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 36 - Jul/Aug/Sep/2014


1 - Neuroprogression and staging in psychiatry: historical considerations
Flavio Kapczinski; Luis Guilherme Streb
Pages: 187 - 188


2 - Looking beyond the prevalence of depression in Brazil: are we prepared to go further?
Laura H. Andrade; Yuan-Pang Wang
Pages: 189 - 190


3 - Exposure to maltreatment and urban violence in children working on the streets in São Paulo, Brazil: factors associated with street work
Andrea F. Mello; Mariana R. Maciel; Victor Fossaluza; Cristiane S. de Paula; Rodrigo Grassi-Oliveira; Luciana P. Cavalcante-Nóbrega; Giuliana C. Cividanes; Yusaku Soussumi; Sonia P. Soussumi; Dirce N. M. Perissinotti; Isabel A. Bordin; Marcelo F. Mello; Jair J. Mari
Pages: 191 - 198

OBJECTIVE: To quantitatively study the exposure to childhood maltreatment and urban violence in children from families with at least one child working on the streets and to investigate the relationship between these factors and street work.
METHODS: Families who participated in a nongovernmental organization (NGO) program to eliminate child labor were included. Data concerning sociodemographic characteristics, punishment methods used in the family environment against the children, five types of abuse and neglect perpetrated by the caregivers, urban violence exposure and family functioning were collected.
RESULTS: The sample included 126 children who were working on the streets and 65 siblings who were not working on the streets. Caregivers reported high levels of severe physical punishment. The children reported high levels of abuse and neglect, and high levels of urban violence exposure. The families showed a predominance of dysfunctional and unsatisfactory relationships. A multiple logistic regression model showed that age older than 12 years and severe physical punishment at home were associated with street work.
CONCLUSION: Interventions to decrease the risk of child street work should be family-focused and should aim to reduce violence in the family environment.

Descriptors: Street children; child abuse; child maltreatment; family functioning; urban violence

4 - Factors associated with recurrence of alcohol-related traffic violations in southern Brazil
Aurinez R. Schmitz; José R. Goldim; Luciano S. P. Guimarães; Fernanda M. Lopes; Felix Kessler; Tanara Sousa; Veralice M. Gonçalves; Flavio Pechansky
Pages: 199 - 205

OBJECTIVE: To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil.
METHODS: This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level.
RESULTS: A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for > 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08).
CONCLUSION: In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.

Descriptors: Alcohol; driving-under-the-influence, traffic violations

5 - Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury
Marcelo L. Schwarzbold; Alexandre P. Diaz; Jean C. Nunes; Daniel S. Sousa; Alexandre Hohl; Ricardo Guarnieri; Marcelo N. Linhares; Roger Walz
Pages: 206 - 212

OBJECTIVE: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI).
METHODS: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard.
RESULTS: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs.
CONCLUSION: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points.

Descriptors: Traumatic brain injury; depression; ROC curve; screening

6 - Personality changes and return to work after severe traumatic brain injury: a prospective study
Alexandre P. Diaz; Marcelo L. Schwarzbold; Maria E. Thais; Gisele G. Cavallazzi; Roseli Schmoeller; Jean C. Nunes; Alexandre Hohl; Ricardo Guarnieri; Marcelo N. Linhares; Roger Walz
Pages: 213 - 219

OBJECTIVE: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients.
METHODS: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels.
RESULTS: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28).
CONCLUSIONS: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition.

Descriptors: Traumatic brain injury; return to work; mental disorders

7 - Fluvoxamine alters the activity of energy metabolism enzymes in the brain
Gabriela K. Ferreira; Mariane R. Cardoso; Isabela C. Jeremias; Cinara L. Gonçalves; Karolina V. Freitas; Rafaela Antonini; Giselli Scaini; Gislaine T. Rezin; João Quevedo; Emilio L. Streck
Pages: 220 - 226

