Brazilian Journal of Psychiatry, Volume: 35, Issue: 1, Published: 2013
  • Biological mechanisms underlying neuroprogression in bipolar disorder Editorials

    Budni, Josiane; Valvassori, Samira S.; Quevedo, João
  • More than two dozen "autisms" Editorials

    Mercadante, Marcos Tomanik; Leckman, James F.
  • Is positive affect in pregnancy protective of postpartum depression? Original Articles

    Bos, Sandra Carvalho; Macedo, António; Marques, Mariana; Pereira, Ana Telma; Maia, Berta Rodrigues; Soares, Maria João; Valente, José; Gomes, Ana Allen; Azevedo, Maria Helena

    Abstract in English:

    OBJECTIVE: To investigate the predictive/protective role of negative affect/positive affect in late pregnancy on the outcome of postpartum depression. METHODS: A total of 491 pregnant women participated in the study. The participants were asked to fill out a series of questionnaires, which included the Profile of Mood States, the Beck Depression Inventory-II, psychosocial variables and socio-demographic characteristics and were asked to participate in a psychiatric interview. After delivery, 272 mothers participated again in the study and filled out a similar series of questionnaires. RESULTS: Negative affect was associated with more intense depressive symptomatology, more self-perceived stress, lower self-reported social support, lower quality of life and perception of having a more difficult infant. By contrast, positive affect was negatively associated with these variables. Negative affect in late pregnancy increased the likelihood of experiencing postpartum depression (DSM-IV/OR = 2.1, 95%CI = 1.3-3.4, p = .003; ICD-10/OR = 2.1, 95%CI = 1.5-3.0, p < .001), while positive affect increased the odds of not having this condition (DSM-IV/OR = 2.0, 95%CI = 1.5-2.7, p = .042). CONCLUSION: In pregnancy, negative affect was a predictor of postpartum depression, whereas positive affect showed a protective role. Future studies are required to explore whether psychotherapeutic strategies focusing on decreasing negative affect and enhancing positive affect in the last trimester of pregnancy can reduce the risk of postpartum depression.
  • Chronic pain and quality of life in schizophrenic patients Original Articles

    Almeida, Jouce Gabriela de; Braga, Patrícia Emilia; Lotufo Neto, Francisco; Pimenta, Cibele Andrucioli de Mattos

    Abstract in English:

    OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia). Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief) data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001). There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age) and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.
  • Effects of Panax ginseng extract in patients with fibromyalgia: a 12-week, randomized, double-blind, placebo-controlled trial Original Articles

    Braz, Alessandra S.; Morais, Liana Clébia S.; Paula, Ana Patríca; Diniz, Margareth F. F. M.; Almeida, Reinaldo N.

    Abstract in English:

    The purpose of the study was to evaluate the efficacy of an extract of Panax ginseng in patients with fibromyalgia. A randomized, double-blind, controlled clinical trial was carried out over 12 weeks to compare the effects of P. ginseng (100 mg/d) with amitriptyline (25 mg/d) and placebo in 38 patients with fibromyalgia: 13 in Group I (amitriptyline), 13 in Group II (placebo), and 12 in Group III (P. ginseng). Ratings on the Visual Analogue Scale (VAS) revealed a reduction in pain in the P. ginseng group (p < .0001), an improvement in fatigue (p < .0001) and an improvement in sleep (p < .001), with respect to baseline characteristics, but there were no differences between the three groups. With respect to anxiety, improvements occurred in the P. ginseng group compared to baseline (p < .0001); however, amitriptyline treatment resulted in significantly greater improvements (p < .05). P. ginseng reduced the number of tender points and improved patients' quality of life (using the Fibromyalgia Impact Questionnaire - FIQ); however, there were no differences between groups. The beneficial effects experienced by patients for all parameters suggest a need for further studies to be performed on the tolerability and efficacy of this phytotherapic as a complementary therapy for fibromyalgia.
  • Religion as a protective factor against drug use among brazilian university students: a national survey Original Articles

