Objectives: Religiosity and spirituality (R/S) have been negatively associated with several mental health problems, including delinquency. The study aimed to investigate the relationship between R/S and interpersonal violence using a systematic review. Methods: We conducted a descriptive systematic review followed by meta-analyses using seven different databases. We included observational studies that assessed the relationship between R/S and different types of interpersonal violence (physical and sexual aggression and domestic violence). Results: A total of 16,599 articles were screened in the databases and, after applying the eligibility criteria, 67 were included in the systematic review and 43 were included in the meta-analysis. The results showed that higher levels of R/S were significantly associated with decreased physical and sexual aggression, but not domestic violence. All selected studies evidenced sufficient methodological quality, with 26.8% being cohort studies. In the subanalyses, the role of R/S was more prevalent among adolescents. Conclusion: There is an inverse relationship between R/S and physical and sexual aggression, suggesting a protective role. However, these results were not observed for domestic violence. Healthcare professionals and managers should be aware of their patients’ beliefs when investigating interpersonal violence to create tailored interventions for reducing violent behavior.

Objective: Cocaine use disorders (CUDs) represent a major public health problem in many countries. To better understand the interaction between the environmental modulations and phenotype, the aim of the present study was to investigate the DNA methylation pattern of CUD patients, who had concomitant cocaine and crack dependence, and healthy controls. Methods: We studied DNA methylation profiles in the peripheral blood of 23 CUD patients and 24 healthy control subjects using the Illumina Infinium HumanMethylation450 BeadChip arrays. Results: Comparison between CUD patients and controls revealed 186 differentially methylated positions (DMPs; adjusted p-value [adjP] < 10-5) related to 152 genes, with a subset of CpGs confirmed by pyrosequencing. DNA methylation patterns discriminated CUD patients and control groups. A gene network approach showed that the EHMT1, EHMT2, MAPK1, MAPK3, MAP2K1, and HDAC5 genes, which are involved in transcription and chromatin regulation cellular signaling pathways, were also associated with cocaine dependence. Conclusion: The investigation of DNA methylation patterns may contribute to a better understanding of the biological mechanisms involved in CUD.

Objective: To examine the relationship between psychiatrists’ religious/spiritual beliefs and their attitudes regarding religion and spirituality in clinical practice. Methods: A cross-sectional survey of religion/spirituality (R/S) in clinical practice was conducted with 121 psychiatrists from the largest academic hospital complex in Brazil. Results: When asked about their R/S beliefs, participants were more likely to consider themselves as spiritual rather than religious. A total of 64.2% considered their religious beliefs to influence their clinical practice and 50% reported that they frequently enquired about their patients’ R/S. The most common barriers to approaching patients’ religiosity were: lack of time (27.4%), fear of exceeding the role of the doctor (25%), and lack of training (19.1%). Those who were less religious or spiritual were also less likely to find difficulties in addressing a patient’s R/S. Conclusion: Differences in psychiatrists’ religious and spiritual beliefs are associated with different attitudes concerning their approach to R/S. The results suggest that medical practice may lead to a religious conflict among devout psychiatrists, making them question their faith. Training might be of importance for handling R/S in clinical practice and for raising awareness about potential evaluative biases in the assessment of patients’ religiosity.

A esquizofrenia é um grave transtorno psicótico que apresenta frequentes recaídas e incapacitação progressiva. Resulta de uma interação gene-ambiente ainda pouco compreendida. O polimorfismo Taq1A (localizado no grupamento genético NTAD) é considerado um possível candidato para esquizofrenia. O polimorfismo genético rs1800497 foi associado com alteração da expressão do gene do DRD2. Assim, o presente trabalho objetivou investigar a possível associação de tal polimorfismo com esquizofrenia. A distribuição de seus alelos e genótipos foi investigada em uma amostra brasileira composta de 235 pacientes e 834 controles. As frequências genotípicas estavam em equilíbrio de Hardy-Weinberg. Houve uma tendência de associação alélica entre o polimorfismo Taq1A (rs1800497) e esquizofrenia na amostra estudada. No entanto, não houve diferenças estatisticamente significantes entre os grupos de casos e controles, quando analisados por gênero e subtipos da esquizofrenia.

