portuguese | english Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
JCR IF 2016: 2.049
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Support vector machine-based classification of neuroimages in Alzheimer's disease: direct comparison of FDG-PET, rCBF-SPECT and MRI data acquired from the same individuals
Luiz K. Ferreira; Jane M. Rondina; Rodrigo Kubo; Carla R. Ono; Claudia C. Leite; Jerusa Smid; Cassio Bottino; Ricardo Nitrini; Geraldo F. Busatto; Fabio L. Duran; Carlos A. Buchpiguel
Abstract

OBJECTIVE: To conduct the first support vector machine (SVM)-based study comparing the diagnostic accuracy of T1-weighted magnetic resonance imaging (T1-MRI), F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and regional cerebral blood flow single-photon emission computed tomography (rCBF-SPECT) in Alzheimer's disease (AD). METHOD: Brain T1-MRI, FDG-PET and rCBF-SPECT scans were acquired from a sample of mild AD patients (n=20) and healthy elderly controls (n=18). SVM-based diagnostic accuracy indices were calculated using whole-brain information and leave-one-out cross-validation. RESULTS: The accuracy obtained using PET and SPECT data were similar. PET accuracy was 68B71% and area under curve (AUC) 0.77B0.81; SPECT accuracy was 68B74% and AUC 0.75B0.79, and both had better performance than analysis with T1-MRI data (accuracy of 58%, AUC 0.67). The addition of PET or SPECT to MRI produced higher accuracy indices (68B74%; AUC: 0.74B0.82) than T1-MRI alone, but these were not clearly superior to the isolated neurofunctional modalities. CONCLUSION: In line with previous evidence, FDG-PET and rCBF-SPECT more accurately identified patients with AD than T1-MRI, and the addition of either PET or SPECT to T1-MRI data yielded increased accuracy. The comparable SPECT and PET performances, directly demonstrated for the first time in the present study, support the view that rCBF-SPECT still has a role to play in AD diagnosis.

Descriptors: Alzheimer's disease; support vector machine; MRI; FDG-PET; SPECT


Barriers to early identification of autism in Brazil
Sabrina H. Ribeiro; Cristiane S. de Paula; Daniela Bordini; Jair J. Mari; Sheila C. Caetano
Abstract

OBJECTIVE: Parents of children with autism spectrum disorders (ASD) seem to perceive that their child's development is not following the normal pattern as early as the first year of life. However, ASD children may not receive a diagnosis until they are of preschool age, especially in low- and middle-income countries. The objective of this study was to evaluate the pathway between initial parental concerns about atypical child development and ASD diagnosis in Brazil. METHODS: Nineteen mothers whose children had been diagnosed with ASD participated and were interviewed. The ASD group consisted of two girls and 17 boys, with a mean age of 93.0 months (SD 48.4 months; range 39-197 months). RESULTS: Mothers had their first concerns regarding ASD when children were 23.6±11.6 months old, but formal diagnosis occurred at a mean ± SD age of 59.6±40.5 months, corresponding to a 3-year delay. Most mothers felt discouraged to address their concerns due to negative experiences with health professionals. CONCLUSION: In Brazil, mothers perceived the first signs of ASD in their children at an age similar to that reported in other countries, but the diagnosis of ASD seemed to be delayed. Consistent with the literature, mothers reported negative experiences with health professionals during the pathway to achieving ASD diagnosis.

Descriptors: Autism spectrum disorder; parental identification; delayed diagnosis; low-and middle-income countries


Childhood emotional and behavior problems and their associations with cesarean delivery
Erigene Rutayisire; Xiaoyan Wu; Kun Huang; Shuman Tao; Yunxiao Chen; Fangbiao Tao
Abstract

OBJECTIVE: To determine the prevalence of childhood emotional and behavioral problems and examine their associations with cesarean delivery. METHODS: Our sample consisted of 8,900 preschoolers from 35 kindergartens in four cities in East China. Parents completed the Strengths and Difficulties Questionnaire (SDQ) and provided other information. Children's emotional and behavioral problems were assessed using five subscales of the SDQ. Mode of delivery was classified as vaginal or cesarean section (CS); in sub-analyses, we divided CS into elective or emergency delivery. Logistic regression was used to examine associations. RESULTS: A total of 1,209 (13.6%) children had a total SDQ score within abnormal range; 25.5% had peer problems within abnormal range, 9.0% had abnormal emotional symptoms, 13.9% had abnormal conduct problems, 18.9% had abnormal hyperactivity problems, and 16.2% were rated abnormal in pro-social behavior. Overall, 67.3% of the children who participated were delivered by CS. In fully adjusted analysis, CS was significantly associated with abnormal total SDQ score (OR = 1.27; 95%CI 1.10-1.46; p < 0.05) and pro-social behavior (OR = 1.27; 95%CI 1.12-1.45; p < 0.0001). No significant association was found between CS and risk of having conduct problems (OR 1.13; 95%CI 0.98-1.29), peer problems (OR 1.11; 95%CI 0.99-1.24), hyperactivity (OR 1.02; 95%CI 0.91-1.15), or emotional problems (OR 1.06; 95%CI 0.90-1.24). CONCLUSION: In this sample, CS was associated with risk of behavioral problems, but not with emotional problems. Further research is needed to better understand these associations.

Descriptors: Problem behavior; cesarean section; delivery mode; pregnancy; preschool children


Gender incongruence: a comparative study using ICD-10 and DSM-5 diagnostic criteria
Bianca M. Soll; Rebeca Robles-García; Angelo Brandelli-Costa; Daniel Mori; Andressa Mueller; Anna M. Vaitses-Fontanari; Dhiordan Cardoso-da-Silva; Karine Schwarz; Maiko Abel-Schneider; Alexandre Saadeh Maria-Inês-Rodrigues Lobato
Abstract

OBJECTIVE: To compare the presence of criteria listed in the DSM-5 and ICD-10 diagnostic manuals in a Brazilian sample of transgender persons seeking health services specifically for physical transition. METHODS: This multicenter cross-sectional study included a sample of 103 subjects who sought services for gender identity disorder in two main reference centers in Brazil. The method involved a structured interview encompassing the diagnostic criteria in the two manuals. RESULTS: The results revealed that despite theoretical disagreement about the criteria, the manuals overlap regarding diagnosis confirmation; the DSM-5 was more inclusive (97.1%) than the ICD-10 (93.2%) in this population. CONCLUSIONS: Although there is no consensus on diagnostic criteria on transgenderism in the diversity of social and cultural contexts, more comprehensive diagnostic criteria are evolving due to society's increasing inclusivity.

