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 39 - Jul/Aug/Sep/2017


1 - Impact of inequalities in health care on the mortality risk of individuals with severe mental illnesses
Elisa Brietzke; Rodrigo B. Mansur; Roger S. McIntyre
Pages: 193 - 194


2 - Elevated plasma concentrations of S100 calcium-binding protein B and tumor necrosis factor alpha in children with autism spectrum disorders
Selin Aktan Guloksuz; Osman Abali; Esin Aktas Cetin; Sema Bilgic Gazioglu; Gunnur Deniz; Abdurrahman Yildirim; Ivana Kawikova; Sinan Guloksuz; James F. Leckman
Pages: 195 - 200

OBJECTIVE: To investigate plasma concentrations of S100B (a calcium-binding protein derived primarily from the glia) and inflammatory cytokines in children with autism and the relationship between S100B and cytokine concentrations. METHODS: Plasma levels of S100B, tumor necrosis factor alpha (TNF-α), interferon gamma, interleukin (IL)-1β, IL-4, IL-6, IL-10, and IL-17A were measured in 40 unmedicated children with autism and 35 normally developing healthy children. The severity of autism was assessed using the Childhood Autism Rating Scale (CARS). RESULTS: Concentrations of both S100B and TNF-α were higher in children with autism before and after adjusting for a priori-selected confounders (age, sex, and body mass index). S100B concentrations were higher in children with severe autism compared to children with mild-moderate autism. However, this association remained as a trend after adjusting for confounders. S100B concentrations correlated positively with TNF-α concentrations. CONCLUSION: Our findings showing an increase in peripheral concentrations of S100B and TNF-α provide limited support to the hypothesis about the roles of altered immune function and S100B in autism spectrum disorder (ASD). Studies of larger numbers of well-characterized individuals with ASD are needed to clarify the potential role of the immune system in the pathophysiology of this disorder.

Descriptors: Autism; inflammation; glia; tumor necrosis factor; cytokine; S100B

3 - Amphetamine-type stimulant use and conditional paths of consumption: data from the Second Brazilian National Alcohol and Drugs Survey
Luciana T.S. Massaro; Renata R. Abdalla; Ronaldo Laranjeira; Raul Caetano; Ilana Pinsky; Clarice S. Madruga
Pages: 201 - 207

OBJECTIVE: The aim of this study was to estimate nationally representative prevalence rates of amphetamine-type stimulant (ATS) use and to identify consumption-associated factors, proposing a conditional model of direct and indirect consumption paths. METHOD: Using data from the Second Brazilian National Alcohol and Drugs Survey, this cross-sectional study analyzed a subsample of 3,828 participants between 15 and 64 years old, gathering information on the use of psychoactive substances in a probabilistic sample of the Brazilian household population. RESULTS: Rates of lifetime and last-year ATS use were, respectively, 4.1 and 1.6%. Economically privileged individuals and users of other substances were more at risk for using ATS. The results suggest that higher education decreases the chances of ATS consumption. The conditional model showed that higher income increased ATS use, higher education lowered the odds of such an increase, and cocaine use cancelled that associative effect. CONCLUSION: Brazil presents high rates of ATS use. Prevention and treatment strategies should focus on the protective effect of higher education levels and should target polydrug use. Knowledge of ATS-associated factors and user profiles is the starting point for developing effective treatments and tailored prevention strategies.

Descriptors: Amphetamine-type stimulants; moderation model; epidemiology; prevalence; Brazil

4 - Association between dietary patterns and mental disorders in pregnant women in Southern Brazil
Jéssica T.A. Paskulin; Michele Drehmer; Maria T. Olinto; Juliana F. Hoffmann; Andréa P. Pinheiro; Maria I. Schmidt Maria A. Nunes
Pages: 208 - 215

OBJECTIVE: To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil. METHODS: Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants' mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR). RESULTS: In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%CI 1.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93). CONCLUSIONS: Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy.

