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 35 - Jul/Aug/Sep/2013


1 - Difficulties in panic studies
Donald F. Klein
Pages: 215 - 216


2 - Why we should use long-acting injectable antipsychotics more frequently
João Paulo Maia-de-Oliveira; Rodrigo A. Bressan; Helio Elkis; João Paulo Machado-de-Sousa; Jaime E.C. Hallak
Pages: 217 - 218


3 - Familial idiopathic basal ganglia calcification: rediscovering an old challenge in organic psychiatric disorders
João Ricardo Mendes de Oliveira; Matheus Fernandes de Oliveira
Pages: 219 - 220


4 - Polydrug use among college students in Brazil: a nationwide survey
Lúcio Garcia de Oliveira; Denis Guilherme Alberghini; Bernardo dos Santos; Arthur Guerra de Andrade
Pages: 221 - 230

OBJECTIVE: To estimate the frequency of polydrug use (alcohol and illicit drugs) among college students and its associations with gender and age group.
METHODS: A nationwide sample of 12,544 college students was asked to complete a questionnaire on their use of drugs according to three time parameters (lifetime, past 12 months, and last 30 days). The co-use of drugs was investigated as concurrent polydrug use (CPU) and simultaneous polydrug use (SPU), a subcategory of CPU that involves the use of drugs at the same time or in close temporal proximity.
RESULTS: Almost 26% of college students reported having engaged in CPU in the past 12 months. Among these students, 37% had engaged in SPU. In the past 30 days, 17% college students had engaged in CPU. Among these, 35% had engaged in SPU. Marijuana was the illicit drug mostly frequently used with alcohol (either as CPU or SPU), especially among males. Among females, the most commonly reported combination was alcohol and prescribed medications.
CONCLUSIONS: A high proportion of Brazilian college students may be engaging in polydrug use. College administrators should keep themselves informed to be able to identify such use and to develop educational interventions to prevent such behavior.

Descriptors: Ethanol; illicit drugs; students; epidemiology; Brazil

5 - Psychological distress among postpartum mothers of preterm infants and associated factors: a neglected public health problem
Abdulbari Bener
Pages: 231 - 236

OBJECTIVE: The aim of the present study was to determine the prevalence of psychological distress, depression, anxiety, and stress among postpartum Arab mothers of preterm or low birth weight (LBW) infants and to identify maternal characteristics that can predict psychological distress among mothers of preterm infants.
METHODS: A hospital-based study was conducted. A representative sample of 2,091 postpartum mothers was surveyed and 1,659 women (79.3%) gave their consent to participate in the study. The study was based on a face-to-face interview with a designed questionnaire covering sociodemographic characteristics, anthropometric measures, medical history, and maternal characteristics. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale (DASS-21).
RESULTS: In the study sample, 10.2% of the postpartum mothers had preterm/LBW infants. Depression (29.4 vs. 17.3%) and anxiety (26.5 vs. 11.6%) were significantly more common among mothers of preterm births compared to mothers of full term infants (p < 0.001). The risk of depression in mothers of preterm/LBW infants was two times the risk in mothers of full term infants, while the risk of anxiety was 2.7 times in mothers of preterm/LBW infants than in mothers of full term infants. Young mothers and those who had less than secondary education (42.0 vs. 21.7%; p = 0.007) and lower monthly household income (72.0 vs. 53.3%; p = 0.024) were more depressed and anxious after the preterm birth when compared with mothers of full term infants. Psychological distress was higher in mothers with history of preterm birth (30.0 vs. 21.7%) and delivery complications (52.0 vs. 33.3%).
CONCLUSIONS: We found a greater risk of depression and anxiety in mothers of preterm births than in mothers of full term infants. Our analysis revealed that depressed and anxious women of preterm infants were younger, less educated, had a lower body weight and low household income than non-depressed and non-anxious women.

