portuguese | english Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
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Current issue 2, Volume 36 - Apr/May/Jun/2014


1 - Comorbid psychiatric disorders and stages of change in cannabis-dependent, treatment-seeking patients
Hercilio P. Oliveira; Andre Malbergier
Pages: 101 - 105

OBJECTIVES: To determine whether and to what extent cannabis dependence is associated with comorbid psychiatric disorders and specific stages of change in treatment-seeking patients.
METHODS: We evaluated 80 cannabis-dependent, treatment-seeking patients residing in an urban area. Data on cannabis dependence, psychiatric disorders, and motivation were obtained using the Schedules for Clinical Assessment in Neuropsychiatry and the University of Rhode Island Change Assessment (URICA).
RESULTS: A diagnosis of schizophrenia was found to correlate with lower motivation scores (p = 0.038), which could have a negative effect on adherence to treatment.
CONCLUSION: The high prevalence of concurrent psychiatric disorders in cannabis-dependent patients should serve as a stimulus for early screening and treatment of such disorders. Health care professionals should be aware of the magnitude of this association to increase the level of motivation in cannabis-dependent patients with severe concurrent psychiatric disorders.

Descriptors: Psychoactive substance use disorder; psychosocial aspects of drug treatment; outpatient psychiatry; mood disorders/unipolar; psychosis

2 - Use of psychotropic medications during pregnancy: perception of teratogenic risk among physicians in two Latin American countries
Amaury Cantilino; Laura Lorenzo; Juliane dos A. de Paula; Adrienne Einarson
Pages: 106 - 110

OBJECTIVE: Pregnant women and their health care professionals commonly believe that use of medications during pregnancy may be harmful to the unborn fetus. The objective of this study was to evaluate the risk perception of psychotropic drug use in pregnancy among physicians in different medical specialties.
METHOD: This was a convenience survey conducted at outpatient clinics in the cities of Recife, Brazil, and La Plata, Bahía Blanca, and Buenos Aires, Argentina. Physicians who agreed to participate were asked to rate their perception of teratogenic risk among different classes of drugs, which included antidepressants, antipsychotics, anticonvulsants, and benzodiazepines.
RESULTS: Two hundred and thirty-eight physicians completed the survey (response rate, 98%). These included psychiatrists, obstetricians, neurologists, cardiologists, gastroenterologists, and general practitioners. Among different specialties, a minority of psychiatrists perceived psychotropic drugs to be highly teratogenic (antidepressants, 12.5%; antipsychotics, 15%; benzodiazepines, 25%) as compared with other specialties (p < 0.003 for each drug class). There was no difference in perceived risk of antiepileptic drugs among specialties, including psychiatrists.
CONCLUSION: The risk associated with use of psychotropic drugs in pregnancy was overestimated by physicians of all medical specialties, except psychiatry. All physicians should be aware of the safety/risk of psychotropic agents in pregnancy, as they may be required to give advice and/or prescribe these drugs to pregnant women.

Descriptors: Perception; psychotropic drugs; pregnancy; teratogens

3 - Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study
Analise de Souza Vivan; Lidiane Rodrigues; Guilherme Wendt; Mônica Giaretton Bicca; Daniela Tusi Braga; Aristides Volpato Cordioli
Pages: 111 - 118

OBJECTIVE: To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender.
METHOD: Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring > 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version K-SADS-PL).
RESULTS: The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3±3.8) and symmetry (85.3%; 5.9±3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006).
CONCLUSION: OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD.

Descriptors: Obsessive-compulsive disorder; obsessive-compulsive symptoms; adolescents; epidemiology; gender

4 - Delusional disorder: no gender differences in age at onset, suicidal ideation, or suicidal behavior
Alexandre González-Rodríguez; Oriol Molina-Andreu; Víctor Navarro; Cristóbal Gastó; Rafael Penadés; Rosa Catalán
Pages: 119 - 124

OBJECTIVE: To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD).
METHOD: We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates.
RESULTS: Seventy-six percent of the patients were women. The average age at onset was 48.76±12.67 years, mean age at first psychiatric consultation was 54.13±13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up.
CONCLUSION: Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders.

