Brazilian Journal of Psychiatry, Volume: 41, Issue: 1, Published: 2019
  • Brazilian Journal of Psychiatry Editorial

    Quevedo, João; Nardi, Antonio E.; da Silva, Antônio Geraldo
  • Global mental health and psychiatric nosology: DSM-5, ICD-11, and RDoC Editorial

    Stein, Dan J.; Reed, Geoffrey M.
  • Genetics and epigenetics as tools to inform the pathophysiology of neuropsychiatric disorders Editorial

    Fries, Gabriel Rodrigo
  • Celebrating the 80th anniversary of electroconvulsive therapy Editorial

    Selek, Salih; Quevedo, João
  • Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test Original Article

    Linares, Ila M.; Zuardi, Antonio W.; Pereira, Luis C.; Queiroz, Regina H.; Mechoulam, Raphael; Guimarães, Francisco S.; Crippa, José A.

    Abstract in English:

    Objective: Cannabidiol (CBD), one of the non-psychotomimetic compounds of Cannabis sativa, causes anxiolytic-like effects in animals, with typical bell-shaped dose-response curves. No study, however, has investigated whether increasing doses of this drug would also cause similar curves in humans. The objective of this study was to compare the acute effects of different doses of CBD and placebo in healthy volunteers performing a simulated public speaking test (SPST), a well-tested anxiety-inducing method. Method: A total of 57 healthy male subjects were allocated to receive oral CBD at doses of 150 mg (n=15), 300 mg (n=15), 600 mg (n=12) or placebo (n=15) in a double-blind procedure. During the SPST, subjective ratings on the Visual Analogue Mood Scale (VAMS) and physiological measures (systolic and diastolic blood pressure, heart rate) were obtained at six different time points. Results: Compared to placebo, pretreatment with 300 mg of CBD significantly reduced anxiety during the speech. No significant differences in VAMS scores were observed between groups receiving CBD 150 mg, 600 mg and placebo. Conclusion: Our findings confirm the anxiolytic-like properties of CBD and are consonant with results of animal studies describing bell-shaped dose-response curves. Optimal therapeutic doses of CBD should be rigorously determined so that research findings can be adequately translated into clinical practice.
  • Studying ICD-11 Primary Health Care bodily stress syndrome in Brazil: do many functional disorders represent just one syndrome? Original Article

    Fortes, Sandra; Ziebold, Carolina; Reed, Geoffrey M.; Robles-Garcia, Rebeca; Campos, Monica R.; Reisdorfer, Emilene; Prado, Ricardo; Goldberg, David; Gask, Linda; Mari, Jair J.

    Abstract in English:

    Objective: Disorders characterized by “distressing unexplained somatic symptoms” are challenging. In the ICD-11 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (ICD-11 PHC), a new category, bodily stress syndrome (BSS), was included to diagnose patients presenting unexplained somatic symptoms. The present study investigated the association of BSS with anxiety, depression, and four subgroups of physical symptoms in a Brazilian primary health care (PHC) sample. Methodology: As part of the international ICD-11 PHC study, 338 patients were evaluated by their primary care physicians, followed by testing with Clinical Interview Schedule (CIS-R) and World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0). BSS was diagnosed in the presence of at least three somatic symptoms associated with incapacity. The association between anxiety, depression, and four subgroups of physical symptoms with being a BSS case was analyzed. Results: The number of somatic symptoms was high in the overall sample of 338 patients (mean = 8.4), but even higher in the 131 BSS patients (10.2; p < 0.001). Most BSS patients (57.3%) had at least three symptoms from two, three, or four subgroups, and these were associated with anxiety and depression in 80.9% of these patients. The symptom subgroup most strongly associated with “being a BSS” case was the non-specific group (OR = 6.51; 95%CI 1.65-24.34), followed by musculoskeletal (OR = 2,31; 95%CI 1.19-4.72). Conclusion: Somatic symptoms were frequent in a sample of PHC patients in Brazil. In the present sample, one third were BSS cases and met the criteria for at least two symptom subgroups, supporting the hypothesis that different functional symptoms are related to each other.
  • Component mechanisms of executive function in schizophrenia and their contribution to functional outcomes Original Article

    Berberian, Arthur A.; Gadelha, Ary; Dias, Natália M.; Mecca, Tatiana P.; Comfort, William E.; Bressan, Rodrigo A.; Lacerda, Acioly T.