Schizophrenia is a severe psychotic disorder with recurrent relapse and functional impairment. It results from a poorly understood gene-environment interaction. The Taq1A polymorphism (located in the gene cluster NTAD) is a likely candidate for schizophrenia. Its rs1800497 polymorphism was shown to be associated with DRD2 gene expression. Therefore the present work aims to investigate a possible association between schizophrenia and such polymorphism. The compared distribution of the alleles and genotypes of the studied polymorphism was investigated in a Brazilian sample of 235 patients and 834 controls. Genotypic frequencies were in Hardy-Weinberg equilibrium. There was a trend of allelic association between the Taq1A polymorphism (rs1800497) with schizophrenia in the studied sample. However no statistically differences were found between cases and controls when analyzed by gender or schizophrenia subtypes.

Objective: The connection between lower alcohol use and religiousness has been extensively examined. Nevertheless, few studies have assessed how religion and religiousness influence public policies. The present study seeks to understand the influence of religious beliefs on attitudes toward alcohol use. Methods: A door-to-door, nationwide, multistage population-based survey was carried out. Self-reported religiousness, religious attendance, and attitudes toward use of alcohol policies (such as approval of public health interventions, attitudes about drinking and driving, and attitudes toward other alcohol problems and their harmful effects) were examined. Multiple logistic regression was used to control for confounders and to assess explanatory variables. Results: The sample was composed of 3,007 participants; 57.3% were female and mean age was 35.7 years. Religiousness was generally associated with more negative attitudes toward alcohol, such as limiting hours of sale (p < 0.01), not having alcohol available in corner shops (p < 0.01), prohibiting alcohol advertisements on TV (p < 0.01), raising the legal drinking age (p < 0.01), and raising taxes on alcohol (p < 0.05). Higher religious attendance was associated with less alcohol problems (OR: 0.61, 95%CI 0.40-0.91, p = 0.017), and self-reported religiousness was associated with less harmful effects of drinking (OR: 0.61, 95%CI 0.43-0.88, p = 0.009). Conclusions: Those with high levels of religiousness support more restrictive alcohol policies. These findings corroborate previous studies showing that religious people consume less alcohol and have fewer alcohol-related problems.

CONTEXTO E OBJETIVOS Apesar do grande número de escalas sobre espiritualidade e religiosidade (E/R) para uso em pesquisas internacionais, ainda existem poucas informações sobre essas escalas na língua portuguesa. Objetiva-se mapear as escalas disponíveis para pesquisa clínica em língua portuguesa. TIPO DE ESTUDO E LOCAL Revisão sistemática de estudos encontrados em bases de dados. MÉTODOS Conduziu-se uma revisão sistemática em três fases. Fases 1 e 2: artigos em português, espanhol e inglês, publicados até novembro de 2011, com a tradução ou validação para o português de instrumentos para aferir E/R na pesquisa clínica, foram selecionados de seis bancos de dados. Fase 3: os instrumentos foram agrupados de acordo com autoria, adaptação transcultural, consistência interna, validade concorrente/discriminativa e procedimentos de teste-reteste. RESULTADOS Vinte instrumentos foram encontrados. Destes, 45% avaliavam religiosidade, 40% espiritualidade, 10% coping (enfrentamento) religioso/espiritual e 5% espiritualidade e religiosidade. Destes, 90% foram traduzidos (n = 15) ou criados (n = 3) para a língua portuguesa no Brasil e 2 (10%) somente para o português de Portugal. Entretanto, a maioria dos instrumentos não possuía análises psicométricas. Apenas 40% dos instrumentos apresentavam validação concorrente, 45% validação discriminativa e 15% teste-reteste. A característica de cada instrumento foi analisada de forma individualizada com vantagens, desvantagens e propriedades psicométricas. CONCLUSÃO No momento, existem 20 instrumentos para aferição de E/R disponíveis para a língua portuguesa. A maioria é traduzida (n = 15) ou desenvolvida (n = 3) no Brasil apresentando boa consistência interna. Entretanto, poucas escalas foram avaliadas quanto a todas as suas qualidades psicométricas.

