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 2, Volume 38 - Apr/May/Jun/2016


1 - Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Maria A. Nunes; Andréa P. Pinheiro; Marina Bessel; André R. Brunoni; Andrew H. Kemp; Isabela M. Benseñor; Dora Chor; Sandhi Barreto; Maria I. Schmidt
Pages: 91 - 97

OBJECTIVE: To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.
METHODS: We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score > 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression.
RESULTS: CMD (CIS-R score > 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%Ci 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%).
CONCLUSION: The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.

Descriptors: Common mental disorders; depression; anxiety; low and middle-income countries; mental health

2 - Intimate partner violence trends in Brazil: data from two waves of the Brazilian National Alcohol and Drugs Survey
Elizabeth Z. Ally; Ronaldo Laranjeira; Maria C. Viana; Ilana Pinsky; Raul Caetano; Sandro Mitsuhiro; Clarice S. Madruga
Pages: 98 - 105

OBJECTIVE: To compare intimate partner violence (IPV) prevalence rates in 2006 and 2012 in a nationally representative household sample in Brazil. The associations between IPV and substance use were also investigated.
METHODS: IPV was assessed using the Conflict Tactic Scale-R in two waves (2006/2012) of the Brazilian Alcohol and Drugs Survey. Weighted prevalence rates and adjusted logistic regression models were calculated.
RESULTS: Prevalence rates of IPV victimization decreased significantly, especially among women (8.8 to 6.3%). The rates of IPV perpetration also decreased significantly (10.6 to 8.4% for the overall sample and 9.2 to 6.1% in men), as well as the rates of bidirectional violence (by individuals who were simultaneously victims and perpetrators of violence) (3.2 to 2.4% for the overall sample). Alcohol increased the likelihood of being a victim (odds ratio [OR] = 1.6) and perpetrator (OR = 2.4) of IPV. Use of illicit drugs increased up to 4.5 times the likelihood of being a perpetrator.
CONCLUSIONS: In spite of the significant reduction in most types of IPV between 2006 and 2012, violence perpetrated by women was not significantly reduced, and the current national rates are still high. Further, this study suggests that use of alcohol and other psychoactive drugs plays a major role in IPV. Prevention initiatives must take drug misuse into consideration.

Descriptors: Domestic violence; intimate partner violence; epidemiology; violence; Brazil

3 - High-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil
Sandra L. Ulinski; Simone T. Moysés; Renata I. Werneck; Samuel J. Moysés
Pages: 106 - 112

OBJECTIVE: To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil.
METHOD: Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used.
RESULTS: The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation.
CONCLUSIONS: A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

Descriptors: Risk factors; traffic; alcohol; traffic violations

4 - Mid- and long-term anxiety levels associated with presymptomatic testing of Huntington's disease, Machado-Joseph disease, and familial amyloid polyneuropathy
Susana Lêdo; Ângela Leite; Teresa Souto; Maria A. Dinis; Jorge Sequeiros
Pages: 113 - 120

OBJECTIVE: To study anxiety as a variable of the mid- and long-term psychological impact of presymptomatic testing for three autosomal dominant late-onset disorders - Huntington's disease (HD), Machado-Joseph disease (MJD) and familial amyloid polyneuropathy (FAP) TTR V30M - in a Portuguese sample.
METHODS: This cross-sectional study included 203 participants: 170 (83.7%) underwent pre-symptomatic testing for FAP, 29 (14.3%) for hD, and 4 (2%) for MJD. Of the 203 participants, 73 (36.0%) were asymptomatic carriers, 29 (14.5%) were symptomatic carriers, 9 (4.5%) were diagnosed with FAP and had a liver transplant, and 89 (44.5%) were non-carriers. Most were women (58.1%) and married (66.5%). The anxiety variable was assessed using the Zung Self-Rating Anxiety Scale (SAS).
RESULTS: The anxiety scores were higher for symptomatic carriers and for those who underwent psychological support consultations over the years. For symptomatic carriers, the mean scores were superior to 40 points, which reflects clinical anxiety.
CONCLUSION: Although it was not possible to differentiate between the mid- and long-term psychological impacts, this study supports the conclusion that the proximity to the age of symptoms onset might be a trigger for anxiety.

Descriptors: Psychology; anxiety; middle- and long-term impact; neurodegenerative diseases; pre-symptomatic testing

5 - Is semantic verbal fluency impairment explained by executive function deficits in schizophrenia?
Arthur A. Berberian, Giovanna V. Moraes, Ary Gadelha, Elisa Brietzke, Ana O. Fonseca, Bruno S. Scarpato, Marcella O. Vicente, Alessandra G. Seabra, Rodrigo A. Bressan, Acioly L. Lacerda
Pages: 121 - 126

OBJECTIVE: To investigate if verbal fluency impairment in schizophrenia reflects executive function deficits or results from degraded semantic store or inefficient search and retrieval strategies.
METHOD: Two groups were compared: 141 individuals with schizophrenia and 119 healthy age and education-matched controls. Both groups performed semantic and phonetic verbal fluency tasks. Performance was evaluated using three scores, based on 1) number of words generated; 2) number of clustered/related words; and 3) switching score. A fourth performance score based on the number of clusters was also measured.
RESULTS: Individuals with schizophrenia produced fewer words than controls. After controlling for the total number of words produced, a difference was observed between the groups in the number of cluster-related words generated in the semantic task. In both groups, the number of words generated in the semantic task was higher than that generated in the phonemic task, although a significant group vs. fluency type interaction showed that subjects with schizophrenia had disproportionate semantic fluency impairment. Working memory was positively associated with increased production of words within clusters and inversely correlated with switching.
CONCLUSION: Semantic fluency impairment may be attributed to an inability (resulting from reduced cognitive control) to distinguish target signal from competing noise and to maintain cues for production of memory probes.

Descriptors: Psychosis; schizophrenia; cognitive neuroscience; chronic psychiatric illness; language

6 - Childhood trauma and dimensions of depression: a specific association with the cognitive domain
Edgar A. Vares; Giovanni A. Salum; Lucas Spanemberg; Marco A. Caldieraro; Lívia H. de Souza; Roberta de P. Borges; Marcelo P. Fleck
Pages: 127 - 134

OBJECTIVE: To investigate associations between a history of childhood trauma and dimensions of depression in a sample of clinically depressed patients.
METHODS: A sample of 217 patients from a mood-disorder outpatient unit was investigated with the Beck Depression Inventory, the Hamilton Depression Rating Scale, the CORE Assessment of Psychomotor Change, and the Childhood Trauma Questionnaire. A previous latent model identifying six depressive dimensions was used for analysis. Path analysis and Multiple Indicators Multiple Causes (MIMIC) models were used to investigate associations between general childhood trauma and childhood maltreatment modalities (emotional, sexual, and physical abuse; emotional and physical neglect) with dimensions of depression (sexual, cognition, insomnia, appetite, non-interactiveness/retardation, and agitation).
RESULTS: The overall childhood trauma index was uniquely associated with cognitive aspects of depression, but not with any other depressive dimension. An investigation of childhood maltreatment modalities revealed that emotional abuse was consistently associated with depression severity in the cognitive dimension.
CONCLUSION: Childhood trauma, and specifically emotional abuse, could be significant risk factors for the subsequent development of cognitive symptoms of major depression. These influences might be specific to this depressive dimension and not found in any other dimension, which might have conceptual and therapeutic implications for clinicians and researchers alike.