    Abstract in English:

    Objective: In schizophrenia, scores reflecting deficits in different cognitive processes are strongly correlated, making it difficult to establish a solid relationship between different cognitive mechanisms and other features of this disorder. The objective of this study was to explore whether three frequently postulated executive functions (updating, shifting, and inhibition) could be compared between groups and considered independently in terms of their respective roles in functional outcome. Methods: This study relied on confirmatory factor analysis of schizophrenia patients (n=141) and healthy controls (n=119). The main analyses examined the degree to which three executive functions (updating, set-shifting, and inhibition) could be separated in schizophrenia and compared this model among groups. Structural equation modeling analysis was also performed to examine the extent to which executive function components contribute to functional outcome in schizophrenia. Results: Multiple-group confirmatory factor analysis with unconstrained model parameters indicated that the full three-factor model may fit the data in both groups (χ2 = 61.48, degrees of freedom = 34, p < 0.001, comparative fit index = 0.95; standardized root mean square residual = 0.037; root mean square error of approximation = 0.04; Akaike’s information criteria = 169.49; normed fit index = 0.90), although there was also a good data fit for the patient group with a two-factor model. In the patient group, structural equation modeling suggested that shifting and (principally) updating were associated with the general measure of functional outcome (regression path coefficients: 0.34, p < 0.005; 0.39, p < 0.005, respectively), although when combined the mechanisms fail to contribute. Conclusion: This data suggests that the factor structure may be similar but not identical between groups, and both updating and shifting may play an important role in functional outcome in schizophrenia.
  • Structural equation modeling of psychopathic traits in Chilean female offenders using the Self-Report Psychopathy-Short Form (SRP-SF) Scale: a comparison of gender-based item modifications versus standard items Original Article

    León-Mayer, Elizabeth; Rocuant-Salinas, Joanna; Eisenbarth, Hedwig; Folino, Jorge; Neumann, Craig

    Abstract in English:

    Objective: To examine the utility of the Self-Report Psychopathy-Short Form (SRP-SF) to assess psychopathic traits in female offenders and to test gender-based item modifications. Method: A South American sample of female offenders (n=210) was assessed with the Psychopathy Checklist-Revised (PCL-R); 110 subjects also completed the standard SRP-SF, while 109 completed a version with items rewritten to be more relevant for females. The underlying latent structure of the PCL-R and both versions of the SRP-SF were examined. Results: Most of the modified items showed higher average item responses. The PCL-R showed a stronger association with the modified SRP-SF than with the standard SRP-SF. The four-factor model showed very good fit in accounting for the PCL-R data, consistent with previous research. For both SRP-SF versions, the results indicated good model fit. Structural equation models were tested separately, in which a superordinate SRP-SF factor was set to predict a broad factor reflecting chronic misconduct. Both versions showed good model fit, and the SRP-SF superordinate factor significantly predicted a chronic misconduct factor. Conclusions: Both versions of the SRP-SF adequately reflected psychopathic features in this female sample; the modified items added robustness to representation of these features.
  • Metabolic syndrome and psychiatric disorders: a population-based study Original Article

    Moreira, Fernanda Pedrotti; Jansen, Karen; Cardoso, Taiane de A.; Mondin, Thaíse C.; Magalhães, Pedro V.; Kapczinski, Flavio; Souza, Luciano D.M.; da Silva, Ricardo A.; Oses, Jean Pierre; Wiener, Carolina D.

    Abstract in English:

    Objective: To identify the association of metabolic syndrome (MetS) and psychiatric disorders in young adults in southern Brazil. Methods: This population based cross-sectional study involved a total of 1,023 young adults between the ages of 21 and 32 years. Current episodes of psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview – Plus version. MetS was evaluated using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). Results: Of the 1,023 participants, 24.3% were identified with MetS, 13.5% were diagnosed with anxiety disorders, 7.5% with current depression, 3.9% with bipolar disorders and 10.1% were at risk of suicide. MetS was associated with ethnicity (p = 0.022), excess weight (p < 0.001), current anxiety disorders (p < 0.001), current mood disorders (bipolar disorder in mood episode and current depression) (p < 0.001), and suicide risk (p < 0.001). Conclusions: MetS was associated with psychiatric disorders. Awareness of factors associated with MetS can help identify high-risk individuals and stimulate disease prevention and control programs, as well as lifestyle changes.
  • Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle Original Article

    Madruga, Clarice S.; Paim, Thales L.; Palhares, Hamer N.; Miguel, Andre C.; Massaro, Luciana T.S.; Caetano, Raul; Laranjeira, Ronaldo R.

