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 4, Volume 37 - Oct/Nov/Dec/2015


1 - Schizophrenia, the forgotten disorder: the scenario in Brazil
Gabriela Matos; Francisco B. Guarniero; Jaime E. Hallak; Rodrigo A. Bressan
Pages: 269 - 270


2 - A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial
Bruna Andrade e Silva; Ricardo C. Cassilhas; Cecília Attux; Quirino Cordeiro; André L. Gadelha; Bruno A. Telles; Rodrigo A. Bressan; Francine N. Ferreira; Paulo H. Rodstein; Claudiane S. Daltio; Sérgio Tufik; Marco T. de Mello
Pages: 271 - 279

OBJECTIVE: To evaluate the effects of 20 weeks of resistance and concurrent training on psychotic and depressive symptoms, quality of life outcomes, and serum IGF-1, IGFBP-3, and brain-derived neurotrophic factor (BDNF) concentrations in patients with schizophrenia.
METHODS: In this blind, randomized controlled clinical trial, 34 patients with schizophrenia were assigned to one of three groups: control (CTRL, n=13), resistance exercise (RESEX, n=12), or concurrent exercise (CONCEX, n=9). Symptoms, quality of life, strength, and other variables were assessed.
RESULTS: A significant time-by-group interaction was found for the RESEX and CONCEX groups on the Positive and Negative Syndrome Scale (PANSS) total score for disease symptoms (p = 0.007), positive symptoms (p = 0.003), and on the arm extension one-repetition maximum (1RM) test (p = 0.016). In addition, significant improvements on negative symptoms (p = 0.027), on the role-physical domain of the Short Form-36 Health Survey (p = 0.019), and on the chest press 1RM test (p = 0.040) were observed in the RESEX group. No changes were observed for the other variables investigated.
CONCLUSIONS: In this sample of patients with schizophrenia, 20 weeks of resistance or concurrent exercise program improved disease symptoms, strength, and quality of life. NCT01674543.

Descriptors: Physical exercise; IGF-1; BDNF; IGFBP-3; schizophrenia; resistance exercise; concurrent exercise

3 - Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder
Mariane N. Noto; Cristiano Noto; André C. Caribé; Ângela Miranda-Scippa; Sandra O. Nunes; Ana C. Chaves; Denise Amino; Rodrigo Grassi-Oliveira; Christoph U. Correll; Elisa Brietzke
Pages: 280 - 288

OBJECTIVES: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms.
METHODS: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ).
RESULTS: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8±68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6±23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia.
CONCLUSIONS: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Descriptors: Bipolar disorder; mania; prodrome; childhood maltreatment; depression; early stages

4 - Attention deficit hyperactivity disorder and intellectual giftedness: a study of symptom frequency and minor physical anomalies
Daniel Minahim; Luis A. Rohde
Pages: 289 - 295

OBJECTIVE: To evaluate the presence of symptoms of attention deficit and hyperactivity disorder (ADHD) in intellectually gifted adults and children. METHODS: Two cross-sectional studies were performed in children and adults whose intelligence quotient (IQ) had been previously evaluated using Raven's Progressive Matrices (RPM) test. Seventy-seven adults displaying IQ scores above the 98th percentile were assessed using the Adult Self-Report Scale (ASRS-18) for signs of ADHD and a modified Waldrop scale for minor physical anomalies (MPAs). Thirty-nine children (grades 1-5) exhibiting IQ scores above the 99th percentile, as well as an equally matched control group, were assessed for ADHD by teachers using the Swanson, Nolan and Pelham IV Rating Scale (SNAP-IV) as used in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA-SNAP-IV). RESULTS: In gifted adults, the frequency of ADHD-positive cases was 37.8%, and the total MPA score was significantly associated with ADHD (p < 0.001). In children, the ADHD-positive case frequency was 15.38% in the gifted group and 7.69% in the control group (odds ratio [OR] = 2.18, p = 0.288). CONCLUSIONS: The high frequency of ADHD symptoms observed, both in gifted adults and in gifted (and non-gifted) children, further supports the validity of this diagnosis in this population. Furthermore, the significant association between MPAs and ADHD suggests that a neurodevelopmental condition underlies these symptoms.