Descriptors: Prevalence; obstetric risks; low birth weight; preterm; depression; postpartum; Arab

6 - Disordered eating behaviors and body image in male athletes
Fernanda Reistenbach Goltz; Lucia Marques Stenzel; Cláudia Dornelles Schneider
Pages: 237 - 242

OBJECTIVE: To identify disordered eating behaviors and body image dissatisfaction, as well as their relationship to body fat (BF), among male athletes in high risk sports for eating disorders.
METHODS: One hundred and fifty-six male athletes were divided into the following categories: weight-class sports, sports where leanness improves performance, and sports with aesthetic ideals. BF was assessed and three questionnaires were used: the Eating Attitudes Test; the Bulimic Investigatory Test, Edinburgh; the Body Shape Questionnaire.
RESULTS: Disordered eating behaviors and body image dissatisfaction were found in 43 (27.6%) and 23 athletes (14.7%), respectively, and an association was detected between the two variables (p < 0.001). Athletes with and without disordered eating behaviors did not differ in %BF (11.0±5.2% and 9.8±4.0%, respectively; p = 0.106). However, athletes with body image dissatisfaction had higher %BF than those who were satisfied (12.6±5.9% and 9.7±3.9%, respectively; p = 0.034). There were no differences in BF, frequency of disordered eating behaviors, and body image dissatisfaction between sports categories.
CONCLUSION: Nearly one-quarter of athletes showed disordered eating behaviors, which was associated with body image dissatisfaction. Athletes with higher %BF were more likely to be dissatisfied with body image. There was no difference in eating behavior and body image between athletes from different sports categories.

Descriptors: Athletes; body composition; body image; eating behavior; eating disorders

7 - Changing core beliefs with trial-based cognitive therapy may improve quality of life in social phobia: a randomized study
Vania Bitencourt Powell; Olivia Haun de Oliveira; Camila Seixas; Cláudia Almeida; Maria Conceição Grangeon; Milke Caldas; Thaís Delavechia Bonfim; Martha Castro; Galvão-de Almeida; Roberta de Oliveira Moraes; Donna Sudak; Irismar Reis de-Oliveira
Pages: 243 - 247

OBJECTIVE: To determine whether there are differences in quality of life (QoL) improvement after treatment with the trial-based thought record (TBTR) versus conventional cognitive therapy (CCT) in patients with social anxiety disorder (SAD).
METHOD: A randomized trial comparing TBTR with a set of CCT techniques, which included the standard 7-column dysfunctional thought record (DTR) and the positive data log (PDL) in patients with SAD, generalized type.
RESULTS: Repeated measures analysis of variance (ANOVA) revealed a significant time effect in the general health, vitality, social functioning, and mental health domains of the Short Form 36. It also indicated significant treatment effects on the bodily pain, social functioning, role-emotional, and mental health domains, with higher scores in the TBTR group. One-way analysis of covariance (ANCOVA), using pretreatment values as covariates, showed that TBTR was associated with significantly better QoL post-treatment (bodily pain, social functioning and role-emotional) and at follow-up (role-emotional). A significant treatment effect on the role-emotional domain at 12-month follow-up denoted a sustained effect of TBTR relative to CCT.
CONCLUSION: This study provided preliminary evidence that TBTR is at least as effective as CCT in improving several domains of QoL in SAD, specifically when the standard 7-column DTR and the PDL are used.

Descriptors: Cognitive therapy; randomized trial; social anxiety disorder; social phobia; quality of life; trial-based cognitive therapy; trial-based thought record

8 - Human experimental anxiety: actual public speaking induces more intense physiological responses than simulated public speaking
Antonio Waldo Zuardi; José Alexandre de Souza Crippa; Jaime Eduardo Cecílio Hallak; Ricardo Gorayeb
Pages: 248 - 253

