Scielo RSS <![CDATA[Revista Brasileira de Psiquiatria]]> http://www.scielo.br/rss.php?pid=1516-444620140001&lang=pt vol. 36 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Sixty years (1954-2014) of José Leme Lopes's fundamental book: <italic>As dimensões do diagnóstico psiquiátrico</italic>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100001&lng=pt&nrm=iso&tlng=pt <![CDATA[The missing link: what mediates the relationship between religiosity and alcohol use?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100003&lng=pt&nrm=iso&tlng=pt <![CDATA[Religious beliefs and alcohol control policies: a Brazilian nationwide study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100004&lng=pt&nrm=iso&tlng=pt 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 &lt; 0.01), not having alcohol available in corner shops (p &lt; 0.01), prohibiting alcohol advertisements on TV (p &lt; 0.01), raising the legal drinking age (p &lt; 0.01), and raising taxes on alcohol (p &lt; 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. <![CDATA[Have drivers at alcohol outlets changed their behavior after the new traffic law?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100011&lng=pt&nrm=iso&tlng=pt Objective: In an attempt to reduce high levels of traffic crashes, a new legislation was approved in Brazil in 2008. This study aimed to assess behavioral change among drivers who had drunk at alcohol outlets (AO) after implementation of the law. Method: A three-stage probability sampling survey was conducted in Porto Alegre, state of Rio Grande do Sul, Brazil. Individuals seen leaving AOs after drinking were approached (n=3,018). Selected drivers (n=683) answered a structured interview, were breathalyzed, and had saliva specimens collected for drug screening. Results: Overall, 60.3% (SE 4.5) of drivers reported they did not change their behavior. Among those who reported behavioral changes, most reported drinking less as their main strategy toward safer driving behavior. Variables independently associated with behavior change included having drunk at a high outlet density area (odds ratio [OR] 1.7 [1.1-2.8]) and having a favorable opinion about the law (OR 4.3 [2.1-8.9]). Conclusions: Our findings suggest that awareness of the law has not been enough to promote behavioral change. As most drivers had a favorable opinion of the law and this variable was found to be the strongest predictor of behavior change, efforts to better integrate education and enforcement seem to be pivotal and might be well received by the population. <![CDATA[Nonprescribed use of tranquilizers and use of other drugs among Brazilian students]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100016&lng=pt&nrm=iso&tlng=pt Objectives: To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances. Methods: A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances. Results: The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers. Conclusions: Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs. <![CDATA[Role of personality traits in cocaine craving throughout an outpatient psychosocial treatment program]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100024&lng=pt&nrm=iso&tlng=pt Objective: Cocaine dependence is a major international public health concern. Its chronically relapsing nature is possibly related to craving intensity, which can be influenced by diverse biological and psychological aspects. This study aimed to evaluate the role of different personality traits in craving measured throughout a psychosocial treatment program. Method: The sample comprised 66 cocaine-dependent outpatients who were enrolled in an individual and manualized cognitive-behavioral therapy program. The influence of personality traits on craving intensity, frequency, and duration was analyzed using a generalized estimating equations model with an autoregressive correlation structure. Results: Craving varied during treatment. The personality traits of novelty seeking, reward dependence, and harm avoidance interacted with craving intensity, and the personality trait of persistence interacted with craving duration throughout the treatment period. Furthermore, there were significant interactions between drug use and craving intensity, and between different routes of administration and craving intensity. Participants who used cocaine/crack while in treatment and concurrent users of crack (i.e., freebase) cocaine and powder cocaine also had a higher craving intensity. Conclusion: The extent of craving variation can depend on certain personality styles. This study shows that craving is influenced by personality traits, and this may presumably change clinical expression involved in disease. <![CDATA[Cortical morphology changes in women with borderline personality disorder: a multimodal approach]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100032&lng=pt&nrm=iso&tlng=pt Objective: Borderline personality disorder (BPD) is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. Methods: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II) and a 1.5 T magnetic resonance imaging (MRI) brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. Results: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. Conclusion: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters. <![CDATA[Histone deacetylase activity and brain-derived neurotrophic factor (BDNF) levels in a pharmacological model of mania]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100039&lng=pt&nrm=iso&tlng=pt Objective: In the present study, we aimed to examine the effects of repeated D-amphetamine (AMPH) exposure, a well-accepted animal model of acute mania in bipolar disorder (BD), and histone deacetylase (HDAC) inhibitors on locomotor behavior and HDAC activity in the prefrontal cortex (PFC) and peripheral blood mononuclear cells (PBMCs) of rats. Moreover, we aimed to assess brain-derived neurotrophic factor (BDNF) protein and mRNA levels in these samples. Methods: We treated adult male Wistar rats with 2 mg/kg AMPH or saline intraperitoneally for 14 days. Between the 8th and 14th days, rats also received 47.5 mg/kg lithium (Li), 200 mg/kg sodium valproate (VPT), 2 mg/kg sodium butyrate (SB), or saline. We evaluated locomotor activity in the open-field task and assessed HDAC activity in the PFC and PBMCs, and BDNF levels in the PFC and plasma. Results: AMPH significantly increased locomotor activity, which was reversed by all drugs. This hyperactivity was associated with increased HDAC activity in the PFC, which was partially reversed by Li, VPT, and SB. No differences were found in BDNF levels. Conclusion: Repeated AMPH administration increases HDAC activity in the PFC without altering BDNF levels. The partial reversal of HDAC increase by Li, VPT, and SB may account for their ability to reverse AMPH-induced hyperactivity. <![CDATA[Cognitive behavioral therapy in combination with systemic family therapy improves mild to moderate postpartum depression]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100047&lng=pt&nrm=iso&tlng=pt Objective: To explore the effect of cognitive behavioral therapy (CBT) in combination with systemic family therapy (SFT) on mild to moderate postpartum depression and sleep quality. Methods: 249 primiparous women with mild to moderate postpartum depression were recruited and randomly assigned to a control group (n=128), which received conventional postpartum care, or to a psychological intervention group (n=121), which received conventional postpartum care combined with psychological intervention. The Edinburgh