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Nardi AE, Mendlowicz MV. A Homage to Professor Adolpho Hoirisch (1930-2023), a luminary of Brazilian Psychiatry, and his humanitarian and public commitment. Trends Psychiatry Psychother 2024. [PMID: 38193590 DOI: 10.47626/2237-6089-2023-0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Affiliation(s)
| | - Mauro V Mendlowicz
- Universidade Federal do Rio de Janeiro, RJ, Brazil. Universidade Federal Fluminense, Niterói, RJ, Brazil
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Mendlowicz MV, Mendlowicz V, Ribeiro N, Nardi AE, Gekker M. Impaired Decision-Making Capacity in the Elderly King David (c. 1040-970 BCE): Was Hypothyroidism the Underlying Cause? Ann Indian Acad Neurol 2023; 26:183-186. [PMID: 37179664 PMCID: PMC10170999 DOI: 10.4103/aian.aian_825_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 02/10/2023] Open
Abstract
It has been suggested in the medical literature that in the last period of his life King David (c. 1040-970 BCE) suffered from dementia, osteoporosis, hyperparathyroidism, Parkinson's disease, autonomic neuropathy, major depression, and malignancy. The goal of this study was to identify, based on the "Succession Narrative (SN)," a historically objective section of the Old Testament, the clinical syndrome presented by King David and to determine whether an impaired decision making capacity may have been manipulated by his courtiers to influence his succession's politics. The "SN" indicates that besides forgetfulness and trouble in thinking, King David suffered from marked cold intolerance and sexual dysfunction. The symptom triad consisting of cognitive impairment, cold intolerance, and sexual dysfunction is more strongly suggestive of hypothyroidism than of any other diagnoses proposed in the medical literature so far. We hypothesized that hypothyroidism was the underlying cause of the elderly King David's clinical picture and that his sometimes troubled thinking was successfully manipulated by the courtiers to favor his son Solomon's accession to the throne, with profound historical consequences.
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Affiliation(s)
- Mauro V. Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, Rio de Janeiro, RJ, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, Niterói, RJ, Brazil
| | - Victoria Mendlowicz
- School of Medicine, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, Niterói, RJ, Brazil
| | - Nathália Ribeiro
- School of Medicine, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, Niterói, RJ, Brazil
| | - Antônio E. Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, Rio de Janeiro, RJ, Brazil
| | - Márcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, Rio de Janeiro, RJ, Brazil
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Mendlowicz MV, Nardi AE. A pioneer of psychopharmacology who strove to build bridges between people and countries: Tom Ban (1929-2022). J bras psiquiatr 2022. [DOI: 10.1590/0047-2085000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mendlowicz MV, Levitan MN, Nardi AE, Shorter E. The notable humanist and scientist Aaron Beck (1921-2021), the revolutionary founder of cognitive therapy. Braz J Psychiatry 2022; 44:221-222. [PMID: 35293524 PMCID: PMC9169475 DOI: 10.1590/1516-4446-2021-2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Mauro V. Mendlowicz
- Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | | | - Antonio E. Nardi
- Laboratório de História de Psiquiatria, Neurologia e Saúde Mental, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Edward Shorter
- Jason A Hannah Professor of the History of Medicine, Faculty of Medicine, University of Toronto, ON, Canada
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Valença AM, Studart Leal CC, Oliveira GC, de Moraes TM, Nardi AE, Mendlowicz MV. Case Report: Depression × dementia with Lewy bodies in the elderly: The importance of differential diagnosis. Front Psychiatry 2022; 13:1059150. [PMID: 36601524 PMCID: PMC9806251 DOI: 10.3389/fpsyt.2022.1059150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dementia is a clinical syndrome which is more common in elderly people. Dementia with Lewy bodies (LBD) is not so rare in elderly people, with cognitive impairment in about 30% over age 65. The clinical picture is characterized by fluctuation in cognitive functions, recurrent, well-formed, detailed visual hallucinations, and Parkinsonism, with rigidity, tremor, bradykinesia, and slurred speech. CASE PRESENTATION We present a case report of LBD in a 73-year-old retired teacher, which a initial wrong diagnosis of refractory depression for at least 3 years. We also conduct a review of recent works on theme. CONCLUSION LBD diagnosis can be neglected for years, with a legal and clinical issues to patients and their families. Detailed medical research, including differential diagnosis, are very necessary on those cases, specially when they are called refractory. We encourage new research and adequate clinical training to prevent damage.
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Affiliation(s)
- Alexandre M Valença
- Department of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Gustavo C Oliveira
- Department of Psychiatry, University Center of Brasilia, Brasília, Brazil.,Department of Psychiatry, University of Brasília, Brasília, Brazil
| | - Talvane M de Moraes
- Department of Psychiatry, Academia Nacional de Medicina, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Department of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry, Fluminense Federal University, Rio de Janeiro, Brazil
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Magalhaes AA, Gama CMF, Gonçalves RM, Portugal LCL, David IA, Serpeloni F, Wernersbach Pinto L, Assis SG, Avanci JQ, Volchan E, Figueira I, Vilete LMP, Luz MP, Berger W, Erthal FS, Mendlowicz MV, Mocaiber I, Pereira MG, de Oliveira L. Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents. Psychol Res Behav Manag 2021; 14:1359-1369. [PMID: 34512046 PMCID: PMC8420784 DOI: 10.2147/prbm.s317343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. Methods The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). Results We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. Conclusion These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.
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Affiliation(s)
- Andressa A Magalhaes
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Camila M F Gama
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Raquel M Gonçalves
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Liana C L Portugal
- Department of Physiological Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, 20550-170, Brazil
| | - Isabel A David
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Fernanda Serpeloni
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Liana Wernersbach Pinto
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Simone G Assis
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil.,The Neurology Postgraduate Program, Hospital Gaffrée and Guinle, Unirio, RJ, 20270-901, Brazil
| | - Joviana Q Avanci
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Ivan Figueira
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Liliane M P Vilete
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana P Luz
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Fatima S Erthal
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Fluminense Federal University, Niterói, RJ, 24030-215, Brazil
| | - Izabela Mocaiber
- Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, 28890-000, Brazil
| | - Mirtes G Pereira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
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Nardi AE, Cheniaux E, Mendlowicz MV, Carta MG, Hupfeld-Moreno D, Moreno RA. Homage for Hagop Souren Akiskal (1944-2021): Former co-Editor-in Chief of the Journal of Affective Disorders, a world-known charismatic psychiatrist and a creative researcher in mood disorders. J Affect Disord 2021; 287:350-351. [PMID: 33813255 DOI: 10.1016/j.jad.2021.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio E Nardi
- Institute of Psychiatry. Universidade Federal do Rio de Janeiro, Brazil.
| | - Elie Cheniaux
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro & Universidade do Estado do Rio de Janeiro, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Mauro G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
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Melani MS, Paiva JM, Silva MC, Mendlowicz MV, Figueira I, Marques-Portella C, Luz MP, Ventura PR, Berger W. Absence of definitive scientific evidence that benzodiazepines could hinder the efficacy of exposure-based interventions in adults with anxiety or posttraumatic stress disorders: A systematic review of randomized clinical trials. Depress Anxiety 2020; 37:1231-1242. [PMID: 33241637 DOI: 10.1002/da.23078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure-based interventions (EBIs) are the first-line treatment for anxiety disorders and posttraumatic stress disorder. Although common, the association between EBIs and benzodiazepines is controversial. Therefore, we systematically reviewed the literature to evaluate if benzodiazepines could undermine the efficacy of EBIs in treating these disorders. METHODS We conducted a systematic review aiming for randomized clinical trials (RCTs) in ISI Web of Science, Scopus, PubMed/MEDLINE, and PsycINFO databases. We scrutinized the reference list of selected papers and other systematic reviews. Finally, we evaluated the methodological quality and the scientific evidence of the studies. RESULTS We screened 1,529 studies and included 12 RCTs in this review (all showing some concerns or high risk of bias). Benzodiazepines did not impact the efficacy of EBIs in nine studies at posttreatment, improved efficacy in two, and reduced it in one. In the follow-up, benzodiazepines (after its discontinuation) did not impact the efficacy in six studies and reduced it in five. The scientific level of evidence achieved was B for both phases. CONCLUSIONS Until now there is no definitive evidence that benzodiazepines could hinder the EBIs' efficacy for treating posttraumatic stress disorder and anxiety disorders.
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Affiliation(s)
- Marina S Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jéssica M Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria C Silva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carla Marques-Portella
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana P Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Rui Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Valença AM, de Moraes TM, Meyer LF, Petribú KCLD, Nardi AE, Mendlowicz MV. Violent behavior by involuntarily committed female offenders with mental disorders: A population-based case series. J Forensic Sci 2020; 66:656-663. [PMID: 33253419 DOI: 10.1111/1556-4029.14638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023]
Abstract
The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.
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Affiliation(s)
- Alexandre M Valença
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Talvane M de Moraes
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Leonardo F Meyer
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Antonio E Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Abstract
We reported a case of a 10-year-old girl who developed a PTSD-like syndrome after watching a horror movie. After 6 years, the now 16-year-old patient still fulfilled the DSM-IV criteria for PTSD, except for the trauma itself. We reviewed the scientific literature for case reports of PTSD-like syndrome induced by horror movies and found 13 cases. In only two was the presence of the DSM criteria confirmed. Watching horror movies may thus trigger PTSD-like syndromes in vulnerable viewers
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Mannarino VS, Pereira DCS, Gurgel WS, Costa CBF, Valença AM, Fontenelle LF, Mendlowicz MV. Self-Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review. J Forensic Sci 2016; 62:953-961. [PMID: 27982450 DOI: 10.1111/1556-4029.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/07/2016] [Accepted: 09/17/2016] [Indexed: 11/27/2022]
Abstract
Self-embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty-two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two-thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.
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Affiliation(s)
- Victor S Mannarino
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Débora C S Pereira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil
| | - Wagner S Gurgel
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Carolina B F Costa
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Alexandre M Valença
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil.,D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Rio de Janeiro, RJ, Brazil.,School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, 3800, Australia
| | - Mauro V Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil
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Oliveira GC, Valença AM, de Moraes TM, Mendlowicz MV, Forrest MC, Batista FF, Mendes GA, Lima TN, Gonçalves VR, Mecler K. Cessation of dangerousness status: an analysis of 224 reports from the Instituto de Perícias Heitor Carrilho, Rio de Janeiro, Brazil. ACTA ACUST UNITED AC 2016; 39:45-54. [PMID: 27706372 PMCID: PMC7112734 DOI: 10.1590/1516-4446-2015-1871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/08/2016] [Indexed: 12/14/2022]
Abstract
Objectives: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision. Methods: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis. Results: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress. Conclusions: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.
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Affiliation(s)
- Gustavo C Oliveira
- Unidade de Psiquiatria, Hospital de Base do Distrito Federal, Brasília, DF, Brazil.,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Alexandre M Valença
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Talvane M de Moraes
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Miles C Forrest
- Departamento de Psiquiatria, Instituto de Saúde Mental (ISM), Brasília, DF, Brazil
| | | | | | | | | | - Kátia Mecler
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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13
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Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, Quintana MI, Bressan RA, Andreoli SB, Mari JJ, Figueira I. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res 2016; 72:51-7. [PMID: 26540404 DOI: 10.1016/j.jpsychires.2015.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/17/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conditional risk for PTSD is the risk of developing PTSD after exposure to traumatic events. This epidemiological study of the general urban population from the two largest cities in Brazil reports exposure to traumatic events; conditional risk for PTSD; and proportion/estimated number of PTSD cases secondary to each type of traumatic event. METHOD Cross-sectional study of general population (15-75 y.o.) from Rio de Janeiro and São Paulo. PTSD was assessed through Composite International Diagnostic Interview 2.1. RESULTS Our main findings, from 3744 participants, were: 1) high prevalence of traumatic events (86%), urban violence being the most common; 2) conditional risk for PTSD was 11.1%; 3) women (15.9%) have overall conditional risk 3 times higher than men (5.1%); 4) war-related trauma (67.8%), childhood sexual abuse (49.1%) and adult sexual violence (44.1%) had the highest conditional risks; 5) 35% of PTSD cases (estimated 435,970 individuals) were secondary to sudden/unexpected death of a close person, and 40% secondary to interpersonal violence. CONCLUSIONS Brazilian urban population is highly exposed to urban violence, and overall conditional risk for PTSD was 11.1%. Violence prevention and enhancement of resilience should be part of public policies, and mental health sequelae of trauma should be better recognized and treated.
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Affiliation(s)
- Mariana Pires Luz
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil.
| | - Evandro S F Coutinho
- National School of Public Health (ENSP/FIOCRUZ), Rua Leopoldo Bulhões 1480/823, Manguinhos, Rio de Janeiro, RJ 21041-210, Brazil
| | - William Berger
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Mauro V Mendlowicz
- Fluminense Federal University (UFF), Rua Miguel de Frias 9, Icaraí, Niterói, RJ 24220-008, Brazil
| | - Liliane M P Vilete
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Marcelo F Mello
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Maria Inês Quintana
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Sérgio B Andreoli
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Jair J Mari
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Ivan Figueira
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
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Maia DB, Nóbrega A, Marques-Portella C, Mendlowicz MV, Volchan E, Coutinho ES, Figueira I. Peritraumatic tonic immobility is associated with PTSD symptom severity in Brazilian police officers: a prospective study. ACTA ACUST UNITED AC 2014; 37:49-54. [PMID: 25466958 DOI: 10.1590/1516-4446-2013-1267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 06/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). METHODS Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. RESULTS Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). CONCLUSIONS Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
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Affiliation(s)
- Deborah B Maia
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Augusta Nóbrega
- Polícia Militar do Estado de Goiás (PMGO), Goiânia, GO, Brazil
| | - Carla Marques-Portella
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, RJ, Brazil
| | - Eliane Volchan
- Instituto de Biofísica Carlos Chagas Filho (IBCCF), UFRJ, Rio de Janeiro, RJ, Brazil
| | - Evandro S Coutinho
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Fontenelle LF, Lins-Martins NM, Melca IA, Lima ALC, de Menezes GB, Torres AR, Yücel M, Miguel EC, Mendlowicz MV. Exaggerating, mislabeling or simulating obsessive-compulsive symptoms: case reports of patients claiming to have obsessive-compulsive disorder. Compr Psychiatry 2014; 55:1188-94. [PMID: 24794641 DOI: 10.1016/j.comppsych.2014.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There are no reported cases of factitious or simulated obsessive-compulsive disorder (OCD). However, over the last years, our clinic has come across a number of individuals that seem to exaggerate, mislabel or even intentionally "produce" obsessive and/or compulsive symptoms in order to be diagnosed with OCD. METHODS In this study, experienced clinicians working on a university-based OCD clinic were requested to provide clinical vignettes of patients who, despite having a formal diagnosis of OCD, were felt to display non-genuine forms of this condition. RESULTS Ten non-consecutive patients with a self-proclaimed diagnosis of OCD were identified and described. Although patients were diagnosed with OCD according to various structured interviews, they exhibited diverse combinations of the following features: (i) overly technical and/or doctrinaire description of their symptoms, (ii) mounting irritability, as the interviewer attempts to unveil the underlying nature of these descriptions; (iii) marked shifts in symptom patterns and disease course; (iv) an affirmative "yes" pattern of response to interview questions; (v) multiple Axis I psychiatric disorders; (vi) cluster B features; (vii) an erratic pattern of treatment response; and (viii) excessive or contradictory drug-related side effects. CONCLUSIONS In sum, reliance on overly structured assessments conducted by insufficiently trained or naïve personnel may result in invalid OCD diagnoses, particularly those that leave no room for clinical judgment.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil; Departamento de Psiquiatria e Saúde Mental, Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Niterói, Brazil.
| | - Natália M Lins-Martins
- Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Isabela A Melca
- Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - André Luís C Lima
- Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Albina R Torres
- Departmento de Neurologia, Psicologia e Psiquiatria, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Murat Yücel
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Euripedes C Miguel
- Departmento de Psiquiatria, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Mauro V Mendlowicz
- Departamento de Psiquiatria e Saúde Mental, Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Niterói, Brazil
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Valença AM, Nardi AE, Nascimento I, Jozef F, Mendlowicz MV. Homicide by a forensic female sample in Brazil: a preliminary study. J Forensic Sci 2014; 59:790-2. [PMID: 24502443 DOI: 10.1111/1556-4029.12373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 02/03/2013] [Accepted: 02/10/2013] [Indexed: 11/29/2022]
Abstract
The objective of the study was to evaluate the mental status of all women (n = 14) who were acquitted by reason of insanity of charges of murder or attempted murder and committed to a forensic psychiatric hospital in the state of Rio de Janeiro, Brazil. All cases were retrospectively examined, including medical files, technical records, and forensic experts' official reports. A conclusive psychiatric diagnosis was established using the Structured Clinical Interview for DSM-IV Axis I and II Disorders and clinical and forensic records. The most common diagnosis was schizophrenia/schizoaffective disorders (n = 8; 57.3%). Most victims (n = 12; 75%) were close relatives of the patients. We found that 43% (n = 6) of the patients had a previous history of violent behavior. According to the initial psychiatric forensic evaluation, 5 patients (35.7%) had psychotic symptoms. It is expected that a growing understanding of motivational factors underlying homicidal behavior in mentally disturbed female offenders may further the implementation of effective preventive and therapeutic interventions.
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Affiliation(s)
- Alexandre M Valença
- Department of Psychiatry and Mental Health Universidade Federal Fluminense (MSM-UFF). Rua Marquês do Paraná 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil; Institute of Psychiatry Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos , Rio de Janeiro, RJ, Brazil
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Melca IA, Rodrigues CL, Serra-Pinheiro MA, Pantelis C, Velakoulis D, Mendlowicz MV, Fontenelle LF. Delusional misidentification syndromes in obsessive-compulsive disorder. Psychiatr Q 2013; 84:175-81. [PMID: 22922811 DOI: 10.1007/s11126-012-9237-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Delusional misidentification syndromes (DMS) have been rarely reported in patients with conditions other than schizophrenia-related disorders, diffuse brain disease (dementia) and focal neurological illness. In this report, we describe DMS (i.e. Capgras and Fregoli syndromes) in two patients with severe and treatment resistant obsessive-compulsive disorder (OCD), one with paranoid personality disorder (PPD) and the other with a pervasive developmental disorder (PDD) not otherwise specified. While our findings highlight an interesting phenomenon (the occurrence of DMS in OCD), it is presently unclear whether this association is rare or underreported. Misidentification syndromes might be the ultimate result of a combination of obsessive fears and preexisting cognitive bias/deficits, such as mistrustfulness (in PPD) or poor theory of mind (in PDD).
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Affiliation(s)
- Isabela A Melca
- Anxiety and Depression Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Visconde de Pirajá, 547, Sala 719, Ipanema, Rio de Janeiro, 22410-003, Brazil
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Abstract
Introduction This study explored the associations between sleep duration and emotion regulation among urban black women (mean age=59 ± 7 yrs). Method Eligible women (n=523) provided sociodemographic data during face-to-face interviews. We used the Comprehensive Assessment and Referral Examination Physical to measure health status; women also estimated their habitual sleep duration. We utilized a modified version of Weinberger’s conceptual model of repression, the Index of Self-Regulation (ISE) to measure emotion regulation. ISE scores were derived by amalgamating the defensive subscale from the Social Desirability Scale and the anxiety subscale from the State-Trait Anxiety Inventory. Results The median habitual sleep duration was 7 hours; 20% of the women were short sleepers (<6 hours) and 6% were long sleepers (>8 hours). Short sleepers, rather than long sleepers, had a greater likelihood of reporting insomnia symptoms than those sleeping 6–8 hours [63.4% vs. 28.1%; Χ2 = 41.87, p<0.001]. In the first logistic regression model, the odds of being a short sleeper for low regulators were 3 times greater than for high regulators [OR = 3.22 95% CI: 2.05–5.06; p<0.0001]. In multivariate-adjusted analysis, OR was reduced to 2.06, but remained significant. In the second logistic model, the likelihood of being a long sleeper among low regulators were 37% greater than for high regulators, but results were not significant [OR=1.37, 95% CI: 0.62–3.01; NS]. Discussion Short and long sleep duration are associated with reduced ability for emotion regulation. Women sleeping 6–8 hrs might be more adept at regulating emotions in their daily lives. Insomnia symptoms might mediate associations between emotion regulations and sleep durations.
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Affiliation(s)
- Christie Racine
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
| | - Kaushal Kalra
- Department of Family Practice, SUNY Downstate Medical Centre, NY, USA
| | - Mirnova Ceide
- Albert Einstein College of Medicine of Yeshiva University, Department of Psychiatry and Behavioural Sciences, NY, USA
| | - Natasha J Williams
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, NY, USA ; Institute of Psychiatry, Universidade Federal do Rio de Janeiro, NY, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
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Maia DB, Marmar CR, Henn-Haase C, Nóbrega A, Fiszman A, Marques-Portella C, Mendlowicz MV, Coutinho ESF, Figueira I. Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation. Braz J Psychiatry 2012; 33:362-6. [PMID: 22189925 DOI: 10.1590/s1516-44462011000400009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/23/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers. METHOD In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms. RESULTS Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found. CONCLUSIONS The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers.
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Affiliation(s)
- Deborah B Maia
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro, Brazil.
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Portugal LCL, Pereira MG, Alves RDCS, Tavares G, Lobo I, Rocha-Rego V, Marques-Portella C, Mendlowicz MV, Coutinho ES, Fiszman A, Volchan E, Figueira I, de Oliveira L. Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students. Revista Brasileira de Psiquiatria 2012; 34:60-5. [DOI: 10.1590/s1516-44462012000100011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/06/2011] [Indexed: 11/21/2022]
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Portugal LCL, Pereira MG, Alves RDCS, Tavares G, Lobo I, Rocha-Rego V, Marques-Portella C, Mendlowicz MV, Coutinho ES, Fiszman A, Volchan E, Figueira I, de Oliveira L. Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students. Revista Brasileira de Psiquiatria 2012. [DOI: 10.1016/s1516-4446(12)70011-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Woodruff E, Genaro LT, Landeira-Fernandez J, Cheniaux E, Laks J, Jean-Louis G, Nardi AE, Versiani MC, Akiskal HS, Mendlowicz MV. Validation of the Brazilian brief version of the temperament auto-questionnaire TEMPS-A: the brief TEMPS-Rio de Janeiro. J Affect Disord 2011; 134:65-76. [PMID: 21782248 DOI: 10.1016/j.jad.2011.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 01/19/2011] [Accepted: 02/01/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the last thirty years, Akiskal and collaborators have described and developed operationalized diagnostic criteria for five types of affective temperaments - cyclothymic, irritable, hyperthymic, depressive, and anxious. A 110-item, yes-or-no questionnaire, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), was specifically developed for measuring temperamental variation. The TEMPS-A was translated into more than 25 languages and cross-culturally valid versions are now available in Italian, French, German, Japanese, Turkish, Arabic, Polish, Hungarian, Spanish and Portuguese. Recent studies in the US and in Europe, however, have suggested that shorter versions of TEMPS-A can be just as efficient as the full ones while potentially enhancing the compliance of respondents. The main objective of the present study was to validate a brief Brazilian Portuguese version of TEMPS-A (brief TEMPS-Rio de Janeiro). METHODS Our main sample consisted of 997 undergraduate students (female = 72.6%) from seven different universities located in the city of Rio de Janeiro, Brazil. An additional group of 167 healthy senior citizens (women = 83.8%) was recruited in senior community centers in the city of Rio de Janeiro, Brazil. All participants were asked to complete the 110-item, Brazilian translation of the full version of the TEMPS-A. RESULTS An exploratory factor analysis (PCA type 2, Varimax rotation) vying for a five-factor solution yielded mixed results, with cyclothymic traits, physical symptoms of anxiety and preoccupation with the well-being of a family member loading together on the first factor. When a forced six-factor solution was attempted, cyclothymic, irritable, hyperthymic, and depressive were delineated as predicted by the theory. The original generalized anxious temperament was split into two sharply delimited components, a "worrying" subscale and an abbreviated anxious subscale, which included physical symptoms of anxiety and concerns with the well-being of relatives. Based on the tripartite model of anxiety and depression, we proposed that the abridged anxious subscale, which includes physical symptoms of anxiety, represents the "true" generalized anxious temperament, while the "worrying" subscale corresponds to the "general distress factor". The internal consistency of the six subscales thus identified was generally good, ranging from 0.67 (anxious subscale) to 0.81 (worrying subscale), with cyclothymic, irritable, depressive, and hyperthymic subscales exhibiting intermediate values (0.74, 0.74, 0.72, and 0.7, respectively). LIMITATIONS The present study was based on a non-clinical sample that does not reflect accurately the characteristics of the Brazilian population. The relative uniformity of the sample in terms of age and education precluded a more in-depth analysis of the influence of these highly relevant factors. Further, we did not assess convergent, divergent or test-retest validity. CONCLUSIONS We believe that the brief Brazilian version of the TEMPS-A auto-questionnaire will provide Brazilian researchers and clinicians with a psychometrically sound instrument and thus contribute toward the creation of a worldwide research network dedicated to the investigation of affective temperaments.