    Gomes, Fernanda Carolina; Andrade, Arthur Guerra de; Izbicki, Rafael; Moreira-Almeida, Alexander; Oliveira, Lúcio Garcia de

    Abstract in English:

    OBJECTIVE: To investigate the relationship between religiosity and drug use among Brazilian university students. METHODS: This manuscript is part of the "First Nationwide Survey on the Use of Alcohol, Tobacco and Other Drugs among College Students in the 27 Brazilian State Capitals". In this study, 12,595 university students were divided into two groups according to their attendance at religious services: frequent attenders (FR; 39.1%) and non-frequent attenders (NFR; 60.8%). Subsequently, we analyzed their responses to a structured, anonymous questionnaire on drug use and other behaviors. Individual multivariate logistic regression models tested the association between religiosity and drug use (alcohol, tobacco, marijuana and at least one illicit drug). RESULTS: Drug use over the last 30 days was higher among NFR students even after controlling for demographic variables. NFR students were more likely to use alcohol OR = 2.52; 95% CI: 2.08-3.06, tobacco (2.83; 2.09-3.83), marijuana (2.09; 1.39-3.11) and at least one illicit drug (1.42; 1.12-1.79) compared to FR students. CONCLUSION: Religiosity was found to be a strongly protective factor against drug use among Brazilian university students. However, more studies are needed to identify the mechanisms by which religiosity exerts this protective influence.
  • Cross-cultural adaptation, validation and reliability of the brazilian version of the Richmond Compulsive Buying Scale Original Articles

    Leite, Priscilla; Rangé, Bernard; Kukar-Kiney, Monika; Ridgway, Nancy; Monroe, Kent; Ribas Junior, Rodolfo; Landeira-Fernandez, J.; Nardi, Antonio Egidio; Silva, Adriana

    Abstract in English:

    OBJECTIVE: To present the process of transcultural adaptation of the Richmond Compulsive Buying Scale to Brazilian Portuguese. METHODS: For the semantic adaptation step, the scale was translated to Portuguese and then back-translated to English by two professional translators and one psychologist, without any communication between them. The scale was then applied to 20 participants from the general population for language adjustments. For the construct validation step, an exploratory factor analysis was performed, using the scree plot test, principal component analysis for factor extraction, and Varimax rotation. For convergent validity, the correlation matrix was analyzed through Pearson's coefficient. RESULTS: The scale showed easy applicability, satisfactory internal consistency (Cronbach's alpha=.87), and a high correlation with other rating scales for compulsive buying disorder, indicating that it is suitable to be used in the assessment and diagnosis of compulsive buying disorder, as it presents psychometric validity. CONCLUSION: The Brazilian Portuguese version of the Richmond Compulsive Buying Scale has good validity and reliability
  • The Val66Met polymorphism at the BDNF gene does not influence Wisconsin Card Sorting Test results in children and adolescents with bipolar disorder Original Articles

    Zeni, Cristian Patrick; Tramontina, Silzá; Zeni, Thamis Aline; Coelho, Roberta; Pheula, Gabriel; Bernardi, Julio; Maldaner, Ursula; Silva, Talita Lopes; Salatino-Oliveira, Angélica; Hutz, Mara; Rohde, Luis Augusto

    Abstract in English:

    OBJECTIVES: To assess the role of the Val66Met polymorphism at the brain-derived neurotrophic factor (BDNF) gene on the performance of children and adolescents with bipolar disorder [juvenile bipolar disorder (JBD)] on the Wisconsin Card Sorting Test (WCST). METHODS: Children and adolescents were assessed by the K-SADS-PL and a clinical evaluation for BD and comorbid conditions. Manic and depressive symptoms were assessed with the Young Mania Rating Scale and the Children Depression Rating Scale - Reviewed. The Val66Met polymorphism at the BDNF was genotyped from a blood sample. Patients' IQ and executive functions were assessed by a standard cognitive flexibility test (WCST). RESULTS: Fifty-three subjects were included in the study. No significant difference was observed between the Val/Val and Val/Met+Met/Met groups on any WCST scores in the MANCOVA (F48,5 = .76; p = .59; Perseverative Errors, p = .66; Nonperseverative Errors, p = .58; Categories Completed, p = .34; Attempts to Reach First Category, p=.64; and Percentage of Conceptual Level Responses, p = .99). CONCLUSIONS: Our findings from this sample of children and adolescents with BD do not replicate results from studies of adults and suggest the existence of differences in the neurobiology of this disorder across the life cycle. Investigations of larger samples are necessary to confirm these data.
  • Major depressive disorder during teenage pregnancy: socio-demographic, obstetric and psychosocial correlates Original Articles

    Coelho, Fábio Monteiro da Cunha; Pinheiro, Ricardo Tavares; Silva, Ricardo Azevedo; Quevedo, Luciana de Ávila; Souza, Luciano Dias de Mattos; Castelli, Rochele Dias; Matos, Mariana Bonati de; Pinheiro, Karen Amaral Tavares

    Abstract in English:

    OBJECTIVES: To describe the prevalence of Major Depressive Disorder (MDD) during pregnancy in teenage mothers and to assess its association with socio-demographic characteristics, obstetric history and psychosocial variables. METHODS: A cross-sectional study was conducted with a sample of pregnant teenagers enrolled in the national public health system in the urban area of Pelotas, southern Brazil. MDD was assessed with the Mini International Neuropsychiatric Interview, the Abuse Assessment Screen was used to identify physical abuse within the last 12 months and during pregnancy, and social support was assessed with the Medical Outcomes Survey Social Support Scale. RESULTS: Forty-three (4.94%) potential subjects refused to participate, resulting in 828 total participants. The prevalence of MDD was 17.8%, 9.2% reported they had been subjected to violence within the last 12 months, while 5.8% had suffered violence during pregnancy, and the mean (SD) overall social support score was 87.40 (11.75). After adjustment, we found the highest incidence of MDD in adolescents with less than 8 years of education, followed by those with previous episodes of MDD and those with lower overall social support. CONCLUSIONS: MDD is a relatively common condition in pregnant teenagers and appears to be more prevalent in young mothers who are both socioeconomically and psychosocially underprivileged.
  • The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype Original Articles

    Freire, Rafael Christophe; Nascimento, Isabella; Valença, Alexandre Martins; Lopes, Fabiana Leão; Mezzasalma, Marco André; Melo Neto, Valfrido Leão de; Zin, Walter Araujo; Nardi, Antonio Egidio

    Abstract in English:

    OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.
  • Validation of the state version of the Self-Statement during Public Speaking Scale Brief Communications

    Osório, Flávia L.; Crippa, José Alexandre S.; Loureiro, Sonia Regina

    Abstract in English:

    OBJECTIVE: To adapt the trait version of the Self Statements during Public Speaking (SSPS) scale to a state version (SSPS-S) and to assess its discriminative validity for use in the Simulated Public Speaking Test (SPST). METHOD: Subjects with and without social anxiety disorder (n = 45) were assessed while performing the SPST, a clinical-experimental model of anxiety with seven different phases. RESULTS: Alterations in negative self-assessment occurred with significant changes throughout the different phases of the procedure (p = .05). Non-cases presented significantly higher mean values of the SSPS-S in all phases of the procedure than cases (p < .01). CONCLUSION: Cases assessed themselves in a less positive and more negative manner during the SPST than did non-cases. SSPS-S is adequate for this assessment, especially its negative subscale, and shows good psychometric qualities.
  • Increased BDNF levels in long-term bipolar disorder patients Brief Communications

