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 2, Volume 34 - Apr/May/Jun/2012


1 - Cover note
Aracy Amaral
Pages:   -  


2 - On Museums and Scientific Journals
José Alexandre S. Crippa; Marcos Hortes Nisihara Chagas; João Quevedo; Marcelo Q. Hoexter; Tais Moriyama; Giovanni Abrahão Salum; Leonardo F. Fontenelle; Guilherme V. Polanczyk; Marcelo P. Fleck
Pages: 125 - 128


4 - How can connectomics advance our knowledge of psychiatric disorders?
Luca Cocchi; Andrew Zalesky; Leonardo F. Fontenelle
Pages: 131 - 134


5 - High mortality, violence and crime in alcohol dependents: 5 years after seeking treatment in a Brazilian underprivileged suburban community
Jairo Valentim Silva; Viviane de Castro; Ronaldo Laranjeira; Neliana Buzi Figlie
Pages: 135 - 142

OBJECTIVE: To investigate the results of alcohol-related consequences in an underprivileged area of São Paulo.
METHOD: One hundred and ninety one adult patients who sought alcohol treatment in 2002 were reassessed in 2007 regarding alcohol use and involvement with crime. The interview consisted of demographic questions and questionnaires assessing alcohol dependence and pattern of alcohol use. Risk and protective factors and involvement with crime were further explored.
RESULTS: High mortality rate (16.9%, n = 41) was found in this sample and 97.4% were identified as being severe alcohol dependents. The sample consisted of a homogeneous group, average age of 42, 81.9% male, 57.5% black, 52.2% unemployed and 100% of low socioeconomic status. Individuals ageing 35 or younger, not engaged in religious activities and with intense alcohol consumption in the last month had 2.7 times more chance on committing crimes (95% CI = [1.22; 5.93] p = 0.014). Subjects who consumed alcohol in the last month also had a 4.1 greater chance of becoming involved in crime (95% CI = [1.2; 14.24] p = 0.024).
CONCLUSION: Alcohol dependence within an underprivileged community was associated with high rates of crime and mortality. Religious affiliation was negatively associated with delinquent behavior.

Descriptors: Alcohol; Violence/Aggression; Religion; Outpatient Psychiatry; Other Psychosocial Techniques/ Treatments.

6 - Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system
Ricardo Silva; Karen Jansen; Luciano Souza; Luciana Quevedo; Luana Barbosa; Inácia Moraes; Bernardo Horta; Ricardo Pinheiro
Pages: 143 - 148

OBJECTIVE: To assess the sociodemographic risk factors for the prevalence and incidence of relevant postpartum depressive symptoms.
METHOD: We studied a cohort of women in their perinatal period with the assistance of the public health system in the city of Pelotas-RS, Brazil. We assessed depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) in the prenatal and postnatal periods.
RESULTS: We interviewed 1,109 women. The prevalence of meaningful depressive symptoms during pregnancy was 20.5% and postpartum was 16.5%. Women with prenatal depression were at higher risk for postpartum depression.
CONCLUSION: The mother's poverty level, psychiatric history, partner absence and stressful life events should be considered important risk factors for relevant postpartum depressive symptoms.

Descriptors: Community Mental Health; Women; Mood Disorders - Postpartum; Mood Disorders - Unipolar; Epidemiology.

7 - The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study
Elie Leal de Barros Calfat; Pedro Maia Pan; Pedro Shiozawa; Ana Cristina Chaves
Pages: 149 - 154

OBJECTIVES: To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES).
METHOD: From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral.
RESULTS: 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at followup (OR 2.88; IC 95% 1.33-6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036-1.61; p = 0.475).
CONCLUSIONS: Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months.

Descriptors: Emergency psychiatry; Public-sector psychiatry; Compliance.