Descriptors: Depression; dimensions; childhood trauma; emotional abuse; cognition

7 - Eating behaviors, body image, perfectionism, and self-esteem in a sample of Portuguese girls
Maria D. Teixeira; Ana T. Pereira; Mariana V. Marques; Jorge M. Saraiva; António F. de Macedo
Pages: 135 - 140

OBJECTIVE: Eating disorders are an increasingly prevalent health problem among adolescent girls. It is well known that biological, psychosocial, and family-related factors interact in the development of this group of disorders. However, the mechanisms underlying the interaction between these variables are still poorly understood, especially in Portuguese adolescents. The aim of this study was to investigate the relationship between eating behaviors, body dissatisfaction, self-esteem, and perfectionism in a sample of Portuguese girls.
METHOD: A community sample of 575 Portuguese girls attending secondary school, answered self-report questionnaires including data on weight, height, and the Portuguese versions of the Contour Figures Rating Scale, the Child and Adolescent Perfectionism Scale, the Children Eating Attitudes Test, and the Rosenberg Self-Esteem Scale. SPSS version 20.0 for Windows was used for statistical analyses.
RESULTS: High scores in the Children Eating Attitudes Test were associated with significantly higher levels of body dissatisfaction (r = 0.339), socially prescribed perfectionism (r = 0.175), self-oriented perfectionism (r = 0.211), and low self-esteem (r = -0.292) (all p < 0.001). Self-oriented perfectionism partially mediated the relation between body dissatisfaction and disordered eating behaviors.
CONCLUSION: In this sample, dysfunctional eating behaviors appeared to correlate strongly with body dissatisfaction, low self-esteem, and perfectionism in girls. These themes should be addressed among female adolescents in the community.

Descriptors: Eating behaviors; body image; perfectionism; self-esteem

8 - Outcomes of inpatients with severe mental illness: a naturalistic descriptive study
Gabriela L. Nuernberg; Fernanda L. Baeza; Marcelo P. Fleck; Neusa S. Rocha
Pages: 141 - 147

OBJECTIVE: To describe and evaluate the response and predictors of remission during inpatient treatment in a psychiatric unit in a general hospital based on symptomatology, functionality, and quality of life (QoL).
METHODS: Patients were admitted to a psychiatric unit in a tertiary general hospital in Brazil from June 2011 to December 2013 and included in the study if they met two of the severe mental illness (SMI) criteria: Global Assessment of Functioning (GAF) < 50 and duration of service contact > 2 years. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) Severity Scale , GAF, the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-Bref), and specific diagnostic scales.
RESULTS: A total of 239 patients were included. BPRS mean scores were 25.54±11.37 at admission and 10.96±68.11 at discharge (p < 0.001). Patients with manic episodes (odds ratio: 4.03; 95% confidence interval: 1.14-14.30; p = 0.03) were more likely to achieve remission (CGI < 2 at discharge) than those with depressive episodes. Mean length of stay was 28.95±19.86 days. All QoL domains improved significantly in the whole sample.
CONCLUSION: SMI patients had marked improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episodes had higher chance of remission according to the CGI.

Descriptors: Severe mental illness; inpatient treatment; psychiatric hospitalization; quality of life

9 - The Mood Rhythm Instrument: development and preliminary report
Camila M. de Souza; Alicia Carissimi; Daniele Costa; Ana Paula Francisco; Madeleine S. Medeiros; Carlos A. Ilgenfritz; Melissa A. de Oliveira; Benicio N. Frey; Maria Paz Hidalgo
Pages: 148 - 153

OBJECTIVE: To describe the initial steps in the development and validation of a new self-reported instrument designed to assess daily rhythms of mood symptoms, namely, the Mood Rhythm Instrument.
METHODS: A multidisciplinary group of experts took part in systematic meetings to plan the construction of the instrument. Clarity of items, their relevance to evaluation of mood states, and the consistency of findings in relation to the available evidence on the biological basis of mood disorders were investigated. The internal consistency of the questionnaire was evaluated through Cronbach's alpha.
RESULTS: All of the items proposed in a first version were well rated in terms of clarity. The items more frequently rated as "rhythmic" were related to the somatic symptoms of mood. Their peaks in 24 hours were more frequent in the morning. The items associated with affective symptoms of mood were rated as less rhythmic, and their peak in 24 hours occurred more frequently in the afternoon and evening. Males and females behaved more similarly with respect to somatic than behavioral-affective items. The second version of the Mood Rhythm Instrument had a Cronbach's alpha of 0.73.
CONCLUSION: The proposed Mood Rhythm Instrument may be able to detect individual rhythms of cognitive and behavioral measures associated with mood states. Validation in larger samples and against objective measures of rhythms, such as actigraphy, is warranted.

