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 1, Volume 34 - Jan/Feb/Mar/2012


1 - RBP has a new layout
Antônio Geraldo da Silva
Pages: 1 - 1


2 - RBP Psychiatry the crowning of an editorial policy
Marcelo P. Fleck; Giovanni Abrahão Salum; João Quevedo; Christian Kieling; Marcelo Q. Hoexter; Tais Moriyama; Marcos Hortes Nisihara Chagas; Leonardo F. Fontenelle; Guilherme V. Polanczyk; José Alexandre S. Crippa
Pages: 5 - 6


3 - Burden of Mental Disorders based on the World Mental Health Surveys
Jordi Alonso
Pages: 7 - 11


4 - The role of the World Psychiatric Association in facilitating development of psychiatric publications from low- and middle-income countries
Christopher Paul Szabo; Jair de Jesus Mari; Christian Kieling; Helen Herrman
Pages: 12 - 15


5 - Gender parity and drug use: are girls catching up with boys?
André Malbergier; Luciana Roberta Donola Cardoso; Ricardo Abrantes do Amaral; Verena Castellani Vitor Santos
Pages: 16 - 23

OBJECTIVE: To evaluate the association between gender and use of alcohol, tobacco, and other drugs in adolescents aged 10 to 18 years in the municipalities of Jacareí and Diadema, São Paulo, Brazil.
METHODS: A total of 971 adolescents completed the Drug Use Screening Inventory (DUSI).
RESULTS: In our sample, 55% of adolescents were male, 33.8% reported having made use in the previous month of alcohol, 13.5% of cigarettes, and 6.4% of illicit drugs. There was no significant difference between genders in the use of alcohol, tobacco, and illicit drugs in any of the analysis (p > 0.05). The use of alcohol, tobacco, and illicit drugs was associated with the city, age, educational level, school failure, and relationship with parents (p < 0.05).
CONCLUSIONS: Substance abuse among adolescents in our sample seems to follow the recent global trend towards the equalization of drug use between genders. This result should be taken into account by public health professionals in developing policies for this problem.

Descriptors: Adolescents; Gender; Alcohol abuse; Psychoactive substance use disorder; Epidemiology.

6 - Psychometric properties of the sixth version of the Addiction Severity Index (ASI-6) in Brazil
Felix Kessler; John Cacciola; Arthur Alterman; Sibele Faller; Maria Lucia Souza-Formigoni; Marcelo Santos Cruz Sílvia Brasiliano; Flavio Pechansky
Pages: 24 - 33

BACKGROUND: There are few research tools in Brazil to assess more broadly the alcohol and other drug related problems.
OBJECTIVE: To test the psychometric properties of ASI in its sixth version (ASI-6).
METHODS: A multicenter cross-sectional study was conducted in four Brazilian state capitals. Four research centers interviewed 150 adult inpatients or outpatients, and one research center interviewed 140 patients. A total of 740 substance abusers were selected. Training and supervision of interviewers were performed to assure the quality of dada collected.
RESULTS: Most areas of the ASI showed good reliability between the instrument and the interviewers, with no statistically significant differences between the ASI-6 Summary Scores for Recent Functioning (SS-Rs) of both interviews. Cronbach's alpha for ASI-6 subscales ranged from 0.64 to 0.95. Correlations between the ASI-6 Alcohol and Drug scores and the concurrent instrument (ASSIST) were high (0.72 and 0.89, respectively). There was a significant negative correlation between the scores in psychiatric, medical and drug areas and the scores of WHOQOL.
CONCLUSION: Analysis of the psychometric properties of ASI-6 both in outpatients and inpatients in Brazil indicate a good reliability and validity of this instrument for the Brazilian culture. The development of this instrument in Brazil is an important advancement, which will certainly have implications for the prevention, clinical research, and social rehabilitation fields.

Descriptors: Assessment; Evaluation; Instrument; Scale; Validation; Substance abuse; Cross-cultural.

