Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
JCR IF 2017: 2.093
Fully open access
No submission fees
No publication charges

Current issue 4, Volume 33 - Oct/Nov/Dec/2011


 

EDITOR'S NOTE
1 - One more step to increase the internationalization and visibility of the RBP psychiatry
José Alexandre S. Crippa; Rodrigo A. Bressan; Giovanni Abrahão Salum; João Quevedo; Christian Kieling; Marcelo Queiroz Hoexter; Tais Moriyama; Marcos Hortes N. Chagas; Leonardo Fontenelle; Guilherme Vanoni Polanczyk; Marcelo Pio de Almeida Fleck
Pages: 317 - 317

Descriptors:


EDITORIALS
2 - Psychosis continuum and neurocognition in bipolar disorder
Emre Bora; Michael Berk
Pages: 319 - 320

Descriptors:


3 - N-acetylcysteine as a mitochondrial enhancer: a new class of psychoactive drugs?
Gabriel Rodrigo Fries; Flavio Kapczinski
Pages: 321 - 322

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ORIGINAL ARTICLES
4 - Concession of sickness benefit to social security beneficiaries due to mental disorders
Adriana Kelmer Siano; Luiz Cláudio Ribeiro; Mário Sérgio Ribeiro
Pages: 323 - 331
Abstract

Objective: Assess the odds of having an initial claim for statutory sickness benefit awarded (ascribed to mental disorder as the main registered diagnosis), in relation to institutional, clinical, sociodemographic and welfare factors in Juiz de Fora-MG, Brazil. Method: Two models of logistic regression, taking into account the categories of the medical examiners, were built with the aim of characterizing the relative weight of several variables affecting the medical conclusion.Results: The factors more strongly related to an award of benefit were claimants assessed by a physician without a specialization in psychiatry; with a diagnosis of psychosis; up to 29 years of age; with other non-psychiatric (musculoskeletal and cardiovascular) co-morbidities; registered with the national insurance system as employed; and male. Discussion: In both models, examiners with a specialization in psychiatry were associated with a lower likelihood of award of benefit.This suggests that examinations undertaken by doctors having a specialty related to the diagnosis supporting the sickness benefit claim are stricter than those undertaken by non-specialists.Conclusion: The results suggest that benefit award odds were associated with the specialty of the examiner, medical diagnosis, age, gender and claimant category.

Descriptors: Mental disorders; Disabled persons; Social security; Diagnosis; Evaluation of results of therapeutic interventions.


5 - Depression and quality of life of hemodialysis patients living in a poor region of Brazil
Paulo Roberto Santos
Pages: 332 - 337
Abstract

Objective: To determine the correlation between depression and quality of life (QOL) of patients in hemodialysis (HD). Method: One hundred and sixty six patients over 18 years of age who had been in HD for at least three months and had no history of transplant. QOL was assessed using the SF-36. To categorize depression, a score > 10 was used on the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Comparisons between depressed and nondepressed patients were performed using the chi-square test, Student's t-test, and Mann-Whitney test. Multiple regression was performed to assess the predictive variables of patients' QOL. Results: Symptoms of depression were found in 13 (7.8%) patients. The only variable that differed among depressed patients was QOL. Depressed patients presented lower scores in vitality (40.7 vs. 57.3; p = 0.010), role-emotional (25.6 vs. 62.5; p = 0.006), and mental health (50.1 vs. 65.4; p = 0.023). Regression analysis demonstrated that depression was a predictor of role-emotional (OR = 0.981, CI = 0.967-0.996; p = 0.010) and mental health (OR = 0.970, CI = 0.946-0.996; p = 0.022). Conclusion: Depressed patients experience a poor QOL because, in addition to their chronically affected physical aspects, they also feel limited in the mental dimensions, which usually have the highest score among non-depressed HD patients.

Descriptors: Depression; Kidney failure, Chronic; Renal dialysis; Quality of life; Chronic disease.


6 - Reliability study of the Behavioral Assessment of the Dysexecutive Syndrome adapted for a Brazilian sample of older-adult controls and probable early Alzheimer's disease patients
Fabíola Canali; Sonia M.D. Brucki; Paulo H.F. Bertolucci; Orlando F.A. Bueno
Pages: 338 - 346
Abstract

Objective: Ecological tests are useful in assessing executive function deficits and may be of value in appraising response to treatment in Alzheimer's disease patients. Our aims were to examine executive function using the Behavioral Assessment of the Dysexecutive Syndrome for a Brazilian sample of older-adult controls and probable early Alzheimer's disease patients, and verify the applicability of this test battery. Method: Forty-one older-adult controls were matched with mild Alzheimer's disease patients by age, education, and gender. Results: There significant inter-group differences in overall profile and almost all subtests except temporal judgment, time spent on planning the first and second Zoo Map visit, number of errors when copying drawings, naming pictures and Six Modified Elements arithmetic, and dysexecutive questionnaire self-rating. The Behavioral Assessment of the Dysexecutive Syndrome item that best discriminated controls from patients was the Modified Six Elements - adapted (general index), with a sensitivity of 80% and specificity of 90%, (AUC = 0.91, p < 0.001). Conclusion: Behavioral Assessment of the Dysexecutive Syndrome was effective in detecting executive function deficits in mild Alzheimer's disease patients, particularly the task switching, time monitoring, and rule-shift subtests.

