Secular trends in suicidal ideation and associated factors among adolescents

Objectives:

Suicide is one of the leading causes of death in adolescence, and the second most common cause of death among young people. The objective of this study was to identify trends in suicidal ideation by sex and ascertain factors associated with this outcome.

Methods:

Secular trend study with statewide coverage conducted at 5-year intervals, with 4,207 adolescents (2006), 6,264 adolescents (2011) and 6,026 adolescents (2016). Logistic regression was used to evaluate the secular trend of suicidal ideation. Multilevel logistic regressions evaluated the factors associated with suicidal ideation in the survey conducted in 2016.

Results:

There was a positive trend in suicidal ideation prevalence in 2016 compared to the prevalence in 2006 and 2011, in both boys and girls. Low social support, poor sleep quality, and low parental supervision were associated with suicidal ideation in boys and girls. Exposure to violence and bullying was associated with suicidal ideation only in girls. TV time and computer and videogame time were not associated with suicidal ideation in boys or girls.

Conclusion:

There is an alarming trend of increased suicidal ideation in adolescents. Several dimensions were associated with suicidal ideation in adolescents, especially social support, sleep quality, and parental supervision.

An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: a multicentre study

OBJECTIVE

In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD.

METHODS

This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown obsessive-compulsive scale, as well as with the Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI).

RESULTS

We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR=1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001).

CONCLUSION

Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels.

AD8-Brazil: cross-cultural validation of the ascertaining dementia interview in Portuguese

Dementia is a global public health problem and detection in the primary care setting, particularly in developing countries, is challenging. The aim of this research was to produce the cross-cultural validation of the AD8 interview to the Brazilian Portuguese Language. The original version of the AD8 was submitted to translation, back-translation, and application of the questionnaire to 20 elderly informants for face validation. The AD8-Brazil was then evaluated in 109 community-dwelling elderly with a sociodemographic questionnaire, clinical examination, Mini Mental State Examination (MMSE), Katz Inventory of Activities of Daily Living (ADL), and Clinical Dementia Rating scale (CDR). The AD8-Brazil was compared with the other instruments and with the clinical diagnosis (DSM-IV) for criterion validation. There was significant agreement of AD8-Brazil with diagnosis of dementia (p < 0.001), MMSE (p = 0.047), and ADL (PFisher = 0.004). Also, the AD8-Brazil was able to differentiate the stages of dementia by CDR scale. The reliability was high (alpha = 0.818) and reproducibility analysis showed excellent inter-rater (kappa = 0.889) and test-retest consistency (kappa = 0.814). The AD8-Brazil showed excellent discrimination between CDR 0 and CDR > 0 (area under the curve 86.1%) and between CDR 0 and CDR 0.5 (area under the curve 76.9%). The administration of the questionnaire took 2.3 ± 0.1 minutes. The Brazilian version of the AD8 is a valid, reliable, quick, and easy screening instrument for dementia.

Cognitive dysfunction in post-traumatic obsessive-compulsive disorder

OBJECTIVE

To investigate whether patients who develop obsessive-compulsive disorder (OCD) after posttraumatic stress disorder, i.e. post-traumatic OCD (PsT-OCD), display a distinctive neurocognitive pattern of dysfunction.

METHODS

Patients with PsT-OCD (n = 16), pre-traumatic OCD (PrT-OCD) (n = 18), non-traumatic OCD (NonT-OCD) (n = 67) and healthy controls (n = 17) had their performance compared on the following neuropsychological tests: the Wisconsin Card Sorting Test, the Iowa Gambling Task, the Wechsler Memory Scale Logical Memory, the Brief Visual Memory Test - Revised, and the Wechsler Abbreviated Scale for Intelligence.

RESULTS

Patients with OCD, as a group, were characterized by poor set-shifting abilities and impaired verbal and visuospatial memories. Impaired set-shifting abilities were found to correlate with the severity of obsessive-compulsive symptoms in all groups of patients with OCD, with the exception of PsT-OCD. Only patients with PsT-OCD were characterized by impaired visuospatial recognition, which was found to correlate with poor set-shifting abilities in this particular group of patients, but not in individuals with other types of OCD or in healthy controls.

CONCLUSIONS

Our study suggests that PsT-OCD is associated with a distinctive pattern of neurocognitive dysfunction, thus providing support for a different subtype of OCD.

[Changes the sexual quality of life of the obeses submitted Fobi-Capella gastroplasty surgery]

OBJECTIVES

Examine changes in the quality of sexual life of men with morbid obesity offered by a reduction in body weight following Fobi-Capella gastroplasty.

METHOD

A quantitative, prospective, longitudinal, cross-sectional study was carried out on 21 men with morbid obesity between March 2005 and March 2007. Inclusion criteria were: aged 20 to 50 years, body mass index (BMI) = 40 kg/m(2) and failure in attempts of clinical treatment for obesity in the previous two years. Data collection from clinical records and the administering of a specific questionnaire on issues relating to sexual function was performed prior to and six months following surgery. Scores were analyzed with the help of the Epi-Info 6 program, using the Student's t-test for paired samples.