8 - Exploratory factor analysis of the Brazilian version of the Post- Traumatic Stress Disorder Checklist - Civilian Version (PCL-C)
Roberta Benitez Freitas Passos; Ivan Figueira; Mauro Vítor Mendlowicz; Claudia Leite Moraes; Evandro Silva Freire Coutinho
Pages: 155 - 161

OBJECTIVE: To evaluate the factor structure of the Brazilian Portuguese version of the Post- Traumatic Stress Disorder Checklist - civilian version (PCL-C), in order to complement its validation process in Brazil.
METHOD: An exploratory factor analysis with promax rotation was conducted in 175 ambulance workers of the Emergence Rescue Group (GSE from Portuguese) of the Rio de Janeiro fire brigade and 343 military police officers (MP) (150 from an elite unit of the state of Goiás).
RESULTS: The results revealed a two-factor solution: re-experience/avoidance, numbing/ hyperarousal. All variables loaded highly in at least one factor, except for one; variable 16. This item may have had a bad performance because the analysis was based on a sample of police officers, whose professional activity demands hypervigilance as one of its basic characteristics. Internal consistency values were acceptable.
CONCLUSIONS: Avoidance and numbing seem to be independent dimensions, differently from what is expected according to the DSM-IV. Therefore, new trials should be carried out in other populations, with victims of different kinds of trauma, and including females, to verify these findings.

Descriptors: Factor Analysis, Statistical; Validation Studies; Stress Disorders; Post Traumatic; Stress.

9 - Depressive symptoms in HIV-infected patients treated with highly active antiretroviral therapy
Marysabel Pinto Telis Silveira; Marília Cruz Guttier; Cezar Arthur Tavares Pinheiro; Tatiana Vanessa Silveira Pereira; Ana Laura Sica Cruzeiro; Leila Beltrami Moreira
Pages: 162 - 167

INTRODUCTION: The prevalence of depressive disorders in HIV-infected patients ranges from 12% to 66% and is undiagnosed in 50% to 60% of these patients. Depression in HIV-infected individuals may be associated with poor antiretroviral treatment (ART) outcomes, since it may direct influence compliance.
OBJECTIVE: To assess the presence of symptoms and risk factors for depression in patients on ART.
METHODS: Cross-sectional study. Certified interviewers administered questionnaires and the Beck Depression Inventory (BDI), and participants' self-reported compliance to ART. Clinical and laboratory variables were obtained from clinical records. Patients with BDI > 12 were defined as depressed.
RESULTS: Out of the 250 patients invited to participate, 246 (98%) consented. Mean age was 41 ± 9.9 years; most were male (63%). Income ranged from 0-14 Brazilian minimum wages. AIDS (CDC stage C) had been diagnosed in 97%, and 81% were in stable immune status. One hundred ninety-one (78%) reported compliance, and 161 (68%) had undetectable viral loads. The prevalence of depressive symptoms was 32% (95% CI 26-40). In multivariate analysis, depressive symptoms were significantly associated with income (prevalence ratio [PR] = 0.85; 95% CI 0.74-0.97; p = 0.02).
CONCLUSIONS: Depressive symptoms are frequent in patients on ART, and are associated with low income.

Descriptors: AIDS; CNS Depressants; Drug side effects - other; Epidemiology; Other psychological issues.

10 - Energy metabolism, leptin, and biochemical parameters are altered in rats subjected to the chronic administration of olanzapine
Alexandra I. Zugno; Mariely Barcelos; Larissa de Oliveira; Leila Canever; Renata D. de Luca; Daiane B. Fraga; Maria Paula Matos; Gislaine T. Rezin; Giselli Scaini; Márcio Búrigo; Emilio L. Streck; João Quevedo
Pages: 168 - 175

OBJECTIVES: Olanzapine, an atypical antipsychotic drug with affinities for dopamine, serotonin, and histamine binding sites appears to be associated with substantial weight gain and metabolic alterations. The aim of this study was to evaluate weight gain and metabolic alterations in rats treated with olanzapine on a hypercaloric diet.
METHODS: We used 40 rats divided into 4 groups: Group 1, standard food and water conditions (control); Group 2, standard diet plus olanzapine; Group 3, cafeteria diet (hypercaloric); and Group 4, olanzapine plus cafeteria diet. Olanzapine was administered by gavage at a dose of 3 mg/kg for 9 weeks.
RESULTS: There were no significant changes in the cholesterol levels in any group. Glucose levels increased in Group 3 by the fourth week. Triglyceride levels were altered in group 2 toward the end of the experiment. Leptin levels decreased in Groups 2 and 4. Complex II activity in the muscles and liver was altered in Group 2 (muscle), and Groups 2, 3, and 4 (liver). Complex IV activity was altered only in the liver in Group 2, without significant alterations within the muscles.
CONCLUSION: These results suggest that olanzapine is correlated with weight gain and the risks associated with obesity.