OBJECTIVE: Several studies support the hypothesis that metabolism impairment is involved in the pathophysiology of depression and that some antidepressants act by modulating brain energy metabolism. Thus, we evaluated the activity of Krebs cycle enzymes, the mitochondrial respiratory chain, and creatine kinase in the brain of rats subjected to prolonged administration of fluvoxamine.
METHODS: Wistar rats received daily administration of fluvoxamine in saline (10, 30, and 60 mg/kg) for 14 days. Twelve hours after the last administration, rats were killed by decapitation and the prefrontal cortex, cerebral cortex, hippocampus, striatum, and cerebellum were rapidly isolated.
RESULTS: The activities of citrate synthase, malate dehydrogenase, and complexes I, II-III, and IV were decreased after prolonged administration of fluvoxamine in rats. However, the activities of complex II, succinate dehydrogenase, and creatine kinase were increased.
CONCLUSIONS: Alterations in activity of energy metabolism enzymes were observed in most brain areas analyzed. Thus, we suggest that the decrease in citrate synthase, malate dehydrogenase, and complexes I, II-III, and IV can be related to adverse effects of pharmacotherapy, but long-term molecular adaptations cannot be ruled out. In addition, we demonstrated that these changes varied according to brain structure or biochemical analysis and were not dose-dependent.

Descriptors: Brain; creatine kinase; fluvoxamine; Krebs cycle; mitochondrial respiratory chain

8 - Association study between the MDR1 gene and clinical characteristics in schizophrenia
Carlos A. Tovilla-Zárate, Iván Vargas, Sandra Hernández, Ana Fresán, Alejandro Aguilar, Raúl Escamilla, Ricardo Saracco, Jorge Palacios, Beatriz Camarena
Pages: 227 - 232

OBJECTIVE: Schizophrenia is a complex psychiatric disorder, characterized by disturbed patterns of thought and affecting 0.3-2.0% of the world population. Previously, the multidrug resistance 1 (MDR1) gene has been associated with schizophrenia in treatment response studies in psychotic patients. The aim of this study was to determine the association between MDR1 gene polymorphisms and clinical characteristics in patients with schizophrenia.
METHODS: Positive and negative symptoms of schizophrenia were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) in 158 Mexican patients with schizophrenia. Analyses of MDR1 gene polymorphisms were performed using TaqMan technology. A multivariate ANOVA was performed with MDR1 polymorphisms and gender as independent variables.
RESULTS: Males with the G/G genotype of MDR1 rs2032582 presented significantly higher levels of delusions (p = 0.02). When comparing female vs. male groups, the difference was statistically significant (p = 0.0003). Analyses of the MDR1 gene rs1045642 variant showed no significant differences.
CONCLUSION: Our findings suggest that male carriers of the G allele of variant rs2032582 exhibit greater severity of delusions; however, these results should be taken as preliminary, and replication studies in other populations of different ethnic origins are required to confirm these findings.

Descriptors: Schizophrenia; MDR1 gene; polymorphism; Mexican population; SANS; SAPS

9 - First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms?
Ana M. Bassols; Lucas S. Okabayashi; Anais B. da Silva; Bruna B. Carneiro; Fernando Feijó; Guilherme C. Guimarães; Gabriela N. Cortes; Luis A. Rohde; Claudio L. Eizirik
Pages: 233 - 240

OBJECTIVE: Medical training is considered a significant stress factor. We sought to assess the prevalence and intensity of anxiety and depressive symptoms in medical students and compare samples of first-year and sixth-year students.
METHOD: This was a cross-sectional study of first- and sixth-year medical students who attended classes regularly. The study instruments were a sociodemographic questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).
RESULTS: A total of 232 students (110 first-year, 122 sixth-year) completed the questionnaires, for a response rate of 67.4%. Overall 50.4% of respondents were male (56.4% of first-year and 45.1% of sixth-year students). Anxiety symptoms were reported by 30.8% of first-year students and 9.4% of sixth-year students (p < 0.001). Female students were more affected by anxiety. There were no significant between-group differences in depressive symptoms.
CONCLUSION: A higher prevalence of anxiety symptoms was found in first-year medical students as compared with sixth-year students. Strategies should be developed to help medical students, particularly female students, manage these symptoms at the beginning of their medical training.