Descriptors: Alzheimer's disease; Executive functions; Dementia; Signs and symptoms; Neuropsychological tests.


7 - Alcohol screening instruments in elderly male: a population-based survey in metropolitan São Paulo, Brazil
Janaina Barbosa de Oliveira; Jair Lício Ferreira Santos; Florence Kerr-Corrêa; Maria Odete Simão; Maria Cristina Pereira Lima
Pages: 347 - 352
Abstract

Objective: This study compares the efficacy of the AUDIT (gold standard) with the more easily and quickly applied instruments CAGE, TWEAK, and T-ACE for men aged > 60 using data from a representative stratified sample of the general population of metropolitan São Paulo. Method: The GENACIS questionnaire was administered to a total sample of 2,083 people aged over 18, with a response rate of 74.5%. The elderly male sample consisted of 169 men. Sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve, and confidence intervals were calculated for each instrument (95% CI). Results: Respondents were predominantly married (81.7%), had up to 11 years of education (61.3%) and a monthly per capita income of up to 300 US dollars. Current abstinence rate was high (61.6%) and 38% reported being former drinkers. There were no statistically significant differences among the instruments tested; however, the TWEAK had a higher area under the receiver operating characteristic curve (95% CI; 0.90-0.99). Conclusion: Research in the general population with screening instruments is scarce, especially among the elderly. However, it can provide specific information concerning this age group and be useful in the formulation of policies and prevention strategies.

Descriptors: Psychometrics; Alcoholism; Men; Epidemiology; Geriatric psychiatry.


8 - The impact of a history of psychotic symptoms on cognitive function in euthymic bipolar patients: a comparison with schizophrenic patients and healthy controls
Sofia Brissos; Vasco Videira Dias; Márcio Gerhardt Soeiro-de-Souza; Vicent Balanzá-Martínez; Flavio Kapczinski
Pages: 353 - 361
Abstract

Background: About two-thirds of patients with bipolar disorder (BD) have a lifetime history of at least one psychotic symptom. Objective: To compare the neurocognitive performance of four groups: BD patients with and without a history of psychotic symptoms (BD HPS+ and BD HPS-, respectively); patients with schizophrenia (SZ); and healthy control (HC) subjects. Method: In this cross-sectional study, 35 stabilized patients with SZ, 79 euthymic (44 HPS+ and 35 HPS-) patients with BD, and 50 HC were administered a comprehensive battery of neuropsychological tests. Results: There was worse neurocognitive functioning in both BD and SZ patients compared to HC. Overall, data from both groups of BD patients did not differ on sociodemographic, clinical, or neurocognitive variables. However, BD HPS+ patients had significantly more negative symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS), and showed a trend toward worse performance on executive functions compared to BD HPS- patients. Moreover, both BD groups had better performance on all neurocognitive tests compared to SZ group. Conclusions: Neurocognitive dysfunction may be more marked in SZ than in BD, yet qualitatively similar. A history of past psychotic symptoms in BD was not associated with more severe cognitive impairment during euthymia. Therefore, BD with psychotic symptoms does not appear to be a distinct neurocognitive phenotype.

Descriptors: Patients; Neurobehavioral manifestations; Psychotic disorders; Schizophrenia; Bipolar disorder.


9 - Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation
Deborah B. Maia; Charles R. Marmar; Clare Henn-Haase; Augusta Nóbrega; Adriana Fiszman; Carla Marques-Portella; Mauro V. Mendlowicz; Evandro S.F. Coutinho; Ivan Figueira
Pages: 362 - 366
Abstract

Background: Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers. Method: In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms. Results: Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found. Conclusions: The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers.

Descriptors: PTSD; Police; Predictors; Negative affect; Peritraumatic; Dissociation.