Descriptors: Schizophrenia; Olanzapine; Cafeteria diet; Energy metabolism; Leptin.

11 - Criminal career-related factors among female robbers in the State of São Paulo, Brazil, and a presumed 'revolving-door' situation
Fernando Henrique Nadalini Mauá; Danilo Antonio Baltieri1
Pages: 176 - 184

INTRODUCTION: Risk-taking behaviors, family criminality, poverty, and poor parenting have been frequently associated with an earlier onset of criminal activities and a longer criminal career among male convicts.
OBJECTIVE: This study aims to identify factors related to the onset and recurrence of criminal behavior among female robbers in the State of São Paulo - Brazil.
METHOD: It was a cross-sectional study carried out inside a feminine penitentiary in São Paulo. From June 2006 to June 2010, 175 inmates convicted only for robbery were recruited to be evaluated about family antecedents of criminal conviction, alcohol and drug misuse, impulsiveness, depressive symptoms, and psychosocial features.
RESULTS: Having family antecedents of criminal conviction consistently predicted an earlier onset of criminal activities and a longer criminal career among female robbers. Drug use in youth and the severity of drug misuse were significantly related to the initiation and recurrence of criminal behavior, respectively.
DISCUSSION: Prisons must systematically screen detainees and provide treatments for those with health problems in general. Children of inmates should obtain help to modify the negative consequences of their parents' incarceration in order to mitigate the negative consequences of pursuing this 'static' factor.

Descriptors: Female Inmates; Robbery; Substance Misuse; Trans-Generational Theory.

12 - Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system
Alexandre Andrade Loch
Pages: 185 - 192

OBJECTIVE: The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission.
METHODS: Prospective observational study, conducted in São Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related.
RESULTS: Oneyear re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95%CI 2.3-31.2) and to the survival model (OR = 3.2, 95%CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy.
CONCLUSIONS: Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.

Descriptors: Schizophrenia; Psychosis; Community Mental Health; Mood Disorders - Bipolar Disorder; Outpatient Psychiatry.

13 - Socioeconomic influences on alcohol use patterns among private school students in São Paulo
Danilo Locatelli; Zila Sanchez; Emerita Opaleye; Claudia Carlini; Ana Noto
Pages: 193 - 200

OBJECTIVES: To describe alcohol use by socioeconomic level and gender among private high school students in the city of São Paulo, Brazil.
METHODS: Cross-sectional study of students in private schools in São Paulo. An anonymous self-administered questionnaire was distributed in the classroom. A total of 2,613 students were selected by the stratification and conglomerate methods. Chi-squared tests, t-tests and ANOVA were used to test for associations between alcohol use and gender and socioeconomic status; for binge drinking, an ordered logistic regression model was developed.
RESULTS: Overall, 88% of students reported lifetime alcohol use, with 31.6% in combination with energy drinks. Half of the students (51.3%) reported alcohol use in the last month, most frequently beer (35.2%), alcopop (32%) and vodka (31.7%); 33.2% reported binge drinking in the last month (5 drinks per occasion). Most evaluated parameters showed higher rates of use among males and higher social classes. The regression model exhibited an increasing rate of binge drinking with increasing socioeconomic status.
CONCLUSIONS: The results suggest that socioeconomic features help to define alcohol use among São Paulo students. Use behaviors such as binge drinking are more prevalent among students from the upper social classes.

Descriptors: Alcoholic Drinks; Students; binge drinking; Gender; Socioeconomic Class; Teenagers.

