Scielo RSS <![CDATA[Archives of Clinical Psychiatry (São Paulo)]]> http://www.scielo.br/rss.php?pid=0101-608320170002&lang=pt vol. 44 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Age and gender changes in children and adolescent patients of a Brazilian eating disorder program]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832017000200033&lng=pt&nrm=iso&tlng=pt ABSTRACT Background International studies have demonstrated an increase in the prevalence of boys and a decrease of patients’ age at the beginning of outpatient treatment for eating disorders (ED). Objective To evaluate if these changes are also present in the Brazilian population participating in the PROTAD, a Brazilian ED program, and to discuss its clinical implication for treatment. Methods Cross-sectional study. We evaluated 150 medical records of patients under 18 years diagnosed with ED (DSM IV-TR). Patients were divided into two groups: G1 (2001-2007) (n = 77) and G2 (2008-2014) (n = 73). The girl/boy proportion and the mean age of patients were compared. Results In G1, six boys (7.8%) were admitted (girl/boy proportion: 11.8:1), while in G2, 16 (22%) boys were admitted (girl/boy proportion: 3.5:1) (p &lt; 0.05). The mean age in G1 was 15.6 years (SD = 1.7; 95%CI: 15.2-15.9), whereas the mean age in G2 was 14.9 years (SD = 1.9; 95%CI: 14.4-15.3) (p &gt; 0.05). Discussion The increase in the number of boys treated for EDs reported in international studies was also found at the PROTAD. Contrary to what has been reported in international studies, the mean age of patients at the PROTAD did not decrease significantly. Gender and sexual orientation issues, clinical presentation, prior overweight history and culture/media impact on boys should be addressed by the healthcare team to increase the therapeutic efficacy. <![CDATA[Efficacy of single dose antihistamine vs. single dose valerian-hops in subjective sleep measures among war refugees: a comparison trial]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832017000200035&lng=pt&nrm=iso&tlng=pt Abstract Background Many sedatives and anxiolytics are used in single dose or chronically to aid sleep. Clinically important sedatives include valerian-hops and antihistamines as they are used over the counter and are highly accessible and safe agents. Objectives To evaluate and compare a single dose of chlorpheniramine versus valerian-hops combination in modulating subjective sleep measures in insomniac war refugees. Methods Insomnia among refugees was screened using the Insomnia Severity Index (ISI). Insomniac subjects were randomized to received a single dose valerian-hops (320/80 mg) (n = 65), or chlorpheneramine (4 mg) (n = 50) or placebo (n = 76) two hours prior sleeping. Participants were instructed to complete Leeds Sleep Evaluation Questionnaire (LSEQ), visual analogue scales of anxiety and sedation. Also sleep latency, total hours slept and self-rated improvement were obtained. Results Almost 75% of screened refugees had insomnia. Chlorpheneramine reduced sleep latency and anxiety significantly, however it resulted in poor sleep quality. Valerian-hops group showed marked anxiolysis one hour after dosing, a sleep quality similar to placebo and better than chlorpheneramine, and better alertness compared to placebo. Participants satisfaction was higher with chlorpheneramine and there was no difference in the total hours slept. Discussion Valerian-hops combination may provide better sleep quality than antihistamines. <![CDATA[External validity study of a personality disorders screening test in a community sample]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832017000200040&lng=pt&nrm=iso&tlng=pt Abstract Background A screening test for personality disorders was recently developed in Brazil, the Dimensional Clinical Personality Inventory – screening version (IDCP-SV). However, no relationship between this screening measure and other scales or external criteria was tested. Objective To seek for validity evidence based on related criteria (e.g., other psychological tests) and external criteria (e.g., sample demographics). Methods Sample comprised 804 participants from São Paulo (Brazil), most female and college students, with mean age equal to 29.65 (SD = 10.73). They answered the IDCP-SV and another screening for personality disorders (IPDS), a depression measure (EBADEP-screening), a scale assessing reasoning for living (EMVIVER), and a self-report for personality disorders categories assessment (SCID-II-PQ). Results IDCP-SV identified 46.4% of community sample as positive for personality disorders. The positive group showed the great mean for almost all comparisions, including psychological tests and the demographics characteristics, including large expressive effect sizes. Discussion Data suggest