portuguese | english Revista Brasileira de Psiquiatria ISSN print 1516-4446
ISSN on-line 1809-452X
JCR IF 2016: 2.049
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Current issue 2, Volume 39 - Apr/May/Jun/2017


1 - What can BDNF genotype tell us about our memory?
Breno S. Diniz
Pages: 87 - 87


2 - Staging in bipolar disorder: one step closer to precision psychiatry
Brisa S. Fernandes; Michael Berk
Pages: 88 - 89


3 - The brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism affects memory performance in older adults
Lucas A. de Azeredo; Tatiana De Nardi; Mateus L. Levandowski; Saulo G. Tractenberg; Julia Kommers-Molina; Andrea Wieck; Tatiana Q. Irigaray; Irênio G. da Silva Filho; Rodrigo Grassi-Oliveira
Pages: 90 - 94

OBJECTIVE: Memory impairment is an important contributor to the reduction in quality of life experienced by older adults, and genetic risk factors seem to contribute to variance in age-related cognitive decline. Brain-derived neurotrophic factor (BDNF) is an important nerve growth factor linked with development and neural plasticity. The Val66Met polymorphism in the BDNF gene has been associated with impaired episodic memory in adults, but whether this functional variant plays a role in cognitive aging remains unclear. The purpose of this study was to investigate the effects of the BDNF Val66Met polymorphism on memory performance in a sample of elderly adults. METHODS: Eighty-seven subjects aged > 55 years were recruited using a community-based convenience sampling strategy in Porto Alegre, Brazil. The logical memory subset of the Wechsler Memory Scale-Revised was used to assess immediate verbal recall (IVR), delayed verbal recall (DVR), and memory retention rate. RESULTS: BDNF Met allele carriers had lower DVR scores (p = 0.004) and a decline in memory retention (p = 0.017) when compared to Val/Val homozygotes. However, we found no significant differences in IVR between the two groups (p = 0.088). CONCLUSION: These results support the hypothesis of the BDNF Val66Met polymorphism as a risk factor associated with cognitive impairment, corroborating previous findings in young and older adults.

Descriptors: Aging; brain-derived neurotrophic factor; cognition; memory; polymorphism

4 - Associations of cerebrovascular metabolism genotypes with neuropsychiatric symptoms and age at onset of Alzheimer's disease dementia
Fabricio F. de Oliveira; Elizabeth S. Chen; Marilia C. Smith; Paulo H. Bertolucci
Pages: 95 - 103

OBJECTIVE: To study associations of cerebrovascular metabolism genotypes and haplotypes with age at Alzheimer's disease dementia (AD) onset and with neuropsychiatric symptoms according to each dementia stage. METHODS: Consecutive outpatients with late-onset AD were assessed for age at dementia onset and Neuropsychiatric Inventory scores according to Clinical Dementia Rating scores, apolipoprotein E gene (APOE) haplotypes, angiotensin-converting enzyme gene (ACE) variants rs1800764 and rs4291, low-density lipoprotein cholesterol receptor gene (LDLR) variants rs11669576 and rs5930, cholesteryl ester transfer protein gene (CETP) variants I422V and TaqlB, and liver X receptor beta gene (NR1H2) polymorphism rs2695121. RESULTS: Considering 201 patients, only APOE-ε4 carriers had earlier dementia onset in multiple correlations, as well as less apathy, more delusions, and more aberrant motor behavior. Both ACE polymorphisms were associated with less intense frontally mediated behaviors. Regarding LDLR variants, carriers of the A allele of rs11669576 had less anxiety and more aberrant motor behavior, whereas carriers of the A allele of rs5930 had less delusions, less anxiety, more apathy, and more irritability. CETP variants that included G alleles of I422V and TaqlB were mostly associated with less intense frontally mediated behaviors, while severely impaired carriers of the T allele of rs2695121 had more anxiety and more aberrant motor behavior. CONCLUSION: Though only APOE haplotypes affected AD onset, cerebrovascular metabolism genotypes were associated with differences in several neuropsychiatric manifestations of AD.

Descriptors: Alzheimer disease; dementia; cerebrovascular disorders; genetics; neuropsychiatry

5 - The rs11191580 variant of the NT5C2 gene is associated with schizophrenia and symptom severity in a South Chinese Han population: evidence from GWAS
Zhen Li; Juan Jiang; Jianxiong Long; Weijun Ling; Guifeng Huang; Xiaojing Guo; Li Su
Pages: 104 - 109

OBJECTIVE: Recent genome-wide association studies have identified a significant relationship between the NT5C2 variant rs11191580 and schizophrenia (SCZ) in European populations. This study aimed to validate the association of rs11191580 polymorphism with SCZ risk in a South Chinese Han population. The relationship of this polymorphism with the severity of SCZ clinical symptoms was also explored. METHODS: A case-control study was performed in 462 patients with SCZ and 598 healthy controls. rs11191580 was genotyped by the Sequenom MassARRAY iPLEX platform. A total of 459 SCZ patients completed the Positive and Negative Syndrome Scale (PANSS) evaluation. Data were analyzed by PLINK software. RESULTS: We confirmed an association of the rs11191580 polymorphism with SCZ risk in South Chinese Han under a dominant genetic model (ORadj = 0.769; 95%CIadj = 0.600-0.984; padj = 0.037). PANSS scores showed a significant association between variant rs11191580 and total score (padj = 0.032), lack of response scale score (padj = 0.022), and negative scale score (additive: padj = 0.004; dominant: padj = 0.016; recessive: padj = 0.021) after data were adjusted for age and sex. CONCLUSION: NT5C2 variant rs11191580 conferred susceptibility to SCZ and affected the clinical symptoms of SCZ in a South Chinese Han population.

Descriptors: Schizophrenia; susceptibility; clinical symptom; rs11191580; GWAS-supported genetic variant

6 - Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks
Kornanong Yuenyongchaiwat; Ian S. Baker; David Sheffield
Pages: 110 - 117

OBJECTIVE: Anxiety and depression have been linked to blunted blood pressure (BP) and heart rate (HR) reactions to mental stress tests; however, most studies have not included indices of underlying hemodynamics nor multiple stress tasks. This study sought to examine the relationships of anxiety and depression with hemodynamic responses to acute active and passive coping tasks. METHODS: A total of 104 participants completed the Hospital Anxiety and Depression Scales and mental arithmetic, speech, and cold pressor tasks while BP, HR, total peripheral resistance, and cardiac output (CO) were assessed. RESULTS: After adjustment for traditional risk factors and baseline cardiovascular activity, depression scores were negatively associated with systolic BP, HR, and CO responses to the mental arithmetic task, while anxiety scores were inversely related to the systolic BP response to mental arithmetic. CONCLUSION: High anxiety or depression scores appear to be associated with blunted cardiac reactions to mental arithmetic (an active coping task), but not to the cold pressor test or speech tasks. Future research should further examine potential mechanisms and longitudinal pathways relating depression and anxiety to cardiovascular reactivity. CLINICAL TRIAL REGISTRATION NUMBER: TCTR20160208004

Descriptors: Cardiovascular reactivity; active coping; passive coping; anxiety; depression; mental stress test

7 - Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias
Paola P. Laporte; Pedro M. Pan; Mauricio S. Hoffmann; Lauren S. Wakschlag; Luis A. Rohde; Euripedes C. Miguel; Daniel S. Pine; Gisele G. Manfro; Giovanni A. Salum
Pages: 118 - 125

OBJECTIVE: To distinguish normative fears from problematic fears and phobias. METHODS: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. RESULTS: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. CONCLUSION: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears.

Descriptors: Developmental psychopathology; child/adolescent; phobia/phobic disorders; anxiety/anxiety disorders; specific/social fears

8 - How to tell a happy from an unhappy schizotype: personality factors and mental health outcomes in individuals with psychotic experiences
Letícia O. Alminhana; Miguel Farias; Gordon Claridge; Claude R. Cloninger; Alexander Moreira-Almeida
Pages: 126 - 132

OBJECTIVE: It is unclear why some individuals reporting psychotic experiences have balanced lives while others go on to develop mental health problems. The objective of this study was to test if the personality traits of harm avoidance, self-directedness, and self-transcendence can be used as criteria to differentiate healthy from unhealthy schizotypal individuals. METHODS: We interviewed 115 participants who reported a high frequency of psychotic experiences. The instruments used were the Temperament and Character Inventory (140), Structured Clinical Interview for DSM-IV, and the Oxford-Liverpool Inventory of Feelings and Experiences. RESULTS: Harm avoidance predicted cognitive disorganization (β = 0.319; t = 2.94), while novelty seeking predicted bipolar disorder (β = 0.136, Exp [β] = 1.146) and impulsive non-conformity (β = 0.322; t = 3.55). Self-directedness predicted an overall decrease in schizotypy, most of all in cognitive disorganization (β = -0.356; t = -2.95) and in impulsive non-conformity (β = -0.313; t = -2.83). Finally, self-transcendence predicted unusual experiences (β = 0.256; t = 2.32). CONCLUSION: Personality features are important criteria to distinguish between pathology and mental health in individuals presenting high levels of anomalous experiences (AEs). While self-directedness is a protective factor, both harm avoidance and novelty seeking were predictors of negative mental health outcomes. We suggest that the impact of AEs on mental health is moderated by personality factors.

Descriptors: Diagnosis and classification; outpatient psychiatry; personality disorders - cluster A (paranoid-schizoid-schizotypal); psychosis; religion

9 - Suicide attempts in bipolar I patients: impact of comorbid personality disorders
Severino Bezerra-Filho; Amanda Galvão-de-Almeida; Paula Studart; Davi F. Martins Jr.; André C. Caribé; Paulo A. Schwingel; Ângela Miranda-Scippa
Pages: 133 - 139

OBJECTIVE: To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD). METHODS: One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics. RESULTS: History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis. CONCLUSIONS: Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.

Descriptors: Mood disorders; bipolar; personality disorders; suicide

10 - Validation of the Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST) and association of PSST scores with health-related quality of life
Rachel de A. Câmara; Cristiano A. Köhler; Benicio N. Frey; Thomas N. Hyphantis; André F. Carvalho
Pages: 140 - 146

OBJECTIVE: To develop and validate a Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST), a questionnaire used for the screening of premenstrual syndrome (PMS) and of the most severe form of PMS, premenstrual dysphoric disorder (PMDD). The PSST also rates the impact of premenstrual symptoms on daily activities. METHODS: A consecutive sample of 801 women aged ≥ 18 years completed the study protocol. The internal consistency, test-retest reliability, and content validity of the Brazilian PSST were determined. The independent association of a positive screen for PMS or PMDD and quality of life determined by the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-Bref) was also assessed. RESULTS: Of 801 participants, 132 (16.5%) had a positive screening for PMDD. The Brazilian PSST had adequate internal consistency (Cronbach's alpha = 0.91) and test-retest reliability. The PSST also had adequate convergent/discriminant validity, without redundancy. Content validity ratio and content validity index were 0.61 and 0.94 respectively. Finally, a positive screen for PMS/PMDD was associated with worse WHOQOL-Bref scores. CONCLUSIONS: These findings suggest that PSST is a reliable and valid instrument to screen for PMS/PMDD in Brazilian women.

Descriptors: premenstrual dysphoric disorder; mood disorders; quality of life; premenstrual symptoms screening tool; psychiatry

11 - An evolutionary approach to mania studying Sardinian immigrants to Argentina
Mauro G. Carta; Alessandra Perra; Michela Atzeni; Silvia D'Oca; Maria F. Moro; Peter K. Kurotschka; Daniela Moro; Federica Sancassiani; Luigi Minerba; Maria V. Brasesco; Gustavo Mausel; Antonio E. Nardi; Leonardo Tondo
Pages: 147 - 153

OBJECTIVE: To ascertain lifetime prevalence of positivity to a screening questionnaire for bipolar disorders (BD) in Sardinian immigrants to Argentina and residents of Sardinia and assess whether such positivity affects quality of life (QoL) in either group. Our hypothesis is that screen positivity for BD may be more frequent in immigrants. METHODS: Observational study. Subjects were randomly selected from the membership lists of associations of Sardinian immigrants in Argentina. A study carried out in Sardinia using the same methodology was used for comparison. The Mood Disorder Questionnaire was used to screen for mania/hypomania and the Short-Form Health Survey-12 to measure QoL. RESULTS: A higher prevalence of manic/hypomanic episodes was found in Sardinian immigrants to Argentina (p < 0.0001; odds ratio = 3.0, 95% confidence interval 1.87-4.77). Positivity at screening was associated with a lower QoL both in Sardinian immigrants to Argentina and in residents of Sardinia. CONCLUSIONS: To the best of our knowledge, this is the first study to show a higher lifetime prevalence of manic/hypomanic episodes in a general-population sample of individuals who migrated to a foreign country. Our results are in agreement with the hypothesis that hyperactive/novelty-seeking features may represent an adaptive substrate in certain conditions of social change.

Descriptors: Epidemiology; mood disorders, bipolar; models/theories of psychiatry; social and political issues

12 - Postpartum depression: bipolar or unipolar? Analysis of 434 Polish postpartum women
Rafał R. Jaeschke; Dominika Dudek; Roman Topór-Mądry; Katarzyna Drozdowicz; Wojciech Datka; Marcin Siwek; Janusz Rybakowski
Pages: 154 - 159

OBJECTIVE: To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology. METHODS: Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features. RESULTS: Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics. CONCLUSION: Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.

Descriptors: Postpartum depression; bipolarity; personality; EPDS; MDQ

13 - The role of the CNR1 gene in schizophrenia: a systematic review including unpublished data
Eduardo S. Gouvêa; Airton F. Santos Filho; Vanessa K. Ota; Vinicius Mrad; Ary Gadelha; Rodrigo A. Bressan; Quirino Cordeiro; Sintia I. Belangero
Pages: 160 - 171

OBJECTIVE: Schizophrenia is a multifactorial disorder. It is known that a combination of extensive multiple common alleles may be involved in its etiology, each contributing with a small to moderate effect, and, possibly, some rare alleles with a much larger effect size. We aimed to perform a systematic review of association studies between schizophrenia (and its subphenotypes) and polymorphisms in the CNR1 gene, which encodes cannabinoid receptors classically implicated in schizophrenia pathophysiology, as well as to present unpublished results of an association study in a Brazilian population. METHODS: Two reviewers independently searched for eligible studies and extracted outcome data using a structured form. Papers were retrieved from PubMed and ISI Web of Knowledge using the search term schizophrenia in combination with CNR1 or CB1 or cannabinoid receptor. Twenty-four articles met our inclusion criteria. We additionally present data from a study of our own comparing 182 patients with schizophrenia and 244 healthy controls. RESULTS: No consistent evidence is demonstrated. CONCLUSION: Some seemingly positive association studies stress the need for further investigations of the possible role of endocannabinoid genetics in schizophrenia.

Descriptors: Cannabinoid receptors; cannabinoid receptors type-1; gene; association studies

14 - A systematic review of the neural correlates of positive emotions
Leonardo Machado; Amaury Cantilino
Pages: 172 - 179

OBJECTIVE: To conduct a systematic literature review of human studies reporting neural correlates of positive emotions. METHODS: The PubMed and Web of Science databases were searched in January 2016 for scientific papers written in English. No restrictions were placed on year of publication. RESULTS: Twenty-two articles were identified and 12 met the established criteria. Five had been published during the last 4 years. Formation and regulation of positive emotions, including happiness, are associated with significant reductions in activity in the right prefrontal cortex and bilaterally in the temporoparietal cortex, as well as with increased activity in the left prefrontal regions. They are also associated with increased activity in the cingulate gyrus, inferior and middle temporal gyri, amygdalae, and ventral striatum. CONCLUSION: It is too early to claim that there is an established understanding of the neuroscience of positive emotions and happiness. However, despite overlap in the brain regions involved in the formation and regulation of positive and negative emotions, we can conclude that positive emotions such as happiness activate specific brain regions.

Descriptors: Emotions; happiness; electroencephalography; neuroimaging

15 - Frequency of brain tissue donation for research after suicide
Vanessa K. Longaray; Carolina S. Padoan; Pedro D. Goi; Rodrigo C. da Fonseca; Daniel C. Vieira; Francine H. de Oliveira; Flávio Kapczinski; Pedro V. Magalhães
Pages: 180 - 182

OBJECTIVES: To describe the frequency of brain tissue donation for research purposes by families of individuals that committed suicide. METHODS: All requests for brain tissue donation to a brain biorepository made to the families of individuals aged 18-60 years who had committed suicide between March 2014 and February 2016 were included. Cases presenting with brain damage due to acute trauma were excluded. RESULTS: Fifty-six cases of suicide were reported. Of these, 24 fulfilled the exclusion criteria, and 11 others were excluded because no next of kin was found to provide informed consent. Of the 21 remaining cases, brain tissue donation was authorized in nine (tissue fragments in seven and the entire organ in two). CONCLUSIONS: Donation of brain tissue from suicide cases for research purposes is feasible. The acceptance rate of 42.8% in our sample is in accordance with international data on such donations, and similar to rates reported for neurodegenerative diseases.

Descriptors: Suicide; ethics; community mental health; molecular biology; neuroanatomy

16 - Chronotype and anxiety are associated in patients with chronic primary insomnia
Giselle S. Passos; Marcos G. Santana; Dalva Poyares; Carolina V. D'Aurea; Alexandre A. Teixeira; Sergio Tufik; Marco T. de Mello
Pages: 183 - 186

OBJECTIVE: To assess the interaction of chronotype with anxiety in patients with chronic primary insomnia. METHODS: Sixty-four patients (50 women) with mean age 43.9±8.1 years were investigated with the Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) and State-Trait Anxiety Inventory (STAI). RESULTS: Significant negative correlations of chronotype-MEQ score with STAI state-anxiety (r = -0.40, p < 0.05), STAI trait-anxiety (r = -0.40, p < 0.05), and STAI pre-sleep state anxiety (r = -0.30, p < 0.05) were observed. Eveningness preference was associated with higher trait, state, and pre-sleep state anxiety. CONCLUSIONS: These results suggest that chronotype may be an important parameter to identifying the origin and significance of a vicious anxiety-insomnia-depression cycle in patients with chronic primary insomnia.

Descriptors: Chronotype; insomnia; anxiety; eveningness; State-Trait Anxiety Inventory

17 - A case of bleach addiction associated with severe obsessive-compulsive disorder
Raphael Doukhan; Luc Mallet; Antoine Pelissolo
Pages: 187 - 188


18 - S-(+)-ketamine-induced dissociative symptoms as a traumatic experience in patients with treatment-resistant depression
Fernanda S. Correia-Melo; Samantha S. Silva; Lucas Araújo-de-Freitas; Lucas C. Quarantini
Pages: 188 - 189


19 - An index to examine the sexual HIV risk of psychiatric service users based on sexual partners
Andrea Norcini Pala; Karen McKinnon; Melanie M. Wall; Francine Cournos; Mark D. Guimaraes; Milton L. Wainberg
Pages: 189 - 190


20 - Current inpatient prescription practices for the treatment of schizophrenia in public hospitals of Minas Gerais, Brazil
Fernando M. Volpe; André S. Santos; Laíse S. Rodrigues; Raíza R. Rocha; Patrícia G. de Magalhães; Cristina M. Ruas
Pages: 190 - 192