OBJECTIVES: a) To perform a systematic and meta-analytic review to verify whether the Simulated Public Speaking Task (SPST) leads to a greater increase in self-rated anxiety than in physiological correlates of anxiety; and b) to compare the results obtained with the SPST with an actual public speaking task involving healthy volunteers.
METHODS: a) The PubMed and ISI Web of Knowledge databases were searched for studies involving the SPST prior to 2012. Eleven publications were eligible and provided data from 143 healthy volunteers for meta-analysis; b) 48 university students without somatic or psychiatric disorders were divided into three experimental groups of 16 subjects to undergo one of the following: SPST, real-world public speaking task (real-world), and control situation (control).
RESULTS: The meta-analysis showed that the SPST induced a significant increase in the Visual Analogue Mood Scale (VAMS) anxiety factor, but no significant increases in systolic blood pressure or heart rate. The empirical study showed that the real-world public speaking task increased heart rate, systolic blood pressure and diastolic blood pressure significantly more than the control and SPST conditions.
CONCLUSIONS: These results suggest that real public speaking might be better than SPST in inducing experimental anxiety.

Descriptors: Experimental anxiety; public speaking; simulated; real-world; meta-analysis

9 - Efficacy of the telephone-based Brief Motivational Intervention for alcohol problems in Brazil
Luciana Signor; Pollianna Sangalli Pierozan; Maristela Ferigolo; Simone Fernandes; Taís de Campos Moreira; Claudia Galvão Mazoni; Helena Maria Tannhauser Barros
Pages: 254 - 261

BACKGROUND: The Brief Motivational Intervention (BMI) is an effective treatment for alcohol misuse but has not been adequately tested for use in helplines for alcoholics. The main objective of this study was to evaluate the efficacy of a telephone-based BMI for Brazilians seeking help with alcohol use cessation.
METHODS: A randomized, controlled trial was performed with Brazilian subjects. Participants were randomly assigned to either the minimal intervention group (i.e., given reference materials) or the BMI group. Alcohol abstinence was evaluated in a 6-month follow-up telephone counseling session. The analysis was based on the intention to treat (ITT).
RESULTS: Of the 5,896 drug users who called the helpline, 700 (12%) used alcohol, 637 of whom enrolled in this study. At 6-month follow-up, 70% of the BMI group had stopped consuming alcohol compared to 41% in the control group (odds ratio = 1.5; 95% confidence interval = 1.2-1.9; p = 0.001).
CONCLUSIONS: A helpline-based BMI helps alcohol users achieve abstinence.

Descriptors: Alcoholism; motivation; telephone

10 - Ketamine alters behavior and decreases BDNF levels in the rat brain as a function of time after drug administration
Daiane B. Fraga; Gislaine Z. Réus; Helena M. Abelaira; Renata D. De Luca; Leila Canever; Bianca Pfaffenseller; Gabriela D. Colpo; Flávio Kapczinski; João Quevedo; Alexandra I. Zugno
Pages: 262 - 266

OBJECTIVE: To evaluate behavioral changes and brain-derived neurotrophic factor (BDNF) levels in rats subjected to ketamine administration (25 mg/kg) for 7 days.
METHOD: Behavioral evaluation was undertaken at 1 and 6 hours after the last injection.
RESULTS: We observed hyperlocomotion 1 hour after the last injection and a decrease in locomotion after 6 hours. Immobility time was decreased and climbing time was increased 6 hours after the last injection. BDNF levels were decreased in the prefrontal cortex and amygdala when rats were killed 6 hours after the last injection, compared to the saline group and to rats killed 1 hour after the last injection. BDNF levels in the striatum were decreased in rats killed 6 hours after the last ketamine injection, and BDNF levels in the hippocampus were decreased in the groups that were killed 1 and 6 hours after the last injection.
CONCLUSION: These results suggest that the effects of ketamine on behavior and BDNF levels are related to the time at which they were evaluated after administration of the drug.

Descriptors: Brain-derived-neurotrophic factor; forced swimming test; behavioral; ketamine

11 - Lack of association of S100β and neuron-specific enolase with mortality in critically ill patients
Roberta Candal de Macedo; Cristiane Damiani Tomasi; Vinicius René Giombelli; Sarah Cascaes Alves; Maria de Lourdes Ugioni Bristot; Maria Fernanda Topanotti Locks; Fabrícia Petronilho; Carmen Grandi; João Quevedo; Felipe Dal-Pizzol; Cristiane Ritter
Pages: 267 - 270

OBJECTIVE: To evaluate the relationship between brain damage biomarkers and mortality in the intensive care unit (ICU).
METHODS: The sample comprised 70 patients admitted to an ICU. Blood samples were collected from all patients on ICU admission, and levels of S100β and neuron-specific enolase (NSE) were determined by ELISA.
RESULTS: Acute Physiologic and Chronic Health Evaluation (APACHE II) score was associated with mortality, but NSE and S100β were not associated with this outcome. In contrast, S100β levels were significantly higher in delirious and non-delirious patients who required mechanical ventilation during ICU stay.
CONCLUSION: Levels of brain biomarkers at the time of ICU admission did not predict mortality in critically ill patients.

Descriptors: Delirium; S100β; enolase; ICU; mortality

12 - The Crack Use Relapse Scale (CURS): development and psychometric validation
Rosemeri Pedroso; Márcia Pettenon; Luciano Guimarães; Félix Henrique Kessler; Flavio Pechansky
Pages: 271 - 273

OBJECTIVE: To report the development and validation of the Crack Use Relapse Scale (CURS) in an inpatient population.
METHODS: A pilot study with 30 male crack users was conducted to generate 35 sentences related to the construct of interest. A five-point Likert scale including 25 items and, initially, nine theoretical factors was generated and utilized in a cross-sectional study with a sample of 333 hospitalized male crack users.
RESULTS: Overall Cronbach's alpha was α = 0.86. The exploratory factor analysis (EFA) with oblimin rotation kept the 25 items (factor loadings > 0.40) and six definitive factors, which explained 62.1% of the total variance.
CONCLUSIONS: The six-factor model yielded by the EFA of the CURS reflects the various dimensions of the construct, assigning satisfactory values and demonstrating good psychometric properties, including validity and reliability.

Descriptors: Relapse; crack users; scale; validation

13 - Higher proportion of inactive Gsk3β in platelets of elderly patients with bipolar disorder: an effect of treatment?
Rodolfo Braga Ladeira; Helena Passarelli Giroud Joaquim; Leda Leme Talib; Paula Villela Nunes; Orestes Vicente Forlenza
Pages: 274 - 278

OBJECTIVE: It has been postulated that mood stabilizers inhibit glycogen synthase kinase 3-beta (Gsk3β) activity, mainly through its phosphorylation on serine-9 (Ser9). However, in vivo studies addressing Gsk3β activity in patients with bipolar disorder are scarce. Here, we compare Gsk3β inactivation (as indicated by Ser9-phosphorylation) in platelets of elderly patients with bipolar disorder undergoing clinical treatment and healthy elderly adults not taking medication.
METHODS: Platelet samples were obtained from 37 elderly adults (bipolar disorder = 19, controls = 18). Relative changes in Gsk3β inactivation was estimated by comparing the ratios of phosphorylated Gsk3β to total Gsk3β (p-Gsk3β Ser9/Gsk3β) between the disease and control groups.
RESULTS: Phosphorylated-Gsk3β (p < 0.001) and the p-Gsk3β Ser9/Gsk3β ratio (p = 0.006) were elevated in bipolar patients. In the bipolar disorder group, p-Gsk3β Ser9/Gsk3β was positively correlated with serum lithium levels (r = 0.478, p = 0.039).
CONCLUSIONS: Gsk3β inactivation is higher in this group of elderly adults undergoing treatment for bipolar disorder. However, whether the treatment or the disease causes Gsk3β inactivation was confounded by the lack of an unmedicated, bipolar control group and the non-uniform treatment regimens of the bipolar disorder group. Thus, further studies should help distinguish whether Gsk3β inactivation is an effect of drug treatment or an intrinsic characteristic of bipolar disorder.

Descriptors: Glycogen synthase kinase 3; bipolar disorder; aged; lithium; blood platelets

14 - The impacts of cognitive-behavioral therapy on the treatment of phobic disorders measured by functional neuroimaging techniques: a systematic review
Amanda Galvao-de Almeida; Gerardo Maria de Araujo Filho; Arthur de Almeida Berberian; Clarissa Trezsniak; Fabiana Nery-Fernandes; Cesar Augusto Araujo Neto; Andrea Parolin Jackowski; Ângela Miranda-Scippa; Irismar Reis de Oliveira
Pages: 279 - 283

OBJECTIVE: Functional neuroimaging techniques represent fundamental tools in the context of translational research integrating neurobiology, psychopathology, neuropsychology, and therapeutics. In addition, cognitive-behavioral therapy (CBT) has proven its efficacy in the treatment of anxiety disorders and may be useful in phobias. The literature has shown that feelings and behaviors are mediated by specific brain circuits, and changes in patterns of interaction should be associated with cerebral alterations. Based on these concepts, a systematic review was conducted aiming to evaluate the impact of CBT on phobic disorders measured by functional neuroimaging techniques.
METHODS: A systematic review of the literature was conducted including studies published between January 1980 and April 2012. Studies written in English, Spanish or Portuguese evaluating changes in the pattern of functional neuroimaging before and after CBT in patients with phobic disorders were included.
RESULTS: The initial search strategy retrieved 45 studies. Six of these studies met all inclusion criteria. Significant deactivations in the amygdala, insula, thalamus and hippocampus, as well as activation of the medial orbitofrontal cortex, were observed after CBT in phobic patients when compared with controls.
CONCLUSION: In spite of their technical limitations, neuroimaging techniques provide neurobiological support for the efficacy of CBT in the treatment of phobic disorders. Further studies are needed to confirm this conclusion.

Descriptors: Phobia; cognitive therapy; functional magnetic resonance imaging; positron-emission tomography

15 - Mild cognitive impairment (part 2): biological markers for diagnosis and prediction of dementia in Alzheimer's disease
Orestes V. Forlenza; Breno S. Diniz; Antonio L. Teixeira; Florindo Stella; Wagner Gattaz
Pages: 284 - 294

OBJECTIVE: To present a critical review of publications reporting on the rationale and clinical implications of the use of biomarkers for the early diagnosis of Alzheimer's disease (AD).
METHODS: We conducted a systematic search of the PubMed and Web of Science electronic databases, limited to articles published in English between 1999 and 2012, and based on the following terms: mild cognitive impairment, Alzheimer's disease OR dementia, biomarkers. We retrieved 1,130 articles, of which 175 were reviews. Overall, 955 original articles were eligible.
RESULTS: The following points were considered relevant for the present review: a) rationale for biomarkers research in AD and mild cognitive impairment (MCI); b) usefulness of distinct biomarkers for the diagnosis and prediction of AD; c) the role of multimodality biomarkers for the diagnosis and prediction of AD; d) the role of biomarkers in clinical trials of patients with AD and MCI; and e) current limitations to the widespread use of biomarkers in research and clinical settings.
CONCLUSION: Different biomarkers are useful for the early diagnosis and prediction of AD in at-risk subjects. Nonetheless, important methodological limitations need to be overcome for widespread use of biomarkers in research and clinical settings.

Descriptors: Alzheimer's disease; mild cognitive impairment; biomarkers; neuroimaging; amyloid-β protein; Tau protein

16 - Recent evidence and potential mechanisms underlying weight gain and insulin resistance due to atypical antipsychotics
Ana Maria Volpato; Alexandra Ioppi Zugno; João Quevedo
Pages: 295 - 304