CONTEXT AND OBJECTIVES Despite numerous spirituality and/or religiosity (S/R) measurement tools for use in research worldwide, there is little information on S/R instruments in the Portuguese language. The aim of the present study was to map out the S/R scales available for research in the Portuguese language. DESIGN AND SETTING Systematic review of studies found in databases. METHODS A systematic review was conducted in three phases. Phases 1 and 2: articles in Portuguese, Spanish and English, published up to November 2011, dealing with the Portuguese translation and/or validation of S/R measurement tools for clinical research, were selected from six databases. Phase 3: the instruments were grouped according to authorship, cross-cultural adaptation, internal consistency, concurrent and discriminative validity and test-retest procedures. RESULTS Twenty instruments were found. Forty-five percent of these evaluated religiosity, 40% spirituality, 10% religious/spiritual coping and 5% S/R. Among these, 90% had been produced in (n = 3) or translated to (n = 15) Brazilian Portuguese and two (10%) solely to European Portuguese. Nevertheless, the majority of the instruments had not undergone in-depth psychometric analysis. Only 40% of the instruments presented concurrent validity, 45% discriminative validity and 15% a test-retest procedure. The characteristics of each instrument were analyzed separately, yielding advantages, disadvantages and psychometric properties. CONCLUSION Currently, 20 instruments for measuring S/R are available in the Portuguese language. Most have been translated (n = 15) or developed (n = 3) in Brazil and present good internal consistency. Nevertheless, few instruments have been assessed regarding all their psychometric qualities.

A esquizofrenia é um grave transtorno psiquiátrico que apresenta freqüentes recorrências psicóticas e incapacitação progressiva. Resulta de uma interação gene-ambiente ainda pouco compreendida. O gene da catecol-O-metiltransferase (COMT) é considerado um possível candidato para esquizofrenia. O polimorfismo genético rs165599 (A/G) da COMT foi associado com alteração da expressão do seu gene. Assim, o presente trabalho tem como objetivo investigar a possível associação de tal polimorfismo com esquizofrenia. A distribuição de seus alelos e genótipos foi investigada em uma amostra brasileira composta de 245 pacientes e 834 controles. As frequências genotípicas estavam em equilíbrio de Hardy-Weinberg e não se encontrou diferença estatisticamente significante entre casos e controles, quando analisados por gênero e subtipos da esquizofrenia. Não houve também diferença de homozigosidade entre casos e controles. Desse modo, na amostra estudada, não houve evidência de associação entre esquizofrenia e o polimorfismo rs165599 (A/G) localizado na região 3' não codificadora do gene da COMT.

Schizophrenia is a severe psychiatric disorder with frequent recurrent psychotic relapses and progressive functional impairment. It results from a poorly understood gene-environment interaction. The gene encoding catechol-O-methyltransferase (COMT) is a likely candidate for schizophrenia. Its rs165599 (A/G) polymorphism has been shown to be associated with alteration of COMT gene expression. Therefore, the present study aimed to investigate a possible association between schizophrenia and this polymorphism. The distribution of the alleles and genotypes of this polymorphism was investigated in a Brazilian sample of 245 patients and 834 controls. The genotypic frequencies were in Hardy-Weinberg equilibrium and no statistically significant differences were found between cases and controls when analyzed according to gender or schizophrenia subtypes. There was also no difference in homozygosis between cases and controls. Thus, in the sample studied, there was no evidence of any association between schizophrenia and rs165599 (A/G) polymorphism in the non-coding region 3' of the COMT gene.

OBJETIVO: Investigar a influência da variação do gene do fator neurotrófico derivado do cérebro (BDNF) no desempenho cognitivo e na sintomatologia clínica durante o primeiro episódio psicótico (PEP). MÉTODOS: Foram realizados a genotipificação das variantes Val66met do BDNF, o teste cognitivo (fluência verbal e repetição de dígitos) e as avaliações da gravidade dos sintomas (conforme avaliado pela Positive and Negative Syndrome Scale [PANSS]) em uma amostra de pacientes com PEP de base populacional (77 com psicose esquizofreniforme e 53 com psicose afetiva) e 191 vizinhos controle saudáveis. RESULTADOS: Não houve diferença na proporção de portadores do alelo Met entre pacientes com PEP e o grupo controle. Não houve influência significativa do genótipo do BDNF sobre a pontuação de cada um dos grupos psicóticos. Foi encontrada uma diminuição da gravidade dos sintomas negativos em sujeitos com PEP portadores do alelo Met, e essa descoberta mostrou-se significativa para o subgrupo com psicose afetiva (p < 0,01, ANOVA). CONCLUSÕES: Os resultados sugerem que, no PEP, o polimorfismo Val66Met do gene do BDNF não exerce uma influência importante sobre o funcionamento cognitivo, mas pode modular a gravidade dos sintomas negativos.

OBJECTIVE: To investigate the influence of brain-derived neurotrophic factor (BDNF) gene variations on cognitive performance and clinical symptomatology in first-episode psychosis (FEP). METHODS: We performed BDNF val66met variant genotyping, cognitive testing (verbal fluency and digit spans) and assessments of symptom severity (as assessed with the PANSS) in a population-based sample of FEP patients (77 with schizophreniform psychosis and 53 with affective psychoses) and 191 neighboring healthy controls. RESULTS: There was no difference in the proportion of Met allele carriers between FEP patients and controls, and no significant influence of BDNF genotype on cognitive test scores in either of the psychosis groups. A decreased severity of negative symptoms was found in FEP subjects that carried a Met allele, and this finding reached significance for the subgroup with affective psychoses (p < 0.01, ANOVA). CONCLUSIONS: These results suggest that, in FEP, the BDNF gene Val66Met polymorphism does not exert a pervasive influence on cognitive functioning but may modulate the severity of negative symptoms.

O transtorno obsessivo-compulsivo (TOC) é um quadro psiquiátrico de prevalência considerável na população e de etiologia desconhecida. No entanto, há evidências de que o sistema imunológico pode desempenhar um papel importante em sua patogênese. No presente estudo, dois polimorfismos (rs1800795 e rs361525), localizados na região promotora do gene que codifica a citocina conhecida como fator de necrose tumoral alfa (TNFA), foram genotipados em 183 pacientes com TOC e 249 controles saudáveis. Os testes estatísticos foram realizados utilizando-se o software PLINK®. Assim, evidenciou-se que o alelo A do polimorfismo rs361525 apresentava associação estatisticamente significante com o TOC (p=0,007). A presença de marcadores genéticos, tais como genes que codificam citocinas inflamatórias, associados com TOC, confere suporte adicional ao papel do sistema imunológico na patogênese desse transtorno.

Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder of unknown etiology. However, there is some evidence that the immune system may play an important role in its pathogenesis. In the present study, two polymorphisms (rs1800795 and rs361525) in the promoter region of the cytokine tumor necrosis factor-alpha (TNFA) gene were genotyped in 183 OCD patients and in 249 healthy controls. The statistical tests were performed using the PLINK® software. We found that the A allele of the TNFA rs361525 polymorphism was significantly associated with OCD subjects, according to the allelic χ² association test (p=0.007). The presence of genetic markers, such as inflammatory cytokines genes linked to OCD, may represent additional evidence supporting the role of the immune system in its pathogenesis.

