portuguese | english Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
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Current issue 1, Volume 39 - Jan/Feb/Mar/2017


1 - Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders
Jorge Barros; Susana Morales; Orietta Echávarri; Arnol García; Jaime Ortega; Takeshi Asahi; Claudia Moya; Ronit Fischman; María P. Maino; Catalina Nuñez
Pages: 1 - 11

OBJECTIVE: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (dM) analysis.
METHODS: A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique.
RESULTS: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one's own capacities and coping abilities.
CONCLUSION: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.

Descriptors: Suicide; mood disorders; data mining

2 - Predictors of response in the treatment of moderate depression
Andre G. Bastos; Luciano S. Guimarães; Clarissa M. Trentini
Pages: 12 - 20

OBJECTIVE: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others.
METHOD: The present study derives from a research project in which depressed patients (n=272) received one of three treatments - long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) - over a 24-month period.
RESULTS: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators.
CONCLUSIONS: The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

Descriptors: Depression; psychotherapy; fluoxetine; moderators; predictors; neurocognition

3 - Association between perceived social support and anxiety in pregnant adolescents
Patrícia J. Peter; Christian L. de Mola; Mariana B. de Matos; Fábio M. Coelho; Karen A. Pinheiro; Ricardo A. da Silva; Rochele D. Castelli; Ricardo T. Pinheiro; Luciana A. Quevedo
Pages: 21 - 27

OBJECTIVE: To evaluate the association between perceived social support and anxiety disorders in pregnant adolescents.
METHODS: We conducted a cross-sectional study with a sample of 871 pregnant women aged 10 to 19 years who received prenatal care in the national public health care system in the urban area of Pelotas, state of Rio Grande do Sul, southern Brazil. We assessed perceived social support and anxiety disorders using the Medical Outcomes Study Social Support Survey and the Mini International Neuropsychiatric Interview. A self-report questionnaire was used to obtain sociodemographic information.
RESULTS: The prevalence of any anxiety disorder was 13.6%. Pregnant adolescents with an anxiety disorder reported less perceived social support in all domains (affectionate, emotional, tangible, informational, and positive social interaction). Older teenagers reported lower perceived support in the emotional, informational, and positive social interaction domains, whereas those with low socioeconomic status reported lower perceived social support in the material domain. Women who did not live with a partner had less perceived social support in the affectionate and positive social interaction domains.
CONCLUSION: Perceived social support seems to be a protective factor against anxiety disorders in pregnant adolescents, with a positive effect on mental health.

Descriptors: Pregnancy; adolescents; social support; anxiety disorder

4 - Sex-specific cognitive abnormalities in early-onset psychosis
Miguel Ruiz-Veguilla; Josefa Moreno-Granados; Maria D. Salcedo-Marin; Maria L. Barrigón; Maria J. Blanco-Morales; Evelio Igunza; Anselmo Canabate; Maria D. Garcia; Teresa Guijarro; Francisco Diaz-Atienza; Maite Ferrin
Pages: 28 - 35

OBJECTIVES: Brain maturation differs depending on the area of the brain and sex. Girls show an earlier peak in maturation of the prefrontal cortex. Although differences between adult females and males with schizophrenia have been widely studied, there has been less research in girls and boys with psychosis. The purpose of this study was to examine differences in verbal and visual memory, verbal working memory, auditory attention, processing speed, and cognitive flexibility between boys and girls.
METHODS: We compared a group of 80 boys and girls with first-episode psychosis to a group of controls.
RESULTS: We found interactions between group and sex in verbal working memory (p = 0.04) and auditory attention (p = 0.01). The female controls showed better working memory (p = 0.01) and auditory attention (p = 0.001) than males. However, we did not find any sex differences in working memory (p = 0.91) or auditory attention (p = 0.93) in the psychosis group.
CONCLUSIONS: These results are consistent with the presence of sex-modulated cognitive profiles at first presentation of early-onset psychosis.