Descriptors: Delusional disorder; paranoia; gender; compliance; suicidal behavior

5 - Alexithymia, suicidal ideation, and serum lipid levels among drug-naïve outpatients with obsessive-compulsive disorder
Domenico De Berardis; Nicola Serroni; Stefano Marini; Gabriella Rapini; Alessandro Carano; Alessandro Valchera; Felice Iasevoli; Monica Mazza; Maria Signorelli; Eugenio Aguglia; Giampaolo Perna; Giovanni Martinotti; Paola A. Varasano; Gabriella Lucidi Pressanti; Massimo Di Giannantonio
Pages: 125 - 130

OBJECTIVE: As obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder with a significant suicide risk, the individuation of potential biomarkers of suicidality, such as cholesterol levels, may enable recognition of at-risk subjects. Therefore, the aims of this study were to: 1) evaluate potential differences in clinical and laboratory parameters between patients with and without alexithymia and compare them with healthy controls; and 2) investigate which clinical and laboratory variables were associated with suicidal ideation.
METHOD: 79 drug-naïve adult outpatients with a DSM-IV diagnosis of OCD were recruited. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), suicidal ideation was assessed with the Scale for Suicide Ideation, and depressive symptoms were evaluated with the Montgomery-Åsberg Depression Rating Scale (MADRS). Serum lipid levels of 40 healthy controls were also evaluated.
RESULTS: Alexithymic patients had altered serum lipid levels in comparison with non-alexithymics and healthy controls. Using a linear regression model, the presence of symmetry/ordering obsessions and compulsions, lower HDL-C levels, and difficulty in identifying feelings dimension of the TAS-20 were associated with higher suicidal ideation.
CONCLUSION: Alexithymic individuals with OCD may exhibit dysregulation of the cholesterol balance, which in turn may be linked to suicidal ideation. Further prospective studies are required to elucidate this potential association.

Descriptors: Alexithymia; obsessive-compulsive disorder; suicide ideation; serum lipid levels; drugnaïve

6 - Suicide risk and alcohol and drug abuse in outpatients with HIV infection and Chagas disease
Patrícia M. Guimarães; Sonia R. Passos; Guilherme A. Calvet; Yara H. Hökerberg; José L. Lessa; Carlos A. de Andrade
Pages: 131 - 137

OBJECTIVE: To evaluate psychiatric comorbidities in outpatients receiving care for HIV and Chagas disease at Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
METHOD: Cross-sectional study with a consecutive sample of 125 patients referred to an outpatient psychiatric clinic from February to December 2010. The Mini International Neuropsychiatric Interview (MINI) was used. Factors associated with more frequent mental disorders were estimated by odds ratios (OR) with 95% confidence intervals (95%CI) by multiple logistic regression.
RESULTS: Seventy-six (60.8%) patients with HIV, 40 (32%) patients with Chagas disease, and nine (7.2%) patients with human T-lymphotropic virus were interviewed. The majority were women (64%), with up to 8 years of formal education (56%), and unemployed (81.6%). The median age was 49 years. Suicide risk (n=71) (56%), agoraphobia (n=65) (52%), major depressive episode (n=56) (44.8%), and alcohol/drug abuse (n=43) (34.4%) predominated, the latter being directly associated with lower family income (OR = 2.64; 95%CI 1.03-6.75) and HIV infection (OR = 5.24; 95%CI 1.56-17.61). Suicide risk was associated with non-white skin color (OR = 2.21; 95%CI 1.03-4.75), unemployment (OR = 2.72; 95%CI 1.01-7.34), and diagnosis of major depression (OR = 3.34; 95%CI 1.54-7.44).
CONCLUSION: Measures targeting adverse socioeconomic conditions and psychiatric and psychological monitoring and care should be encouraged in this population, considering the association with abuse of alcohol/other psychoactive drugs and suicide risk.

Descriptors: Mental disorder; infectious disease; suicide; HIV; Chagas disease

7 - Evaluation of Na+, K+-ATPase activity in the brain of young rats after acute administration of fenproporex
Gislaine T. Rezin; Giselli Scaini; Cinara L. Gonçalves; Gabriela K. Ferreira; Mariane R. Cardoso; Andréa G. K. Ferreira; Maira J. Cunha; Felipe Schmitz; Roger B. Varela; João Quevedo; Angela T. S. Wyse; Emilio L. Streck
Pages: 138 - 142

OBJECTIVE: Fenproporex is an amphetamine-based anorectic which is rapidly converted into amphetamine in vivo. Na+, K+-ATPase is a membrane-bound enzyme necessary to maintain neuronal excitability. Considering that the effects of fenproporex on brain metabolism are poorly known and that Na+, K+-ATPase is essential for normal brain function, this study sought to evaluate the effect of this drug on Na+, K+-ATPase activity in the hippocampus, hypothalamus, prefrontal cortex, and striatum of young rats.
METHOD: Young male Wistar rats received a single injection of fenproporex (6.25, 12.5, or 25 mg/kg intraperitoneally) or polysorbate 80 (control group). Two hours after the last injection, the rats were killed by decapitation and the brain was removed for evaluation of Na+, K+-ATPase activity.
RESULTS: Fenproporex decreased Na+, K+-ATPase activity in the striatum of young rats at doses of 6.25, 12.5, and 25 mg/kg and increased enzyme activity in the hypothalamus at the same doses. Na+, K+-ATPase activity was not affected in the hippocampus or prefrontal cortex.
CONCLUSION: Fenproporex administration decreased Na+, K+-ATPase activity in the striatum even in low doses. However, in the hypothalamus, Na+, K+-ATPase activity was increased. Changes in this enzyme might be the result of the effects of fenproporex on neuronal excitability.

Descriptors: Na+, K+-ATPase activity; brain; fenproporex

8 - Development, validity, and reliability of the General Activities of Daily Living Scale: a multidimensional measure of activities of daily living for older people
Jonas J. de Paula; Laiss Bertola; Rafaela T. de Ávila; Luciana de O. Assis; Maicon Albuquerque; Maria A. Bicalho; Edgar N. de Moraes; Rodrigo Nicolato; Leandro F. Malloy-Diniz
Pages: 143 - 152

OBJECTIVE: To propose and evaluate the psychometric properties of a multidimensional measure of activities of daily living (ADLs) based on the Katz and Lawton indices for Alzheimer's disease (AD) and mild cognitive impairment (MCI).
METHOD: In this study, 85 patients with MCI and 93 with AD, stratified by age (< 74 years, > 74 years), completed the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale, and their caregivers completed scales for ADLs. Construct validity (factor analysis), reliability (internal consistency), and criterion-related validity (receiver operating characteristic analysis and logistic regression) were assessed.
Results: Three factors of ADL (self-care, domestic activities, and complex activities) were identified and used for item reorganization and for the creation of a new inventory, called the General Activities of Daily Living Scale (GADL). The components showed good internal consistency (> 0.800) and moderate (younger participants) or high (older participants) accuracy for the distinction between MCI and AD. An additive effect was found between the GADL complex ADLs and global ADLs with the MMSE for the correct classification of younger patients.
CONCLUSION: The GADL showed evidence of validity and reliability for the Brazilian elderly population. It may also play an important role in the differential diagnosis of MCI and AD.

Descriptors: Activities of daily living; older people; Alzheimer's disease; mild cognitive impairment; functional assessment; psychometric properties

9 - Homicide and Klinefelter syndrome: a complex interaction
Stéphane Richard-Devantoy; Fabrice Jollant; Anne-Isabelle Bouyer-Richard; Jean-Paul Lhuillier; Philip Gorwood
Pages: 153 - 155

INTRODUCTION: Several studies have shown an association between homicide and sexual chromosomal abnormalities, but data are still lacking regarding Klinefelter syndrome.
METHOD: We retrospectively reviewed two cases of homicide perpetrators who were both diagnosed with Klinefelter syndrome on the basis of a karyotype analysis. A neurocognitive assessment was also performed (MMSE, Frontal Assessment Battery, brain CT, and electroencephalogram).
RESULTS: Numerous intermediate risk factors of homicide were shared by our two cases, including dispositional (male gender, young age, low socioeconomic status), historical (prior arrest record and past conviction for any offense), contextual (unemployment), and clinical (alcohol abuse).
CONCLUSION: It is important that clinicians go beyond obvious risk factors, such as chromosomal abnormalities, to pinpoint other meaningful risk factors and potentially facilitate preventive approaches.