OBJECTIVES: Approximately 40-60% of obsessive-compulsive disorder patients are nonresponsive to serotonin reuptake inhibitors. Genetic markers associated with treatment response remain largely unknown. We aimed (1) to investigate a possible association of serotonergic polymorphisms in obsessive-compulsive disorder patients and therapeutic response to selective serotonin reuptake inhibitors and (2) to examine the relationship between these polymorphisms and endocrine response to intravenous citalopram challenge in responders and non-responders to serotonin reuptake inhibitors and in healthy volunteers. METHODS: Patients with obsessive-compulsive disorder were classified as either responders or non-responders after long-term treatment with serotonin reuptake inhibitors, and both groups were compared with a control group of healthy volunteers. The investigated genetic markers were the G861C polymorphism of the serotonin receptor 1Dβ gene and the T102C and C516T polymorphisms of the serotonin receptor subtype 2A gene. RESULTS: The T allele of the serotonin receptor subtype 2A T102C polymorphism was more frequent among obsessive-compulsive disorder patients (responders and non-responders) than in the controls (p<0.01). The CC genotype of the serotonin receptor subtype 2A C516T polymorphism was more frequent among the non-responders than in the responders (p<0.01). The CC genotype of the serotonin receptor subtype 1Dβ G681C polymorphism was associated with higher cortisol and prolactin responses to citalopram (p<0.01 and p<0.001, respectively) and with a higher platelet-rich plasma serotonin concentration among the controls (p<0.05). However, this pattern was not observed in the non-responders with the same CC genotype after chronic treatment with serotonin reuptake inhibitors. This CC homozygosity was not observed in the responders.

OBJETIVO: A religiosidade tem sido associada à saúde física e mental com especial importância na população idosa. Existe uma carência de estudos abordando os mediadores desta associação, dentre eles o suporte social. O objetivo deste trabalho é analisar a associação entre dimensões de religiosidade e prevalência de transtornos mentais comuns entre idosos e testar o suporte social como mecanismo de mediação desta suposta associação. MÉTODO: A amostra foi constituída pela população idosa de uma região de baixa renda de São Paulo (N = 1.980). Foram coletados dados sociodemográficos, suporte social, indicadores de religiosidade e prevalência de transtorno mental comum. RESULTADOS: 90,7% da amostra considerou-se religiosa (66,6% Católica); 41,2% frequentam uma ou mais vezes alguma atividade religiosa semanalmente. A presença de transtorno mental comum não foi associada com filiação religiosa ou considerar-se religioso. A prevalência de transtorno mental comum para os que frequentam serviço religioso foi aproximadamente a metade (OR entre 0,43 e 0,55, p < 0,001) daqueles que nunca frequentam. Maior frequência a serviços religiosos também se associou a maiores níveis de suporte social. A associação entre maior frequência e menos transtorno mental comum não sofreu alterações relevantes após inclusão das variáveis de suporte social. CONCLUSÃO: A amostra apresentou altos níveis de religiosidade, forte associação entre freqüência religiosa e menor prevalência de TMCs, que não foi explicada pelo suporte social.

OBJECTIVE: Religiosity has been associated with mental health, especially in the elderly. There is a shortage of studies on the factors that mediate this association, including social support. The aim of this study was to assess the association between the various dimensions of religiosity and the prevalence of common mental disorders among the elderly, and to verify whether social support can work as a mechanism that explains such mediation. METHOD: The sample consisted of an elderly population living in a low income region of the city of São Paulo (N = 1,980). Data on the socio-demographic profile of this population and on the prevalence of common mental disorders were collected, and indicators of religiosity and social support were identified. RESULTS: 90.7% of the sample considered themselves to be religious. In terms of denomination, 66.6% were Catholic. Forty-one per cent attended some kind of religious activity at least once or more times a week. The presence of common mental disorders was not associated with religious affiliation or subjective religiosity. The prevalence of common mental disorders in followers attending religious services was approximately half (OR between 0.43 and 0.55, p < 0.001) compared to those who never attend a religious service. Attending religious services was associated with higher levels of social support. The association between a higher attendance frequency and fewer common mental disorders did not change after the inclusion of relevant of social support variables. CONCLUSION: The study showed that subjects presented high levels of religiosity and that there is a strong association between religious attendance and the prevalence of common mental disorders, which could not be explained by social support.