Descriptors: Adolescents: schizophrenia; gender differences; cognitive neuroscience; psychosis

5 - Development and validation of the Gambling Follow-up Scale, Self-Report version: an outcome measure in the treatment of pathological gambling
Ana M. Galetti; Hermano Tavares
Pages: 36 - 44

OBJECTIVE: To validate the Gambling Follow-up Scale, Self-Report version (GFS-SR), a 10-item scale designed to assess gambling frequency, time and money spent on gambling, gambling craving, debts, emotional distress, family relationships, autonomy, and frequency of and satisfaction with leisure activities in individuals diagnosed with gambling disorder according to the DSM-5 criteria.
METHODS: One hundred and twenty treatment-seeking gamblers were evaluated, 84 of whom proceeded to treatment. Fifty-two relatives provided collateral informant reports at baseline. Six months later, the 50 patients who completed the program were reassessed.
RESULTS: The GFS-SR showed good inter-rater agreement and internal consistency. Factor analysis presented a three-factor solution: gambling behavior (factor 1); social life (factor 2); and personal hardship (factor 3). There was a high degree of convergence between GFS-SR scores and those of reference scales. The GFS-SR scores showed excellent sensitivity to change (factor 1), predictive validity for treatment response (factor 2), and ability to distinguish recovered from unrecovered patients after treatment (factor 3). A cutoff score of 33 was found to have 87% sensitivity and 80% specificity for gambling recovery.
CONCLUSION: The GFS-SR is well suited to providing reliable follow-up of gamblers under treatment and assessing the efficacy of their treatment.

Descriptors: Gambling; treatment outcome; questionnaires; psychometrics; self-report

6 - Cessation of dangerousness status: an analysis of 224 reports from the Instituto de Perícias Heitor Carrilho, Rio de Janeiro, Brazil
Gustavo C. Oliveira; Alexandre M. Valença; Talvane M. de Moraes; Mauro V. Mendlowicz; Miles C. Forrest; Fred F. Batista; Gabriella A. Mendes; Tiago N. Lima; Vinicius R. Gonçalves; Kátia Mecler
Pages: 45 - 54

OBJECTIVES: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision.
METHODS: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis.
RESULTS: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress.
CONCLUSIONS: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.

Descriptors: Forensic psychiatry; commitment of the mentally ill; insanity defense; mental disorders; violence

7 - Trends in suicide attempts at an emergency department
Verônica M. Alves; Leilane C. Francisco; Aryane R. de Melo; Cinthya R. Novaes; Flaviane M. Belo; Antonio E. Nardi
Pages: 55 - 61

OBJECTIVE: To characterize the profile of suicide attempts treated at an emergency department in the municipality of Arapiraca, state of Alagoas, Brazil, from 2009 to 2012.
METHODS: We analyzed all emergency department records containing a diagnosis of suicide attempt. Data were evaluated using Student's t test and Pearson's chi-square test. Significance was accepted at p<0.05.
RESULTS: We identified 2,142 cases. Suicide attempts were more frequent among women and young adults, but deaths were more frequent among men. Suicide attempts were most frequent among patients aged 10 to 39 years (81.1%). Drug intoxication (65.0%) and non-drug poisoning (16.2%) were significantly more prevalent than other methods of suicide. The month of April (10.6%) accounted for the greatest number of cases, and July had the smallest number (5.5%). Suicide attempts were most prevalent in spring (28.3%), on Sundays (18.4%) and Saturdays (16.8%), and from 12:00 p.m. to 5:59 p.m.
CONCLUSION: Suicide prevention measures should focus on young women. Further research into the care provided to suicide attempters and better monitoring of the sale and use of medicines and poisons could be useful.

Descriptors: Suicide attempt; poisoning; emergency

8 - Health-related quality of life and self-reported long-term conditions: a population-based survey
Ivan R. Zimmermann; Marcus T. Silva; Tais F. Galvao; Mauricio G. Pereira
Pages: 62 - 68

OBJECTIVE: To estimate and compare the effect of self-reported long-term health conditions and sociodemographic factors on perceived health-related quality of life (HRQoL).
METHODS: A population-based survey of adults (18 to 65 years) living in Brasilia, Brazil, was conducted in 2012. Descriptive and multivariate analyses using a Tobit model were performed with data on sociodemographic variables, self-reported conditions, and the European Quality of Life-5 Dimensions (EQ-5D) health states, providing utility scores (preferred health state) between 0 and 1 for HRQoL estimates.
RESULTS: The mean utility of 1,820 adults interviewed (mean age: 38.4±12.6 years) was 0.883 (95% confidence interval [95%CI] 0.874-0.892), with 76.2% in the highest utility range (0.8 to 1.0). eQ-5D dimensions with moderate problems were pain/discomfort (33.8%) and anxiety/depression (20.5%). Serious problems were reported by only 0.3% of the sample in the mobility and self-care domain and by 3.1% in the pain/discomfort domain. Multivariate analysis revealed reduced HRQoL in individuals with depression, diabetes, and hypertension. Living in satellite towns (outside the city core), belonging to a lower economic class, or not being formally employed were also associated with decreased HRQoL. Beta coefficients for these impacts ranged from -0.033 (not formally employed) to -0.141 (depression), reflecting the strongest impact.
CONCLUSION: Of the long-term health conditions studied, depression had the greatest impact on HRQoL. Social class, employment status, and place of residence also affected HRQoL.