Descriptors: Homicide; Klinefelter syndrome; risk factors; chromosomal abnormalities

10 - Mitochondria and the central nervous system: searching for a pathophysiological basis of psychiatric disorders
Emilio L. Streck; Cinara L. Gonçalves, Camila B. Furlanetto; Giselli Scaini; Felipe Dal-Pizzol; João Quevedo
Pages: 156 - 167

INTRODUCTION: Mitochondrial dysfunction has been postulated to participate in the development of many neuropsychiatric disorders, but there is no consensus as to its role. The aim of this paper is to review recent studies and to outline the current understanding of the association between mitochondrial dysfunction and psychiatric disorders.
METHODOLOGY: We reviewed articles that evaluated mitochondrial dysfunction and psychiatric disorders, with a particular focus on depression, bipolar disorder, anxiety disorders, obsessive-compulsive disorder, and autism spectrum disorder, and the association between mitochondrial dysfunction and development of these disorders.
RESULTS: Evidence suggests that alterations in mitochondrial morphology, brain energy metabolism, and mitochondrial enzyme activity may be involved in the pathophysiology of different neuropsychiatric disorders, given their key role in energy metabolism in the cell.
CONCLUSIONS: Understanding the interactions between mitochondrial dysfunction and development of psychiatric disorders may help establish more effective therapeutic strategies for these disorders and thus lead to better outcomes for affected subjects.

Descriptors: Mitochondria; central nervous system; neuroplasticity; cell death

11 - Systematic review of N-acetylcysteine in the treatment of addictions
Elson Asevedo; Ana C. Mendes; Michael Berk; Elisa Brietzke
Pages: 168 - 175

OBJECTIVE: To conduct the first systematic literature review of clinical trials of N-acetylcysteine (NAC) for the treatment of substance abuse disorders and addictive behaviors.
METHODS: A search of the MEDLINE, Embase and PsycINFO databases was conducted. The inclusion criteria for the review were clinical trials that used NAC in the treatment of a disorder related to substance use and/or addictive behaviors, limited to texts in English, Spanish, or French. The selected studies were evaluated with respect to type of trial, sample size, diagnostic input, intervention, length of follow-up, outcome variables, and results.
RESULTS: Nine studies analyzing a total of 165 patients met the eligibility criteria and were included in qualitative analysis. These studies evaluated the role of NAC in cocaine dependence (three studies), cannabis dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled.
CONCLUSIONS: The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and cannabis dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction.

Descriptors: Drug dependence; addictive behaviors; N-acetylcysteine; glutamatergic receptors; smoking

12 - Clinical implications of spirituality to mental health: review of evidence and practical guidelines
Alexander Moreira-Almeida; Harold G. Koenig; Giancarlo Lucchetti
Pages: 176 - 182

OBJECTIVE: Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment.
METHODS: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice.
RESULTS: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility.
CONCLUSIONS: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.

Descriptors: Spirituality; religion and psychology; practice guidelines; spiritual therapies; diagnosis

13 - Serotonin-norepinephrine reuptake inhibitor desvenlafaxine for the treatment of interferon alfa-associated depression in patients with hepatitis C
Bruno Fábregas; Alexandre Moura; Renata Ávila; Ricardo Carmo; Antônio Lúcio Teixeira
Pages: 183 - 183


14 - Major depression caused by Wilson's disease
Lucas Araújo-de-Freitas; Marlos Rocha; Vania Gondim; Lucas Quarantini; Angela Miranda-Scippa
Pages: 184 - 184


15 - Is insight really necessary for diagnosis of Charles Bonnet syndrome? A case report
Lucas G. Romano; Maria C. Ristum; Marcos H. Chagas
Pages: 184 - 185