assistência religiosa a pacientes com transtornos psiquiátricos graves internados é um problema pouco discutido entre psiquiatras. Aspectos legais asseguram o direito à assistência religiosa aos pacientes, no entanto alguns aspectos específicos conduzem a reflexão e cautela em determinadas situações. Assim, objetiva-se com o presente trabalho discutir os aspectos éticos, legais e científicos da assistência religiosa em hospitais psiquiátricos. Serão abordados também alguns comentários sobre os conceitos de autonomia, beneficência e não maleficência, contidos nos princípios bioéticos. Ao final, é apresentada a experiência do Hospital João Evangelista na abordagem de tais casos. Como conclusão, situações de conflito ético e legal podem surgir, pois os pacientes têm direito a receber assistência religiosa, porém podem apresentar manifestações psicopatológicas que poderiam levar a prejuízo de seu quadro clínico diante da abordagem religiosa. A orientação dos familiares e as relações entre hospital, médico, paciente e família são essenciais para a resolução de tais conflitos.

The religious assistance to inpatients with severe psychiatric disorders is a problem rarely discussed among psychiatrists. Legal aspects ensure the right to religious assistance to such patients, although some specific aspects lead to reflection and caution in certain situations. Thus, the main of the work is to discuss ethical, legal, scientific and religious aspects of religious assistance in psychiatric hospitals. It will also address some comments on the concepts of autonomy, beneficence and nonmaleficence, contained in bioethical principles. Finally, it will be presented the experience of the João Evangelista Hospital approach on such cases. In conclusion, ethical and legal conflicts can appear because patients have the right to receive a religious attendance. However, in some conditions, this assistance could lead to a worse in patient’s clinical status. Family orientation and doctor-patient-hospital relationship are essential to resolve these conflicts.

Estudos epidemiológicos têm demonstrado que o componente genético é um importante fator de risco para a esquizofrenia. Os genes que codificam os diferentes componentes do sistema dopaminérgico passaram a despertar interesse para estudos moleculares em pacientes com esquizofrenia, pois os antipsicóticos, em especial os de primeira geração, exercem sua ação nesse sistema. Assim, o objetivo do presente estudo foi investigar a associação entre um novo polimorfismo de nucleotídeo único (rs6347) localizado no exon 9 do gene do transportador de dopamina (SLC6A3) e esquizofrenia. Um total de 235 pacientes e 834 controles pareados para sexo e idade foi selecionado para a investigação da distribuição dos alelos e genótipos do polimorfismo investigado entre os grupos de pacientes e controles. Houve diferenças estatisticamente significantes nas distribuições alélicas (χ2=5,97, 1d.f. , p=0,01, OR=1,33-1,05<OR<1,69) e genotípicas (χ2=6,56, 2d.f. , p=0,03) entre pacientes e controles. Assim, o polimorfismo SLC6A3 A1343G mostrou associação com esquizofrenia na amostra estudada.

Epidemiological studies have demonstrated that the genetic component is an important risk factor for the development of schizophrenia. The genes that codify the different compounds of the dopaminergic system have created interest for molecular investigations in patients with schizophrenia because the antipsychotic drugs, especially those of first generation, act on this cerebral system. Thus the aim of the present study was to investigate the possible association between a new single nucleotide polymorphism (rs6347) located in exon 9 of the protein transporter (SLC6A3) and schizophrenia. The distribution of the alleles and genotypes of the studied polymorphism was investigated in a sample of 235 patients and 834 controls matched by gender and age. There were statistical differences in the allelic (χ2=5.97, 1d.f. , p=0.01, OR=1.33-1.05<OR<1.69) and genotypic (χ2=6.56, 2d.f. , p=0.03) distributions between patients and controls. Thus the SLC6A3 A1343G polymorphism was associated to the SCZ phenotype in the investigated sample.