Descriptors: Dietary patterns; food patterns; food intake; pregnancy; mental health

5 - Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt
Maria C. Rossetti; Adele Tosone; Paolo Stratta; Alberto Collazzoni; Valeria Santarelli; Elisabetta Guadagni; Rodolfo Rossi; Alessandro Rossi
Pages: 216 - 219

OBJECTIVE: Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to depression, interpersonal sensitivity, humiliation, and resilience. METHODS: One hundred consecutively admitted patients with an index depressive episode were recruited. The Brief Symptom Inventory, Humiliation Inventory, and Resilience Scale for Adult were administered. RESULTS: Scores for humiliation, interpersonal sensitivity, and depression were higher in subjects with history of suicide attempt, while higher scores for resilience were observed in the group with no such history. Different patterns of relationships among the variables of interest were found in the two groups. Resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with a past suicide attempt. CONCLUSIONS: Resilience factors can modulate and reduce the impact of suicide risk. Assessing risk and protective factors could enhance the ability to intervene appropriately.

Descriptors: Suicide; humiliation; interpersonal sensitivity; depression; resilience

6 - Suicide and meteorological factors in São Paulo, Brazil, 1996-2011: a time series analysis
Daniel H. Bando; Chei T. Teng; Fernando M. Volpe; Eduardo de Masi; Luiz A. Pereira; Alfésio L. Braga
Pages: 220 - 227

OBJECTIVE: Considering the scarcity of reports from intertropical latitudes and the Southern Hemisphere, we aimed to examine the association between meteorological factors and suicide in São Paulo. METHOD: Weekly suicide records stratified by sex were gathered. Weekly averages for minimum, mean, and maximum temperature(ºC), insolation (hours), irradiation (MJ/m2), relative humidity (%), atmospheric pressure (mmHg), and rainfall (mm) were computed. The time structures of explanatory variables were modeled by polynomial distributed lag applied to the generalized additive model. The model controlled for long-term trends and selected meteorological factors. RESULTS: The total number of suicides was 6,600 (5,073 for men), an average of 6.7 suicides per week (8.7 for men and 2.0 for women). For overall suicides and among men, effects were predominantly acute and statistically significant only at lag 0. Weekly average minimum temperature had the greatest effect on suicide; there was a 2.28% increase (95%CI 0.90-3.69) in total suicides and a 2.37% increase (95%CI 0.82-3.96) among male suicides with each 1 ºC increase. CONCLUSION: This study suggests that an increase in weekly average minimum temperature has a short-term effect on suicide in São Paulo.

Descriptors: Suicide; meteorological factors; São Paulo; time series; epidemiology

7 - Chronic dosing with mirtazapine does not produce sedation in rats
Alberto Salazar-Juárez; Susana Barbosa-Méndez; Paola Merino-Reyes; Maura Matus-Ortega; Jorge A. Hernández-Calderón; Benito Antón
Pages: 228 - 236

OBJECTIVE: Sedation/somnolence are major side effects of pharmacotherapies for depression, and negatively affect long-term treatment compliance in depressed patients. Use of mirtazapine (MIR), an atypical antidepressant approved for the treatment of moderate to severe depression with comorbid anxiety disorders, is associated with significant sedation/somnolence, especially in short-term therapy. Nonetheless, studies with human subjects suggest that MIR-induced sedation is transient, especially when high and repeated doses are used. The purpose of this study was to explore the effects of acute and chronic administration of different doses of MlR on sedation in the rat. METHODS: Assessment of sedation was carried out behaviorally using the rotarod, spontaneous locomotor activity, and fixed-bar tests. RESULTS: A 15-mg/kg dose of MIR induced sedative effects for up to 60 minutes, whereas 30 mg/kg or more produced sedation within minutes and only in the first few days of administration. CONCLUSION: These results suggest that 30 mg/kg is a safe, well-tolerated dose of MIR which generates only temporary sedative effects.