RESULTS

The total score increased at the six-month post operative in 76.19%; remained unaltered in 14.29%; and decreased in 9.52%. Scores in areas related to erectile function and sexual relations increased in 71.42%; sexual desire increased in 52.38%; and orgasms increased in 28.57%. General sexual satisfaction increased in 57.14%. The average total score and scores on the domains of the questionnaire prior to and six months following surgery revealed statistically significant differences, except those relating to sexual desire and orgasm.

CONCLUSION

The quality of sexual life in morbid obese men improves following Fobi-Capella surgery. Favorable changes occurred in sexual function after these individuals underwent this type of bariatric surgery.

Psychometric evaluation of a Brazilian version of the impact of weight on quality of life (IWQOL-Lite) instrument

PURPOSE

The impact of weight on quality of life (IWQOL-Lite) is a self-administered instrument that assesses quality of life in obesity. It is composed of 31 items and five domains (physical function, self-esteem, sexual life, public distress, and work). The aim of the present study was to evaluate reliability (test-retest), internal structure, construct validity and discriminant validity.

METHODS

IWQOL-Lite scores were obtained from 89 people in a Weight Watchers institution (clinical sample) and 156 community volunteers (community sample). The participants were selected based on the same criteria: gender (female) and age (> 24 years), except for BMI. The community sample also completed the SF-36, a generic measure of health-related quality of life.

RESULTS

The Brazilian IWQOL-Lite demonstrated good test-retest reliability, internal consistency, discriminative validity and convergent validity.

CONCLUSIONS

The IWQOL-Lite is the first specific instrument validated in Brazil for assessing quality of life in obesity. The results reveal that IWQOL-Lite is an instrument with good psychometric properties. Nevertheless, in some cases results were dissimilar to those reported in earlier studies using the original American English.

The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results

OBJECTIVE: To describe the recruitment of patients, assessment instruments, implementation, methods and preliminary results of The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, which includes seven university sites. METHOD: This cross-sectional study included a comprehensive clinical assessment including semi-structured interviews (sociodemographic data, medical and psychiatric history, disease course and comorbid psychiatric diagnoses), and instruments to assess obsessive-compulsive (Yale-Brown Obsessive-Compulsive Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale), depressive (Beck Depression Inventory) and anxious (Beck Anxiety Inventory) symptoms, sensory phenomena (Universidade de São Paulo Sensory Phenomena Scale), insight (Brown Assessment Beliefs Scale), tics (Yale Global Tics Severity Scale) and quality of life (Medical Outcome Quality of Life Scale Short-form-36 and Social Assessment Scale). The raters' training consisted of watching at least five videotaped interviews and interviewing five patients with an expert researcher before interviewing patients alone. The reliability between all leaders for the most important instruments (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale) was measured after six complete interviews. RESULTS: Inter-rater reliability was 96%. By March 2008, 630 obsessive-compulsive disorder patients had been systematically evaluated. Mean age (±SE) was 34.7 (±0.51), 56.3% were female, and 84.6% Caucasian. The most prevalent obsessive compulsive symptom dimensions were symmetry and contamination. The most common comorbidities were major depression, generalized anxiety and social anxiety disorder. The most common DSM-IV impulsive control disorder was skin picking. CONCLUSION: The sample was composed mainly by Caucasian individuals, unmarried, with some kind of occupational activity, mean age of 35 years, onset of obsessive-compulsive symptoms at 13 years of age, mild to moderate severity, mostly of symmetry, contamination/cleaning and comorbidity with depressive disorders. The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders has established an important network for standardized collaborative clinical research in obsessive-compulsive disorder and may pave the way to similar projects aimed at integrating other research groups in Brazil and throughout the world.

Avaliação da qualidade de vida em adolescentes: revisão da literatura

OBJETIVO: Revisar criticamente a disponibilidade de instrumentos de satisfação com a vida utilizados para avaliar a qualidade de vida em adolescentes. MÉTODO: Nesta revisão foram selecionados estudos que utilizavam escalas de satisfação com a vida em adolescentes, exclusivamente. Foram excluídos estudos dirigidos à população em geral, ou que investigassem satisfação na relação com os pais, com cuidadores e com serviços de saúde. Foram consultadas as bases eletrônicas MedLine, Lilacs, PsycINFO, PubMed e Adolec, sendo incluída checagem manual das referências bibliográficas dos artigos selecionados. RESULTADOS: Foram encontrados 22 estudos conforme os critérios de inclusão, verificando-se a existência de nove escalas de satisfação com a vida, sendo duas variações (abreviada e versão adolescente) da escala de um mesmo autor. Foi adicionada à seleção uma escala de qualidade de vida que continha avaliações de domínios de satisfação com a vida. CONCLUSÃO: As validações das principais escalas são descritas, observando-se o reduzido número de estudos transculturais disponíveis. O uso do conceito de qualidade de vida por meio de instrumentos de satisfação com a vida é relativamente novo, e necessita de estudos mais abrangentes no que diz respeito à cultura e às diferentes realidades econômicas.

Depressão em esquizofrenia

Realizou-se uma revisão da literatura acerca da presença de depressão em pacientes esquizofrênicos e, em particular, da depressão pós-esquizofrênica (DPE). A pesquisa foi realizada por meio do Medline, envolvendo os anos de 1966 e 2000, com o objetivo de identificar artigos originais e de revisão. Focalizaram-se os seguintes tópicos: dados históricos, principais estudos, quadro clínico e curso evolutivo, diagnóstico e diagnóstico diferencial, etiopatogenia e prognóstico. Conclui-se que a depressão pós-esquizofrênica tem plena autonomia sindrômica, deve ser considerada uma manifestação clínica das formas delirantes da esquizofrenia e integra o curso evolutivo de um transtorno esquizofrênico.

Characterization of depressive syndrome in schizophrenic outpatients

OBJECTIVE: The authors carried out a cross-sectional study with the aim of characterizing and describing depressive pictures in schizophrenic patients seen at the Psychiatry Outpatient Clinic of the Federal University of Pernambuco (HC-UFPE). The patients had the diagnosis of schizophrenia confirmed on the basis of the operating criteria of the DSM-IV. METHODS: Those who where in the period of stabilization of the clinical picture were selected for the study defined according the following criteria:the last psychotic episode must be happened two months before at least, and during this period the alterations of the antipsychotics doses had been lower than 5 mg of haloperidol or equivalent doses of others neuroleptics. A total of one hundred and four patients took part. Following the identification of the depressive symptoms using the Calgary Depression Scale for Schizophrenia (CDSS), thirty-one patients (29.8%) fulfilled the diagnostic criteria described in the DSM-IV. Of these, 22.1% had the diagnosis of major depression and 7.7% of minor depression according the DSM-IV. Two groups were constituted: Group A, schizophrenics with a depressive syndrome, and Group B, schizophrenics without such a syndrome. An assessment was made of the distribution of the symptoms of the CDSS scores in both groups, the sociodemographic, clinical and therapeutic variables in relation to the frequency of the depressive syndrome, and the patients clinical course. For the investigation of certain clinical features, the following tools were used: problem list (psychosocial stressors) contained in axis IV of the DSM-IV intended to detect the presence of factors triggering the initial episode of schizophrenia and the Global Assessment of Functioning (GAF -- Axis V -- DSM-IV) to characterize the current functioning of the patients. CONCLUSIONS: The results obtained allowed the authors to draw the following conclusions: all the items that comprise the Brazilian version of the CDSS were statistically significant in characterizing the depressive syndrome; a comparison of the sociodemographic and therapeutic variables revealed no statistically significant differences between the two groups, and this was also the case with the majority of the clinical features. Statistically significant differences, however, were found in relation to the greater frequency of life events (psychosocial stressors) in triggering the first episode of schizophrenia and the higher incidence of affective disorders antecedents in family members (first and second degree) among the depressed patients. The mean duration of the depressive syndrome during follow-up of the patients was 5.30 months. The patients in whom there was a recurrence of the psychotic episode presented a delusional-hallucinatory clinical picture. This study seeks to contribute to the inclusion of the Postpsychotic Depressive Disorder (PSD) of Schizophrenia (DSM-IV), in the group of Schizophrenic Disorders.

Nortriptyline blood levels and clinical outcome: meta-analysis of published studies

INTRODUCTION: An optimum range has been suggested for nortriptyline blood levels, above or below which patients respond poorly or do not respond at all to treatment. METHODS: A meta-analysis of published studies was performed to verify the existence of an optimal blood concentration range or therapeutic window in nortriptyline-treated depression patients. A MEDLINE search through the years 1970-1999 was carried out to identify original papers and review articles. Data concerning blood levels and percentage improvement were obtained concerning all included pacients. Univariate and multivariate analyses were performed for data comparison. Possible confounding variables, such as pre-treatment, setting (in or outpatients), and duration of treatment were also evaluated. RESULTS: From the 22 published studies found, only six of them with patients' individual data were included. We found an optimal range for nortriptyline concentrations (OR= 2.25, 95% CI = 1.15 to 4.39, p= 0.02). CONCLUSIONS: There may be a biphasic relationship of efficacy to plasma concentrations of nortriptyline, with a therapeutic window between 46 to 236 ng/ml.

Síndrome de Tourette - revisão bibliográfica e relato de casos

A Síndrome de Tourette (ST), outrora considerada rara - apenas uma curiosidade médica - tem sido alvo de crescente relevância na literatura e prática neuropsiquiátricas. Atualmente, estudos epidemiológicos têm demonstrado que sua freqüência é bem maior do que se supunha. Associando-se ao Transtorno Obsessivo-Compulsivo (TOC), integra-se ao "Espectro Obsessivo-Compulsivo", despertando o interesse de centros de pesquisa. Este trabalho busca revisar a literatura sobre o tema. Aborda o transtorno em sua perspectiva histórica. Comenta as teorias etiopatogênicas, o diagnóstico, o quadro clínico, e os tratamentos disponíveis. Serão relatados e discutidos três casos atendidos pela autora no Ambulatório de TOC e Transtornos Relacionados do HC-UFPE: um caso clássico, peculiaridades da ST em um portador de retardo mental e um caso de Tourettismo.