Descriptors: Medical students; depression; anxiety

10 - Psychopathic traits in young offenders vs. non-offenders in similar socioeconomic condition
Gustavo B. Castellana; Daniel M. de Barros; Antonio de P. Serafim; Geraldo Busatto Filho
Pages: 241 - 244

OBJECTIVE: To analyze the differences in psychopathic traits between offender and non-offender youths with similar socioeconomic backgrounds.
METHOD: The Psychopathy Checklist Revised (PCL-R) scale was used to identify whether 39 young offenders with no history of mental disorders or criteria for psychopathy exhibited differences in its total score, and specifically for factor 1 or factor 2 of this scale, when compared with 32 other young people, living in similar socioeconomic conditions, who had not committed offenses.
RESULTS: We observed statistically significant between-group differences (p < 0.01) in mean PCL-R scores, with a mean score of 13.4 in the offender group vs. 2.1 in the non-offender group. We also detected significant between-group differences when we analyzed mean factor 1 (p < 0.01) and factor 2 (p < 0.01) scores separately. Although the groups exhibited statistically significant difference in educational attainment, between-group comparison of mean PCL-R scores controlling for educational attainment by analysis of covariance (ANCOVA) showed that the difference in PCL-R scores remained statistically significant (p < 0.01).
CONCLUSIONS: We conclude that, in this sample, the presence of both primary (interpersonal/affective characteristics) and secondary (lifestyle/antisocial behavior) psychopathic traits differed between offender and non-offender youths, even when excluding psychopathy and other mental disorders from the assessments. These results suggest a need for wide-ranging interventions, not restricted to socioeconomic aspects, for the management of juvenile delinquency.

Descriptors: Juvenile delinquency; psychopathic personality; antisocial personality disorder; conduct disorder

11 - Parameters for screening music performance anxiety
Ana E. Barbar; José A. Crippa; Flávia L. Osório
Pages: 245 - 247

OBJECTIVE: To assess the discriminative capacity of the Kenny Music Performance Anxiety Inventory (K-MPAI), in its version adapted for Brazil, in a sample of 230 Brazilian adult musicians.
METHOD: The Social Phobia Inventory (SPIN) was used to assess the presence of social anxiety indicators, adopting it as the gold standard. The Mann-Whitney U test and the receiver operating characteristic (ROC) curve were used for statistical analysis, with p < 0.05 set as the significance level.
RESULTS: Subjects with social anxiety indicators exhibited higher mean total K-MPAI scores, as well as higher individual scores on 62% of its items. The area under the ROC curve was 0.734 (p = 0.001), and considered appropriate. Within the possible cutoff scores presented, the score -15 had the best balance of sensitivity and specificity values. However, the score -7 had greater specificity and accuracy.
CONCLUSION: The K-MPAI showed appropriate discriminant validity, with a marked association between music performance anxiety and social anxiety. The cutoff scores presented in the study have both clinical and research value, allowing screening for music performance anxiety and identification of possible cases.

Descriptors: Anxiety; performance; music; scale; screening

12 - Sensorimotor performance in euthymic bipolar disorder: the MPraxis (PennCNP) analysis
Maila de C. Neves; Maicon R. Albuquerque; Fernando S. Neves; Guilherme M. Lage; Leandro Malloy-Diniz; Rodrigo Nicolato; Humberto Corrêa
Pages: 248 - 250

CKGROUND: Sensorimotor deficits are an important phenomenological facet observed in patients with bipolar disorder (BD). However, there is little research on this topic. We hypothesize that the MPraxis test can be used to screen for motor impairments in BD aiming movements.
METHOD: The MPraxis, which is a quick and easy-to-apply computerized test, measures sensorimotor control. During the test, the participant must move the computer mouse cursor over an ever-shrinking green box and click on it once. We predict that the MPraxis test is capable of detecting differences in sensorimotor performance between patients with BD and controls. We assessed 21 euthymic type I BD patients, without DSM-IV-TR Axis I comorbidity, and 21 healthy controls.
RESULTS AND CONCLUSIONS: Compared to the controls, the patients with BD presented a lower response time in their movements in all conditions. Our results showed sensorimotor deficits in BD and suggested that the MPraxis test can be used to screen for motor impairments in patients with euthymic BD.

Descriptors: Psychomotor performance; bipolar disorder; neuropsychological test

13 - Septic encephalopathy: does inflammation drive the brain crazy?
Felipe Dal-Pizzol; Cristiane D. Tomasi; Cristiane Ritter
Pages: 251 - 258

Sepsis and the multiorgan dysfunction syndrome are among the most common reasons for admission to an intensive care unit, and are a leading cause of death. During sepsis, the central nervous system (CNS) is one of the first organs affected, and this is clinically manifested as sepsis-associated encephalopathy (SAE). It is postulated that the common final pathway that leads to SAE symptoms is the deregulation of neurotransmitters, mainly acetylcholine. Thus, it is supposed that inflammation can affect neurotransmitters, which is associated with SAE development. In this review, we will cover the current evidence (or lack thereof) for the mechanisms by which systemic inflammation interferes with the metabolism of major CNS neurotransmitters, trying to explain how systemic inflammation drives the brain crazy.

Descriptors: Sepsis-associated encephalopathy; acetylcholine; amines; GABA; inflammation

14 - Industry withdrawal from psychiatric medication development
Donald F. Klein; Ira D. Glick
Pages: 259 - 261

Between 1950 and 1969, on a serendipitous basis, psychiatric drug development flourished. However, there has been a steep decline in the development of new medication classes. Instead of new molecular entities, slight molecular modifications producing "me-too" drugs attempted to garner market share. With failing profitability, industry is now withdrawing from psychiatric medication development. Managed care drastically shortened contact between patients and clinicians, so the possible observation of unexpected benefits has been nullified. The randomized, parallel-groups design met FDA requirements for specific pharmacological efficacy. However, it does not determine whether a patient who improved while drug-treated required the drug or would have gotten better on his own. Further, pathophysiology benefit remains obscure. The major psychotropic drugs have no benefits for normal subjects. Their remarkable benefits must stem from a necessary interaction with a pathophysiological state. Therefore, understanding therapeutic benefit by treating normal subjects becomes unlikely. The claim that therapeutic knowledge in psychiatry proceeds from bench to bedside has proven vacuous, primarily because of our limited understanding of brain pathophysiology. The utility of the alternative intensive design for understanding diagnosis, therapeutic benefit, and pathophysiology is emphasized.

Descriptors: Psychotropic drugs; psychopharmacology; psychopathology; antidepressant; antipsychotic

15 - Prevalence of depression morbidity among Brazilian adults: a systematic review and meta-analysis
Marcus T. Silva; Tais F. Galvao; Silvia S. Martins; Mauricio G. Pereira
Pages: 262 - 270

OBJECTIVE: To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults.
METHODS: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects.
RESULTS: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified.
CONCLUSION: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.

Descriptors: Depression; major depressive disorder; prevalence; adults; Brazil

16 - Will the DSM-5 changes in criteria for premenstrual dysphoric disorder impact clinical practice?
Patricia C. Cirillo; Roberta B. Passos; Jose R. López; Antônio E. Nardi
Pages: 271 - 271


17 - Obsessive-compulsive disorder in fathers during pregnancy and postpartum
Fábio M. Coelho; Ricardo A. da Silva; Luciana de Á. Quevedo; Luciano D. Souza; Karen A. Pinheiro, Ricardo T. Pinheiro
Pages: 271 - 273


18 - Developmental disability in schoolchildren from four Brazilian regions
Rosane Lowenthal; Livia Zaqueu; Luis A. Rohde; Jair Mari; Cristiane S. Paula
Pages: 273 - 274


19 - Mental health of refugees: report of a successful case in Brazil
Gustavo C. Medeiros; Daniela Sampaio; Sônia Sampaio; Francisco Lotufo-Neto
Pages: 274 - 275