that the IDCP-SV discriminates a similar percentage of people from the community to what was reported previously using other screening measures; besides, the mean comparisons between groups showed good discriminative capacity by IDCP-SV items. <![CDATA[Efficacy of electroconvulsive therapy augmentation for partial response to clozapine: a pilot randomized ECT – sham controlled trial]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832017000200045&lng=pt&nrm=iso&tlng=pt Abstract Background Thirty percent of schizophrenia patients are treatment-resistant. Objective This is a single-blinded sham-controlled trial to assess the efficacy of electroconvulsive therapy (ECT) as augmentation strategy in patients with clozapine-resistant schizophrenia. Methods Twenty three subjects were randomly assigned to 12 sessions of ECT (N = 13) or placebo (Sham ECT) (N = 10). The primary outcome was improvement on psychotic symptoms as measured by the mean reduction of the PANSS positive subscale. The assessments were performed by blind raters. Results At baseline both groups were similar, except for negative and total symptoms of the PANSS, which were higher in the Sham group. At the endpoint both groups had a significant decrease from basal score. In the ECT group the PANSS total score decreased 8.78%, from 81.23 to 74.75 (p = 0.042), while the positive subscale had a mean reduction of 19% (19.31 to 16.17, p = 0.006). In the Sham group, the mean reduction of PANSS total score was 15.27% (96.80 to 87.43; p = 0.036), and the PANSS positive subscale decreased 27.81% (22.90 to 19.14, p = 0.008). The CGI score in ECT group decreased 23.0% (5.23 to 4.17; p = 0.001) and decreased 24.31% in the Sham ECT group (5.80 to 4.86; p = 0.004). Discussion In this pilot study, we found no difference between the groups. <![CDATA[Serum cortisol level and depression severity in a sample of Brazilian elders]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832017000200051&lng=pt&nrm=iso&tlng=pt Abstract Background Thirty percent of schizophrenia patients are treatment-resistant. Objective This is a single-blinded sham-controlled trial to assess the efficacy of electroconvulsive therapy (ECT) as augmentation strategy in patients with clozapine-resistant schizophrenia. Methods Twenty three subjects were randomly assigned to 12 sessions of ECT (N = 13) or placebo (Sham ECT) (N = 10). The primary outcome was improvement on psychotic symptoms as measured by the mean reduction of the PANSS positive subscale. The assessments were performed by blind raters. Results At baseline both groups were similar, except for negative and total symptoms of the PANSS, which were higher in the Sham group. At the endpoint both groups had a significant decrease from basal score. In the ECT group the PANSS total score decreased 8.78%, from 81.23 to 74.75 (p = 0.042), while the positive subscale had a mean reduction of 19% (19.31 to 16.17, p = 0.006). In the Sham group, the mean reduction of PANSS total score was 15.27% (96.80 to 87.43; p = 0.036), and the PANSS positive subscale decreased 27.81% (22.90 to 19.14, p = 0.008). The CGI score in ECT group decreased 23.0% (5.23 to 4.17; p = 0.001) and decreased 24.31% in the Sham ECT group (5.80 to 4.86; p = 0.004). Discussion In this pilot study, we found no difference between the groups. <![CDATA[Melanoma brain metastases presenting as delirium: a case report]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832017000200053&lng=pt&nrm=iso&tlng=pt Abstract Background Metastatic tumours sometimes present with neuropsychiatric symptoms, however psychiatric symptoms as rarely the first clinical manifestation. Cutaneous melanoma is the third most common cause of brain metastasis, with known risk factors increasing the chance of such central nervous system metastization. Objectives We present a clinical report of delirium as the first clinical manifestation of melanoma brain metastases, illustrating the relevance of an adequate and early differential diagnosis. Methods In addition to describing the clinical case, searches were undertaken in PubMed and other databases using keywords such as “brain metastasis”, “melanoma”, “agitation”, “psychiatric” and “delirium”. Results We here report the case of a 52-year-old female patient evaluated by Liaison Psychiatry after sudden onset of delirium while admitted at the Gastroenterology Department to study a hypothesis of pancreatitis. A head CT scan identified brain metastases, and after further examination, including brain biopsy, melanoma brain metastization was confirmed. Discussion Some of the diagnostic challenges of psychiatric symptoms associated with secondary brain tumours are discussed, underlining the importance of an adequate differential diagnosis when working in Psychiatry Liaison.