Descriptors: Mirtazapine; sedation; depression; dosing schedules; pharmacotherapy; antidepressant

8 - Association of weight control behaviors with body mass index and weight-based self-evaluation
Sabrina Chapuis-de-Andrade; Rafael M. de Araujo; Diogo R. Lara
Pages: 237 - 243

OBJECTIVE: To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation. METHODS: Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years). RESULTS: The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-3o times higher risk of inducing vomiting. CONCLUSION: The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Descriptors: Weight perception; body weight; weight loss; body mass index; self-concept

9 - Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs
Laura R. Magni; Clarissa Ferrari; Giuseppe Rossi; Elena Staffieri; Aldo Uberti; Dario Lamonaca; Ileana Boggian; Silvia Merlin; Giuseppe Primerano; Alessandra Mombrini; Roberto Poli; Francesco M. Saviotti; Maria T. Caldera; Luciana Zanotti; Roberta Rossi
Pages: 244 - 251

OBJECTIVE: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. METHOD: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. RESULTS: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. CONCLUSION: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

Descriptors: Antipsychotic; cognitive-behavioral therapy; obesity; weight gain

10 - Biting myself so I don't bite the dust: prevalence and predictors of deliberate self-harm and suicide ideation in Azorean youths
Célia Barreto Carvalho; Carolina da Motta; Marina Sousa; Joana Cabral
Pages: 252 - 262

OBJECTIVE: To characterize non-suicidal self-injury (NSSI) behaviors, methods, and functions as well as suicide ideation in the adolescent population of a Portuguese community in São Miguel Island, Azores. Increasing rates of NSSI behaviors among adolescents have been observed globally, while suicidal behavior has been pointed as a major cause of death during adolescence. METHODS: A sample of 1,763 adolescents, aged 14 to 22, was randomly drawn from public and private schools and administered a set of self-report questionnaires. Descriptive and regression analyses were used to look for specific relationships and predictors of NSSI and suicide ideation in this isolated community. RESULTS: Approximately 30% of youths reported at least one NSSI behavior, a rate that is twice as high as most studies carried out in mainland Portugal and in other European countries. Biting oneself was the most frequent form of NSSI, and NSSI behaviors served predominantly automatic reinforcement purposes (i.e., regulation of disruptive emotional states). NSSI and suicide ideation encompassed different distal and proximal risk factors. CONCLUSIONS: Exploring and characterizing these phenomena is necessary to provide a better understanding, enhance current conceptualizations, and guide the development of more effective prevention and intervention strategies in youths.

Descriptors: Non-suicidal self-injury; suicide ideation; adolescence; risk-behaviors; impulsivity

11 - TBARS and BDNF levels in newborns exposed to crack/cocaine during pregnancy: a comparative study
Victor Mardini; Luis A. Rohde; Keila M. Ceresér; Carolina M. Gubert; Emily G. da Silva; Fernando Xavier; Rodrigo Parcianello; Liane M. Röhsig; Flávio Pechansky; Claudia M. Szobot
Pages: 263 - 266

OBJECTIVES: To compare levels of a marker of lipid peroxidation (thiobarbituric acid reactive substances, TBARS) and brain-derived neurotrophic factor (BDNF) in umbilical cord blood (UCB) between newborns exposed to crack/cocaine in utero (exposed newborns [EN], n=57) and non-exposed newborns (nEn, n=99), as well as in maternal peripheral blood at delivery. METHODS: This was a cross-sectional study. Potential confounders, including perinatal parameters, psychopathology, and use of other substances, were assessed. RESULTS: After adjusting for potential confounders, adjusted mean BDNF was significantly higher in EN (3.86 ng/mL, 95% confidence interval [95%CI] 2.29-5.43) than in NEN (0.85 ng/mL, 95%CI 0.47-1.23; p < 0.001; Cohen effect size: 1.12), and significantly lower in crack/cocaine mothers than in control mothers (4.03 ng/mL, 95%CI 2.87-5.18 vs. 6.67 ng/mL, 95%CI 5.60-7.74; p = 0.006). The adjusted mean TbArS level was significantly lower in EN (63.97 µM MDA, 95%CI 39.43-88.50) than NEN (177.04 µM MDA, 95%CI 140.93-213.14; p < 0.001; effect size = 0.84), with no difference between mother groups (p = 0.86). CONCLUSIONS: The changes in TBARS levels observed in EN suggest that fetuses exposed to cocaine mobilize endogenous antioxidant routes since very early stages of development. The increase in BDNF levels in EN might indicate changes in fetal development, whereas the changes in BDNF levels in mothers provide evidence of the complex metabolic processes involved in drug use during pregnancy.

