Silzá Tramontina; Thamis Aline Zeni; Roberta Coelho; Gabriel Pheula; Julio Bernardi; Ursula Maldaner; Talita Lopes Silva; Angélica Salatino-Oliveira; Mara Hutz; Luis Augusto Rohde
Pages: 44 - 50

OBJECTIVES: To assess the role of the Val66Met polymorphism at the brain-derived neurotrophic factor (BDNF) gene on the performance of children and adolescents with bipolar disorder [juvenile bipolar disorder (JBD)] on the Wisconsin Card Sorting Test (WCST).
METHODS: Children and adolescents were assessed by the K-SADS-PL and a clinical evaluation for BD and comorbid conditions. Manic and depressive symptoms were assessed with the Young Mania Rating Scale and the Children Depression Rating Scale - Reviewed. The Val66Met polymorphism at the BDNF was genotyped from a blood sample. Patients' IQ and executive functions were assessed by a standard cognitive flexibility test (WCST).
RESULTS: Fifty-three subjects were included in the study. No significant difference was observed between the Val/Val and Val/Met+Met/Met groups on any WCST scores in the MANCOVA (F48,5 = .76; p = .59; Perseverative Errors, p = .66; Nonperseverative Errors, p = .58; Categories Completed, p = .34; Attempts to Reach First Category, p=.64; and Percentage of Conceptual Level Responses, p = .99).
CONCLUSIONS: Our findings from this sample of children and adolescents with BD do not replicate results from studies of adults and suggest the existence of differences in the neurobiology of this disorder across the life cycle. Investigations of larger samples are necessary to confirm these data.

Descriptors: BDNF; Bipolar Disorder; Children; Adolescents; Wisconsin Card Sorting Test.

10 - Major depressive disorder during teenage pregnancy: socio-demographic, obstetric and psychosocial correlates
Fábio Monteiro da Cunha Coelho; Ricardo Tavares Pinheiro; Ricardo Azevedo Silva; Luciana de Ávila Quevedo; Luciano Dias de Mattos Souza; Rochele Dias Castelli; Mariana Bonati de Matos; Karen Amaral Tavares Pinheiro
Pages: 51 - 56

OBJECTIVES: To describe the prevalence of Major Depressive Disorder (MDD) during pregnancy in teenage mothers and to assess its association with socio-demographic characteristics, obstetric history and psychosocial variables.
METHODS: A cross-sectional study was conducted with a sample of pregnant teenagers enrolled in the national public health system in the urban area of Pelotas, southern Brazil. MDD was assessed with the Mini International Neuropsychiatric Interview, the Abuse Assessment Screen was used to identify physical abuse within the last 12 months and during pregnancy, and social support was assessed with the Medical Outcomes Survey Social Support Scale.
RESULTS: Forty-three (4.94%) potential subjects refused to participate, resulting in 828 total participants. The prevalence of MDD was 17.8%, 9.2% reported they had been subjected to violence within the last 12 months, while 5.8% had suffered violence during pregnancy, and the mean (SD) overall social support score was 87.40 (11.75). After adjustment, we found the highest incidence of MDD in adolescents with less than 8 years of education, followed by those with previous episodes of MDD and those with lower overall social support.
CONCLUSIONS: MDD is a relatively common condition in pregnant teenagers and appears to be more prevalent in young mothers who are both socioeconomically and psychosocially underprivileged.

Descriptors: Antenatal depression; Epidemiology; Major Depressive Disorder; Social support; Teenage pregnancy.

11 - The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype
Rafael Christophe Freire; Isabella Nascimento; Alexandre Martins Valença; Fabiana Leão Lopes; Marco André Mezzasalma; Valfrido Leão de Melo Neto; Walter Araujo Zin; Antonio Egidio Nardi
Pages: 57 - 62

OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features.
METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score.
RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD.
CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

Descriptors: Anxiety Disorders; Depressive Disorder; Carbon Dioxide; Panic Attack; Respiratory System.

12 - Validation of the state version of the Self-Statement during Public Speaking Scale
Flávia L. Osório; José Alexandre S. Crippa; Sonia Regina Loureiro
Pages: 63 - 66

OBJECTIVE: To adapt the trait version of the Self Statements during Public Speaking (SSPS) scale to a state version (SSPS-S) and to assess its discriminative validity for use in the Simulated Public Speaking Test (SPST).
METHOD: Subjects with and without social anxiety disorder (n = 45) were assessed while performing the SPST, a clinical-experimental model of anxiety with seven different phases.
RESULTS: Alterations in negative self-assessment occurred with significant changes throughout the different phases of the procedure (p = .05). Non-cases presented significantly higher mean values of the SSPS-S in all phases of the procedure than cases (p < .01).
CONCLUSION: Cases assessed themselves in a less positive and more negative manner during the SPST than did non-cases. SSPS-S is adequate for this assessment, especially its negative subscale, and shows good psychometric qualities.

Descriptors: Anxiety, Experimental Model, Public Speaking, Scale, Validation.

13 - Increased BDNF levels in long-term bipolar disorder patients
Izabela Guimarães Barbosa; Natália Pessoa Rocha; Aline Silva de Miranda; Rodrigo Barreto Huguet; Moisés Evandro Bauer; Helton José Reis; Antônio Lúcio Teixeira
Pages: 67 - 69

INTRODUCTION: Bipolar disorder (BD) is a prevalent, chronic and progressive illness. There is a growing body of evidence indicating that brain-derived neurotrophic factor (BDNF) plays an important role in the pathophysiology of BD.
OBJECTIVE: The aim of this study was to evaluate BDNF plasma levels in BD patients with long term illness in comparison with controls.
METHODS: 87 BD type I patients and 58 controls matched by age, gender and education level were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview and the patients by the Young Mania Rating Scale and the Hamilton Depression Rating Scale. The plasma levels of BDNF were measured by ELISA.
RESULTS: On average, patients had suffered from BD for 23.4 years. In comparison with controls, BD patients with mania presented a 1.90-fold increase in BDNF plasma levels (p = .001), while BD patients in remission presented a 1.64-fold increase in BDNF plasma levels (p = .03). BDNF plasma levels were not influenced by age, length of illness or current medications.
CONCLUSIONS: The present study suggests that long-term BD patients exhibit increased circulating levels of BDNF.

Descriptors: Bipolar Disorder; BDNF; Mania; Neurotrophic Factor; Pathophysiology.

14 - Staging and neuroprogression in bipolar disorder: a systematic review of the literature
Clarissa Severino Gama; Maurício Kunz; Pedro V.S. Magalhães; Flavio Kapczinski
Pages: 70 - 74

INTRODUCTION: The use of clinical staging models is emerging as a novel and useful paradigm for diagnosing severe mental disorders. The term "neuroprogression" has been used to define the pathological reorganization of the central nervous system along the course of severe mental disorders. In bipolar disorder (BD), neural substrate reactivity is changed by repeated mood episodes, promoting a brain rewiring that leads to an increased vulnerability to life stress.
METHOD: A search in the PubMed database was performed with the following terms: "staging", "neuroprogression", "serum", "plasma", "blood", "neuroimaging", "PET scan", "fMRI", "neurotrophins", "inflammatory markers" and "oxidative stress markers", which were individually crossed with "cognition", "functionality", "response to treatments" and "bipolar disorder". The inclusion criteria comprised original papers in the English language. Abstracts from scientific meetings were not included.
RESULTS: We divided the results according to the available evidence of serum biomarkers as potential mediators of neuroprogression, with brain imaging, cognition, functioning and response to treatments considered as consequences.
CONCLUSION: The challenge in BD treatment is translating the knowledge of neuronal plasticity and neurobiology into clinical practice. Neuroprogression and staging can have important clinical implications, given that early and late stages of the disorder appear to present different biological features and therefore may require different treatment strategies.

Descriptors: Bipolar Disorder; Clinical Response; Neuroimaging; Neuroprogression; Serum Biomarkers; Staging.

15 - The history and development of Australia's Black Dog Institute
Gordon Parker
Pages: 75 - 80

OBJECTIVE: To overview the development of the Sydney-based Black Dog Institute. Methods: The strengths and limitations of the Institute's predecessor (the Mood Disorders Unit) gave way to a more ambitious Black Dog Institute, and this article gives an overview of the Institute's structural and functional components.
RESULTS: It is argued that the Institute serves as a model for modern psychiatric service delivery.
CONCLUSIONS: The Institute's model of linking clinical, research, education and community activities to advance the understanding, diagnosis and management of mood disorders is detailed for wider consideration.

Descriptors: Australian Psychiatry; Bipolar Disorder; Black Dog Institute; Depression.

16 - Pathophysiology of bacterial infection of the central nervous system and its putative role in the pathogenesis of behavioral changes
Tatiana Barichello; Jaqueline S. Generoso; Graziele Milioli; Samuel G. Elias; Antônio Lúcio Teixeira
Pages: 81 - 87

Invasion of the central nervous system (CNS) by microorganisms is a severe and frequently fatal event during the course of many infectious diseases. It may lead to deafness, blindness, cerebral palsy, hydrocephalus, cognitive impairment or permanent neurological dysfunction in survivors. Pathogens can cross the blood-brain barrier by transcellular migration, paracellular migration and in infected macrophages. Pathogens may breach the blood-brain barrier and be recognized by antigen-presenting cells through the binding of Toll-like receptors. This induces the activation of nuclear factor kappa B or mitogen-activated protein kinase pathways and subsequently induces leukocyte infiltration and proliferation and the expression of numerous proteins involved in inflammation and the immune response. Many brain cells can produce cytokines, chemokines and other pro-inflammatory molecules in response to bacteria stimuli; as a consequence, polymorphonuclear cells are attracted and activated, and release large amounts of superoxide anion and nitric oxide, leading to peroxynitrite formation and oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage and blood-brain barrier breakdown, contributing to cellular injury during neuronal infection. Current evidence suggests that bacterial CNS infections can play a role in the etiopathogenesis of behavioral disorders by increasing pro-inflammatory cytokines and bacterial virulence factors. The aim of this review is to summarize the current knowledge of the relevant pathophysiologic steps in CNS infections.

Descriptors: Bacterial Infection; Behavior; Central Nervous System; Inflammation; Meningitis.

17 - Bipolar disorder and metabolic syndrome: a systematic review
Letícia Czepielewski; Ledo Daruy Filho; Elisa Brietzke; Rodrigo Grassi-Oliveira
Pages: 88 - 93

OBJECTIVE: Summarize data on metabolic syndrome (MS) in bipolar disorder (BD). Methods: A systematic review of the literature was conducted using the Medline, Embase and PsycInfo databases, using the keywords "metabolic syndrome", "insulin resistance" and "metabolic X syndrome" and cross-referencing them with "bipolar disorder" or "mania". The following types of publications were candidates for review: (i) clinical trials, (ii) studies involving patients diagnosed with bipolar disorder or (iii) data about metabolic syndrome. A 5-point quality scale was used to assess the methodological weight of the studies.
RESULTS: Thirty-nine articles were selected. None of studies reached the maximum quality score of 5 points. The prevalence of MS was significantly higher in BD individuals when compared to a control group. The analysis of MS subcomponents showed that abdominal obesity was heterogeneous. Individuals with BD had significantly higher rates of hypertriglyceridemia than healthy controls. When compared to the general population, there were no significant differences in the prevalence of low HDL-c in individuals with BD. Data on hypertension were also inconclusive. Rates of hyperglycemia were significantly greater in patients with BD compared to the general population.
CONCLUSIONS: The overall results point to the presence of an association between BD and MS, as well as between their subcomponents.

Descriptors: Bipolar Disorder; Cholesterol; Glucose; Insulin; Metabolic Syndrome; Mood Disorders; Triglycerides.

18 - Was Meduna's theory really wrong?
Moacyr Rosa
Pages: 94 - 94


19 - Successful re-exposure to clozapine after eosinophilia and clinically suspected myocarditis
Nara Matos Granja-Ingram; Jason James; Nathaniel Clark; Jeffrey Stovall; Stephan Heckers
Pages: 95 - 96


20 - Could disulfiram be a new treatment for crack cocaine dependence? A pilot study
Leonardo Baldaçara; Thaynne Almeida Diniz; Bruna Leal Parreira; Jaqueline Jerônimo Milhomem; Lincoln Jose Cueto de Almeida; Camila Campitelli Fernandes
Pages: 97 - 98


21 - rTMS to treat social anxiety disorder: a case report
Flávia Paes; Sergio Machado; Oscar Arias-Carrión; Adriana Cardoso Silva Antonio Egidio Nardi
Pages: 99 - 100


22 - Understanding mental disorders through Woody Allen's films
Elie Cheniaux; J. Landeira-Fernandez
Pages: 101 - 101


23 - Panic disorder: theory and practice
Rafael Faria Sanches; Simone Bianchi
Pages: 102 - 103


24 - Depression and Pain
Alexandre Annes Henriques
Pages: 104 - 105


25 - Temperament and character dimensions and their relationship to major depression and panic disorder
Marina Dyskant Mochcovitch; Antonio Egidio Nardi; Adriana Cardoso
Pages: 106 - 106


26 - Psychiatry Revista Brasileira de Psiquiatria Psychiatric comorbidities in temporal lobe epilepsy: Possible relationships between psychotic disorders and involvement of limbic circuits
Ludmyla Kandratavicius; Cleiton Lopes-Aguiar; Lézio Soares Bueno-Júnior Rodrigo Neves Romcy-Pereira; Jaime Eduardo Cecilio Hallak; João Pereira Leite
Pages: 107 - 107