Descriptors: Diagnosis and classification; gender differences; minority issues and cross-cultural psychiatry; history of psychiatry; social and political issues


Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1
Aline R. Wageck; Felipe S. Torres; Clarissa S. Gama; Dayane S. Martins; Ellen Scotton; Ramiro Reckziegel; Monise Costanzi Regis G. Rosa; Flávio Kapczinski; Maurício Kunz
Abstract

OBJECTIVE: Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS) in individuals with bipolar disorder type 1. METHODS: Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0) or positive (CCS > 0). Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations. RESULTS: Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001) and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5;p = 0.04) when compared with CCS-negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001). CONCLUSION: Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

Descriptors: Bipolar disorder; cardiovascular diseases; diagnostic techniques; cardiovascular; coronary disease


When the past is present
Albina R. Torres; Daniel L.C. Costa; Eurípedes C. Miguel

Descriptors:


The relationship between multiple sclerosis and neuropsychiatric syndromes
James McLoughlin; Brian P. Hallahan

Descriptors:


Crack-cocaine users have less family cohesion than alcohol users
Nino C. Marchi; Juliana N. Scherer; Mayra P. Pachado; Luciano S. Guimarães; Gerson Siegmund; Melina N. de Castro; Silvia Halpern; Daniela Benzano; Maria L. Formigoni; Marcelo Cruz; Flavio Pechansky; Felix H. Kessler
Abstract

OBJECTIVE: Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1) alcohol-only users and 2) crack-cocaine users. METHODS: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Subjects were evaluated through the Family Environment Scale and the Addiction Severity Index, 6th version (ASI-6). ASI-6 t-scores were compared by analysis of variance (ANOVA) and post-hoc tests. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t-score. RESULTS: We found a significant difference between groups in the cohesion subscale (p = 0.044). The post-hoc test revealed a difference of 1.06 points (95%Ci 0.11-2.01) between groups 1 (6.45±0.28) and 2 (5.38±0.20). No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other (30.4% vs. 13.2%, p = 0.007) and that people in their family frequently compared each other regarding work and/or school achievement (57.2% vs. 42.6%, p = 0.041). CONCLUSION: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached.

Descriptors: Family; family relationships; cohesion; substance abuse; alcohol use; crack-cocaine use


Screening for common mental disorders using the SRQ-20 in Brazil: what are the alternative strategies for analysis?
Maria B. Barreto do Carmo; Leticia M. dos Santos; Caroline A. Feitosa; Rosemeire L. Fiaccone; Nívea B. da Silva; Darci N. dos Santos; Maurício L. Barreto; Leila D. Amorim
Abstract

OBJECTIVE: To analyze the prevalence of common mental disorders (CMD) assessed with the Self Reporting Questionnaire (SRQ-20), using the established cutoff point, and comparing it with the results of a joint correspondence factor analysis (CFA) and cluster analysis and of a latent class analysis (LCA). METHODS: A cross-sectional study was carried out in an urban sample of 1,095 women aged 19 to 55 years. Joint CFA-cluster analysis and LCA were used. RESULTS: We found a high prevalence of CMD, regardless of classification method (37.6% when using the cutoff point; 44.4% and 52% for LCA and joint CFA-cluster, respectively). The alternative analysis strategies describe the cases more efficiently when compared to the traditional cutoff method, especially regarding more severe symptoms. Both alternative strategies also provide a description of the SRQ-20 dimensions in their particularities, which may be useful for the planning and implementation of specific actions in a given population. CONCLUSION: The SRQ-20 cutoff point seems to underestimate the magnitude of CMD among women. The alternative methods of analysis presented herein highlight the different possibilities of using this important instrument of screening for mental health.

Descriptors: Screening; mental health; multivariate analysis; latent class analysis; correspondence analysis


Clinical outcomes of psychotherapy dropouts: does dropping out of psychotherapy necessarily mean failure?
Rodrigo T. Lopes; Miguel M. Gonçalves; Dana Sinai; Paulo P. Machado
Abstract

OBJECTIVE: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. METHODS: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. RESULTS: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). CONCLUSION: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.

Descriptors: Patient dropout; psychotherapy; outcome assessment; unipolar depression


Portuguese and Brazilian guidelines for the treatment of depression: exercise as medicine
Lara F. Carneiro; Maria P. Mota; Felipe Schuch; Andrea Deslandes; José Vasconcelos-Raposo
Abstract

Depression is a psychiatric disorder and major contributor to the burden of disease worldwide. The strength of evidence of the benefits of exercise as a therapeutic intervention for patients with depression has expanded in the last 30 years. In fact, the available evidence indicates exercise can not only help manage depressive symptoms, but also effect significant improvements in other health outcomes. Clinical guidelines including such recommendations have been issued by different agencies, namely the UK National Institute for Health and Clinical Excellence (NICE), the American Psychiatric Association (APA), and the Royal Australian and New Zealand College of Psychiatrists (rAnZCP). With increasing recognition of the benefits of exercise and shortcomings of healthcare systems, other countries, such as Sweden and Canada, have included exercise in their national guidelines for treating depression. Unfortunately, progress in incorporating exercise guidelines into clinical practice has been slow, and Portugal and Brazil reflect this reality. In this update, we reemphasize the importance of bridging this gap and integrating exercise into clinical practice guidelines as an essential component of depression treatment.

Descriptors: Depression; treatment; exercise; guidelines


Alcohol-related blackouts among college students: Impact of low level of response to alcohol, ethnicity, sex, and environmental characteristics
Priscila D. Gonçalves; Tom L. Smith; Robert M. Anthenelli; George Danko; Marc A. Schuckit
Abstract

OBJECTIVE: To explore how a genetically-influenced characteristic (the level of response to alcohol [LR]), ethnicity, and sex relate to environmental and attitudinal characteristics (peer drinking [PEER], drinking to cope [COPE], and alcohol expectancies [EXPECT]) regarding future alcohol-related blackouts (ARBs). METHODS: Structural equation models (SEMs) were used to evaluate how baseline variables related to ARB patterns in 462 college students over 55 weeks. Data were extracted from a longitudinal study of heavy drinking and its consequences at a U.S. university. RESULTS: In the SEM analysis, female sex and Asian ethnicity directly predicted future ARBs (beta weights 0.10 and -0.11, respectively), while all other variables had indirect impacts on ARBs through alcohol quantities (beta weights ~0.23 for European American ethnicity and low LR, 0.21 for cannabis use and COPE, and 0.44 for PEER). Alcohol quantities then related to ARBs with beta = 0.44. The SEM explained 23% of the variance. CONCLUSION: These data may be useful in identifying college students who are more likely to experience future ARBs over a 1-year period. They enhance our understanding of whether the relationships of predictors to ARBs are direct or mediated through baseline drinking patterns, information that may be useful in prevention strategies for ARBs.

Descriptors: Alcohol; blackout; college students; peer drinking; drinking to cope; drinking behavior; alcohol drinking in college; binge drinking


Mental health problems among medical students In Brazil: a systematic review and meta-analysis
João P. Pacheco; Henrique T. Giacomin; Wilson W. Tam; Tássia B. Ribeiro; Claudia Arab; Italla M. Bezerra; Gustavo C. Pinasco
Abstract

OBJECTIVE: To provide a comprehensive picture of mental health problems (MHPs) in Brazilian medical students by documenting their prevalence and association with co-factors. METHODS: We systematically searched the MEDLINE/PubMed, SciELO, LILACS, and PsycINFO databases for cross-sectional studies on the prevalence of MHPs among medical students in Brazil published before September 29, 2016. We pooled prevalences using a random-effects meta-analysis, and summarized factors associated with MHP. RESULTS: We included 59 studies in the analysis. For meta-analyses, we identified the summary prevalence of different MHPs, including depression (25 studies, prevalence 30.6%), common mental disorders (13 studies, prevalence 31.5%), burnout (three studies, prevalence 13.1%), problematic alcohol use (three studies, prevalence 32.9%), stress (six studies, prevalence 49.9%), low sleep quality (four studies, prevalence 51.5%), excessive daytime sleepiness (four studies, prevalence 46.1%), and anxiety (six studies, prevalence 32.9%). Signs of lack of motivation, emotional support, and academic overload correlated with MHPs. CONCLUSION: Several MHPs are highly prevalent among future physicians in Brazil. Evidence-based interventions and psychosocial support are needed to promote mental health among Brazilian medical students.

Descriptors: Mental health; depression; medical students; mental disorders



Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study
André R. Simioni; Pedro M. Pan; Ary Gadelha; Gisele G. Manfro; Jair J. Mari; Euripedes C. Miguel; Luis A. Rohde; Giovanni A. Salum
Abstract

OBJECTIVES: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y) in a community-based study. METHODS: Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC) and their mothers were assessed in structured interviews. Current (last month) and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children's clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors. RESULTS: The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1%) and lifetime DSH was 1.6% (1.8% and 1.5%, respectively). Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder. CONCLUSION: Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.

Descriptors: Deliberate self-harm; self-injurious behavior; suicide attempt; community survey; family health; psychopathology


Schizophrenia and work: aspects related to job acquisition in a follow-up study
Larissa C. Martini; Jair B. Barbosa Neto; Beatriz Petreche; Ana O. Fonseca; Fernanda V. dos Santos; Lílian Magalhães; Alessandra G. Marques; Camila Soares; Quirino Cordeiro; Cecília Attux; Rodrigo A. Bressan
Abstract

OBJECTIVE: Work is considered one of the main forms of social organization; however, few individuals with schizophrenia find work opportunities. The purpose of this study was to evaluate the relationship between schizophrenia symptoms and job acquisition. METHOD: Fifty-three individuals diagnosed with schizophrenia from an outpatient treatment facility were included in an 18-month follow-up study. After enrollment, they participated in a prevocational training group. At the end of training (baseline) and 18 months later, sociodemographic, clinical data and occupational history were collected. Positive and negative symptoms (Positive and Negative Syndrome Scale - RANSS), depression (Calgary Depression Scale), disease severity (Clinical Global Impression - CGI), functionality (Global Assessment of Functioning - GAF), personal and social performance (Personal and Social Performance - RSR) and cognitive functions (Measurement and Treatment Research to Improve Cognition in Schizophrenia - MATRICS battery) were applied at baseline and at the end of the study. RESULTS: Those with some previous work experience (n=19) presented lower scores on the PANSS, Calgary, GAF, CGI and PSP scales (p < 0.05) than those who did not work. Among those who worked, there was a slight worsening in positive symptoms (positive PANSS). CONCLUSIONS: Individuals with less severe symptoms were more able to find employment. Positive symptom changes do not seem to affect participation at work; however, this calls for discussion about the importance of employment support.

Descriptors: Schizophrenia; work; symptom; support


Effectiveness evaluation of mood disorder treatment algorithms in Brazilian public healthcare patients
Ana F. Lima; Sandro R. Miguel Mírian Cohen; Jacques J. Zimmermann; Flávio M. Shansis; Luciane N. Cruz; Patrícia K. Ziegelmann; Carisi A. Polanczyk; Marcelo P. Fleck
Abstract

OBJECTIVE: To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system. METHODS: A randomized pragmatic trial was conducted with an algorithm developed for treating episodes of major depressive disorder (MDD), bipolar depressive episodes and mixed episodes of bipolar disorder (BD). RESULTS: The sample consisted of 259 subjects diagnosed with BD or MDD (DSM-IV-TR). After the onset of symptoms, the first treatment occurred ~6 years and the use of mood stabilizers began ~12 years. All proposed algorithms were effective, with response rates around 80%. The majority of the subjects took 20 weeks to obtain a therapeutic response. CONCLUSIONS: The algorithms were effective with the medications available through the Brazilian Unified Health System. Because therapeutic response was achieved in most subjects by 20 weeks, a follow-up period longer than 12 weeks may be required to confirm adequate response to treatment. Remission of symptoms is still the main desired outcome. Subjects who achieved remission recovered more rapidly and remained more stable over time. CLINICAL TRIAL REGISTRATION: NCT02901249, NCT02870283, NCT02918097

Descriptors: Mood disorders; bipolar; mood disorders; unipolar; clinical drug studies; economic issues; epidemiology


Analysis of suicide mortality in Brazil: spatial distribution and socioeconomic context
Ana P. Dantas; Ulicélia N. de Azevedo; Aryelly D. Nunes; Ana E. Amador; Marilane V. Marques; Isabelle R. Barbosa
Abstract

OBJECTIVE: To perform a spatial analysis of suicide mortality and its correlation with socioeconomic indicators in Brazilian municipalities. METHODS: This is an ecological study with Brazilian municipalities as a unit of analysis. Data on deaths from suicide and contextual variables were analyzed. The spatial distribution, intensity and significance of the clusters were analyzed with the global Moran index, MoranMap and local indicators of spatial association (LISA), seeking to identify patterns through geostatistical analysis. RESULTS: A total of 50,664 deaths from suicide were registered in Brazil between 2010 and 2014. The average suicide mortality rate in Brazil was 5.23/100,000 population. The Brazilian municipalities presenting the highest rates were Taipas do Tocantins, state of Tocantins (79.68 deaths per 100,000 population), Itaporã, state of Mato Grosso do Sul (75.15 deaths per 100,000 population), Mampituba, state of Rio Grande do Sul (52.98 deaths per 100,000 population), Paranhos, state of Mato Grosso do Sul (52.41 deaths per 100,000 population), and Monjolos, state of Minas Gerais (52.08 deaths per 100,000 population). Although weak spatial autocorrelation was observed for suicide mortality (I = 0.2608), there was a formation of clusters in the South. In the bivariate spatial and classical analysis, no correlation was observed between suicide mortality and contextual variables. CONCLUSION: Suicide mortality in Brazil presents a weak spatial correlation and low or no spatial relationship with socioeconomic factors.

Descriptors: Suicide; epidemiology; social and political issues; community mental health; statistics


Amphetamine-type stimulant use and conditional paths of consumption: data from the Second Brazilian National Alcohol and Drugs Survey
Luciana T.S. Massaro; Renata R. Abdalla; Ronaldo Laranjeira; Raul Caetano; Ilana Pinsky; Clarice S. Madruga
Abstract

OBJECTIVE: The aim of this study was to estimate nationally representative prevalence rates of amphetamine-type stimulant (ATS) use and to identify consumption-associated factors, proposing a conditional model of direct and indirect consumption paths. METHOD: Using data from the Second Brazilian National Alcohol and Drugs Survey, this cross-sectional study analyzed a subsample of 3,828 participants between 15 and 64 years old, gathering information on the use of psychoactive substances in a probabilistic sample of the Brazilian household population. RESULTS: Rates of lifetime and last-year ATS use were, respectively, 4.1 and 1.6%. Economically privileged individuals and users of other substances were more at risk for using ATS. The results suggest that higher education decreases the chances of ATS consumption. The conditional model showed that higher income increased ATS use, higher education lowered the odds of such an increase, and cocaine use cancelled that associative effect. CONCLUSION: Brazil presents high rates of ATS use. Prevention and treatment strategies should focus on the protective effect of higher education levels and should target polydrug use. Knowledge of ATS-associated factors and user profiles is the starting point for developing effective treatments and tailored prevention strategies.