    Abstract in English:

    Objective: This study aimed to determine the prevalence of benzodiazepine (BZD) use in Brazil and to investigate the direct and indirect effects of alcohol consumption, sedentary lifestyle (SL), depressive symptoms (DS), and sleep dissatisfaction (SD) on BZD use. Methods: The Second Brazilian Alcohol and Drugs Survey (II BNADS) used stratified cluster probabilistic sampling to select 4,607 individuals aged 14 years and older from the Brazilian household population. Results: The lifetime and 12-month prevalence of BZD use was 9.8 and 6.1%, respectively. Older participants (age 40 and older) and women had higher rates. Alcohol use disorder, DS, and SD were significantly more prevalent in BZD users. The parallel multiple mediator model showed a positive direct effect of alcohol consumption on BZD use, with significant positive indirect effects of SL, SD, and DS as simultaneous mediators leading to higher BZD intake. Other statistically significant indirect pathways were DS alone, SD alone, and all of the above except SL. Conclusion: The prevalence of BZD use in Brazil is high compared to that of other countries. Knowledge of the main risk factors and pathways to consumption can guide prevention initiatives and underlie the development of better tailored and effective treatment strategies.
  • Effects of resistance exercise training and stretching on chronic insomnia Original Article

    D’Aurea, Carolina V.R.; Poyares, Dalva; Passos, Giselle S.; Santana, Marcos G.; Youngstedt, Shawn D.; Souza, Altay A.; Bicudo, Juliana; Tufik, Sergio; de Mello, Marco T.

    Abstract in English:

    Objective: The aim of this study was to assess the effects of resistance exercise and stretching on sleep, mood, and quality of life in chronic insomnia patients. Methods: Three 4-month treatments included: resistance exercise (n=10), stretching (n=10), and control (n=8). Sleep was evaluated with polysomnography, actigraphy, and questionnaires. Mood and quality of life were assessed with the Profile of Mood States (POMS) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), respectively. Results: There were no significant treatment differences between resistance exercise and stretching. However, compared with the control treatment, resistance exercise and stretching led to significantly greater improvements in Insomnia Severity Index scores (-10.5±2.3, -8.1±2.0 vs. 2.3±1.8, respectively), and actigraphic measures of sleep latency (-7.1±4.6, -5.2±1.9 vs. 2.2±2.1 min), wake after sleep onset (-9.3±2.8, -7.1±3.0 vs. 3.6±4.2 min), and sleep efficiency (4.4±1.8, 5.0±0.8 vs. -2.3±2%). Pittsburgh Sleep Quality Index (PSQI) global scores (-5.3±0.8, -3.9±1.5 vs. -0.1±0.8) and sleep duration (1.2±0.3, 1.6±0.6 vs. -0.1±0.2 h) also improved following both experimental treatments compared with control. PSQI-Sleep efficiency increased after resistance exercise compared with control (19.5±3.9 vs. 2.1±4.3%). No significant differences were observed in polysomnography or quality of life measures. Tension-anxiety was lower in the stretching group than the control group. Conclusion: Moderate-intensity resistance exercise and stretching led to similar improvements in objective and subjective sleep in patients with chronic insomnia. Clinical trial registration: NCT01571115
  • How psychiatrists think about religious and spiritual beliefs in clinical practice: findings from a university hospital in São Paulo, Brazil Original Article

    Menegatti-Chequini, Maria C.; Maraldi, Everton de O.; Peres, Mario F.P.; Leão, Frederico C.; Vallada, Homero

    Abstract in English:

    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.
  • Exploring the structural and construct validity of the Brazilian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) Brief Communication

    Queiroz de Medeiros, Anna C.; Pedrosa, Lucia de F.C.; Yamamoto, Maria E.

