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 Supl.1, Volume 34 - Jun/2012


1 - The entartete Kunst of Paul Klee
Helouise Costa
Pages:   -  


2 - Panic Developments
Donald F. Klein
Pages: 1 - 4


3 - New trends in anxiety disorders
Antonio E. Nardi; Leonardo F. Fontenelle; José Alexandre S. Crippa
Pages: 5 - 8


4 - The psychological development of panic disorder: implications for neurobiology and treatment
Fiammetta Cosci
Pages: 9 - 31

OBJECTIVES: The aim of this study was to survey the available literature on psychological development of panic disorder with or without agoraphobia [PD(A)] and its relationship with the neurobiology and the treatment of panic.
METHODS: Both a computerized (PubMed) and a manual search of the literature were performed. Only English papers published in peer-reviewed journals and referring to PD(A) as defined by the diagnostic classifications of the American Psychiatric Association or of the World Health Organization were included.
CONCLUSIONS: A staging model of panic exists and is applicable in clinical practice. In a substantial proportion of patients with PD(A), a prodromal phase and, despite successful treatment, residual symptoms can be identified. Both prodromes and residual symptoms allow the monitoring of disorder evolution during recovery via the rollback phenomenon. The different stages of the disorder, as well as the steps of the rollback, have a correspondence in the neurobiology and in the treatment of panic. However, the treatment implications of the longitudinal model of PD(A) are not endorsed, and adequate interventions of enduring effects are missing.

Descriptors: Staging; Panic Disorder; Subclinical Symptoms; Neurobiology; Treatment.

5 - Panic disorder and the respiratory system: clinical subtype and challenge tests
Rafael C. Freire; Antonio E. Nardi
Pages: 32 - 52

INTRODUCTION: Respiratory changes are associated with anxiety disorders, particularly panic disorder (PD). The stimulation of respiration in PD patients during panic attacks is well documented in the literature, and a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in PD patients. Investigators hypothesized that there is a fundamental abnormality in the physiological mechanisms that control breathing in PD.
METHODS: The authors searched for articles regarding the connection between the respiratory system and PD, more specifically papers on respiratory challenges, respiratory subtype, and current mechanistic concepts.
CONCLUSIONS: Recent evidences support the presence of subclinical changes in respiration and other functions related to body homeostasis in PD patients. The fear network, comprising the hippocampus, medial prefrontal cortex, amygdala and its brainstem projections, may be abnormally sensitive in PD patients, and respiratory stimulants like CO2 may trigger panic attacks. Studies indicate that PD patients with dominant respiratory symptoms are particularly sensitive to respiratory tests compared to those who do not manifest dominant respiratory symptoms, representing a distinct subtype. The evidence of changes in several neurochemical systems might be the expression of the complex interaction among brain circuits.

Descriptors: Anxiety Disorders; Carbon Dioxide; Panic Attack; Respiratory System.

6 - Anxiety and joint hypermobility association: a systematic review
Simone H. Bianchi Sanches; Flávia de Lima Osório; Marc Udina; Rocío Martín-Santos; José Alexandre S. Crippa
Pages: 53 - 68

BACKGROUND: Anxiety disorders are often associated with several non-psychiatric medical conditions. Among the clinical conditions found in association with anxiety stands out the joint hypermobility (JH).
OBJECTIVE: To carry out a systematic review of the clinical association between anxiety disorders and JH. Method: A survey was conducted in MEDLINE, PsychINFO, LILACS e SciELO databases up to December 2011. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety. The reference lists of selected articles were systematically hand-searched for other publications relevant to the review.
RESULTS: Seventeen articles were included in the analysis and classified to better extract data. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Panic disorder/agoraphobia was the anxiety disorder associated with JH in several studies. Etiological explanation of the relationship between anxiety and JH is still controversial.
CONCLUSION: Future research in large samples from the community and clinical setting and longitudinal studies of the association between anxiety and HA and the underlying biological mechanisms involved in this association are welcome.

Descriptors: Anxiety, Hypermobility; Panic Disorder/ Agoraphobia; Anxiety Disorders; Methodology; Joint Hypermobility Syndrome.

7 - Social anxiety and negative early life events in university students
Cynthia Binelli; Ana Ortiz; Armando Muñiz; Estel Gelabert; Liliana Ferraz; Alaor S Filho; José Alexandre S. Crippa; Antonio E Nardi; Susana Subirà; Rocío Martín-Santos
Pages: 69 - 80

INTRODUCTION: There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students.
METHODS: In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale.
RESULTS: Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social anxiety score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05).
CONCLUSION: University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.

Descriptors: Negative Early Life Events; Childhood Adversities; Family Violence; Social Anxiety; Liebowitz Social Anxiety Scale.

8 - Outlining new frontiers for the comprehension of obsessive-compulsive disorder: a review of its relationship with fear and anxiety
Juliana Belo Diniz; Euripedes Constantino Miguel; Amanda Ribeiro de Oliveira; Adriano Edgar Reimer; Marcus Lira Brandão; Maria Alice de Mathis; Marcelo Camargo Batistuzzo; Daniel Lucas Conceição Costa; Marcelo Queiroz Hoexter
Pages: 81 - 103

Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders.
OBJECTIVES: The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field.
RESULTS: Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. CONCLUSION: It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.

Descriptors: Obsessive-Compulsive Disorder; Anxiety Disorders; Fear; Stress Disorders, Post-Traumatic; Neuroimaging; Epidemiology; Treatment.

9 - Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug
Alexandre Rafael de Mello Schier; Natalia Pinho de Oliveira Ribeiro; Adriana Cardoso de Oliveira e Silva; Jaime Eduardo Cecilio Hallak; José Alexandre S. Crippa; Antonio E. Nardi; Antonio Waldo Zuardi
Pages: 104 - 117

OBJECTIVES: To review and describe studies of the non-psychotomimetic constituent of Cannabis sativa, cannabidiol (CBD), as an anxiolytic drug and discuss its possible mechanisms of action. METHOD: The articles selected for the review were identified through searches in English, Portuguese, and Spanish in the electronic databases ISI Web of Knowledge, SciELO, PubMed, and PsycINFO, combining the search terms "cannabidiol and anxiolytic", "cannabidiol and anxiolyticlike", and "cannabidiol and anxiety". The reference lists of the publications included, review articles, and book chapters were handsearched for additional references. Experimental animal and human studies were included, with no time restraints. RESULTS: Studies using animal models of anxiety and involving healthy volunteers clearly suggest an anxiolytic-like effect of CBD. Moreover, CBD was shown to reduce anxiety in patients with social anxiety disorder. CONCLUSION: Future clinical trials involving patients with different anxiety disorders are warranted, especially of panic disorder, obsessive-compulsive disorder, social anxiety disorder, and post-traumatic stress disorders. The adequate therapeutic window of CBD and the precise mechanisms involved in its anxiolytic action remain to be determined.

Descriptors: Cannabidiol; Cannabis sativa; Anxiolytics; Anxiety disorders.