Descriptors: Depression; chronic disease; health status disparities; quality of life; patient preference

9 - Virginia Woolf, neuroprogression, and bipolar disorder
Manuela V. Boeira; Gabriela de Á. Berni; Ives C. Passos; Márcia Kauer-Sant'Anna; Flávio Kapczinski
Pages: 69 - 71

Family history and traumatic experiences are factors linked to bipolar disorder. It is known that the lifetime risk of bipolar disorder in relatives of a bipolar proband are 5-10% for first degree relatives and 40-70% for monozygotic co-twins. It is also known that patients with early childhood trauma present earlier onset of bipolar disorder, increased number of manic episodes, and more suicide attempts. We have recently reported that childhood trauma partly mediates the effect of family history on bipolar disorder diagnosis. In light of these findings from the scientific literature, we reviewed the work of British writer Virginia Woolf, who allegedly suffered from bipolar disorder. Her disorder was strongly related to her family background. Moreover, Virginia Woolf was sexually molested by her half siblings for nine years. Her bipolar disorder symptoms presented a pernicious course, associated with hospitalizations, suicidal behavioral, and functional impairment. The concept of neuroprogression has been used to explain the clinical deterioration that takes places in a subgroup of bipolar disorder patients. The examination of Virgina Woolf's biography and art can provide clinicians with important insights about the course of bipolar disorder.

Descriptors: Mood disorders; bipolar; suicide; stress; sexual assault; cognitive neuroscience

10 - Critical neuropsychobiological analysis of panic attack-and anticipatory anxiety-like behaviors in rodents confronted with snakes in polygonal arenas and complex labyrinths: a comparison to the elevated plus- and T-maze behavioral tests
Norberto C. Coimbra; Tatiana Paschoalin-Maurin; Gabriel S. Bassi; Alexandre Kanashiro; Audrey F. Biagioni; Tatiana T. Felippotti; Daoud H. Elias-Filho; Joyce Mendes-Gomes; Jade P. Cysne-Coimbra; Rafael C. Almada; Bruno Lobão-Soares
Pages: 72 - 83

OBJECTIVE: To compare prey and snake paradigms performed in complex environments to the elevated plus-maze (EPM) and T-maze (eTm) tests for the study of panic attack- and anticipatory anxiety-like behaviors in rodents.
METHODS: PubMed was reviewed in search of articles focusing on the plus maze test, EPM, and ETM, as well as on defensive behaviors displayed by threatened rodents. In addition, the authors' research with polygonal arenas and complex labyrinth (designed by the first author for confrontation between snakes and small rodents) was examined.
RESULTS: The EPM and ETM tests evoke anxiety/fear-related defensive responses that are pharmacologically validated, whereas the confrontation between rodents and snakes in polygonal arenas with or without shelters or in the complex labyrinth offers ethological conditions for studying more complex defensive behaviors and the effects of anxiolytic and panicolytic drugs. Prey vs. predator paradigms also allow discrimination between non-oriented and oriented escape behavior.
CONCLUSIONS: Both EPM and ETM simple labyrinths are excellent apparatuses for the study of anxiety-and instinctive fear-related responses, respectively. The confrontation between rodents and snakes in polygonal arenas, however, offers a more ethological environment for addressing both unconditioned and conditioned fear-induced behaviors and the effects of anxiolytic and panicolytic drugs.

Descriptors: Innate fear; panic attacks; prey versus snakes paradigms; polygonal arenas for snakes; elevated plus-maze test; elevated T-maze test

11 - Cognitive-behavioral therapy as an effective, safe, and acceptable intervention for OCD during pregnancy
Marina Iniesta-Sepúlveda; Eric A. Storch
Pages: 84 - 84


12 - Panic psychosis: paroxysmal panic anxiety concomitant with auditory hallucinations in schizophrenia
Thalita Gabínio; Thaysse G. Ricci; Jeffrey P. Kahn; Dolores Malaspina; André B. Veras
Pages: 85 - 86


13 - Vortioxetine-induced manic mood switch in patient with previously unknown bipolar disorder
Gonçalo Sobreira; João Oliveira; Sofia Brissos
Pages: 86 - 86