Descriptors: Amphetamine-type stimulants; moderation model; epidemiology; prevalence; Brazil


Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting
Camila T. Matsuzaka; Milton L. Wainberg; Andrea Norcini Pala; Elis V. Hoffmann; Bruno M. Coimbra; Rosaly F. Braga; Cristiane S. Duarte; Annika C. Sweetland; Marcelo F. Mello
Abstract

OBJECTIVE: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. METHODS: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). RESULTS: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. CONCLUSION: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Descriptors: Depressive disorder; primary health care; child; caregivers; Brazil


Predictors of length of stay in an acute psychiatric inpatient facility in a general hospital: a prospective study
Fernanda L. Baeza; Neusa S. da Rocha; Marcelo P. Fleck
Abstract

OBJECTIVE: There have been significant reductions in numbers of psychiatric beds and length of stay (LOS) worldwide, making LOS in psychiatric beds an interesting outcome. The objective of this study was to find factors measurable on admission that would predict LOS in the acute psychiatric setting. METHODS: This was a prospective, observational study. RESULTS: Overall, 385 subjects were included. The median LOS was 25 days. In the final model, six variables explained 14.6% of the variation in LOS: not having own income, psychiatric admissions in the preceding 2 years, high Clinical Global Impression and Brief Psychiatric Rating Scale scores, diagnosis of schizophrenia, and history of attempted suicide. All variables were associated with longer LOS, apart from history of attempted suicide. CONCLUSIONS: Identifying patients who will need to stay longer in psychiatric beds remains a challenge. Improving knowledge about determinants of LOS could lead to improvements in the quality of care in hospital psychiatry.

Descriptors: Outcome studies; inpatient psychiatry; chronic psychiatric illness; administration; other delivery issues


Telomere length and hTERT in mania and subsequent remission
Rugül Köse Çinar
Abstract

OBJECTIVE: The findings of telomere length (TL) studies in bipolar disorder (BD) are controversial. The aim of the present study was to detect TL, human telomerase reverse transcriptase (hTERT), and brain derived neurotrophic factor (BDNF) in severe mania and subsequent remission. METHODS: Twenty-one medication-free male patients and 20 age and gender matched controls were recruited. The patients were followed in the inpatient clinic, and comparisons were made between the same patients in their remission state and controls. Patients received lithium plus antipsychotics during the follow-up period. Quantitative real-time polymerase chain reaction was performed to verify leukocyte tL and whole blood hTERT gene expression levels. Serum BDNF levels were verified by enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared to controls, manic patients presented shorter telomeres (p < 0.001) whose length increased with treatment (p = 0.001). Patients in the late stages showed shorter TL than those in the early stages and controls (p < 0.001). hTERT gene expression levels were up-regulated in mania and remission compared to controls (p = 0.03 and p = 0.01, respectively). BDNF changes did not reach statistically significant levels. CONCLUSIONS: TL and hTERT gene expression might reflect a novel aspect of BD pathophysiology and TL might represent a novel biomarker for BD staging.

Descriptors: Bipolar disorder; telomere; TERT protein; human


Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt
Maria C. Rossetti; Adele Tosone; Paolo Stratta; Alberto Collazzoni; Valeria Santarelli; Elisabetta Guadagni; Rodolfo Rossi; Alessandro Rossi
Abstract

OBJECTIVE: Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to depression, interpersonal sensitivity, humiliation, and resilience.
METHODS: One hundred consecutively admitted patients with an index depressive episode were recruited. The Brief Symptom Inventory, Humiliation Inventory, and Resilience Scale for Adult were administered.
RESULTS: Scores for humiliation, interpersonal sensitivity, and depression were higher in subjects with history of suicide attempt, while higher scores for resilience were observed in the group with no such history. Different patterns of relationships among the variables of interest were found in the two groups. Resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with a past suicide attempt.
CONCLUSIONS: Resilience factors can modulate and reduce the impact of suicide risk. Assessing risk and protective factors could enhance the ability to intervene appropriately.

Descriptors: Suicide; humiliation; interpersonal sensitivity; depression; resilience


Indirect self-destructiveness in individuals with schizophrenia
Konstantinos Tsirigotis
Abstract

OBJECTIVE: To explore the indirect self-destructiveness syndrome in patients with schizophrenia.
METHODS: Two hundred individuals with paranoid schizophrenia (117 men and 83 women, mean age 37.15 years), all in remission, were examined using the Polish version of the Chronic Self-Destructiveness Scale. Two hundred well-matched healthy individuals served as a control group.
RESULTS: The intensity of indirect self-destructiveness was greater in the schizophrenia group than in controls. The intensity of each manifestation was as follows (in decreasing order): helplessness and passiveness in the face of difficulties (A5), personal and social neglects (A3), lack of planfulness (A4), poor health maintenance (A2), transgression and risk (A1).
CONCLUSION: Patients with schizophrenia displayed more behaviors that were indirectly self-destructive than healthy controls; they scored better than healthy controls only on caring for their own health. The patients showed the lowest intensity of behaviors connected with the active form of indirect selfdestructiveness, and the highest intensity of behaviors connected with the passive form. These findings may enable delivery of more effective forms of pharmacological and psychosocial help to patients with schizophrenia.

Descriptors: Schizophrenia; indirect self-destructiveness; health maintenance; neglects; planfulness; helplessness


Psychiatric evaluation of civil capacity with the new Brazilian Statute of the Person with Disabilities
Elias Abdalla-Filho
Abstract

The objective of this paper is to provide an update to psychiatrists regarding the new Brazilian Law for the Inclusion of People with Disabilities (BlI, Law 13,146 of 2015), and, specifically, to discuss potential implications of situations in which examination by a forensic psychiatrist points toward civil incompetence, while the above-mentioned law mandates full civil capacity for disabled persons. A study of Law 13,146/2015 was conducted, including a comparative analysis of legal and psychiatric approaches on the subject. This analysis revealed that the BLI has generated differences of opinion among legislators. However, the greatest difference seems to arise between the justice system and psychiatric expertise in relation to the difference of criteria adopted in the two approaches. The BLI is very recent; it should be revised in response to debates among psychiatrists and the criminal justice system, and especially as jurisprudence is formed over time.

Descriptors: Forensic psychiatry; legal interdiction; disability advocacy; discrimination


Empathic skills and theory of mind in female adolescents with conduct disorder
Olber E. Arango Tobón; Antonio Olivera-La Rosa; Viviana Restrepo Tamayo; Isabel C. Puerta Lopera
Abstract

OBJECTIVE: Most studies on conduct disorder (CD) have focused on male adolescents, disregarding analysis of this psychopathology in women. The purpose of this study was to identify differences in empathy and theory of mind (ToM) in a group of adolescent women with CD and a control group.
METHOD: Thirty-six adolescent women were selected from an initial sample of 239 adolescents (CD group = 18, control group = 18). Empathy and ToM were evaluated through objective instruments. Mean comparisons and multivariate analysis were performed to ascertain differences between cases and controls and to propose a prediction model based on clinical status.
RESULTS: Significant differences in empathic abilities and ToM were found between the groups. The model that differentiated both groups was composed of eye-reading ability, perspective taking, and personal distress.
CONCLUSION: These findings are consistent with previous studies. Capacity to take the other's perspective and the recognition of emotions in the face are protective factors against CD in women.

Descriptors: Conduct disorder; empathy; theory of mind; women; callous unemotional traits


Maternal recognition of child mental health problems in two Brazilian cities
Isabel A. Bordin; Bartira M. Curto; Joseph Murray
Abstract

OBJECTIVE: To identify child behaviors and types of impairment that increase the likelihood of maternal recognition of emotional/behavioral problems (EBP) in children and adolescents.
METHODS: Maternal-reported data were obtained from two subsamples of 11-to-16-year-olds derived from cross-sectional studies conducted in two Brazilian municipalities: Itaboraí, state of Rio de Janeiro (n=480), and Embu, state of São Paulo (n=217). The Itaboraí study involved a representative sample of 6-to-16-year-olds (n=1,248; response rate = 86.0%) selected from the Family Health Program registry, which covered 85.5% of the municipal population. The Embu study was based on a probabilistic sample of clusters of eligible households (women aged 15-49 years, child < 18 years), with one mother-child pair selected randomly per household (n=813; response rate = 82.4%). The outcome variable was mother's opinion of whether her child had EBP. Potential correlates included types of child behaviors (hyperactivity/conduct/emotional problems as isolated or combined conditions) and impairment, assessed using the Strengths and Difficulties Questionnaire (SDQ); child's age and gender; maternal education and anxiety/depression (assessed using the Self-Reporting Questionnaire [SRQ]).
RESULTS: Multivariate regression models identified the following correlates of maternal perception of child EBP: comorbidity (co-occurring hyperactivity/conduct/emotional problems), emotional problems alone, and interference of problems with classroom learning and friendships.
CONCLUSION: Comorbidity of different problem types, emotional problems alone, and interference with classroom learning and friendships increase the likelihood of maternal recognition of EBP in children.

Descriptors: Adolescents; child psychiatry; epidemiology; families; community mental health


Depression and psychodynamic psychotherapy
Ângela Ribeiro; João P. Ribeiro; Orlando von Doellinger
Abstract

Depression is a complex condition, and its classical biological/psychosocial distinction is fading. Current guidelines are increasingly advocating psychotherapy as a treatment option. Psychodynamic psychotherapy models encompass a heterogeneous group of interventions derived from early psychoanalytic conceptualizations. Growing literature is raising awareness in the scientific community about the importance of these treatment options, as well as their favorable impact on post-treatment outcomes and relapse prevention. Considering the shifting paradigm regarding treatment of depressive disorder, the authors aim to provide a brief overview of the definition and theoretical basis of psychodynamic psychotherapy, as well as evaluate current evidence for its effectiveness.

Descriptors: Depressive disorder; mood disorders, unipolar; psychotherapy; psychoanalysis and psychodynamic therapies


Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results
Julian Reyes-López; Josefina Ricardo-Garcell; Gabriela Armas-Castañeda; María García-Anaya; Iván Arango-De Montis; Jorge J. González-Olvera; Francisco Pellicer
Abstract

OBJECTIVE: Current treatment of borderline personality disorder (BPD) consists of psychotherapy and pharmacological interventions. However, the use of repetitive transcranial magnetic stimulation (rTMS) could be beneficial to improve some BPD symptoms. The objective of this study was to evaluate clinical improvement in patients with BPD after application of rTMS over the right or left dorsolateral prefrontal cortex (DLPFC).
METHOD: Twenty-nine patients with BPD from the National Institute of Psychiatry, Mexico, were randomized in two groups to receive 15 sessions of rTMS applied over the right (1 Hz, n=15) or left (5 Hz, n=14) DLPFC. Improvement was measured by the Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity Over Time (BEST), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), and Barratt Impulsiveness Scale (BIS).
RESULTS: Intragroup comparison showed significant (p < 0.05) reductions in every psychopathologic domain of the CGI-BPD and in the total scores of all scales in both groups.
CONCLUSIONS: Both protocols produced global improvement in severity and symptoms of BPD, particularly in impulsiveness, affective instability, and anger. Further studies are warranted to explore the therapeutic effect of rTMS in BPD.
CLINICAL TRIAL REGISTRATION: NCT02273674.

Descriptors: Borderline personality disorder; neurophysiology; neurosciences; psychosocial factors


Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q)
Patrícia B. de Abreu; Hugo Cogo-Moreira; Regina A. Pose; Ronaldo Laranjeira; Raul Caetano; Carolina M. Gaya; Clarice S. Madruga
Abstract

OBJECTIVE: To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population.
METHODS: This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use.
RESULTS: The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables).
CONCLUSION: The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.

Descriptors: Brazil; validation; epidemiology; adverse life events assessment


Bipolar disorders: is there an influence of seasonality or photoperiod?
Andrea Aguglia; Antonio Borsotti; Giuseppe Maina
Abstract

OBJECTIVE: To increase understanding of the influence of photoperiod variation in patients with bipolar disorders.
METHODS: We followed a sample of Italian bipolar patients over a period of 24 months, focusing on inpatients. All patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital in Orbassano (Turin, Italy) between September 1, 2013 and August 31, 2015 were recruited. Sociodemographic and clinical data were collected.
RESULTS: Seven hundred and thirty patients were included. The admission rate for bipolar patients was significantly higher during May, June and July, when there was maximum sunlight exposure, although no seasonal pattern was found. Patients with (hypo)manic episodes were admitted more frequently during the spring and during longer photoperiods than those with major depressive episodes.
CONCLUSIONS: Photoperiod is a key element in bipolar disorder, not only as an environmental factor but also as an important clinical parameter that should be considered during treatment.

Descriptors: Bipolar disorder; seasonality; photoperiod; sunlight


Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study
Carolina D. Wiener; Fernanda P. Moreira; Alethea Zago ;Luciano M. Souza; Jeronimo C. Branco; Jacqueline F. de Oliveira; Ricardo A. da Silva; Luis V. Portela; Diogo R. Lara; Karen Jansen; Jean P. Oses
Abstract

OBJECTIVE: To evaluate the prevalence of alcohol abuse and/or dependence in a population-based sample of young adults and assess the prevalence of comorbid mood disorders, anxiety, and suicide risk in this population.
METHODS: This cross-sectional, population-based study enrolled 1,953 young adults aged 18-35 years. The CAGE questionnaire was used to screen for alcohol abuse and/or dependence, with CAGE scores ≥ 2 considered positive. Psychiatric disorders were investigated through the structured Mini International Neuropsychiatric Interview (MINI).
RESULTS: Alcohol abuse and/or dependence was identified in 187 (9.60%) individuals (5.10% among women and 15.20% among men). Alcohol abuse and/or dependence were more prevalent among men than women, as well as among those who used tobacco, illicit drugs or presented with anxiety disorder, mood disorder, and suicide risk.
CONCLUSION: These findings suggest that alcohol abuse and/or dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention programs.

Descriptors: Alcohol abuse and/or dependence; anxiety; mood disorder; depression; suicide risk


Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae
Nasrin Matinnia; Mohammad Haghighi; Leila Jahangard; Faisal B. Ibrahim; Hejar A. Rahman; Ali Ghaleiha; Edith Holsboer-Trachsler; Serge Brand
Abstract

OBJECTIVE: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched.
METHODS: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs.
RESULTS: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support.
CONCLUSIONS: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.

Descriptors: Elective cesarean delivery; vaginal delivery; psychological predictors; Health Belief Model; fear; stress


Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders
Luis Villalobos-Gallegos; Rodrigo Marín-Navarrete; Calos Roncero; Hugo González-Cantú
Abstract

OBJECTIVE: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization.
METHODS: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span.
RESULTS: The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p < 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [χ2[15]] = 30.05, p = 0.012); mild (χ2[1] = 243.90, p < 0.05), mild-moderate (χ2[1] = 198.03, p < 0.05), and moderate (χ2[1] = 526.77, p < 0.05) classes displayed significantly higher treatment utilization.
CONCLUSION: The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

Descriptors: Co-occurring disorders; latent class profile; treatment utilization; psychiatric symptoms


Elevated plasma concentrations of S100 calcium-binding protein B and tumor necrosis factor alpha in children with autism spectrum disorders
Selin Aktan Guloksuz; Osman Abali; Esin Aktas Cetin; Sema Bilgic Gazioglu; Gunnur Deniz; Abdurrahman Yildirim; Ivana Kawikova, Sinan Guloksuz; James F. Leckman
Abstract

OBJECTIVE: To investigate plasma concentrations of S100B (a calcium-binding protein derived primarily from the glia) and inflammatory cytokines in children with autism and the relationship between S100B and cytokine concentrations.
METHODS: Plasma levels of S100B, tumor necrosis factor alpha (TNF-α), interferon gamma, interleukin (IL)-1β, IL-4, IL-6, IL-10, and IL-17A were measured in 40 unmedicated children with autism and 35 normally developing healthy children. The severity of autism was assessed using the Childhood Autism Rating Scale (CARS).
RESULTS: Concentrations of both S100B and TNF-α were higher in children with autism before and after adjusting for a priori-selected confounders (age, sex, and body mass index). S100B concentrations were higher in children with severe autism compared to children with mild-moderate autism. However, this association remained as a trend after adjusting for confounders. S100B concentrations correlated positively with TNF-α concentrations.
CONCLUSION: Our findings showing an increase in peripheral concentrations of S100B and TNF-α provide limited support to the hypothesis about the roles of altered immune function and S100B in autism spectrum disorder (ASD). Studies of larger numbers of well-characterized individuals with ASD are needed to clarify the potential role of the immune system in the pathophysiology of this disorder.

Descriptors: Autism; inflammation; glia; tumor necrosis factor; cytokine; S100B


Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country
Kerryn S. Armstrong; Henk Temmingh
Abstract

OBJECTIVE: The aim of our study was to examine the prevalence of and factors associated with antipsychotic polypharmacy (APP) among patients with serious mental illness in the current South African health care context.
METHODS: We collected data on patient, illness, and treatment characteristics of patients discharged on one or more antipsychotic agents from January to June 2014. We analyzed the associations of APP with demographic and clinical variables using hierarchical multivariable logistic regression, and examined prescription patterns.
RESULTS: The prevalence of APP in our study population of 577 patients was 28.4%. Demographic and clinical characteristics significantly associated with APP included age > 29, male sex, diagnosis of schizophrenia, comorbid intellectual disability, comorbid substance use, greater number of hospital admissions, and high-dose prescribing. First-generation antipsychotics and long-acting injectable preparations were prominent in APP combinations. Co-prescription of anticholinergic agents and sodium valproate demonstrated a significant association with APP.
CONCLUSION: APP appears common in our population, despite lack of evidence for the practice and possible risk of harm. Our findings suggest a complex interplay among patient, illness, and treatment factors relevant to APP in our setting that could be targeted for intervention.

Descriptors: Antipsychotic agents; polypharmacy; mental illness


Catechol-O-methyltransferase (COMT) polymorphisms modulate working memory in individuals with schizophrenia and healthy controls
Camila T. Matsuzaka; Denise Christofolini; Vanessa K. Ota; Ary Gadelha; Arthur A. Berberian; Cristiano Noto; Diego R. Mazzotti; Leticia M. Spindola; Patricia N. Moretti; Marilia A.C. Smith; Maria I. Melaragno; Sintia I. Belangero; Rodrigo A. Bressan
Abstract

OBJECTIVE: Cognitive impairment is a core feature of schizophrenia, related to dopaminergic dysfunction in the prefrontal cortex (PFC). It is hypothesized that functional single nucleotide polymorphism (SNP) rs4680 of the catechol-O-methyltransferase (COMT) gene could mediate the relationship between cognition and dopamine activity in the PFC. Other COMT SNPs could also play a role.
METHODS: We evaluated the role of three COMT SNPs (rs737865, rs165599, and rs4680) in schizophrenia and their impact on three working memory tasks. For genetic association analyses, 212 individuals with schizophrenia and 257 healthy controls (HCs) were selected. The Visual Working Memory (VWM) Task, Keep Track Task, and Letter Memory Task were administered to 133 schizophrenics and 93 HCs.
RESULTS: We found a significant association of rs737865, with the GG genotype exerting a protective effect and the GA haplotype (rs4680/rs165599) exerting a risk effect for schizophrenia. COMT rs4680 AA carriers and rs737865 AA carriers scored lowest on the Keep Track Task. When the genotype*group interaction effect was evaluated, rs165599 exerted opposite effects for VWM and Keep Track task performance in patients and controls, with AA carriers scoring lowest on both tests among controls, but highest among patients.
CONCLUSION: These data support the hypothesis that COMT polymorphisms may be associated with schizophrenia and modulate cognition in patients and controls.

Descriptors: Cognition; dopamine; gene


TBARS and BDNF levels in newborns exposed to crack/cocaine during pregnancy: a comparative study
Victor Mardini; Luis A. Rohde; Keila M. Ceresér; Carolina M. Gubert; Emily G. da Silva; Fernando Xavier; Rodrigo Parcianello; Liane M. Röhsig; Flávio Pechansky; Claudia M. Szobot
Abstract

OBJECTIVES: To compare levels of a marker of lipid peroxidation (thiobarbituric acid reactive substances, TBARS) and brain-derived neurotrophic factor (BDNF) in umbilical cord blood (UCB) between newborns exposed to crack/cocaine in utero (exposed newborns [EN], n=57) and non-exposed newborns (NEN, n=99), as well as in maternal peripheral blood at delivery.
METHODS: This was a cross-sectional study. Potential confounders, including perinatal parameters, psychopathology, and use of other substances, were assessed.
RESULTS: After adjusting for potential confounders, adjusted mean BDNF was significantly higher in EN (3.86 ng/mL, 95% confidence interval [95%CI] 2.29-5.43) than in NEN (0.85 ng/mL, 95%CI 0.47-1.23; p < 0.001; Cohen effect size: 1.12), and significantly lower in crack/cocaine mothers than in control mothers (4.03 ng/mL, 95%CI 2.87-5.18 vs. 6.67 ng/mL, 95%CI 5.60-7.74; p = 0.006). The adjusted mean TbArS level was significantly lower in EN (63.97 µM MDA, 95%CI 39.43-88.50) than NEN (177.04 µM MDA, 95%CI 140.93-213.14; p < 0.001; effect size = 0.84), with no difference between mother groups (p = 0.86).
CONCLUSIONS: The changes in TBARS levels observed in EN suggest that fetuses exposed to cocaine mobilize endogenous antioxidant routes since very early stages of development. The increase in BDNF levels in EN might indicate changes in fetal development, whereas the changes in BDNF levels in mothers provide evidence of the complex metabolic processes involved in drug use during pregnancy.

Descriptors: TBARS; BDNF; pregnancy; crack/cocaine; umbilical cord blood; newborn


Kraepelin's views on obsessive neurosis: a comparison with DSM-5 criteria for obsessive-compulsive disorder
Holger Steinberg; Dirk Carius; Leonardo F. Fontenelle
Abstract

Emil Kraepelin (1856-1926) is considered one of the founders of modern psychiatric nosology. However, his conceptualization of obsessive-compulsive phenomena is relatively understudied. In this article, we compare and contrast excerpts from the eighth edition (1909-1915) of Kraepelin's Textbook of Clinical Psychiatry focusing on what Kraepelin called ''obsessive neurosis'' and related ''original pathological conditions'' with the current DSM-5 criteria for obsessive-compulsive disorder (OCD). Consistently with DSM-5 OCD, Kraepelin described obsessive neurosis as characterized by obsessive ideas, compulsive acts, or both together. His detailed descriptions of these symptoms are broadly coherent with their characterization in DSM-5, which is also true for the differential diagnoses he provided. He also mentioned cases illustrating decreased insight into symptoms and association with tic disorders. In conclusion, Kraepelin's experience, which reflects decades of consistent clinical work, may help validate current ideas and explain how the current conceptualization has emerged and developed. Even though one can hardly say that the classification laid out in DSM-5 goes back to Kraepelin's views directly, it still is true that Kraepelin played an outstanding role in systematizing psychiatric diagnostic criteria in general, and provided a major contribution to the conceptual history of OCD.

Descriptors: History of psychiatry; obsessive-compulsive disorder; diagnosis and classification; neurosis; Tourette's disorder


Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs
Laura R. Magni; Clarissa Ferrari; Giuseppe Rossi; Elena Staffieri; Aldo Uberti; Dario Lamonaca; Ileana Boggian; Silvia Merlin; Giuseppe Primerano; Alessandra Mombrini; Roberto Poli; Francesco M. Saviotti; Maria T. Caldera; Luciana Zanotti; Roberta Rossi
Abstract

OBJECTIVE: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables.
METHOD: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months.
RESULTS: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI.
CONCLUSION: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

Descriptors: Antipsychotic; cognitive-behavioral therapy; obesity; weight gain


Increased affective empathy in bipolar patients during a manic episode
Anna Bodnar; Janusz K. Rybakowski
Abstract

OBJECTIVE: To assess both cognitive and affective empathy in patients with bipolar disorder (BD) during an acute manic or depressive episode.
METHODS: The study included 25 patients with BD (aged 35±14 years) during an acute manic episode, 25 bipolar patients (aged 41±14 years) during a depressive episode, and 25 healthy control subjects (aged 36±11 years). Cognitive and affective empathy were assessed using the Multifaceted Empathy Test.
RESULTS: In both manic and depressive patients, a significant deficit in cognitive empathy was demonstrated. However, indices of affective empathy were significantly higher in the manic group than in depressed and control subjects. In the depressed patients, indices did not differ from those of healthy controls. For affective empathy, a significant positive correlation was found with intensity of manic symptoms and a negative correlation was found with intensity of depressive symptoms. No such correlations were observed with cognitive empathy.
CONCLUSION: We found evidence of increased affective empathy (overempathizing) during a manic episode in bipolar patients. This phenomenon may be connected with disturbances in emotion inhibition related to anastrophic thinking and associated with increased activity of mirror neurons, all of which occur during a manic episode.

Descriptors: Mood disorders, bipolar; cognitive neuroscience; emotion; tests/interviews, psychometric; models/theories of psychiatry


Association between body image dissatisfaction and depressive symptoms in adolescents
Fiorela Flores-Cornejo; Mayumi Kamego-Tome; Mariana A. Zapata-Pachas; German F. Alvarado
Abstract

OBJECTIVE: To determine the association between body image dissatisfaction (BID) and depressive symptoms in adolescents from a school in Lima, Peru.
METHODS: A cross-sectional study was performed through a census of 875 high-school students, aged 13 to 17 years, from a school in Lima. Participants completed a survey containing the Body Shape Questionnaire (BSQ) and the Patient Health Questionnaire-9 (PHQ-9). Data regarding demographics, alcohol and tobacco use, self-esteem, and family history of depression were also obtained. To identify associated factors, Poisson regression with robust variance was used. Prevalence ratios with 95% confidence intervals were calculated.
RESULTS: Of the 875 adolescents, 55.8% were male. The mean age was 14.1±1.5 years. Depressive symptoms were observed in 19.9% of participants. An association between BID and depressive symptoms was found. Alcohol and tobacco use were also associated with the outcome of interest.
CONCLUSIONS: Teens who had BID were 3.7 times more likely to report depressive symptoms. Additionally, those who used tobacco or alcohol were 1.5 and 1.4 times more likely to have depressive symptoms, respectively. Further studies targeting other populations and using longitudinal designs are recommended.

Descriptors: Adolescents; body image; depression


Association between dietary patterns and mental disorders in pregnant women in Southern Brazil
Jéssica T.A. Paskulin; Michele Drehmer; Maria T. Olinto; Juliana F. Hoffmann; Andréa P. Pinheiro; Maria I. Schmidt; Maria A. Nunes
Abstract

OBJECTIVE: To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil.
METHODS: Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants' mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR).
RESULTS: In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%C11.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93).
CONCLUSIONS: Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy.

Descriptors: Dietary patterns; food patterns; food intake; pregnancy; mental health


Association of weight control behaviors with body mass index and weight-based self-evaluation
Sabrina Chapuis-de-Andrade; Rafael M. de Araujo; Diogo R. Lara
Abstract

OBJECTIVE: To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation.
METHODS: Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years).
RESULTS: The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-30 times higher risk of inducing vomiting.
CONCLUSION: The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Descriptors: Weight perception; body weight; weight loss; body mass index; self-concept


Chronic dosing with mirtazapine does not produce sedation in rats
Alberto Salazar-Juárez; Susana Barbosa-Méndez; Paola Merino-Reyes; Maura Matus-Ortega; Jorge A. Hernández-Calderón; Benito Antón
Abstract

OBJECTIVE: Sedation/somnolence are major side effects of pharmacotherapies for depression, and negatively affect long-term treatment compliance in depressed patients. Use of mirtazapine (MIR), an atypical antidepressant approved for the treatment of moderate to severe depression with comorbid anxiety disorders, is associated with significant sedation/somnolence, especially in short-term therapy. Nonetheless, studies with human subjects suggest that MIR-induced sedation is transient, especially when high and repeated doses are used. The purpose of this study was to explore the effects of acute and chronic administration of different doses of MIR on sedation in the rat.
METHODS: Assessment of sedation was carried out behaviorally using the rotarod, spontaneous locomotor activity, and fixed-bar tests.
RESULTS: A 15-mg/kg dose of MIR induced sedative effects for up to 60 minutes, whereas 30 mg/kg or more produced sedation within minutes and only in the first few days of administration.
CONCLUSION: These results suggest that 30 mg/kg is a safe, well-tolerated dose of MIR which generates only temporary sedative effects.

Descriptors: Mirtazapine; sedation; depression; dosing schedules; pharmacotherapy; antidepressant


Psychiatric event in multiple sclerosis: could it be the tip of the iceberg?
Moussa A. Chalah; Samar S. Ayache
Abstract

Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system. Psychiatric comorbidities are highly prevalent in patients with MS, and can have drastic impact on quality of life and interpersonal relationships. Despite this high prevalence, whether psychiatric manifestations may represent the first signs of MS is still debatable. This constitutes an important issue, since early diagnosis of ''psychiatric-onset MS'' would result in prompt management, which usually ameliorates long-term prognosis. Here, we discuss clinical and radiological hints that suggest a diagnosis of psychiatric-onset MS. Briefly, this entity should be considered in healthy patients presenting with late-onset psychiatric symptoms, with or without cognitive decline, and with negative family history of psychiatric diseases. A thorough neurological exam is crucial to detect any subtle neurological signs. Brain magnetic resonance imaging is recommended to rule out frontotemporal lesions that might explain the clinical picture. Poor response to standard psychiatric treatments provides additional evidence for the diagnosis of an organic disease (e.g., MS). Combining psychopharmaceuticals with intravenous corticosteroids would result in good outcomes, but patients should be monitored carefully for possible psychiatric exacerbation, a common side effect of steroids.

Descriptors: Psychiatric relapse; multiple sclerosis; mood; depression; mania; psychosis


Biting myself so I don't bite the dust: prevalence and predictors of deliberate self-harm and suicide ideation in Azorean youths
Célia Barreto Carvalho; Carolina da Motta; Marina Sousa; Joana Cabral
Abstract

OBJECTIVE: To characterize non-suicidal self-injury (NSSI) behaviors, methods, and functions as well as suicide ideation in the adolescent population of a Portuguese community in São Miguel Island, Azores. Increasing rates of NSSI behaviors among adolescents have been observed globally, while suicidal behavior has been pointed as a major cause of death during adolescence.
METHODS: A sample of 1,763 adolescents, aged 14 to 22, was randomly drawn from public and private schools and administered a set of self-report questionnaires. Descriptive and regression analyses were used to look for specific relationships and predictors of NSSI and suicide ideation in this isolated community.
RESULTS: Approximately 30% of youths reported at least one NSSI behavior, a rate that is twice as high as most studies carried out in mainland Portugal and in other European countries. Biting oneself was the most frequent form of NSSI, and NSSI behaviors served predominantly automatic reinforcement purposes (i.e., regulation of disruptive emotional states). NSSI and suicide ideation encompassed different distal and proximal risk factors.
CONCLUSIONS: Exploring and characterizing these phenomena is necessary to provide a better understanding, enhance current conceptualizations, and guide the development of more effective prevention and intervention strategies in youths.

Descriptors: Non-suicidal self-injury; suicide ideation; adolescence; risk-behaviors; impulsivity


The relationship between moderate-to-vigorous physical activity and executive function among individuals with schizophrenia: differences by illness duration
Viviane Grassmann; Mehala Subramaniapillai; Mark Duncan; Kelly Arbour-Nicitopoulos; Guy E. Faulkner
Abstract

OBJECTIVE: Schizophrenia is a chronic mental illness characterized by positive and negative symptoms. Cognitive impairment continues to be a core and consistent deficit. Previous studies have shown that physical activity (PA) is positively associated with cognitive performance. Thus, it may play a supportive role in mitigating cognitive impairments among individuals with schizophrenia. The aim of this study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and executive function among adults with schizophrenia.
METHODS: The weekly amount of MVPA (assessed using accelerometers) and executive function (as per Brief Neurocognitive Assessment for Schizophrenia) of 78 adults with schizophrenia (mean [SD] age 42.4 [11.4] years; illness duration 17.0 [11.0] years; 58.2% male) were assessed in this cross-sectional study. Pearson correlations were calculated, followed by a linear regression. Participants were first analyzed together and then dichotomized on the basis of illness duration.
RESULTS: There was no significant association between MVPA and executive function, independent of the duration of illness. For individuals with < 15 years of illness, there was a significant association between weekly MVPA and working memory performance.
CONCLUSION: PA appears to be associated with executive function in some, but not all, individuals with schizophrenia.

Descriptors: Accelerometry; executive function; physical activity; schizophrenia


''I love you forever (more or less)'' - stability and change in adolescents' romantic love status and associations with mood states
Hafez Bajoghli; Vahid Farnia; Narges Joshaghani; Mohammad Haghighi; Leila Jahangard; Mohammad Ahmadpanah; Dena Sadeghi Bahmani; Edith Holsboer-Trachsler; Serge Brand
Abstract

OBJECTIVE: Experiencing romantic love is an important part of individual development. Here, we investigated stability and change in romantic love and psychological correlates, including mood states, anxiety, and sleep, among Iranian adolescents over a period of 8 months.
METHOD: Two hundred and one adolescents who had taken part in a previous study were contacted; 157 responded. Participants completed a questionnaire covering sociodemographic data, current state of love, and mood, including symptoms of depression, anxiety (state and trait), and hypomania. They also completed a sleep and activity log.
RESULTS: Of 64 participants formerly in love, 45 were still in love; of 86 participants not in love at baseline, 69 were still not in love (overall stability, 76%); 17 had fallen in love recently while 19 were no longer in love. Significant and important changes in mood and anxiety were observed in that experiencing romantic love was associated with higher anxiety scores. Hypomania scores increased in those newly in love, and decreased in those in a longer-lasting romantic relationship. Sleep and sleep-related variables were not associated with romantic love status.
CONCLUSION: These findings suggest that, among Iranian adolescents, the state of love is fairly stable, and that love status seems to be associated with specific states of mood and anxiety.

Descriptors: Adolescents; romantic love; stability; change; state anxiety; hypomania; sleep


Suicide and meteorological factors in São Paulo, Brazil, 1996-2011: a time series analysis
Daniel H. Bando; Chei T. Teng; Fernando M. Volpe; Eduardo de Masi; Luiz A. Pereira Alfésio L. Braga
Abstract

OBJECTIVE: Considering the scarcity of reports from intertropical latitudes and the Southern Hemisphere, we aimed to examine the association between meteorological factors and suicide in São Paulo.
METHOD: WEEKLy suicide records stratified by sex were gathered. Weekly averages for minimum, mean, and maximum temperature (oC), insolation (hours), irradiation (MJ/m2), relative humidity (%), atmospheric pressure (mmHg), and rainfall (mm) were computed. The time structures of explanatory variables were modeled by polynomial distributed lag applied to the generalized additive model. The model controlled for long-term trends and selected meteorological factors.
RESULTS: The total number of suicides was 6,600 (5,073 for men), an average of 6.7 suicides per week (8.7 for men and 2.0 for women). For overall suicides and among men, effects were predominantly acute and statistically significant only at lag 0. Weekly average minimum temperature had the greatest effect on suicide; there was a 2.28% increase (95%CI 0.90-3.69) in total suicides and a 2.37% increase (95%CI 0.82-3.96) among male suicides with each 1 oC increase.
CONCLUSION: This study suggests that an increase in weekly average minimum temperature has a short-term effect on suicide in São Paulo.

Descriptors: Suicide; meteorological factors; São Paulo; time series; epidemiology


Trypophobia: an investigation of clinical features
Michelle Vlok-Barnard; Dan J. Stein
Abstract

OBJECTIVE: Trypophobia refers to the fear of, or aversion to, clusters of holes. We assessed clinical features of trypophobia and investigated whether it most resembled a specific phobia or obsessive-compulsive disorder.
METHODS: An online survey was conducted to gather information on sociodemographic variables, course and duration, severity, associated features, comorbid psychiatric diagnoses, and levels of psychological distress and impairment in individuals with trypophobia. The survey also explored whether such individuals experienced more fear or disgust, and whether symptoms showed more resemblance to a specific phobia or to obsessive-compulsive disorder. Associations of symptom severity and duration with degree of impairment were investigated.
RESULTS: One hundred and ninety-five individuals completed the questionnaire. Symptoms were chronic and persistent. The most common associated comorbidities were major depressive disorder and generalized anxiety disorder. Trypophobia was associated with significant psychological distress and impairment. The majority of individuals experienced disgust rather than fear when confronted with clusters of holes, but were more likely to meet DSM-5 criteria for specific phobia than for obsessive-compulsive disorder. Symptom severity and duration were associated with functional impairment.
CONCLUSIONS: Given that individuals with trypophobia suffer clinically significant morbidity and comorbidity, this condition deserves further attention from clinicians and researchers.

Descriptors: Trypophobia; specific phobia; obsessive-compulsive disorder; internet survey