Descriptors: ADHD; giftedness; minor physical anomalies; twice exceptional

5 - Association of interleukin-10 levels with age of onset and duration of illness in patients with major depressive disorder
Marta Gazal; Karen Jansen; Luciano D. Souza; Jean P. Oses; Pedro V. Magalhães; Ricardo Pinheiro; Gabriele Ghisleni; Luciana Quevedo; Manuella P. Kaster; Flávio Kapczinski; Ricardo A. da Silva
Pages: 296 - 302

OBJECTIVE: To investigate peripheral levels of interleukin-10 (IL-10) in patients with major depressive disorder (MDD) and bipolar disorder (BD) and evaluate the relationship between IL-10, age of disease onset, and duration of illness. METHODS: Case-control study nested in a population-based cohort of 231 individuals (age 18-24 years) living in Pelotas, state of Rio Grande do Sul, Brazil. Participants were screened for psychopathology using the Mini-International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV (SCID-I). Serum IL-10 was measured using commercially available immunoassay kits. RESULTS: Peripheral levels of IL-10 were not significantly different in individuals with MDD or BD as compared to controls. However, higher IL-10 levels were found in MDD patients with a later disease onset as compared with controls or early-onset patients. In addition, IL-10 levels correlated negatively with illness duration in the MDD group. In the BD group, age of onset and duration of illness did not correlate with IL-10 levels. CONCLUSION: Higher levels of IL-10 are correlated with late onset of MDD symptoms. Moreover, levels of this cytokine might decrease with disease progression, suggesting that an anti-inflammatory balance may be involved in the onset of depressive symptoms and disease progression in susceptible individuals.

Descriptors: Mood disorders; bipolar; mood disorders; unipolar; neurochemistry; neuroimmunology; biological markers

6 - Effects of REM sleep restriction during pregnancy on rodent maternal behavior
Gabriel N. Pires; Sergio Tufik; Monica L. Andersen
Pages: 303 - 309

OBJECTIVE: To evaluate the effects of sleep restriction during pregnancy on maternal care and maternal aggression in a rodent model.
METHODS: Twenty-three female Wistar rats were assigned to one of two groups: control (n=12) or sleep restriction (n=11) during the entire pregnancy. At the fifth postpartum day, the animals were subjected to the resident-intruder paradigm and to the pup retrieval test.
RESULTS: Sleep restriction during pregnancy had no direct effects on maternal care. Regarding aggressive behavior, defensive aggression was increased by sleep loss, with a lower responsiveness threshold to hostile environmental stimuli. Sleep deprivation during gestation also reduced self-grooming behavior.
CONCLUSION: Taking increased self-grooming as a behavioral correlate of anxiety in rodents, this study provides evidence that lactating dams were in a condition of reduced anxiety. From an adaptive perspective, this pattern of stress response may function to ensure proper maternal behavior, thereby guaranteeing the survival and viability of the litter. Under a translational perspective, the present article confronts the importance of biological and adaptive features to rodent maternal behavior with the relevance of sociocultural factors to the human mother-infant relationship and to the onset of postpartum depression.

Descriptors: Aggression; postpartum; pregnancy; sleep restriction; sleep

7 - Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS): Brazilian Portuguese translation, cultural adaptation and validation
Maria J. de Brito; Miguel Sabino Neto; Mário F. de Oliveira; Táki A. Cordás; Leandro S. Duarte; Maria F. Rosella; Gabriel A. Felix; Lydia M. Ferreira
Pages: 310 - 316

OBJECTIVE: To translate, culturally adapt, and validate a Brazilian Portuguese version of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS).
METHODS: Ninety-three patients of both sexes seeking rhinoplasty were consecutively selected at the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo, Brazil, between May 2012 and March 2013. The BDD-YBOCS was translated into Brazilian Portuguese. Thirty patients participated in the cultural adaptation of the scale. The final version was tested for reliability in 20 patients, and for construct validity in 43 patients (correlation of the BDD-YBOCS with the Body Dysmorphic Disorder Examination [BDDE]).
RESULTS: Total Cronbach's alpha was 0.918. The BDD-YBOCS had excellent inter-rater (intra-class correlation coefficient [ICC] = 0.934; p < 0.001) and intra-rater reliability (ICC = 0.999; p < 0.001). Significant differences in BDD-YBOCS scores were found between patients with and without BDD symptoms (p < 0.001), and among patients with different levels of BDD severity (p < 0.001). A strong correlation (r = 0.781; p < 0.001) was observed between the BDDE and the BDD-YBOCS. The area under the receiver operating characteristic curve was 0.851, suggesting a very good accuracy for discriminating between presence and absence of BDD symptoms.
CONCLUSION: The Brazilian Portuguese version of the BDD-YBOCS is a reliable instrument, showing face, content and construct validity.

Descriptors: Body dysmorphic disorders; body image; psychiatry; plastic surgery; therapeutics

8 - Trichotillomania and personality traits from the five-factor model
Nancy J. Keuthen; Esther S. Tung; Erin M. Altenburger; Mark A. Blais; David L. Pauls; Christopher A. Flessner
Pages: 317 - 324

OBJECTIVE: To examine whether personality traits have predictive validity for trichotillomania (TTM) diagnosis, pulling severity and control, and hair pulling style.
METHODS: In study 1, logistic regression was used with TTM cases (n=54) and controls (n=25) to determine if NEO Five-Factor Inventory (NEO-FFI) personality domains predicted TTM case vs. control classification. In study 2, hierarchical multiple regression was used with TTM cases (n=164) to determine whether NEO-FFI personality domains predicted hair pulling severity and control as well as focused and automatic pulling styles.
RESULTS: TTM case vs. control status was predicted by NEO-FFI neuroticism. Every 1-point increase in neuroticism scores resulted in a 10% greater chance of TTM diagnosis. Higher neuroticism, higher openness, and lower agreeableness were associated with greater pulling severity. Higher neuroticism was also associated with less control over hair pulling. Higher neuroticism and lower openness were associated with greater focused pulling. None of the personality domains predicted automatic hair pulling.
CONCLUSIONS: Personality traits, especially neuroticism, can predict TTM diagnosis, hair pulling severity and control, and the focused style of pulling. None of the personality traits predicted automatic pulling. Longitudinal studies are needed to determine whether personality variables predispose to TTM onset, impact disorder course, and/or result from hair pulling behavior.

Descriptors: Trichotillomania; personality; comorbidity

9 - Personality prototype as a risk factor for eating disorders
Antonio J. Sanchez-Guarnido; Maria J. Pino-Osuna; Francisco J. Herruzo-Cabrera
Pages: 325 - 330

OBJECTIVE: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups.
METHOD: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created.
RESULTS: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group.
CONCLUSIONS: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Descriptors: Personality disorders; eating disorders; diagnosis and classification; tests/interviews; psychometric properties

10 - Association between perception of maternal bonding styles and social anxiety disorder among young women
Rochele D. Castelli, Luciana de Á. Quevedo, Fábio M. Coelho, Mariane A. Lopez, Ricardo A. da Silva, Denise M. Böhm, Luciano D. Souza, Mariana B. de Matos, Karen A. Pinheiro, Ricardo T. Pinheiro
Pages: 331 - 333

OBJECTIVE: To evaluate the association between social anxiety disorder (SAD) and perceived maternal bonding styles among young women during pregnancy and 30 months after childbirth.
METHODS: A cohort of young women from the city of Pelotas, Brazil was followed up from pregnancy to 30 months postpartum. The Mini Neuropsychiatric Interview Plus was used to assess SAD and the Parental Bonding Instrument was administered to measure maternal bonding styles. Poisson regression with robust variance was used for multivariable analysis.
RESULTS: After adjusting for potential confounding factors, SAD prevalence was 6.39 times higher among young women who perceived their mothers as neglectful (prevalence ratio [PR] 6.39; 95% confidence interval [95%CI] 1.2-32.0), and 5.57 times higher in women who perceived their mothers as affectionless controlling (PR = 5.57; 95%CI 1.5-19.7) when compared with those who received optimal care.
CONCLUSION: Maternal bonding style may have an influence on the development of SAD. Therefore, support and early prevention strategies should be offered to the family.

Descriptors: Phobic disorder; maternal behavior; mother-child relations

11 - Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach
Faruk Uguz
Pages: 334 - 342

Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.

Descriptors: Obsessive-compulsive disorder; pregnancy; antidepressants; antipsychotics

12 - Early stages of bipolar disorder: characterization and strategies for early intervention
Adiel C. Rios; Mariane N. Noto; Lucas B. Rizzo; Rodrigo Mansur; Flávio E. Martins Jr.; Rodrigo Grassi-Oliveira; Christoph U. Correll; Elisa Brietzke
Pages: 343 - 349

OBJECTIVE: To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/subsyndromal stage and first-episode phase, and strategies for their respective treatment.
METHODS: A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania.
RESULTS: As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase.
CONCLUSIONS: Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.

Descriptors: Bipolar disorder; first episode of mania; depression; manic-depressive illness; early intervention; staging

13 - Is ''plausibility'' a core feature of obsessions?
Pedro Morgado
Pages: 350 - 350


14 - Thrombocytopenia with quetiapine: two case reports, one with positive rechallenge
Alexandre Lalli; Bruno Michel; Sébastien Georget; Catherine Bouillot; Anne Mangin; Hervé Javelot
Pages: 351 - 351


15 - NBOMe: a new dangerous drug similar to LSD
Lysa Remy; Nino Marchi; Juliana Scherer; Tais R. Fiorentin; Renata Limberger; Flavio Pechanky; Felix Kessler
Pages: 351 - 352