Descriptors: TBARS; BDNF; pregnancy; crack/cocaine; umbilical cord blood; newborn

12 - Dimensions of youth psychopathy differentially predict concurrent pro- and antisocial behavior
Guilherme W. Wendt; Alice J. Bartoli; Adriane Arteche
Pages: 267 - 270

OBJECTIVE: To investigate the unique contribution of narcissism and impulsivity, in addition to callous-unemotional (CU) traits, in explaining concurrent prosocial and antisocial behavior. METHOD: Two hundred and forty-nine schoolchildren (53% female; age 9-12 years) completed the selfreport Strengths and Difficulties Questionnaire (SdQ) and the Antisocial Process Screening Device (APSD). Two statistical models were tested, predicting conduct problems (CP) and prosocial behavior (PB). In the first one, CU traits and gender were entered into the equation. The second model added narcissism and impulsivity. RESULTS: Gender, narcissism and impulsivity, but not CU, were statistically significant predictors of CP in the second model (F3,226 = 45.07, p < 0.001, R2 = 43.7%; betas: gender = -0.20, narcissism = 0.29, impulsivity = 0.36, CU = 0.06). pB was significantly predicted by all domains except gender (F3,226 = 42.57, p < 0.001, R2 = 42.4%; betas: gender = 0.08, narcissism = -0.16, impulsivity = -0.23, CU = -0.41). CONCLUSION: Our results confirmed that CU traits refer to a distinct manifestation of psychopathy in youth, but we also found that narcissism and impulsivity are equally important when predicting CP. Previous reports of sex differences on APSD and SDQ domains were also corroborated.

Descriptors: Child psychiatry; diagnosis and classification; personality disorders - cluster B (antisocial-borderline-histrionic-narcissistic); violence/aggression; gender differences

13 - Psychiatric evaluation of civil capacity with the new Brazilian Statute of the Person with Disabilities
Elias Abdalla-Filho
Pages: 271 - 273

The objective of this paper is to provide an update to psychiatrists regarding the new Brazilian Law for the Inclusion of People with Disabilities (BlI, Law 13,146 of 2015), and, specifically, to discuss potential implications of situations in which examination by a forensic psychiatrist points toward civil incompetence, while the above-mentioned law mandates full civil capacity for disabled persons. A study of Law 13,146/2015 was conducted, including a comparative analysis of legal and psychiatric approaches on the subject. This analysis revealed that the BLI has generated differences of opinion among legislators. However, the greatest difference seems to arise between the justice system and psychiatric expertise in relation to the difference of criteria adopted in the two approaches. The BLI is very recent; it should be revised in response to debates among psychiatrists and the criminal justice system, and especially as jurisprudence is formed over time.

Descriptors: Forensic psychiatry; legal interdiction; disability advocacy; discrimination

14 - Analyzing leukocyte telomere length in bipolar disorder
Nancy Monroy-Jaramillo
Pages: 274 - 274


15 - Analyzing leukocyte telomere length in bipolar disorder: Authors' reply
Florencia M. Barbé-Tuana; Mariana M. Parisi; Bruna S. Panizzutti; Gabriel R. Fries; Lucas K. Grun; Fátima T. Guma; Flávio Kapczinski; Michael Berk; Clarissa S. Gama; Adriane R. Rosa
Pages: 275 - 276


19 - Psychosis: glia, immunity, and melatonin
George Anderson
Pages: 278 - 279


20 - Impairments of kleptomania: what are they?
Hyoun S. Kim; Aparecida Rangon Christianini; David C. Hodgins; Hermano Tavares
Pages: 279 - 280