Descriptors: Biological rhythm; mood disorders, bipolar; mood disorders, unipolar; epidemiology; tests/interview, psychometrics

10 - Accuracy of three depression screening scales to diagnose major depressive episodes in older adults without neurocognitive disorders
Mônica V. Costa; Maissa F. Diniz; Kenia K. Nascimento; Kelly S. Pereira; Natalia S. Dias; Leandro F. Malloy-Diniz; Breno S. Diniz
Pages: 154 - 156

OBJECTIVE: To determine the sensitivity and specificity of three depression screening scales to diagnose major depressive episodes in the elderly.
METHODS: Participants (n=129, 88% female) answered a semi-structured psychiatric interview (Mini International Neuropsychiatric Interview) to determine the diagnosis of major depressive disorder. After this, depressive symptoms in depressed and non-depressed subjects were assessed by independent administration of the 15-item Geriatric Depression Scale (GDS-15), Patient Health Questionnaire-9 (PHQ-9), and 17-item Hamilton Rating Scale for Depression (HDRS-17).
RESULTS: Patients with major depression and controls did not differ in age and gender distribution. The sensitivity and specificity of all scales to identify a major depressive episode in older adults were > 90%. There were no significant differences between the areas under the curve for PHQ-9 vs. HDRS-17 (z = 1.2, p = 0.2), PHQ-9 vs. GDS-15 (z = 0.26, p = 0.8), or HDRS-17 vs. GDS-15 (z = 1.2, p = 0.2).
CONCLUSION: This study provides evidence supporting the use of PHQ-9 and GDS-15, both of which are simple to administer and easy to interpret, to diagnose major depressive episodes in older adults without neurocognitive disorders.

Descriptors: Late-life depression; diagnosis; screening; geriatric assessment

11 - Quality of life and physical activity levels in outpatients with schizophrenia
Eluana Gomes; Tânia Bastos; Michel Probst; José C. Ribeiro; Gustavo Silva; Rui Corredeira
Pages: 157 - 160

OBJECTIVES: To assess quality of life (QoL) and physical activity (PA) levels of outpatients with schizophrenia and healthy controls matched for age, gender, body mass index (BMI), hip circumference, waist circumference, and waist-to-hip ratio. Additionally, the present study investigated associations between PA levels, QoL, and anthropometric and behavioral measures among outpatients with schizophrenia.
METHODS: Thirty-two outpatients with schizophrenia and 32 individuals without mental illness were included in the study. QoL and PA levels were assessed by the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-Bref) and by GT3X triaxial accelerometers, respectively.
RESULTS: Outpatients with schizophrenia had poorer QoL and lower vigorous PA levels compared with healthy controls (p < 0.05). The group with schizophrenia showed a significant association between higher weight and lower scores in the mental health domain of the WHOQOL-Bref. A higher BMI was also significantly associated with lower scores in the physical health domain of the WHOQOL-Bref. Schizophrenic patients with smoking behaviors were associated with fewer steps per day and with less moderate to vigorous PA.
CONCLUSIONS: This study seeks to shed some light upon the lifestyle of patients with schizophrenia. New psychosocial approaches should focus on PA, weight, and smoking management, thereby helping these patients to improve their QoL.