10 - Differences in drinking patterns between men and women in Brazil
Cynthia C. Wolle; Marcos Sanches; Monica L. Zilberman; Raul Caetano; Marcos Zaleski; Ronaldo R. Laranjeira; Ilana Pinsky
Pages: 367373 - 373
Abstract

Objective: To examine sex differences in alcohol consumption according to age groups, and to assess gender and age effects on several aspects of alcohol consumption patterns. Method: Based on a Brazilian nationwide representative sample (n = 3,007), we analysed the differences in drinking patterns between genders. We also assessed the effects of gender, age, and gender by age interaction for alcohol consumption dimensions (frequent drinking, usual intake, binge drinking, and frequent binge drinking), using logistic and negative binomial regression models. Results: Gender, age, and gender by age interaction had significant effects on the predictive models for all studied drinking patterns, except for the 'usual' dosage. The effect of gender on drinking patterns varies with age. While gender has a greater effect in older age groups, the difference between men and women decreased in the younger age groups. Conclusions: Gender convergence regarding alcohol use is a trend that might be influenced by environmental factors and should be addressed in prevention and treatment programs, as well as in public health policies.

Descriptors: Alcohol drinking; Interpersonal relations; Epidemiology; Adolescents; Women.


11 - N-acetylcysteine for major depressive episodes in bipolar disorder
Pedro V Magalhães; Olívia M Dean; Ashley I Bush; David L Copolov; Gin S Malhi; Kristy Kohlmann; Susan Jeavons; Ian Schapkaitz; Murray Anderson-Hunt; Michael Berk
Pages: 374 - 378
Abstract

Objective: In this report, we aimed to evaluate the effect of add-on N-acetylcysteine (NAC) on depressive symptoms and functional outcomes in bipolar disorder. To that end, we conducted a secondary analysis of all patients meeting full criteria for a depressive episode in a placebo controlled trial of adjunctive NAC for bipolar disorder. Method: Twenty-four week randomised clinical trial comparing adjunctive NAC and placebo in individuals with bipolar disorder experiencing major depressive episodes. Symptomatic and functional outcome data were collected over the study period. Results: Seventeen participants were available for this report. Very large effect sizes in favor of NAC were found for depressive symptoms and functional outcomes at endpoint. Eight of the ten participants on NAC had a treatment response at endpoint; the same was true for only one of the seven participants allocated to placebo. Discussion: These results indicate that adjunctive NAC may be useful for major depressive episodes in bipolar disorder. Further studies designed to confirm this hypothesis are necessary.

Descriptors: Bipolar disorder; Depression; Acetylcysteine; Antioxidants; Oxidative stress.


BRIEF COMMUNICATIONS
12 - Can countertransference at the early stage of trauma care predict patient dropout of psychiatric treatment?
Érico de Moura Silveira Júnior; Guilherme Vanoni Polanczyk; Simone Hauck; Cláudio Laks Eizirik; Lúcia Helena Freitas Ceitlin
Pages: 378 - 384
Abstract

Objectives: To investigate the association between feelings of countertransference (CT) at the early psychiatric care provided to trauma victims and treatment outcome. Method: The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83% were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout. Results: The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4%. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61% less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95% 0.16-0.95). There was no association between initial CT and treatment outcome. Conclusions: In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome.

Descriptors: Countertransference (psychology); Treatment outcome; Stress, psychological; Violence; Brazil.


13 - Cardiorespiratory response to physical exercise and psychological variables in panic disorder
Daniela Caldirola; Caterina Namia; Wilma Micieli; Claudia Carminati; Laura Bellodi; Giampaolo Perna
Pages: 385 - 389
Abstract

Objective: To investigate the possible influence of psychological variables on cardiorespiratory responses and perceived exertion of patients with Panic Disorder (PD) during a submaximal exercise test. Method: Ten outpatients with PD and 10 matched healthy subjects walked up on a treadmill slope at a speed of 4 km/h in order to reach 65% of their maximum heart rate. Cardiorespiratory variables were continuously recorded. Before the exercise, the state and trait anxiety (State-Trait Anxiety Inventory scores), fear of physical sensations (Body Sensation Questionnaire scores), and fear of autonomic arousal (Anxiety Sensitivity Index scores) were assessed; during the exercise, levels of anxiety (VAS-A) and exertion (Borg Scale CR 10) were measured. Results: Compared to controls, patients reached earlier the target HR and the ventilatory threshold, showed lower oxygen consumption, higher HR and lower within-subject standard deviations of HR (a measure of cardiac variability). Exertion was also higher, and there was a significant correlation between breathing frequency, tidal volume and HR. No significant associations were found between cardiorespiratory response, perceived exertion, and psychological variables in patients with PD. Conclusion: Although patients with PD presented poor cardiorespiratory fitness and were required to spend more effort during physical exercise, this did not appear to be related to the psychological variables considered. Further studies with larger groups are warranted.

Descriptors: Panic disorder; Neurophysiology; Biological markers; Cardiology; Exercise.


