portuguese | english Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
2014 JCR® Impact Factor: 1.765
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Current issue 3, Volume 38 - Jul/Aug/Sep/2016


1 - The neurobiological basis of psycho-oncology
Juliana Augusta Garcia; Maria Teresa Lourenço; Jair de Jesus Mari
Pages: 181 - 182


2 - Components of the metabolic syndrome and depressive symptoms in community-dwelling older people: the Bambuí Cohort Aging Study
Luiz Gustavo Ruas; Breno S. Diniz; Josélia O. Firmo; Sérgio V. Peixoto; Juliana V. Mambrini; Antônio Ignácio de Loyola-Filho; Maria Fernanda Lima-Costa; Érico Castro-Costa
Pages: 183 - 189

OBJECTIVE: To investigate the moderating effect of an increasing number of clustered metabolic syndrome (MetS) components on the association between MetS and depressive symptoms in a population-based cohort of older adults in Brazil.
METHODS: This analysis used data from the Bambuí Cohort Aging Study. Participants in this cross-sectional study comprised 1,469 community-dwelling older people aged > 60 years. Analyses were performed to assess both the association between depressive symptoms and each individual MetS component and the association between depressive symptoms and clustering of an increasing number of MetS components.
RESULTS: High triglyceride level was the individual component that showed the strongest association with depressive symptoms (odds ratio [OR]: 1.47; 95% confidence intervals [95%CI] 1.19-1.81; p < 0.0001). Only the presence of three MetS components was associated with depressive symptoms (OR = 1.53; 95%CI 1.05-2.23; p = 0.025). No graded association was detected between increasing number of clustered MetS components and depressive symptoms.
CONCLUSIONS: Increasing the number of MetS components did not impact the association with depressive symptoms. The association between high triglyceride level and depressive symptoms highlights the relevance of lipid metabolism abnormalities for the emergence of depressive symptoms in older adults.

Descriptors: Metabolic syndrome; depressive symptoms; elderly; population-based

3 - Relationship between inflammatory biomarkers and depressive symptoms during late pregnancy and the early postpartum period: a longitudinal study
William Simpson; Meir Steiner; Marg Coote; Benicio N. Frey
Pages: 190 - 196

OBJECTIVE: Perinatal depressive symptoms often co-occur with other inflammatory morbidities of pregnancy. The goals of our study were 1) to examine whether changes in inflammatory markers from the third trimester of pregnancy to 12 weeks postpartum were associated with changes in depressive symptoms; 2) to examine whether third trimester inflammatory markers alone were predictive of postpartum depressive symptoms; and 3) to examine the relationship between inflammatory markers and depressive symptoms during the third trimester of pregnancy and at 12 weeks postpartum.
METHODS: Thirty-three healthy pregnant women were recruited from the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Canada. The impact of depressive symptoms on the levels of interleukin (IL)-6, IL-10, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) at the third trimester of pregnancy, at 12 weeks postpartum, and across time was assessed using linear and mixed-model regression.
RESULTS: Regression analysis revealed no significant association between depressive symptoms and any of the candidate biomarkers during pregnancy, at 12 weeks postpartum, or over time. Pregnancy depressive symptoms (p > 0.001), IL-6 (p = 0.025), and IL-10 (p = 0.006) were significant predictors of postpartum Edinburgh Perinatal Depression Scale (EPDS) score.
CONCLUSIONS: Our study supports previous reports from the literature showing no relationship between inflammatory biomarkers and depressive symptoms during late pregnancy, early postpartum, or across time. Our study is the first to observe an association between late pregnancy levels of IL-6 and IL-10 and postpartum depressive symptoms. Further studies with larger samples are required to confirm these findings.