7 - Suicide mortality in São Gabriel da Cachoeira, a predominantly indigenous Brazilian municipality
Maximiliano Loiola Ponte de Souza; Jesem Douglas Yamall Orellana
Pages: 34 - 37

OBJECTIVE: To describe the characteristics and the raw suicide mortality rates (RSMR) during the period 2000-2007 in the municipality with the largest proportion of self-reported indigenous people in Brazil, São Gabriel da Cachoeira (SGC), State of Amazonas.
METHOD: A retrospective descriptive study was carried out using data from the Information Department of the Brazilian Unified Health System (DATASUS). We considered suicide the cause of death coded in the records as voluntary self-Inflicted injuries according to the International Classification of Diseases and Related Health Problems, 10th revision.
RESULTS: Forty-four suicide cases were registered in this period. The average RSMR was 16.8 per 100,000 inhabitants (male, 26.6; female, 6.3). The highest rates were observed in the age groups 15-24 years and 25-34 years, with RSMR of 43.1 and 30.2 per 100,000 inhabitants, respectively. Most suicides occurred among indigenous people (97.7%), males (81.8%), and unmarried people (70.5%). In most cases, deaths occurred at home (86.4%), during weekends (59.1%) and mainly by hanging (97.7%).
CONCLUSION: Suicide is a significant health and social problem in SGC. The suicide profile observed in this municipality was, as a whole, more similar to that observed in certain indigenous communities than that found in most urban and non-indigenous environments, demonstrating the sociocultural specificity of these events in Brazil.

Descriptors: Suicide; Epidemiology; South American Indians; Adolescents, Brazil.

8 - No association between the HTR1A gene and suicidal behavior: a meta-analysis
Miriam Rivera Angles; Deysi Bermúdez Ocaña; Beatriz Camarena Medellín; Carlos Tovilla-Zárate
Pages: 38 - 42

OBJECTIVE: Dysfunction of serotonin 1A receptors (HTR1A) may play a role in the genesis of suicidal behavior. We studied the association between a functional polymorphism in the HTR1A gene and suicidal behavior.
METHOD: We performed a meta-analysis of published genetic association studies by searching through Medline, PubMed, and Web of Science databases to analyze a possible correlation between the rs6295 polymorphism and suicidal behavior in different populations.
RESULTS: Four studies comprising a total of nine hundred and fifty seven patients with suicidal behavior and nine hundred and fifty seven controls were the eligible. The G allele of the rs6295 polymorphism may not be associated with suicidal behavior (Random-effects model: OR = 1.08; 95% CI: 0.80-1.45; p(Z) = 0.80) in presence of heterogeneity (Q = 17.84, df = 4, p = 0.0013). In a second analysis that presented no heterogeneity, a negative association was also observed (OR = 0.94; 95%CI: 0.79-1.13; p(Z) = 0.99).
CONCLUSION: To our knowledge, the present study is the first meta-analysis searching for a correlation between rs6295 of HTR1A and suicidal behavior. Our results showed no association between HTR1A and suicidal behavior. However, more studies assessing different populations, as well as larger samples, are needed.

Descriptors: Suicide; Serotonin; Serotonin Receptor 1A; Meta-Analysis.

9 - The Brazilian smoker: a survey in the largest cities of Brazil
Emérita Sátiro Opaleye; Zila M Sanchez; Yone Gonçalves de Moura; José Carlos Fernandes Galduróz; Danilo Polverini Locatelli; Ana Regina Noto
Pages: 43 - 51

OBJECTIVE: To understand the sociodemographic factors associated with daily consumption of cigarettes and pattern of cigarette use among Brazilian smokers.
METHOD: A cross-sectional study was performed in 2005 involving the 108 largest Brazilian cities. Data were collected through interviews with subjects aged 12 to 65 years in randomly selected households. Based on a questionnaire adapted to the Brazilian context, a logistic regression model was used to investigate the association between the sociodemographic characteristics of the sample and smoking.
RESULTS: Of the 7,921 subjects interviewed, 16.4% reported daily use of cigarettes. The smoking prevalence was similar between genders, although women reported to start smoking at a later age and smoke fewer cigarettes per day. Almost 65% of the smokers were interested in quitting or reducing their smoking habit. The main sociodemographic characteristics associated with smoking were as follows: adult age (30-59 years old), unemployment, low education level, and low socioeconomic level. Alcohol abuse was also shown to be associated with smoking.
CONCLUSIONS: Our findings suggest that adverse socioeconomic characteristics are implicated in increased susceptibility to smoking in Brazil. In our sample, a high proportion of smokers reported interest to quit or reduce smoking. These data suggest that sociodemographic factors should be considered in the elaboration of smoking prevention and treatment policies.

Descriptors: Tobacco; Smoking; Epidemiology; Brazil; Cross-sectional studies.