14 - Trauma and countertransference: development and validity of the Assessment of Countertransference Scale (ACS)
Érico de Moura Silveira Júnior; Guilherme Vanoni Polanczyk; Mariana Eizirik; Simone Hauck; Cláudio Laks Eizirik; Lúcia Helena Freitas Ceitlin
Pages: 201 - 206

OBJECTIVES: The aim of the present study was to investigate the construct validity of the Assessment of Countertransference Scale (ACS) in the context of the trauma care, through the identification of the underlying latent constructs of the measured items and their homogeneity.
METHODS: ACS assesses 23 feelings of CT in three factors: closeness, rejection and indifference. ACS was applied to 50 residents in psychiatry after the first appointment with 131 victims of trauma consecutively selected during 4 years. ACS was analyzed by exploratory (EFA) and confirmatory (CFA) factor analysis, internal consistence and convergent-discriminant validity.
RESULTS: In spite of the fact that closeness items obtained the highest scores, the EFA showed that the factor rejection (24% of variance, α = 0.88) presented a more consistent intercorrelation of the items, followed by closeness (15% of variance, α = 0.82) and, a distinct factor, sadness (9% of variance, α = 0.72). Thus, a modified version was proposed. In the comparison between the original and the proposed version, CFA detected better goodness-of-fit indexes for the proposed version (GFI = 0.797, TLI = 0.867, CFI = 0.885 vs. GFI = 0.824, TLI = 0.904, CFI = 0.918).
CONCLUSIONS: ACS is a promising instrument for assessing CT feelings, making it valid to access during the care of trauma victims.

Descriptors: Countertransference; Trauma Victims; Validity; Factor Analysis.

15 - The involvement of the orbitofrontal cortex in psychiatric disorders: an update of neuroimaging findings
Andrea Parolin Jackowski; Gerardo Maria de Araújo Filho; Amanda Galvão de Almeida; Célia Maria de Araújo; Marília Reis; Fabiana Nery; Ilza Rosa Batista; Ivaldo Silva; Acioly L. T. Lacerda
Pages: 207 - 212

OBJECTIVE: To report structural and functional neuroimaging studies exploring the potential role of the orbitofrontal cortex (OFC) in the pathophysiology of the most prevalent psychiatric disorders (PD).
METHOD: A non-systematic literature review was conducted by means of MEDLINE using the following terms as parameters: "orbitofrontal cortex", "schizophrenia", "bipolar disorder", "major depression", "anxiety disorders", "personality disorders" and "drug addiction". The electronic search was done up to July 2011.
DISCUSSION: Structural and functional OFC abnormalities have been reported in many PD, namely schizophrenia, mood disorders, anxiety disorders, personality disorders and drug addiction. Structural magnetic resonance imaging studies have reported reduced OFC volume in patients with schizophrenia, mood disorders, PTSD, panic disorder, cluster B personality disorders and drug addiction. Furthermore, functional magnetic resonance imaging studies using cognitive paradigms have shown impaired OFC activity in all PD listed above.
CONCLUSION: Neuroimaging studies have observed an important OFC involvement in a number of PD. However, future studies are clearly needed to characterize the specific role of OFC on each PD as well as understanding its role in both normal and pathological behavior, mood regulation and cognitive functioning.

Descriptors: Orbitofrontal Cortex; Schizophrenia; Mood Disorders; Anxiety Disorders; Personality Disorders; Neuroimaging.

16 - Severe compulsive sexual behaviors: a report on two cases under treatment
Maria Luiza Sant'Ana do Amaral; Marco de Tubino Scanavino
Pages: 213 - 216


17 - Morbidity and Mortality due to mental disorders in Brazil
Rafael Bernardon Ribeiro; Débora Luciana Melzer-Ribeiro; Quirino Cordeiro
Pages: 217 - 220


18 - Psychiatric syndromes secondary to central nervous system infection
Antonio Lucio Teixeira; Tatiana Barichello
Pages: 221 - 222


19 - The first university day hospital in Brazil: 50th Anniversary
José Onildo Betioli Contel
Pages: 223 - 225


20 - A non-affective psychotic syndrome after starting antiretroviral therapy
R Navinés; J Blanch; A Rousaud, Phych; J Moreno-España; R Martín-Santos
Pages: 226 - 229


21 - Affective disorders in childhood and adolescence: diagnosis and treatment
Camila Morelatto de Souza
Pages: 230 - 233


22 - Treating Sexual Desire Disorders
João Paulo Machado-de-Sousa
Pages: 234 - 235