Postnatal Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were employed to evaluate depression and sleep quality, respectively. Results: 104 patients in the intervention group and 109 in the control group completed the study. After intervention, the EPDS score, PSQI score, sleep quality score, sleep latency score, sleep duration score, habitual sleep efficiency score, sleep disturbance score, and daytime dysfunction score were significantly lower in the intervention group than in the control group. The EPDS and PSQI scores of each group at different time points after intervention were markedly decreased compared with those before intervention, and the reduction in the intervention group was more evident than that in the control group. Conclusion: CBT in combination with SFT can improve depression and sleep quality in patients with mild to moderate postpartum depression. <![CDATA[Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100053&lng=pt&nrm=iso&tlng=pt Objective: To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country. Method: Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II. Results: The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p &lt; 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests. Conclusions: Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD. <![CDATA[Revised Reading the Mind in the Eyes Test (RMET) - Brazilian version]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100060&lng=pt&nrm=iso&tlng=pt Objective: To translate and adapt to Brazilian Portuguese the Revised Reading the Mind in the Eyes Test (RMET), in both paper-and-pencil and computerized versions. The RMET is a well-accepted instrument for assessment of Theory of Mind (ToM), an important component of social cognition. Methods: Following a guideline for translation of material for clinical populations, this study had three main phases: 1) formal translation and semantic adaptation to Brazilian Portuguese; 2) an acceptability trial with health professionals as judges evaluating picture-word matching; and 3) a trial using the paper-and-pencil and computerized versions (experiments built in E-Prime 2.0.10 software) with healthy participants to test whether the instrument has similar outputs to those expected in versions in other languages. Results: RMET was adequately adapted to Brazilian Portuguese. This version showed acceptability and outputs similar to versions of the instrument in other languages, including the original one. We kept the same number of images as the original English version. Conclusions: Considering the scarcity of cognitive assessment instruments adequately adapted to Portuguese and the importance of social cognition in many psychiatric disorders, this work adds an important resource to Brazilian research and is administrable in both paper-and-pencil and computerized versions. <![CDATA[Panic disorder and exercise avoidance]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100068&lng=pt&nrm=iso&tlng=pt Objectives: 1) To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2) to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. Methods: Patients with panic disorder were classified as having either the respiratory or the non-respiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. Results: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. Conclusions: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder. <![CDATA[Association between physical activity and quality of life in the elderly: a systematic review, 2000-2012]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100076&lng=pt&nrm=iso&tlng=pt Objective: To review information regarding the association of physical activity (PA) with quality of life (QoL) in the elderly and to identify the study designs and measurement instruments most commonly used in its assessment, in the period 2000-2012. Methods: Relevant articles were identified by a search of four electronic databases and cross-reference lists and by contact with the authors of the included manuscripts. Original studies on the association between PA and QoL in individuals aged 60 years or older were examined. The quality of studies as well as the direction and the consistency of the association between PA and QoL were evaluated. Results: A total of 10,019 articles were identified as potentially relevant, but only 42 (0.42%) met the inclusion criteria and were retrieved and examined. Most studies demonstrated a positive association between PA and QoL in the elderly. PA had a consistent association with the following QoL domains: functional capacity; general QoL; autonomy; past, present and future activities; death and dying; intimacy; mental health; vitality; and psychological. Conclusion: PA was positively and consistently associated with some QoL domains among older individuals, supporting the notion that promoting PA in the elderly may have an impact beyond physical health. However, the associations between PA and other QoL domains were moderate to inconsistent and require further investigation. <![CDATA[A review on the evidence of transgenerational transmission of posttraumatic stress disorder vulnerability]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100089&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. <![CDATA[Presidential pardon and mentally ill offenders detained in forensic hospitals]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100095&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. <![CDATA[HMNC1 gene polymorphism associated with postpartum depression]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100096&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. <![CDATA[The search for mediators of vascular mortality with mania]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100098&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. <![CDATA[Cardiovascular risk in bipolar disorder: beyond medication effects and lifestyle factors]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100100&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. <![CDATA[N-acetylcysteine in the treatment of skin-picking disorder]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100101&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability. <![CDATA[Multidimensional Students' Life Satisfaction Scale: translation into Brazilian Portuguese and cross-cultural adaptation]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000100102&lng=pt&nrm=iso&tlng=pt Objective: To understand the risks of posttraumatic stress disorder (PTSD) development in the next generation of PTSD patients, we conducted a review on the biological, but not genetic, evidence of transgenerational transmission of PTSD vulnerability. Methods: Pertinent articles published from 1985 to September 2011 were searched using online academic search engines, including MEDLINE, EMBASE, ScienceDirect, OVID, PsycLIT, and SCOPUS, and a non-systematic review was conducted. Results: There is paradoxical evidence that hypothalamic-pituitary-adrenal axis changes in PTSD patients may also be evident in their offspring. This effect and biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy. The samples of most studies, which were not large enough and represented the outcome of few research groups, consisted of a specific type of patients with a particular trauma. Conclusions: There is still a need to conduct studies in other geographical areas with different genetic background and larger samples considering different types of trauma other than those specified in the current literature, so as to strengthen the evidence of transgenerational transmission of PTSD vulnerability.