Descriptors: Quality of life; physical activity; outpatients; schizophrenia

12 - Bridging a historical gap: can changes in perceptions of law enforcement and social deterrence accelerate the prevention of drunk driving in low and middle-income countries?
Flavio Pechansky; Aruna Chandran; Tanara Sousa
Pages: 161 - 166

OBJECTIVES: The dangers of driving while under the influence of alcohol/drugs (DWI) have been well established. Many countries have successfully reduced the incidence of DWI through effective law enforcement. We aim to explore the links between how law enforcement is perceived in cultures with different socioeconomic indicators. Our hypothesis is that social norms around definitions of what constitutes "right" vs. "deviant" behavior related to DWI directly contribute to the mode and success of law enforcement.
METHODS: Road safety professionals from six countries with different levels of DWI rates and enforcement strategies were interviewed regarding the expected local response to a case vignette. Sociodemographic, mortality, and economic indicators for each of these countries were extracted from different sources.
RESULTS: The professionals interviewed described a continuum ranging from unequivocal enforcement and punishment (Australia and Norway) to inconsistent enforcement and punishment with the presence of many legal loopholes (Mexico and Brazil). For the six countries, no apparent correlation was identified purely between alcohol consumption and road traffic mortality. However, there seems to be a correlation between the time period of initial DWI legislation and current gross national income, perceptions of local safety, satisfaction with the local environment, and trust in the national government. Higher levels of these scores are seen in nations in which DWI laws were implemented prior to the 1960s.
CONCLUSION: Better performing countries seem to have achieved a level of societal agreement that DWI is deviant, generating social stigma against DWI that allows legislation to be enforced. Lessons learned from these countries could help developing countries reduce morbidity and mortality associated with DWI.

Descriptors: Alcohol abuse; education; drug side effects; epidemiology; violence/aggression

13 - Neurobiological underpinnings of bipolar disorder focusing on findings of diffusion tensor imaging: a systematic review
Juliana A. Duarte; Jaisa Q. de Araújo e Silva; André A. Goldani; Raffael Massuda; Clarissa S. Gama
Pages: 167 - 175

OBJECTIVE: To review the available data on diffusion tensor imaging (DTI) of subjects with bipolar disorder (BD), with a particular focus on fractional anisotropy (FA) in white matter (WM) tracts.
METHODS: The PubMed/MEDLINE database was searched for relevant articles, which were included in a systematic review of the literature. FA reductions and WM abnormalities were divided anatomically into three groups: commissural tracts, association tracts, and projection tracts.
RESULTS: Eighteen studies met the inclusion criteria. The corpus callosum was the main impaired commissural tract as demonstrated by FA reductions. Five studies reported FA reductions in the cingulum. Two studies reported decreased FA in the anterior thalamic radiation, and one in the corticospinal tract. Conversely, three studies found increased FA values in WM tracts involved in BD pathophysiology.
CONCLUSION: Despite considerable heterogeneity, these results indicate a direct link between executive cognitive functioning and abnormal WM microstructural integrity of fronto-limbic tracts in patients with remitted BD, providing further evidence of the neuronal disruption that underlies BD symptomatology.

Descriptors: Bipolar disorder; diffusion tensor imaging; neuroimaging; diffusion tractography

14 - New insights into cortisol levels in PTSD
Gabriela de Moraes Costa
Pages: 176 - 176


15 - Clozapine-induced esophagitis at therapeutic dose: a case report
Hervé Javelot; Bruno Michel; Divya Kumar; Brigitte Audibert
Pages: 176 - 177


16 - Circadian rhythm disturbances and conversion to psychosis in ultra high-risk youth
Bruno Gonçalves; Juliana Castro; Márcio A. Zanini; Lia Bittencourt; Ary Gadelha; Graccielle R. Cunha; Fernando M. Coelho; Sergio Tufik; Rodrigo A. Bressan; Elisa Brietzke
Pages: 177 - 179


17 - Anorexia nervosa presenting as a subacute sensory-motor axonal polyneuropathy
Antonio L. Teixeira; Bruno T. Junho; João L. Barros; Rodrigo S. Gomez
Pages: 179 - 180