Brazilian Journal of Psychiatry, Volume: 42, Issue: 6, Published: 2020
  • Cognitive impairment: an (in)dependent risk factor for mortality in older men? Editorial

    Loureiro, Júlia C.; Pais, Marcos V.; Forlenza, Orestes V.
  • Esketamine/ketamine for treatment-resistant depression Editorial

    Lacerda, Acioly L.T.
  • Ketamine: a new chapter in antidepressant development Editorial

    Zarate Jr., Carlos A.
  • Mild and moderate cognitive impairment and mortality among Brazilian older adults in long-term follow-up: The Bambui Health Aging Study Original Article

    Campos, Cecilia G.; Diniz, Breno S.; Firmo, Josélia O.; Lima-Costa, M. Fernanda; Blay, Sergio L.; Castro-Costa, Erico

    Abstract in English:

    Objective: To compare mortality in older adults with and without mild or moderate cognitive impairment over 15 years of follow-up in a middle-income country, where little information on this subject is available. Methods: A total of 1,281 community-dwelling older adults were followed-up for a median of 13.3 years. We evaluated their cognitive impairment using the Mini-Mental State Examination, categorizing it as none (1.0 SD above cutoff means), mild (1.0 SD below cutoff means) or moderate (2.0 SD below cutoff means). The date of death was determined by reviewing death certificates. Cox’s proportional hazards models were used to evaluate the risk of mortality in participants with cognitive impairment. Results: Participants with mild or moderate cognitive impairment had a higher mortality risk than those without it in the unadjusted model, but these associations did not remain in the final model. After sex stratification, only men with moderate cognitive impairment had a higher mortality risk in the final model. Conclusion: The findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of older adults.
  • Care-seeking as a proxy indicator of the mental health of elderly Brazilians Original Article

    Castro-de-Araujo, Luis F.; Machado, Daiane B.; Barreto, Maurício L.

    Abstract in English:

    Objective: To assess a large set of metadata made public by the Brazilian Ministry of Health on older subjects who visited outpatient mental health services in Brazil from 2008 to 2012. Methods: We extracted data from the Brazilian Unified Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde, DATASUS), then calculated rates of visits per population in each of the five regions of Brazil, using census data for each year. Finally, logistic regressions were performed with depressive disorders or dementias as dependent variables, controlled by age and year of visit, stratified by region. Results: Mood disorders were the leading reason for visits to outpatient mental health services by older adults, followed by delusional disorders. The calculated rates were lower than the known prevalence of depressive disorders and dementias, but the regressions revealed typical patterns. Males were less likely to present with a depressive disorder, while older subjects were more likely to present with depression and dementia. Conclusions: Publicly available data from DATASUS may not enable inferences about the prevalence of mental disorders in elders, but inferential analyses match what is known about these conditions. This approach is supplemental to other more common ones and is of special importance for policymakers and health system managers.
  • Health-related quality of life in patients treated with atypical antipsychotics Original Article

    de Almeida, Juliana L.; Zuppo, Isabella de Figueiredo; Castel, Saulo; Reis, Edna A.; de Oliveira, Helian N.; Ruas, Cristina M.

    Abstract in English:

    Objective: To assess health-related quality of life and associated factors in patients treated with atypical antipsychotics, as well as to determine utility values using the EuroQol-5D-3L instrument. Methods: A cross-sectional study was conducted at a state-run pharmacy in the Brazilian National Health System. Individuals were included if they were using a single atypical antipsychotic and completed the EuroQol-5D-3L. Sociodemographic, behavioral, and clinical data were collected. The dependent variable was the EuroQol-5D-3L utility score. Associations between the independent variables and the dependent variable were analyzed in a multiple linear regression model. Results: A total of 394 patients were included, and their mean utility score was 0.664±0.232. Patients treated with clozapine had the highest mean score (0.762 [0.202]), followed by olanzapine (0.687 [0.230]), risperidone (0.630 [0.252]), ziprasidone (0.622 [0.234]), and quetiapine (0.620 [0.243]). The following variables were related to higher utility scores: income, employment, clozapine use, no illicit psychoactive substance use, no suicide attempts, and no comorbidities. Conclusion: Evaluating health-related quality of life differences in the available atypical antipsychotics can facilitate the choice of treatment, improve health outcomes, and ensure rational prescriptions.
  • Cross-cultural adaptation, factor structure, and evidence of reliability of the Smartphone Addiction Scale in Brazil Original Article

    Laurence, Paulo G.; Serpa, Alexandre O.; Cunha Lima, Helena S.; Mavichian, Helen O.; Macedo, Elizeu C.

    Abstract in English:

    Objective: To translate, adapt, and examine the factor structure and internal consistency of a Brazilian Portuguese version of the Smartphone Addiction Scale (SAS-BR) among university students. Methods: The SAS was translated and adapted for use with Brazilian samples. The resulting instrument (SAS-BR) was then administered to 356 college students. Parallel analysis was used to explore the maximum number of dimensions that underlie the assessment, and data modeling was undertaken using exploratory multidimensional item response theory (E-MIRT). The reliability of the SAS-BR was tested by computing McDonald’s omega (ω) and Cronbach’s alpha (α) coefficients. Results: Parallel analysis revealed a maximum of six factors. E-MIRT analysis revealed that a five-factor model was the best fit for the data. The five emergent factors were salience, positive anticipation, cyberspace-oriented relationship, preoccupation with smartphone, and physical symptoms; these factors together explained 50% of the variance. Confirmatory factor analysis, conducted using data from a second sample, replicated the five-factor structure. The internal consistency of the scale was found to be strong. Conclusion: The emergent factor structure of the SAS-BR was found to be similar to that of previous adaptations of this instrument for other Western countries.
  • Investigation of second to fourth finger length ratio (2D:4D) in patients with bipolar disorder Original Article

    Kɪlɪç, Faruk; Işɪk, Ümit; Demirdaş, Arif; İnci, Hüseyin E.

    Abstract in English:

    Objective: The etiology of bipolar disorder has yet to be fully elucidated, but differences in sex hormones have been suggested to play a role in its pathogenesis. An easily assessed marker of prenatal androgen exposure is the second-to-fourth-digit ratio (2D:4D) of the hand. In this study, we aimed to compare the 2D:4D ratio of patients with bipolar disorder to that of healthy controls. Methods: Seventy patients with bipolar disorder and 70 healthy controls, matched for age and sex, were included in the study. Finger lengths were measured from the palmar digital crease to the tip using a digital vernier caliper. Results: Patients with bipolar disorder had considerably higher right-hand 2D:4D ratios compared to controls. Both the right and left 2D:4D ratios of male patients were significantly greater than those of males in the control group. Female patients showed no differences in right or left 2D:4D ratio compared to healthy controls. Conclusion: These findings suggest that a high 2D:4D digit ratio of right hand is associated with the presence of bipolar disorder in males. Further large-scale, prospective studies are needed to explain the validity of this marker and its relationship with bipolar disorder.
  • Generalized anxiety disorder in type 2 diabetes mellitus: prevalence and clinical characteristics Original Article

    Huang, Chun-Jen; Hsieh, Hui-Min; Tu, Hung-Pin; Jiang, He-Jiun; Wang, Peng-Wei; Lin, Ching-Hua

    Abstract in English:

    Objective: This study investigated the prevalence of generalized anxiety disorder (GAD) in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective observational study was conducted with a random sample of patients from the entire population of National Health Insurance enrollees during 2000-2010 and used ICD-9-CM diagnostic codes to identify T2DM patients and GAD. The prevalence of GAD was compared between T2DM patients and the general population. Results: Between 2000 and 2010, the prevalence of GAD was significantly greater in the T2DM patients than the general population, while the increase of GAD was higher in the general population (from 0.25 to 0.63%) than among T2DM patients (from 0.81 to 1.03%). In T2DM patients, GAD was associated with female gender, a Charlson Comorbidity Index ≥ 1, diabetes mellitus duration > 9 years, and the following comorbidities: congestive heart failure, peripheral vascular disease, and depressive disorder. The prevalence of GAD among T2DM patients was negatively associated with rapid-acting insulin injection therapy and with the use of metformin and sulfonylureas. Conclusion: Since the prevalence of GAD was greater among T2DM patients than the general population, public health initiatives are needed to prevent and treat GAD in T2DM patients, specifically those with the above mentioned risk factors.
  • DRD4 genotyping may differentiate symptoms of attention-deficit/hyperactivity disorder and sluggish cognitive tempo Original Article

    Bolat, Hilmi; Ercan, Eyüp S.; Ünsel-Bolat, Gül; Tahillioğlu, Akin; Yazici, Kemal U.; Bacanli, Ali; Pariltay, Erhan; Aygüneş Jafari, Duygu; Kosova, Buket; Özgül, Semiha; Rohde, Luis A.; Akin, Haluk

    Abstract in English:

    Objective: Studies to reduce the heterogeneity of attention-deficit/hyperactivity disorder (ADHD) have increased interest in the concept of sluggish cognitive tempo (SCT). The aim of this study was to investigate if the prevalence of two variable-number tandem repeats (VNTRs) located within the 3′-untranslated region of the DAT1 gene and in exon 3 of the dopamine D4 receptor (DRD4) gene differ among four groups (31 subjects with SCT but no ADHD, 146 individuals with ADHD but no SCT, 67 subjects with SCT + ADHD, and 92 healthy controls). Methods: We compared the sociodemographic profiles, neurocognitive domains, and prevalence of two VNTRs in SCT and ADHD subjects versus typically developing (TD) controls. Results: The SCT without ADHD group had a higher proportion of females and lower parental educational attainment. Subjects in this group performed worse on neuropsychological tests, except for psychomotor speed and commission errors, compared to controls. However, the ADHD without SCT group performed significantly worse on all neuropsychological domains than controls. We found that 4R homozygosity for the DRD4 gene was most prevalent in the ADHD without SCT group. The SCT without ADHD group had the highest 7R allele frequency, differing significantly from the ADHD without SCT group. Conclusion: The 7R allele of DRD4 gene was found to be significantly more prevalent in SCT cases than in ADHD cases. No substantial neuropsychological differences were found between SCT and ADHD subjects.
  • Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method Special Article

    Ramirez, Ana C.; Grebe, Stacey C.; McNeel, Morgan M.; Limon, Danica L.; Schneider, Sophie C.; Berry, Leandra N.; Goin-Kochel, Robin P.; Cepeda, Sandra L.; Voigt, Robert G.; Salloum, Alison; Storch, Eric A.

    Abstract in English:

    Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a “full-package” treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety – a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
  • The pharmacological interaction of compounds in ayahuasca: a systematic review Review Article

    Ruffell, Simon; Netzband, Nige; Bird, Catherine; Young, Allan H.; Juruena, Mario F.

    Abstract in English:

    Ayahuasca is a South American psychoactive plant brew used as traditional medicine in spiritual and in cultural rituals. This is a review of the current understanding about the pharmacological mechanisms that may be interacting in ayahuasca. Searches were performed using PubMed, PsycINFO, and Web of Science databases and 16 papers were selected. As hypothesized, the primary narrative in existing research revolved around prevention of deamination of N,N-dimethyltryptamine (N,N-DMT, also referred to as DMT) by monoamine oxidase inhibitors (MAOIs) in ayahuasca. Two of the constituents, DMT and harmine, have been studied more than the secondary harmala alkaloids. At present, it is unclear whether the pharmacological interactions in ayahuasca act synergistically or additively to produce psychoactive drug effects. The included studies suggest that our current understanding of the preparation’s synergistic mechanisms is limited and that more complex processes may be involved; there is not yet enough data to determine any potential synergistic interaction between the known compounds in ayahuasca. Our pharmacological understanding of its compounds must be increased to avoid the potential risks of ayahuasca use.
  • Prevalence and correlates of major depressive disorder: a systematic review Review Article

    Gutiérrez-Rojas, Luis; Porras-Segovia, Alejandro; Dunne, Henry; Andrade-González, Nelson; Cervilla, Jorge A.

    Abstract in English:

    Objectives: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD. Methods: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018. Results: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies. Conclusions: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder’s prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.
  • Lowering costs for large-scale screening in psychosis: a systematic review and meta-analysis of performance and value of information for speech-based psychiatric evaluation Review Article

    Argolo, Felipe; Magnavita, Guilherme; Mota, Natalia Bezerra; Ziebold, Carolina; Mabunda, Dirceu; Pan, Pedro M.; Zugman, André; Gadelha, Ary; Corcoran, Cheryl; Bressan, Rodrigo A.

    Abstract in English:

    Objective: Obstacles for computational tools in psychiatry include gathering robust evidence and keeping implementation costs reasonable. We report a systematic review of automated speech evaluation for the psychosis spectrum and analyze the value of information for a screening program in a healthcare system with a limited number of psychiatrists (Maputo, Mozambique). Methods: Original studies on speech analysis for forecasting of conversion in individuals at clinical high risk (CHR) for psychosis, diagnosis of manifested psychotic disorder, and first-episode psychosis (FEP) were included in this review. Studies addressing non-verbal components of speech (e.g., pitch, tone) were excluded. Results: Of 168 works identified, 28 original studies were included. Valuable speech features included direct measures (e.g., relative word counting) and mathematical embeddings (e.g.: word-to-vector, graphs). Accuracy estimates reported for schizophrenia diagnosis and CHR conversion ranged from 71 to 100% across studies. Studies used structured interviews, directed tasks, or prompted free speech. Directed-task protocols were faster while seemingly maintaining performance. The expected value of perfect information is USD 9.34 million. Imperfect tests would nevertheless yield high value. Conclusion: Accuracy for screening and diagnosis was high. Larger studies are needed to enhance precision of classificatory estimates. Automated analysis presents itself as a feasible, low-cost method which should be especially useful for regions in which the physician pool is insufficient to meet demand.
  • Chikungunya-induced manic episode in a patient with no psychiatric history: a case report Letter To The Editors

    Soares, Douglas S.; Fortaleza, Leila Y.; Melo, Matias C.
  • Corrigendum Corrigendum

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