Descriptors: Perinatal; depression; cytokines; inflammation

4 - Serum BDNF levels in unaffected first-degree relatives of patients with bipolar disorder
Fabiano G. Nery; Alexandre D. Gigante; Jose A. Amaral; Francy B. Fernandes; Mariangeles Berutti; Karla M. Almeida; Laura Stertz; Giovana Bristot; Flavio Kapczinski; Beny Lafer
Pages: 197 - 200

OBJECTIVE: Unaffected relatives of bipolar disorder (BD) patients have been investigated for the identification of endophenotypes in an attempt to further elucidate the pathophysiology of the disease. Brain-derived neurotrophic factor (BDNF) is considered to be implicated in the pathophysiology of BD, but its role as an endophenotype has been poorly studied. We investigated abnormal serum BDNF levels in BD patients, in their unaffected relatives, and in healthy controls.
METHODS: BDNF levels were obtained from 25 DSM-IV bipolar I disorder patients, 23 unaffected relatives, and 27 healthy controls. All BD patients were in remission. The unaffected subjects were first-degree relatives of the proband who had no lifetime DSM-IV diagnosis of axis I disorder. BDNF serum levels were determined by sandwich ELISA using monoclonal BDNF-specific antibodies.
RESULTS: There were no statistical differences in BDNF levels among BD patients, relatives, and healthy controls.
CONCLUSION: Serum BDNF levels may not indicate high genetic risk for BD, possibly acting as state markers rather than trait markers of the disease.

Descriptors: Bipolar disorder; endophenotypes; cerebral cortex; hippocampus; brain-derived neurotrophic factor

5 - Cognition and functioning in bipolar depression
Natalia S. Kapczinski; Joana C. Narvaez; Pedro V. Magalhães; Joana Bücker; Ana C. Peuker; Ana C. Loredo; Federico Troiano; Letícia Czepielewski; Adriane Rosa; Gabriel R. Fries; Clarissa S. Gama
Pages: 201 - 206

OBJECTIVES: Depressive symptoms are associated with worse outcomes in patients with bipolar disorder (BD). However, scarce data are available regarding neurocognitive profiles across different areas of functioning among BD patients with moderate and severe depression. Our objective was to assess cognition and global functioning in a group of patients with bipolar depression.
METHODS: Data were available for 100 patients with bipolar depression (78% female) and 70 controls (64% female) paired by age and education level. Cognitive function was assessed with a neuropsychological test battery. Functioning was assessed with the Functioning Assessment Short Test.
RESULTS: In patients, severe depression was associated with poorer cognitive performance on measures of executive function. Patients with severe depression showed worse global functioning than those with moderate depression (z = 2.54, p = 0.011). In patients with severe depression, lower global functioning was associated with lower scores in working memory (r = -0.200, p = 0.010), and executive function (r = -0.210, p = 0.007; and r = 0.293, p < 0.001).
CONCLUSION: Our findings suggest cognitive impairment and global functioning impairment are associated with the severity of depressive symptoms in bipolar depression. Intensive treatment of depressive symptoms in patients with BD is crucial to improve cognitive functioning and, consequently, functional outcomes.

Descriptors: Memory; mood disorders, bipolar; tests/interviews, psychometric; cognitive neuroscience, outcome studies

6 - Sensory processing patterns, coping strategies, and quality of life among patients with unipolar and bipolar disorders
Batya Engel-Yeger; Xenia Gonda; Caterina Muzio; Giorgio Rinosi; Maurizio Pompili; Mario Amore; Gianluca Serafini
Pages: 207 - 215

OBJECTIVE: To compare sensory processing, coping strategies, and quality of life (QoL) in unipolar and bipolar patients; to examine correlations between sensory processing and QoL; and to investigate the relative contribution of sociodemographic characteristics, sensory processing, and coping strategies to the prediction of QoL.
METHODS: Two hundred sixty-seven participants, aged 16-85 years (53.6±15.7), of whom 157 had a diagnosis of unipolar major depressive disorder and 110 had bipolar disorder type I and type II, completed the Adolescent/Adult Sensory Profile, Coping Orientations to Problems Experienced, and 12-item Short-Form Health Survey version 2. The two groups were compared with multivariate analyses.
RESULTS: The unipolar and bipolar groups did not differ concerning sensory processing, coping strategies, or QoL. Sensory processing patterns correlated with QoL independently of mediation by coping strategies. Correlations between low registration, sensory sensitivity, sensation avoidance, and reduced QoL were found more frequently in unipolar patients than bipolar patients. Higher physical QoL was mainly predicted by lower age and lower sensory sensitivity, whereas higher mental QoL was mainly predicted by coping strategies.
CONCLUSION: While age may predict physical QoL, coping strategies predict mental QoL. Future studies should further investigate the impact of sensory processing and coping strategies on patients' QoL in order to enhance adaptive and functional behaviors related to affective disturbances.

Descriptors: Major affective disorders; sensory processing disorders; coping strategies; quality of life

7 - Interview-based assessment of cognition is a strong predictor of quality of life in patients with schizophrenia and severe negative symptoms
Breno F. Cruz; Camilo B. de Resende; Carolina F. Carvalhaes; Clareci S. Cardoso; Antonio L. Teixeira; Richard S. Keefe; Fábio L. Rocha; João V. Salgado
Pages: 216 - 221

OBJECTIVE: To analyze the correlation between quality of life, symptoms, and cognition assessed by the interview-based Schizophrenia Cognition Rating Scale (SCoRS).
METHODS: Seventy-nine outpatients diagnosed with schizophrenia were evaluated with the Quality of Life Scale - Brazilian version (QLS-BR), the SCoRS, and symptoms scales (Positive and Negative Syndrome Scale [PANSS]). After determining the potential explanatory variables using Spearman's correlation and Student's t test results, we ran simple, multivariate, and decision-tree regression analyses to assess the impact of SCoRS and PANSS ratings on mean overall quality of life.
RESULTS: Cognitive deficits and negative symptoms were the best predictors of quality of life. A low degree of negative symptoms (PANSS negative < 11) was a strong predictor of better quality of life (QLS ~ 75), regardless of SCoRS rating. Among participants with more severe negative symptoms, elevated cognitive impairment (interviewer SCoRS ~ 44) was a predictor of worse quality of life (QLS ~ 44).
CONCLUSIONS: Cognitive impairment determined by interview-based assessment seems to be a strong predictor of quality of life in subjects with severe negative symptoms. These results support the usefulness of SCoRS for cognitive assessment that is relevant to the everyday life of patients with schizophrenia.

Descriptors: Schizophrenia; cognitive neuroscience; outpatient psychiatry; tests/interviews, psychometric; chronic psychiatric illness

8 - Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations
Jesem D. Orellana; Antônio A. Balieiro; Fernanda R. Fonseca; Paulo C. Basta; Maximiliano L. Ponte de Souza
Pages: 222 - 230

OBJECTIVE: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil.
METHODS: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall).
RESULTS: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups.
CONCLUSION: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.

Descriptors: Suicide; minority issues and cross-cultural psychiatry; interdisciplinary relations; epidemiology; social anthropology

9 - Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly
Gabriel Coutinho; Cláudia Drummond; Alina Teldeschi; Paulo Mattos
Pages: 231 - 234