ARTICLES REVIEW
14 - Gender differences in obsessive-compulsive disorder: a literature review
Maria Alice de Mathis; Pedro de Alvarenga; Guilherme Funaro; Ricardo Cezar Torresan; Ivanil Moraes; Albina Rodrigues Torres; Monica L. Zilberman; Ana Gabriela Hounie
Pages: 390 - 399
Abstract

Introduction: Obsessive-compulsive disorder (OCD) is a heterogeneous condition, in which subtypes have been proposed. Previous studies suggested that gender plays a relevant role in OCD phenotypic expression. This study aimed to review the literature on gender differences in clinical, genetic or familial aspects of OCD. Method: A conventional review was conducted, including all papers that investigated demographic, clinical, and genetic aspects of OCD according to gender. The search was based on data available in Medline and PsycINFO databases in the last 20 years, using as keywords: obsessive-compulsive disorder; and: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females. Results: Sixty three of 487 phenotypical and genetics studies were selected. Most studies indicate that male patients are more likely than females to be single, present early onset of symptoms and chronic course of the disorder, greater social impairment, more sexual-religious and aggressive symptoms, and greater comorbidity with tic and substance use disorders. Female patients present more contamination/cleaning symptoms and greater comorbidity with eating and impulse-control disorders. Genetic and family studies are inconclusive, but suggest that gender may play a role in the disease expression. Conclusions: Gender is a relevant factor that should be taken into account when evaluating OCD patients. More studies are necessary to determine whether in fact it defines a homogeneous and particular group in OCD.

Descriptors: Obsessive-compulsive disorder; Gender identity; Sex; Phenotype; Genetics.


15 - Therapeutic interventions for vascular depression: a systematic review
Andre Russowsky Brunoni; Isabela Martins Benseñor; Tania Correa de Toledo Ferraz Alves
Pages: 400 - 409
Abstract

Objective: Vascular depression (VaD) hypothesis supports a bidirectional relationship between cerebrovascular risk factors (CRFs) and depression. We examined whether such concept is appropriate for clinical interventions; i.e., whether treating depressive symptoms has an impact on cerebrovascular risk and vice-versa. Method: Systematic review on interventional studies published from October-1997 to April-2010 on MEDLINE and other databases. Search terms were "depressive disorder" (MeSH), "cerebrovascular disorders" (MeSH), and a batch of highly accurate terms to search for experimental and quasi-experimental trials. We used a structured questionnaire to assess the adequacy of the VaD criteria used for vascular, depression, neuroimaging, and neuropsychological features, as well as the main results of each study. Results: Of the 357 retrieved studies, 12 met our eligibility criteria. These studies adequately reported depression criterion, moderately reported neuroimaging and neuropsychological criteria, and showed severe flaws in vascular assessment. Efficacy trials suggested that nimodipine, transcranial magnetic stimulation, carotid stent placement, and citalopram were effective for VaD. Exploratory studies suggested that white-matter hyperintensities and global vascular risk are predictors of poor response. Although the low quality of the studies hinders the findings' generalization, studies of higher validity support the VaD concept for interventions. Conclusion: VaD seems to be a useful concept for clinical interventions; however, further trials should refine CRFs criteria to assess its impact on antidepressant efficacy.

Descriptors: Major depressive disorder; Cerebrovascular disorders; Depression; Review; Therapeutics.


LETTERS TO THE EDITORS
16 - Organic mental disorder after pneumococcal meningoencephalitis with autism-like symptoms
Leonardo Baldaçara; Thaynne Diniz; Bruna Parreira; Jaqueline Milhomem; Raquel Baldaçara
Pages: 410 - 411

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17 - Use of anticholinergic drugs and worsening of pemphigus foliaceus in a patient with bipolar disorder
Lúcio Botelho-Nogueira; Lucas Quarantini; Ângela Miranda-Scippa
Pages: 412 - 413

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18 - Psychiatric disorders associated with body image dissatisfaction
Alexandre Costa Val; Ana Raquel Corrêa e Silva; Paulo Roberto Ferreira Henriques; Cristiane de Freitas Cunha; Roberto Assis Ferreira
Pages: 414 - 415

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19 - Paruresis and Parcopresis in Social Phobia: a case report
Régis Eric Maia Barros
Pages: 416 - 417

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20 - Patients with eating disorders (ED) treated with Zonisamide
Ester Idini; Imma Buj-Alvarez; Josep Pifarre-Paradero; Stella Rodriguez-Picasso; Ester Castan-Campanera
Pages: 418 - 419

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ERRATUM
22 - Concession of sickness benefit to social security beneficiaries due to mental disorders
Adriana Kelmer Siano; Luiz Cláudio Ribeiro; Mário Sérgio Ribeiro
Pages: 422 - 422

Descriptors: