portuguese | english Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
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Current issue 4, Volume 36 - Oct/Nov/Dec/2014


1 - Lack of association between the 5-HTTLPR and positive screening for mental disorders among children exposed to urban violence and maltreatment
Giuliana C. Cividanes; Andrea F. Mello; Juliana M. Sallum; Victor Fossaluza; Marcio de Medeiros; Mariana R. Maciel; Luciana P. Cavalcante-Nóbrega; Jair J. Mari; Marcelo F. Mello; Nina L. Valente
Pages: 277 - 284

OBJECTIVE: To ascertain whether genetic variations in the serotonin transporter gene (5-HTTLPR 44-bp insertion/deletion polymorphism) influence an increase in depressive and anxiety symptoms in children and adolescents exposed to high levels of violence.
METHODS: Saliva samples were collected from a group of children who were working on the streets and from their siblings who did not work on the streets. DNA was extracted from the saliva samples and analyzed for 5-HTTLPR polymorphism genotypes.
RESULTS: One hundred and seventy-seven children between the ages of 7 and 14 years were analyzed (114 child workers and 63 siblings). Data on socioeconomic conditions, mental symptoms, and presence and severity of maltreatment and urban violence were collected using a sociodemographic inventory and clinical instruments. There was no positive correlation between the 5-HTTLPR polymorphism and presence of mental symptoms in our sample, although the children were exposed to high levels of abuse, neglect, and urban violence.
CONCLUSIONS: Despite previous studies that associated adult psychiatric disorders with the 5-HTTLPR polymorphism and a history of childhood maltreatment, no such association was found in this sample of children at risk.

Descriptors: Serotonin transporter polymorphism; child maltreatment; child labor; street children

2 - The joint structure of major depression, anxiety disorders, and trait negative affect
Hudson W. de Carvalho; Sérgio B. Andreoli; Diogo R. Lara; Christopher J. Patrick; Maria I. Quintana; Rodrigo A. Bressan; Marcelo F. Mello; Jair J. Mari; Miguel R. Jorge
Pages: 285 - 292

OBJECTIVE: Dimensional models of psychopathology demonstrate that two correlated factors of fear and distress account for the covariation among depressive and anxiety disorders. Nevertheless, these models tend to exclude variables relevant to psychopathology, such as temperament traits. This study examined the joint structure of DSM-IV-based major depression and anxiety disorders along with trait negative affect in a representative sample of adult individuals residing in the cities of São Paulo and Rio de Janeiro, Brazil.
METHODS: The sample consisted of 3,728 individuals who were administered sections D (phobic, anxiety and panic disorders) and E (depressive disorders) of the Composite International Diagnostic Interview (CIDI) 2.1 and a validated version of the Positive and Negative Affect Schedule. Data were analyzed using correlational and structural equation modeling.
RESULTS: Lifetime prevalence ranged from 2.4% for panic disorder to 23.2% for major depression. Most target variables were moderately correlated. A two-factor model specifying correlated fear and distress factors was retained and confirmed for models including only diagnostic variables and diagnostic variables along with trait negative affect.
CONCLUSIONS: This study provides support for characterization of internalizing psychopathology and trait negative affect in terms of correlated dimensions of distress and fear. These results have potential implications for psychiatric taxonomy and for understanding the relationship between temperament and psychopathology.

Descriptors: Diagnosis and classification; emotion; epidemiology; unipolar mood disorders; generalized anxiety disorder

3 - Oxidative stress markers, cognitive functions, and psychosocial functioning in bipolar disorder: an empirical cross-sectional study
Ömer Aydemir; Zeynep Çubukçuoğlu; Soner Erdin; Cumhur Taş; Ece Onur; Michael Berk
Pages: 293 - 297

OBJECTIVE: This study aimed to evaluate the relationship between oxidative stress markers and cognitive functions and domains of psychosocial functioning in bipolar disorder.
METHODS: Oxidative stress markers, cognitive functions, and domains of psychosocial functioning were evaluated in 51 patients with bipolar disorder who were in remission. Correlation analyses between these parameters were calculated with data controlled for duration of illness and number of episodes.
RESULTS: There was no statistically significant correlation between oxidative stress markers and cognitive functions. In terms of psychosocial functioning, significant correlations were found between malondialdehyde and sense of stigmatization (r = -0.502); household activities and superoxide dismutase (r = 0.501); participation in social activities and nitric oxide (r = 0.414); hobbies and leisure time activities and total glutathione (r = -0.567), superoxide dismutase (r = 0.667), and neurotrophin 4 (r = 0.450); and taking initiative and self-sufficiency and superoxide dismutase (r = 0.597). There was no correlation between other domains of psychosocial functioning and oxidative stress markers.
CONCLUSION: These results imply that oxidative stress markers do not appear to correlate clearly with cognitive impairment and reduced psychosocial functioning. However, there were some associations between selected oxidative markers and activity-oriented functional markers. This may represent a true negative association, or may be an artifact of oxidative stress being a state rather than a trait marker.

Descriptors: Bipolar disorder; biomarkers; neurocognition; psychosocial functioning; oxidative stress

4 - Anxiety disorders are associated with quality of life impairment in patients with insulin-dependent type 2 diabetes: a case-control study
Maria Augusta B. dos Santos; Luciane B. Ceretta; Gislaine Z. Réus; Helena M. Abelaira; Luciano K. Jornada; Mágada T. Schwalm; Morgana V. Neotti; Cristiane D. Tomazzi; Karina G. Gulbis; Renan A. Ceretta; João Quevedo
Pages: 298 - 304

OBJECTIVE: To assess the presence of anxiety disorders and quality of life in patients with insulin-dependent type 2 diabetes.
METHODS: Case-control study of 996 patients with type 2 diabetes and 2,145 individuals without diabetes. The sole inclusion criterion for the case group was insulin-dependent type 2 diabetes. We compared the case and control groups for sociodemographic variables, laboratory and clinical data, and presence of anxiety disorders. Quality of life was evaluated using the WHOQOL-BREF instrument, and the prevalence of anxiety disorder was evaluated by the Mini International Neuropsychiatric Interview (MINI).
RESULTS: Patients with diabetes had a higher prevalence of generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder. The presence of these disorders in combination with type 2 diabetes was associated with worse quality of life in the physical, social, psychological, and environmental domains.
CONCLUSIONS: This study demonstrates the importance of diagnosing and treating anxiety disorders in patients with diabetes, so as to prevent more serious complications associated with these comorbidities.

Descriptors: Anxiety disorders; quality of life; diabetes; comorbidities

5 - Internalizing disorders and quality of life in adolescence: evidence for independent associations
Giovanni A. Salum; Diogo A. DeSousa; Vera L. Bosa; Ilaine Schuch; Marcelo Goldani; Luciano R. Isolan; Stefania P. Teche; Marcelo P. Fleck; Luis A. Rohde; Gisele G. Manfro
Pages: 305 - 312

OBJECTIVE: To investigate whether internalizing disorders are associated with quality of life (QoL) in adolescents, even after accounting for shared risk factors.
METHODS: The sample comprised 102 adolescents from a community cross-sectional study with an oversampling of anxious subjects. Risk factors previously associated with QoL were assessed and divided into five blocks organized hierarchically from proximal to distal sets of risk factors.
RESULTS: Multiple regression analysis yielded a hierarchical model accounting for 72% of QoL variance. All blocks were consistently associated with QoL (p < 0.05), accounting for the following percentages of variance: 12% for demographics; 5.2% for family environment; 37.8% for stressful events; 10% for nutritional and health habits; and 64.2% for dimensional psychopathological symptoms or 22.8% for psychiatric diagnoses (dichotomous). Although most of the QoL variance attributed to internalizing symptoms was explained by the four proximal blocks in the hierarchical model (43.2%), about 21% of the variance was independently associated with internalizing symptoms/diagnoses.
CONCLUSIONS: QoL is associated with several aspects of adolescent life that were largely predicted by our hierarchical model. Our findings reinforce the hypothesis that internalizing disorders and internalizing symptoms in adolescents have a high impact on QoL and deserve proper clinical attention.

Descriptors: Quality of life; anxiety; depression; adolescents

6 - ADHD inattentive symptoms mediate the relationship between intelligence and academic performance in children aged 6-14
Danielle de S. Costa; Jonas J. de Paula; Antônio M. Alvim-Soares Júnior; Breno S. Diniz; Marco A. Romano-Silva; Leandro F. Malloy-Diniz; Débora M. de Miranda
Pages: 313 - 321

OBJECTIVE: Fluid intelligence and the behavioral problems of attention-deficit/hyperactivity disorder (ADHD) are related to academic performance, but how this association occurs is unclear. This study aimed to assess mediation and moderation models that test possible pathways of influence between these factors.
METHODS: Sixty-two children with ADHD and 33 age-matched, typically developing students were evaluated with Raven's Colored Progressive Matrices and the spelling and arithmetic subtests of the Brazilian School Achievement Test. Dimensional ADHD symptomatology was reported by parents.
RESULTS: Our findings suggest that fluid intelligence has a significant impact on academic tests through inattention. The inattentive dimension was the principal behavioral source of influence, also accounting for the association of hyperactive-impulsive manifestations with school achievement. This cognitive-to-behavioral influence path seems to be independent of diagnosis related group, and gender, but lower socioeconomic status might increase its strength.
CONCLUSION: Fluid intelligence is a relevant factor in the influence of ADHD behavioral symptoms on academic performance, but its impact is indirect. Therefore, early identification of both fluid intelligence and inattentive symptoms is of the utmost importance to prevent impaired academic performance and future difficulties in functioning.

Descriptors: Academic performance; attention-deficit/hyperactivity disorder; inattention; intelligence; mediation

7 - Environmental enrichment restores cognitive deficits induced by experimental childhood meningitis
Tatiana Barichello; Glauco D. Fagundes; Jaqueline S. Generoso; Caroline S. Dagostin; Lutiana R. Simões; Márcia C. Vilela; Clarissa M. Comim; Fabricia Petronilho; João Quevedo; Antonio L. Teixeira
Pages: 322 - 329

OBJECTIVE: To evaluate the influence of environmental enrichment (EE) on memory, cytokines, and brain-derived neurotrophic factor (BDNF) in the brain of adult rats subjected to experimental pneumococcal meningitis during infancy.
METHODS: On postnatal day 11, the animals received either artificial cerebrospinal fluid (CSF) or Streptococcus pneumoniae suspension intracisternally at 1 × 106 CFU/mL and remained with their mothers until age 21 days. Animals were divided into the following groups: control, control + EE, meningitis, and meningitis + EE. EE began at 21 days and continued until 60 days of age (adulthood). EE consisted of a large cage with three floors, ramps, running wheels, and objects of different shapes and textures. At 60 days, animals were randomized and subjected to habituation to the open-field task and the step-down inhibitory avoidance task. After the tasks, the hippocampus and CSF were isolated for analysis.
RESULTS: The meningitis group showed no difference in performance between training and test sessions of the open-field task, suggesting habituation memory impairment; in the meningitis + EE group, performance was significantly different, showing preservation of habituation memory. In the step-down inhibitory avoidance task, there were no differences in behavior between training and test sessions in the meningitis group, showing aversive memory impairment; conversely, differences were observed in the meningitis + EE group, demonstrating aversive memory preservation. In the two meningitis groups, IL-4, IL-10, and BDNF levels were increased in the hippocampus, and BDNF levels in the CSF.
CONCLUSIONS: The data presented suggest that EE, a non-invasive therapy, enables recovery from memory deficits caused by neonatal meningitis.

Descriptors: Pneumococcal meningitis; environmental enrichment; cytokines; BDNF

8 - Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A)
Jair B. Barbosa Neto; Anne Germain; Patrícia F. Mattos; Paula M. Serafim; Roberta C. M. Santos; Larissa C. Martini; Deborah Suchecki; Marcelo F. Mello
Pages: 330 - 335

OBJECTIVE: Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD.
METHODS: PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event.
RESULTS: The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQIA-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD.
CONCLUSION: The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings.

Descriptors: Sleep; posttraumatic stress disorder; tests/interviews, psychometric; stress; dreams

9 - Factor structure of the Positive and Negative Syndrome Scale (PANSS) in Brazil: convergent validation of the Brazilian version
Cinthia H. Higuchi; Bruno Ortiz; Arthur A. Berberian; Cristiano Noto; Quirino Cordeiro; Sintia I. Belangero; Jose C. Pitta; Ary Gadelha; Rodrigo A. Bressan
Pages: 336 - 339

OBJECTIVES: The Positive and Negative Syndrome Scale (PANSS) was developed to assess the symptoms of schizophrenia dimensionally. Although it is widely used in clinical trials in Brazil, it is not fully validated. The aim of this study is to assess the factor structure of the Brazilian PANSS and generate validation data for its current version.
METHODS: A total of 292 patients diagnosed with schizophrenia were enrolled.
RESULTS: Principal component analysis suggested a forced five-factor final model that accounted for 58.44% of the total variance, composed of negative, disorganization/cognition, excitement, positive, and depression/anxiety.
CONCLUSION: The Brazilian PANSS has a similar factor structure and internal consistency compared to versions in several other languages.

Descriptors: Schizophrenia; factor analysis; psychometrics

10 - Decreased plasma neurotrophin-4/5 levels in bipolar disorder patients in mania
Izabela G. Barbosa; Isabela B. Morato; Rodrigo B. Huguet; Fabio L. Rocha; Rodrigo Machado-Vieira; Antônio L. Teixeira
Pages: 340 - 343

OBJECTIVE: To evaluate two poorly explored neurotrophins (NT), NT-3 and NT-4/5, in bipolar disorder (BD).
METHODS: Forty patients with type I BD (18 in remission and 22 in mania) and 25 healthy controls matched for age, gender, and educational attainment were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview; the Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to evaluate severity of symptoms in BD patients. Plasma levels of NT-3 and NT-4/5 were measured by enzyme-linked immunosorbent assay (ELISA).
RESULTS: BD patients in mania presented decreased NT-4/5 plasma levels in comparison with controls (p < 0.05). There were no significant differences in NT-3 plasma levels between BD patients and controls.
CONCLUSION: These findings corroborate the view that neurotrophin dysfunction is associated with mood states in patients with BD.

Descriptors: Neurotrophin; mania; depression; bipolar disorder; biomarker

11 - The link between cardiovascular risk, Alzheimer's disease, and mild cognitive impairment: support from recent functional neuroimaging studies
Luiz K. Ferreira; Jaqueline H. Tamashiro-Duran; Paula Squarzoni; Fabio L. Duran; Tania C. Alves; Carlos A. Buchpiguel; Geraldo F. Busatto
Pages: 344 - 357

OBJECTIVE: To review functional neuroimaging studies about the relationship between cardiovascular risk factors (CVRFs), Alzheimer's disease (AD), and mild cognitive impairment (MCI).
METHODS: We performed a comprehensive literature search to identify articles in the neuroimaging field addressing CVRF in AD and MCI. We included studies that used positron emission tomography (PET), single photon emission computerized tomography (SPECT), or functional magnetic resonance imaging (fMRI).
RESULTS: CVRFs have been considered risk factors for cognitive decline, MCI, and AD. Patterns of AD-like changes in brain function have been found in association with several CVRFs (both regarding individual risk factors and also composite CVRF measures). In vivo assessment of AD-related pathology with amyloid imaging techniques provided further evidence linking CVRFs and AD, but there is still limited information resulting from this new technology.
CONCLUSION: There is a large body of evidence from functional neuroimaging studies supporting the hypothesis that CVRFs may play a causal role in the pathophysiology of AD. A major limitation of most studies is their cross-sectional design; future longitudinal studies using multiple imaging modalities are expected to better document changes in CVRF-related brain function patterns and provide a clearer picture of the complex relationship between aging, CVRFs, and AD.

Descriptors: PET; SPECT; fMRI; Alzheimer's disease; cardiovascular risk factors

12 - A fatal case of ischemic colitis during clozapine administration
Trino Baptista
Pages: 358 - 358


14 - Still on religiosity and alcohol use
Olukayode Abayomi
Pages: 360 - 361