OBJECTIVE: Atypical antipsychotics (AAPs) promote obesity and insulin resistance. In this regard, the main objective of this study was to present potential mechanisms and evidence concerning side effects of atypical antipsychotics in humans and rodents.
METHOD: A systematic review of the literature was performed using the MEDLINE database. We checked the references of selected articles, review articles, and books on the subject.
RESULTS: This review provides consistent results concerning the side effects of olanzapine (OL) and clozapine (CLZ), whereas we found conflicting results related to other AAPs. Most studies involving humans describe the effects on body weight, adiposity, lipid profile, and blood glucose levels. However, it seems difficult to identify an animal model replicating the wide range of changes observed in humans. Animal lineage, route of administration, dose, and duration of treatment should be carefully chosen for the replication of the findings in humans.
CONCLUSIONS: Patients undergoing treatment with AAPs are at higher risk of developing adverse metabolic changes. This increased risk must be taken into account when making decisions about treatment. The influence of AAPs on multiple systems is certainly the cause of such effects. Specifically, muscarinic and histaminergic pathways seem to play important roles.

Descriptors: Neuroendocrinology; schizophrenia; drug side effects; antipsychotics; biological markers

17 - Pharmacogenetics in schizophrenia: a review of clozapine studies
Fabiana Barzotti Kohlrausch
Pages: 305 - 317

OBJECTIVES: Clozapine is quite effective to treat schizophrenia, but its use is complicated by several factors. Although many patients respond to antipsychotic therapy, about 50% of them exhibit inadequate response, and ineffective medication trials may entail weeks of unremitted illness, potential adverse drug reactions, and treatment nonadherence. This review of the literature sought to describe the main pharmacogenetic studies of clozapine and the genes that potentially influence response to treatment with this medication in schizophrenics.
METHODS: We searched the PubMed database for studies published in English in the last 20 years using keywords related to the topic.
RESULTS AND CONCLUSIONS: Our search yielded 145 studies that met the search and selection criteria. Of these, 21 review articles were excluded. The 124 studies included for analysis showed controversial results. Therefore, efforts to identify key gene mechanisms that will be useful in predicting clozapine response and side effects have not been fully successful. Further studies with new analysis approaches and larger sample sizes are still required.

Descriptors: Schizophrenia; clozapine; polymorphisms; pharmacogenetics; adverse effects

18 - The carbon dioxide challenge test in panic disorder: a systematic review of preclinical and clinical research
Julio Mario Xerfan do Amaral; Pedro Tadeu Machado Spadaro; Valeska Martinho Pereira; Adriana Cardoso de Oliveira e Silva; Antonio Egidio Nardi
Pages: 318 - 331

This systematic review assesses the current state of clinical and preclinical research on panic disorder (PD) in which the carbon dioxide (CO2) challenge was used as a trigger for panic attacks (PAs). A total of 95 articles published from 1984 to 2012 were selected for inclusion. Some hypotheses for PD evolved greatly due to the reproducibility of PAs in a controlled environment using the safe and noninvasive CO2 test. The 35% CO2 protocol was the method chosen by the majority of studies. Results of the test report specific sensitivity to hypercapnia in PD patients of the respiratory PD subtype. The CO2 challenge helped assess the antipanic effects of medication and non-pharmaceutical approaches such as physical exercise and cognitive behavioral therapy. The test was also used in studies about the genetic component of PD, in which twins and relatives of PD patients were analyzed.

Descriptors: Panic disorder; panic attacks; carbon dioxide challenge; respiratory challenge; clinical research

19 - Angst: origins of anxiety and depression
André Barciela Veras
Pages: 332 - 332


20 - Clinical psychometrics
Marcelo Pio de Almeida Fleck
Pages: 333 - 333


21 - Importance of web-based intervention in minimizing depressive symptoms and associated stigma in depressed medical students
Jorge Alves; Thomas L. Schwenk; Óscar F. Gonçalves; Agavni Petrosyan
Pages: 334 - 334


22 - Spirituality in psychiatric consultation: health benefits and ethical aspects
Diego Librenza Garcia; Tatiana Klaus Sansonowicz; Gabriela Lotin Nuernberg; Marcelo Pio de Almeida Fleck; Neusa Sica da Rocha
Pages: 335 - 336