    Abstract in English:

    Objective: Food cravings play an important role in the neurobiology of appetitive behavior, being positively associated with negative feelings, eating disorders, and obesity. This study aimed to assess the psychometric properties of the Brazilian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r), a short version of the most widely used measure of this behavior. Methods: Undergraduate students (n=505) completed the full version of the FCQ-T and the Three-Factor Eating Questionnaire. Respondents’ height and weight were also measured. Exploratory factor analyses were performed. Results: The FCQ-T-r exhibited a single-factor structure and satisfactory internal consistency (α > 0.80). A positive correlation was observed between FCQ-T-r scores and those of the original version. Furthermore, FCQ-T-r scores correlated positively with uncontrolled eating and emotional eating behaviors. No correlation was found between body mass index and FCQ-T-r scores. Considering our sample characteristics, we suggested specific FCQ-T-r cutoff points for males and females in the Brazilian population. Conclusion: Our results support the structure of the Brazilian adaptation of the FCQ-T-r, which seems to be a viable instrument to investigate food cravings, particularly in time-constrained settings. Further studies are needed to verify these findings in other age ranges and clinical samples.
  • Noninvasive brain stimulation in psychiatric disorders: a primer Special Article

    Brunoni, Andre R.; Sampaio-Junior, Bernardo; Moffa, Adriano H.; Aparício, Luana V.; Gordon, Pedro; Klein, Izio; Rios, Rosa M.; Razza, Lais B.; Loo, Colleen; Padberg, Frank; Valiengo, Leandro

    Abstract in English:

    Objective: Noninvasive brain stimulation (NIBS) techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are increasingly being used to treat mental disorders, particularly major depression. The aim of this comprehensive review is to summarize the main advances, limitations, and perspectives of the field. Methods: We searched PubMed and other databases from inception to July 2017 for articles, particularly systematic reviews and meta-analyses, evaluating the use of NIBS in psychiatric disorders. Results: We reviewed the mechanisms of action, safety, tolerability, efficacy, and relevant clinical parameters of NIBS. Repetitive TMS is already an established technique for the treatment of depression, and there is theoretically room for further methodological development towards a high-end therapeutic intervention. In contrast, tDCS is a technically easier method and therefore potentially suitable for wider clinical use. However the evidence of its antidepressant efficacy is less sound, and a recent study found tDCS to be inferior to antidepressant pharmacotherapy. Clinical trials using rTMS for other mental disorders produced mixed findings, whereas tDCS use has not been sufficiently appraised. Conclusion: The most promising results of NIBS have been obtained for depression. These techniques excel in safety and tolerability, although their efficacy still warrants improvement.
  • Revictimization as a high-risk factor for development of posttraumatic stress disorder: a systematic review of the literature Review Article

    Cividanes, Giuliana C.; Mello, Andrea F.; Mello, Marcelo F.

    Abstract in English:

    Objective: Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PTSD). Methods: Electronic searches were conducted in five databases (MEDLINE/PubMed, Cochrane Library, Campbell Library, PsycINFO, and LILACS), using the terms PTSD, posttraumatic stress disorder, child abuse, and rape. Results: We identified nine articles that established a connection among childhood sexual abuse (CSA), sexual revictimization in adulthood, and development of PTSD. Eight of the nine papers included were classified as having strong methodological quality (grade VI). One was classified as IV, with an average quality-of-evidence rating. The mean methodological quality score of the articles was 5.5, and the quality of evidence was deemed strong. Conclusion: In the included studies, PTSD symptoms were most prevalent in the CSA + adult sexual assault groups, providing further evidence for the revictimization hypothesis.
  • Benefits of using the Psychiatric Risk Assessment Checklist (PRE-CL) to assess risk in general hospital inpatients Letters To The Editor

    Camargo, Ana L.L.S.; Mari, Jair J.; Reis, Elisa A.A.; Citero, Vanessa A.
  • New-onset psychiatric symptoms following intracranial meningioma in a patient with schizophrenia: a case study Letters To The Editor

    Trevizol, Alisson P.; Cerqueira, Raphael de O.; Brietzke, Elisa; Cordeiro, Quirino
  • The Clinician-Administered PTSD Scale (CAPS-5): adaptation to Brazilian Portuguese Letters To The Editor

    Oliveira-Watanabe, Thauana T.; Ramos-Lima, Luis F.; Santos, Roberta C.; Mello, Marcelo F.; Mello, Andrea F.
  • Mosaic 15q duplication syndrome (tetrasomy 15q11.1-q13.2) in a child with behavior disorders: case report Letters To The Editor

    Rodrigues, Maurício A.; Dias, Laura de F.; Moreira, Renata V.; Ribeiro, Patrícia D.
  • Corruption: the culture of a society and/or personality factors? Letters To The Editor

    Serafim, Antonio de Pádua; de Barros, Daniel Martins
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