10 - Low family support perception: a 'social marker' of substance dependence?
Valdir de Aquino Lemos; Hanna Karen Moreira Antunes; Makilim Nunes Baptista; Sergio Tufik; Marco Túlio De Mello; Maria Lucia Oliveira de Souza Formigoni
Pages: 52 - 59

OBJECTIVE: Simultaneously assess the relationship between the family support perception and the intensity of hopelessness, depression, and anxiety symptoms in alcohol or drug dependent (AOD) patients and in non-AOD dependent control group (CON).
METHOD: 60 patients who met the DSM-IV criteria for AOD dependence and 65 individuals with similar profile, but not dependent on AOD completed the Family Support Perception Inventory (FSPI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Beck Hopelessness Scale (BHS).
RESULTS: Logistic regression analysis indicated that high scores in family autonomy (OR = 0.08), and low scores in hopelessness (OR = 0.64) were negatively correlated with AOD dependence. Individuals with high scores in BAI had higher probability (OR = 1.22) of belonging to the AOD group, as well as those who reported previous psychiatric treatment (OR = 68.91). Only in the AOD group the total FSPI scores presented significant correlation with depression, anxiety, and hopelessness.
CONCLUSIONS: Individuals with AOD dependence and low scores of family support perception also presented high scores of depression, anxiety, and hopelessness, suggesting that FSPI scores could be a useful 'social marker' of AOD dependence with psychiatric comorbidities. These data also reinforce the relevance of evaluating family support in AOD treatment planning.

Descriptors: Beck Depression Inventory; Beck Anxiety Inventory; Beck Hopelessness Scale; Family Support Perception Inventory; Substance Abuse.

11 - Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students
Liana Catarina L. Portugal; Mirtes Garcia Pereira; Rita de Cássia S. Alves; Gisella Tavares; Isabela Lobo; Vanessa Rocha-Rego; Carla Marques-Portella Mauro V. Mendlowicz; Evandro S. Coutinho; Adriana Fiszman; Eliane Volchan; Ivan Figueira Letícia de Oliveira
Pages: 60 - 65

OBJETIVO: A imobilidade tônica é uma resposta defensiva que ocorre sob ameaça extrema à vida. Pacientes com transtorno de estresse pós-traumático (TEPT) que relatam imobilidade tônica peritraumática são os que apresentam os sintomas mais graves e a pior resposta ao tratamento. Este estudo investigou o valor preditivo da imobilidade tônica para os sintomas de TEPT em uma amostra não clínica.
MÉTODOS: Os participantes da pesquisa foram 198 estudantes universitários expostos a traumas diversos. A versão brasileira do Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C) e questões referentes à imobilidade tônica foram empregadas. Modelos de regressão linear foram utilizados para investigar a associação dos sintomas de estresse pós-traumático com a imobilidade tônica peritraumática. Foram consideradas como variáveis de confusão a dissociação peritraumática, as reações físicas de pânico peritraumática, o traço de afeto negativo, o gênero, o tipo de trauma e o tempo de trauma.
RESULTADOS: Encontrou-se uma associação significativa entre a imobilidade tônica peritraumática e os sintomas de TEPT em uma amostra não clínica exposta a traumas diversos mesmo quando controlada por variáveis de confusão (β = 1,99; p = 0,017).
CONCLUSÕES: Esta reação defensiva que ocorre sob intensa ameaça, apesar de adaptativa para a defesa, pode ter consequências patológicas como sugere sua associação aos sintomas de TEPT.

Descriptors: Transtorno de estresse pós-traumático; Testes psicométricos; Saúde mental da comunidade (Saúde pública); Outras áreas de pesquisa (Imobilidade tônica); Outros grupos de pacientes/questões (Amostra não clínica).

12 - Prevalence and clinical impact of eating disorders in bipolar patients
Camila Seixas; Ângela Miranda-Scippa; Fabiana Nery-Fernandes; Mônica Andrade-Nascimento; Lucas C. Quarantini; Flavio Kapczinski; Irismar Reis de Oliveira
Pages: 66 - 70

OBJECTIVES: To study the impact of eating disorders (EDs) on the severity of bipolar disorder (BD).
METHODS: The Structured Clinical Interview for DSM-IV Axis I (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were used. Clinical and sociodemographic data were also collected.
RESULTS: Among the 356 bipolar patients included in this study, 19 (5.3%) were also diagnosed with ED. Of these, 57.9% had bulimia nervosa (BN) and 42.1% had anorexia nervosa (AN). Among ED patients, 94.7% were female. Bipolar patients with EDs presented with lower scores in the mental health domain of the WHOQOL-BREF, higher scores of depressive symptoms, and more psychiatric comorbidities.
CONCLUSIONS: ED comorbidities imposed important negative outcomes in bipolar patients. This finding suggests that attention should be given to the presence of EDs in BD patients and that better treatments focused on this population should be developed.

Descriptors: Bipolar Disorder; Eating Disorders; Anorexia Nervosa; Bulimia Nervosa; Quality of Life.