OBJECTIVE: To investigate whether the level of awareness of memory deficits is useful for discriminating between major depressive disorder (MDD) and mild cognitive impairment (MCI) in the elderly.
METHODS: Sixty-three consecutively referred patients (38 women and 25 men) with memory concerns comprising three groups (clinical control, MDD and MCI) underwent a memory test (Rey Auditory Verbal Learning Test [RAVLT]) and completed the Memory Assessment Complaints-Questionnaire (MAC-Q). Level of awareness was estimated by the difference between the MAC-Q score and the score on the fifth presentation of the RAVLT. Memory performance, Mini-Mental State Examination (MMSE) and depressive symptoms (Geriatric Depression Scale [GDS]) were also assessed.
RESULTS: The control (n=25), MDD (n=16), and MCI (n=22) groups were similar in age, educational level, and MMSE (p > 0.05). Among the groups, the MDD group had the most memory complaints, whereas the MCI group had the worst objective memory performance. Level of awareness was capable of discriminating between MDD and MCI (p < 0.05), but not between MDD and clinical controls (p > 0.05). MDD subjects tended to underestimate their memory functioning as compared to controls (p < 0.05).
CONCLUSION: Level of awareness of memory deficits was significantly useful to discriminate between MCI and MDD, which is a common difficulty faced by clinicians. Future studies with larger samples are needed to confirm these findings.

Descriptors: Depression; mild cognitive impairment; level of awareness; memory complaints

10 - Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer's disease dementia: association with activities of daily living
Jonas J. de Paula; Maicon R. Albuquerque; Guilherme M. Lage; Maria A. Bicalho; Marco A. Romano-Silva; Leandro F. Malloy-Diniz
Pages: 235 - 238

OBJECTIVE: Cognitive impairment is a hallmark of mild cognitive impairment (MCI) and Alzheimer's disease dementia (AD). Although the cognitive profile of these patients and its association with activities of daily living (ADLs) is well documented, few studies have assessed deficits in fine motor dexterity and their association with ADL performance. The objective of this research paper is to evaluate fine motor dexterity performance among MCI and AD patients and to investigate its association with different aspects of ADLs.
METHODS: We assessed normal aging controls, patients with multiple- and single-domain amnestic MCI (aMCI), and patients with mild AD. Fine motor dexterity was measured with the Nine-Hole Peg Test and cognitive functioning by the Mattis Dementia Rating Scale. We analyzed the data using general linear models.
RESULTS: Patients with AD or multiple-domain aMCI had slower motor responses when compared to controls. AD patients were slower than those with single-domain aMCI. We found associations between cognition and instrumental ADLs, and between fine motor dexterity and self-care ADLs.
CONCLUSION: We observed progressive slowing of fine motor dexterity along the normal aging-MCI-AD spectrum, which was associated with autonomy in self-care ADLs.

Descriptors: Dementia; mild cognitive impairment; Alzheimer's disease; motor coordination; activities of daily living; nine-hole peg test; motor dexterity

11 - A family-based association study of the HTR1B gene in eating disorders
Sandra Hernández; Beatriz Camarena; Laura González; Alejandro Caballero; Griselda Flores; Alejandro Aguilar
Pages: 239 - 242

OBJECTIVE: To explore the association of three polymorphisms of the serotonin receptor 1Dβ gene (HTR1B) in the etiology of eating disorders and their relationship with clinical characteristics.
METHODS: We analyzed the G861C, A-161T, and A1180G polymorphisms of the HTR1B gene through a family-based association test (FBAT) in 245 nuclear families. The sample was stratified into anorexia nervosa (AN) spectrum and bulimia nervosa (BN) spectrum. In addition, we performed a quantitative FBAT analysis of anxiety severity, depression severity, and Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) in the An and BN-spectrum groups.
RESULTS: FBAT analysis of the A-161T polymorphism found preferential transmission of allele A-161 in the overall sample. This association was stronger when the sample was stratified by spectrums, showing transmission disequilibrium between the A-161 allele and bN spectrum (z = 2.871, p = 0.004). Quantitative trait analysis showed an association between severity of anxiety symptoms and the C861 allele in AN-spectrum participants (z = 2.871, p = 0.004). We found no associations on analysis of depression severity or preoccupation and ritual scores in AN or BN-spectrum participants.
CONCLUSIONS: Our preliminary findings suggest a role of the HTR1B gene in susceptibility to development of BN subtypes. Furthermore, this gene might have an impact on the severity of anxiety in AN-spectrum patients.

Descriptors: Anorexia nervosa; bulimia nervosa; serotonin receptor; association; anxiety

12 - Opioid peptides and gastrointestinal symptoms in autism spectrum disorders
Cristiane P. Lázaro; Milena P. Ponde; Luiz E.A. Rodrigues
Pages: 243 - 246

Autism spectrum disorders (ASDs) are characterized by deficits in the individual's ability to socialize, communicate, and use the imagination, in addition to stereotyped behaviors. These disorders have a heterogenous phenotype, both in relation to symptoms and regarding severity. Organic problems related to the gastrointestinal tract are often associated with ASD, including dysbiosis, inflammatory bowel disease, exocrine pancreatic insufficiency, celiac disease, indigestion, malabsorption, food intolerance, and food allergies, leading to vitamin deficiencies and malnutrition. In an attempt to explain the pathophysiology involved in autism, a theory founded on opioid excess has been the focus of various investigations, since it partially explains the symptomatology of the disorder. Another hypothesis has been put forward whereby the probable triggers of ASDs would be related to the presence of bacteria in the bowel, oxidative stress, and intestinal permeability. The present update reviews these hypotheses.

Descriptors: Autistic disorder; probability theory; opioids; intestinal bacteria; oxidative stress; bowel permeability

13 - Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias
Felipe B. Schuch; Davy Vancampfort; Simon Rosenbaum; Justin Richards; Philip B. Ward; Nicola Veronese; Marco Solmi; Eduardo L. Cadore; Brendon Stubbs
Pages: 247 - 254

OBJECTIVE: To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data. METHODS: We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (> 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted.
RESULTS: Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities.
CONCLUSION: Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.

Descriptors: Exercise; depression; older adults; publication bias; meta-analysis

14 - The effects of regular physical activity on anxiety symptoms in healthy older adults: a systematic review
Marina D. Mochcovitch; Andréa C. Deslandes; Raphael C. Freire; Rafael F. Garcia; Antonio E. Nardi
Pages: 255 - 261

OBJECTIVE: Anxiety symptoms are common in older adults with or without anxiety disorders. Pharmacological options may be limited for these patients. Alternative treatments, such as physical activity (PA), are often indicated, although few trials have evaluated their efficacy. The aim of this review was to evaluate the efficacy of regular PA on improving anxiety symptoms in older adults without anxiety disorders. Potential neuroendocrine, inflammatory, and oxidative mechanisms, as well as cognitive factors to explain these effects are also discussed.
METHODS: A systematic literature review was performed to identify randomized controlled trials, cross-sectional, cohort, and case-control studies, as well as case series including healthy previously sedentary older adults. We searched the PubMed and Web of Science databases for articles published in English, with no set time limits.
RESULTS: Eight studies evaluating the effect of PA on anxiety symptoms in healthy older adults were included in this review. In all studies, regular and supervised PA was directly related to decreased anxiety symptoms in older individuals.
CONCLUSION: Regular PA may be effective for improving anxiety symptoms in older adults. More studies are needed to identify the ideal PA modality, frequency, duration, and intensity for optimizing the positive effects of exercise on anxiety in this population.

Descriptors: Physical exercise; anxiety; aged

15 - Reliability of working memory assessment in neurocognitive disorders: a study of the Digit Span and Corsi Block-Tapping tasks
Jonas J. de Paula; Leandro F. Malloy-Diniz; Marco A. Romano-Silva
Pages: 262 - 263


16 - It is time to prepare mental health services to attend to migrants and refugees
Lineth Hiordana Ugarte Bustamante; Emilie Leclerc; Jair de Jesus Mari; Elisa Brietzke
Pages: 263 - 264


17 - A neurofeedback protocol to improve mild anxiety and sleep quality
July S. Gomes; Daniella V. Ducos; Henrique Akiba; Álvaro M. Dias
Pages: 264 - 265


18 - Corrigendum

Pages: 266 - 266