    Barbosa, Izabela Guimarães; Rocha, Natália Pessoa; Miranda, Aline Silva de; Huguet, Rodrigo Barreto; Bauer, Moisés Evandro; Reis, Helton José; Teixeira, Antônio Lúcio

    Abstract in English:

    INTRODUCTION: Bipolar disorder (BD) is a prevalent, chronic and progressive illness. There is a growing body of evidence indicating that brain-derived neurotrophic factor (BDNF) plays an important role in the pathophysiology of BD. OBJECTIVE: The aim of this study was to evaluate BDNF plasma levels in BD patients with long term illness in comparison with controls. METHODS: 87 BD type I patients and 58 controls matched by age, gender and education level were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview and the patients by the Young Mania Rating Scale and the Hamilton Depression Rating Scale. The plasma levels of BDNF were measured by ELISA. RESULTS: On average, patients had suffered from BD for 23.4 years. In comparison with controls, BD patients with mania presented a 1.90-fold increase in BDNF plasma levels (p = .001), while BD patients in remission presented a 1.64-fold increase in BDNF plasma levels (p = .03). BDNF plasma levels were not influenced by age, length of illness or current medications. CONCLUSIONS: The present study suggests that long-term BD patients exhibit increased circulating levels of BDNF.
  • Staging and neuroprogression in bipolar disorder: a systematic review of the literature Special Articles

    Gama, Clarissa Severino; Kunz, Maurício; Magalhães, Pedro V.S.; Kapczinski, Flavio

    Abstract in English:

    INTRODUCTION: The use of clinical staging models is emerging as a novel and useful paradigm for diagnosing severe mental disorders. The term "neuroprogression" has been used to define the pathological reorganization of the central nervous system along the course of severe mental disorders. In bipolar disorder (BD), neural substrate reactivity is changed by repeated mood episodes, promoting a brain rewiring that leads to an increased vulnerability to life stress. METHOD: A search in the PubMed database was performed with the following terms: "staging", "neuroprogression", "serum", "plasma", "blood", "neuroimaging", "PET scan", "fMRI", "neurotrophins", "inflammatory markers" and "oxidative stress markers", which were individually crossed with "cognition", "functionality", "response to treatments" and "bipolar disorder". The inclusion criteria comprised original papers in the English language. Abstracts from scientific meetings were not included. RESULTS: We divided the results according to the available evidence of serum biomarkers as potential mediators of neuroprogression, with brain imaging, cognition, functioning and response to treatments considered as consequences. CONCLUSION: The challenge in BD treatment is translating the knowledge of neuronal plasticity and neurobiology into clinical practice. Neuroprogression and staging can have important clinical implications, given that early and late stages of the disorder appear to present different biological features and therefore may require different treatment strategies.
  • The history and development of Australia's Black Dog Institute Special Articles

    Parker, Gordon

    Abstract in English:

    OBJECTIVE: To overview the development of the Sydney-based Black Dog Institute. METHODS: The strengths and limitations of the Institute's predecessor (the Mood Disorders Unit) gave way to a more ambitious Black Dog Institute, and this article gives an overview of the Institute's structural and functional components. RESULTS: It is argued that the Institute serves as a model for modern psychiatric service delivery. CONCLUSIONS: The Institute's model of linking clinical, research, education and community activities to advance the understanding, diagnosis and management of mood disorders is detailed for wider consideration.
  • Pathophysiology of bacterial infection of the central nervous system and its putative role in the pathogenesis of behavioral changes Special Articles

    Barichello, Tatiana; Generoso, Jaqueline S.; Milioli, Graziele; Elias, Samuel G.; Teixeira, Antônio Lúcio

    Abstract in English:

    Invasion of the central nervous system (CNS) by microorganisms is a severe and frequently fatal event during the course of many infectious diseases. It may lead to deafness, blindness, cerebral palsy, hydrocephalus, cognitive impairment or permanent neurological dysfunction in survivors. Pathogens can cross the blood-brain barrier by transcellular migration, paracellular migration and in infected macrophages. Pathogens may breach the blood-brain barrier and be recognized by antigen-presenting cells through the binding of Toll-like receptors. This induces the activation of nuclear factor kappa B or mitogen-activated protein kinase pathways and subsequently induces leukocyte infiltration and proliferation and the expression of numerous proteins involved in inflammation and the immune response. Many brain cells can produce cytokines, chemokines and other pro-inflammatory molecules in response to bacteria stimuli; as a consequence, polymorphonuclear cells are attracted and activated, and release large amounts of superoxide anion and nitric oxide, leading to peroxynitrite formation and oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage and blood-brain barrier breakdown, contributing to cellular injury during neuronal infection. Current evidence suggests that bacterial CNS infections can play a role in the etiopathogenesis of behavioral disorders by increasing pro-inflammatory cytokines and bacterial virulence factors. The aim of this review is to summarize the current knowledge of the relevant pathophysiologic steps in CNS infections.
  • Bipolar disorder and metabolic syndrome: a systematic review Review Articles

    Czepielewski, Letícia; Daruy Filho, Ledo; Brietzke, Elisa; Grassi-Oliveira, Rodrigo

    Abstract in English:

    OBJECTIVE: Summarize data on metabolic syndrome (MS) in bipolar disorder (BD). METHODS: A systematic review of the literature was conducted using the Medline, Embase and PsycInfo databases, using the keywords "metabolic syndrome", "insulin resistance" and "metabolic X syndrome" and cross-referencing them with "bipolar disorder" or "mania". The following types of publications were candidates for review: (i) clinical trials, (ii) studies involving patients diagnosed with bipolar disorder or (iii) data about metabolic syndrome. A 5-point quality scale was used to assess the methodological weight of the studies. RESULTS: Thirty-nine articles were selected. None of studies reached the maximum quality score of 5 points. The prevalence of MS was significantly higher in BD individuals when compared to a control group. The analysis of MS subcomponents showed that abdominal obesity was heterogeneous. Individuals with BD had significantly higher rates of hypertriglyceridemia than healthy controls. When compared to the general population, there were no significant differences in the prevalence of low HDL-c in individuals with BD. Data on hypertension were also inconclusive. Rates of hyperglycemia were significantly greater in patients with BD compared to the general population. CONCLUSIONS: The overall results point to the presence of an association between BD and MS, as well as between their subcomponents.
  • Was Meduna's theory really wrong? Letters To The Editors

    Rosa, Moacyr
  • Successful re-exposure to clozapine after eosinophilia and clinically suspected myocarditis Letters To The Editors

    Granja-Ingram, Nara Matos; James, Jason; Clark, Nathaniel; Stovall, Jeffrey; Heckers, Stephan
  • Could disulfiram be a new treatment for crack cocaine dependence?: a pilot study Letters To The Editors

    Baldaçara, Leonardo; Diniz, Thaynne Almeida; Parreira, Bruna Leal; Milhomem, Jaqueline Jerônimo; Almeida, Lincoln Jose Cueto de; Fernandes, Camila Campitelli
  • rTMS to treat social anxiety disorder: a case report Letters To The Editors

    Paes, Flávia; Machado, Sergio; Arias-Carrión, Oscar; Silva, Adriana Cardoso; Nardi, Antonio Egidio
  • Understanding mental disorders through Woody Allen's films Psychiatry And The Arts

    Cheniaux, Elie; Landeira-Fernandez, J.
  • Panic disorder: theory and practice Book Review

    Sanches, Rafael Faria; Bianchi, Simone
  • Depression and Pain Book Review

    Henriques, Alexandre Annes
  • Temperament and character dimensions and their relationship to major depression and panic disorder Corrigendum

  • Psychiatric comorbidities in temporal lobe epilepsy: possible relationships between psychotic disorders and involvement of limbic circuits Corrigendum

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