13 - Peripheral chemokine levels in women with recurrent major depression with suicidal ideation
Rodrigo Grassi-Oliveira; Elisa Brieztke; Antônio Teixeira; Júlio Carlos Pezzi; Márcio Zanini; Rodrigo Pestana Lopes; Moisés Evandro Bauer
Pages: 71 - 75

OBJECTIVE: To compare serum levels of MCP-1/CCL2, RANTES/CCL5, and Eotaxin/CCL11 between female patients with recurrent major depressive disorder (MDD) and healthy controls, verifying if there is a difference in the levels of these mediators between those with or without current suicidal ideation.
METHODS: Thirty female outpatients with recurrent MDD were divided in two groups accordingly the presence or absence of suicidal ideation. These groups were compared with 16 healthy controls. Serum levels of MCP-1/CCL2, RANTES/CCL5, and Eotaxin/CCL11 were determined. Depression severity was evaluated by Beck Depression Inventory (BDI). Suicidal ideation was assessed by SCID-I and BDI.
RESULTS: Patients with recurrent MDD and healthy controls did not differ in age, socioeconomic status, and education. All patients reported high scores of BDI (mean, SD, n; 29.75, 10.55, 28). Multivariable analysis of covariance adjusted for age and BMI showed that MDD patients with suicidal ideation presented lower levels of MCP-1/CCL2 and RANTES/CCL5 (p < 0.001) and higher levels of Eotaxin/CCL11 (p = 0.04) compared to healthy controls. These differences remained significant after adjusting for depression severity.
CONCLUSION: The findings of this study indicated that the presence of recurrent MDD with suicidal ideation is associated with differences in inflammatory chemokines when compared to those without suicidal ideation.

Descriptors: Suicide; Suicidal Ideation; Chemokines; Cytokines; Major Depressive Disorder; Mood Disorders; Inflammation; Immunity.

14 - Development and validation of the Intrinsic Religiousness Inventory (IRI)
Tauily C. Taunay; Eva D. Cristino; Myrela O. Machado; Francisco H. Rola; José W. O. Lima; Danielle S. Macêdo; Francisco de Assis A. Gondim; Alexander Moreira-Almeida; André F. Carvalho
Pages: 76 - 81

OBJECTIVE: The role of religious involvement in mental health has been increasingly investigated in psychiatric research; however, there is a shortage of scales on religiousness in Portuguese. The present study aimed to develop and validate a brief instrument to assess intrinsic religiosity (Intrinsic Religiousness Inventory - IRI) in two Brazilian samples.
METHOD: The initial version was based on literature review and experts' suggestions. University students (sample 1; n = 323) and psychiatric patients (sample 2; n = 102) completed the Duke Religiosity Index (DUREL), the IRI, an instrument of spirituality measurement (WHOQOL-SRPB), as well as measurements of anxiety and depressive symptoms.
RESULTS: The IRI showed adequate internal consistence reliability in sample 1 (Cronbach's α = 0.96; 95% CI; 0.95-0.97) and sample 2 (α = 0.96; 95% CI; 0.95-0.97). The IRI main component analyses indicated a single factor, which explained 73.7% and 74.9% of variance in samples 1 and 2, respectively. Strong correlations between IRI and intrinsic subscale of the DUREL were observed (Spearman's r ranging from 0.87 to 0.73 in samples 1 and 2, respectively, p < 0.001). The IRI showed good test-retest reliability (intraclass correlation coefficients > 0.70).
CONCLUSION: These data indicate that the IRI is a valid instrument and may contribute to study intrinsic religiosity in Brazilian samples.

Descriptors: Religion; Validation Study; Instrument; Mental Health.

15 - Molecular medicine: a path towards a personalized medicine
Debora Marques de Miranda; Marcelo Mamede; Bruno Rezende de Souza; Alexandre Guimarães de Almeida Barros; Luiz Alexandre Magno; Antônio Alvim-Soares Jr.; Daniela Valadão Rosa; Célio José de Castro Jr.; Leandro Malloy-Diniz; Marcus Vinícius Gomez; Luiz Armando De Marco; Humberto Correa; Marco Aurélio Romano-Silva
Pages: 82 - 91

Psychiatric disorders are among the most common human illnesses; still, the molecular and cellular mechanisms underlying their complex pathophysiology remain to be fully elucidated. Over the past 10 years, our group has been investigating the molecular abnormalities in major signaling pathways involved in psychiatric disorders. Recent evidences obtained by the Instituto Nacional de Ciência e Tecnologia de Medicina Molecular (National Institute of Science and Technology - Molecular Medicine, INCT-MM) and others using behavioral analysis of animal models provided valuable insights into the underlying molecular alterations responsible for many complex neuropsychiatric disorders, suggesting that "defects" in critical intracellular signaling pathways have an important role in regulating neurodevelopment, as well as in pathophysiology and treatment efficacy. Resources from the INCT have allowed us to start doing research in the field of molecular imaging. Molecular imaging is a research discipline that visualizes, characterizes, and quantifies the biologic processes taking place at cellular and molecular levels in humans and other living systems through the results of image within the reality of the physiological environment. In order to recognize targets, molecular imaging applies specific instruments (e.g., PET) that enable visualization and quantification in space and in real-time of signals from molecular imaging agents. The objective of molecular medicine is to individualize treatment and improve patient care. Thus, molecular imaging is an additional tool to achieve our ultimate goal.

Descriptors: Molecular Medicine; Biomarkers; Neuroimaging; PET/CT; Animal Models.

16 - A review on predictors of treatment outcome in social anxiety disorder
Sara Costa Cabral Mululo; Gabriela Bezerra de Menezes; Paula Vigne; Leonardo F. Fontenelle
Pages: 92 - 100

OBJECTIVE: This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD).
METHODS: A systematic review of trials identified through databases of ISI, Medline, PsycInfo, Cochrane, LILACS, Current Controlled Trials, and in references of previously selected articles published in English up to December 2010. In our literature search, we used the words prediction/predictors and social anxiety disorder or social phobia.
RESULTS: Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD.
CONCLUSIONS: Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.

Descriptors: Phobic Disorders; Predictors; Treatment Outcome; Review; Clinical Trials.

17 - Neuroimaging in specific phobia disorder: a systematic review of the literature
Ila M.P. Linares; Clarissa Trzesniak; Marcos Hortes N. Chagas; Jaime E. C. Hallak; Antonio E. Nardi; José Alexandre S. Crippa
Pages: 101 - 111

OBJECTIVE: Specific phobia (SP) is characterized by irrational fear associated with avoidance of specific stimuli. In recent years, neuroimaging techniques have been used in an attempt to better understand the neurobiology of anxiety disorders. The objective of this study was to perform a systematic review of articles that used neuroimaging techniques to study SP.
METHOD: A literature search was conducted through electronic databases, using the keywords: imaging, neuroimaging, PET, spectroscopy, functional magnetic resonance, structural magnetic resonance, SPECT, MRI, DTI, and tractography, combined with simple phobia and specific phobia. One-hundred fifteen articles were found, of which 38 were selected for the present review. From these, 24 used fMRI, 11 used PET, 1 used SPECT, 2 used structural MRI, and none used spectroscopy.
RESULT: The search showed that studies in this area were published recently and that the neuroanatomic substrate of SP has not yet been consolidated.
CONCLUSION: In spite of methodological differences among studies, results converge to a greater activation in the insula, anterior cingulate cortex, amygdala, and prefrontal and orbitofrontal cortex of patients exposed to phobia-related situations compared to controls. These findings support the hypotheses of the hyperactivation of a neuroanatomic structural network involved in SP.

Descriptors: Neuroimaging; Specific Phobia; Review; Anxiety Disorder; Phobia.

18 - Cognitive-Behavior Therapy-Online in OCD patient with hoarding symptoms
Helena da Silva Prado; Eduardo Aliende Perin
Pages: 112 - 113


19 - Hypoplastic splenium of the corpus callosum and co-occurrence of attention deficit/hyperactivity and language disorders: a case report
Emerson Nunes; Bruno Schneider; Serdar Dursun; Glen Baker; Jaime Hallak
Pages: 114 - 115


20 - Alcohol and other drug use by Brazilian truck drivers: a cause for concern?
Lúcio Garcia de Oliveira; Maurício Yonamine; Gabriel Andreucceti; Julio de Carvalho Ponce; Vilma Leyton
Pages: 116 - 117


21 - Unfeasibility of a risk mitigation strategy for sibutramine
Francisco José Roma Paumgartten
Pages: 118 - 118


22 - Increased serum levels of C3 and C4 in patients with schizophrenia compared to eutymic patients with bipolar disorder and healthy
Lisiane dos Santos Sória; Carolina de Moura Gubert; Keila Maria Ceresér; Clarissa Severino Gama; Flavio Kapczinski
Pages: 119 - 120


23 - Bases biológicas dos transtornos psiquiátricos: uma abordagem translacional
Ligia Ribeiro Horta
Pages: 121 - 121