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Affiliation(s)
- Erica Woodruff
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, IPUB-UFRJ, Rio de Janeiro, Brazil
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Volchan E, Souza GG, Franklin CM, Norte CE, Rocha-Rego V, Oliveira JM, David IA, Mendlowicz MV, Coutinho ESF, Fiszman A, Berger W, Marques-Portella C, Figueira I. Is there tonic immobility in humans? Biological evidence from victims of traumatic stress. Biol Psychol 2011; 88:13-9. [PMID: 21693167 DOI: 10.1016/j.biopsycho.2011.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 05/25/2011] [Accepted: 06/06/2011] [Indexed: 02/07/2023]
Abstract
Tonic immobility, characterized by profound motor inhibition, is elicited under inescapable threat in many species. To fully support the existence of tonic immobility in humans, our aim was to elicit this reaction in a laboratory setting and measure it objectively. To mimic exposure to life-threatening events in the lab, trauma-exposed participants with PTSD (n=18) and without PTSD (n=15) listened to the script of their autobiographical trauma. Posturography and electrocardiography were employed. Reports of script-induced immobility were associated with restricted area of body sway and were correlated with accelerated heart rate and diminished heart rate variability, implying that tonic immobility is preserved in humans as an involuntary defensive strategy. Immobility reports seemed more evident in PTSD, suggesting that, in some patients, tonic immobility may be elicited during re-experiencing episodes in daily life. This study provided a measure of tonic immobility, a peritraumatic reaction for which cumulative clinical evidence had linked to the severity of PTSD.
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Affiliation(s)
- Eliane Volchan
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Fontenelle JM, Santana LDS, Lessa LDR, Victoria MSD, Mendlowicz MV, Fontenelle LF. [The concept of insight in patients with obsessive-compulsive disorder]. Braz J Psychiatry 2011; 32:77-82. [PMID: 20339738 DOI: 10.1590/s1516-44462010000100015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To update clinicians regarding the existence of a putative subtype of obsessive-compulsive disorder based on poor insight. METHOD Opinionative review based on studies indexed in the PubMed and PsychINFO databases, identified by means of the keywords 'obsessive-compulsive disorder' AND 'insight' OR 'ego-syntonic', and published between 1966 and October 2009. The results were analyzed according to the approach adopted, i.e. a categorical or dimensional view of insight in obsessive-compulsive disorder. RESULTS The review of recent studies led us to identify some issues that cast doubts over the existence of a clear-cut poor insight subtype of obsessive-compulsive disorder. These issues include 1) an extremely variable prevalence of poor insight obsessive-compulsive disorder in categorical studies, 2) a significant degree of homogeneity in the phenotypical findings (i.e. greater severity) associated with lower levels of insight in obsessive-compulsive disorder in both categorical and dimensional studies and, 3) a lack of studies investigating zones of rarity between poor and good insight obsessive-compulsive disorder. CONCLUSION Although a categorical approach to the insight issue in obsessive-compulsive disorder is still important in clinical settings, where decision-making is often a critical issue, a dimensional approach seems to reflect levels of impairment in these patients more reliably.
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Affiliation(s)
- Júlia M Fontenelle
- Programa de Ansiedade e Depressão, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Borges MC, Braga DT, Iêgo S, D'Alcante CC, Sidrim I, Machado MC, Pinto PSP, Cordioli AV, do Rosário MC, Petribú K, Mendlowicz MV, Mari JJ, Miguel EC, Fontenelle LF. Cognitive dysfunction in post-traumatic obsessive-compulsive disorder. Aust N Z J Psychiatry 2011; 45:76-85. [PMID: 21174503 DOI: 10.3109/00048674.2010.527822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Manuela C Borges
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
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Fontenelle IS, Fontenelle LF, Borges MC, Prazeres AM, Rangé BP, Mendlowicz MV, Versiani M. Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Res 2010; 179:198-203. [PMID: 20483484 DOI: 10.1016/j.psychres.2009.04.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 03/24/2009] [Accepted: 04/15/2009] [Indexed: 12/28/2022]
Abstract
The aim of this study was to evaluate the impact of different dimensions of obsessive-compulsive symptoms, of co-morbid anxious depressive symptoms, and of sociodemographic characteristics on the quality of life of patients with obsessive-compulsive disorder (OCD). We evaluated 53 patients with OCD and 53 age- and gender-matched individuals from the community with a sociodemographic questionnaire, the Structured Clinical Interview for the Diagnosis of Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, (DSM-IV), the Short-Form Health Survey-36 (SF-36), the Saving Inventory-Revised, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory and the Beck Anxiety Inventory. A series of stepwise linear regression analyses were performed, having the SF-36 dimensions as the dependent variables and the sociodemographic and clinical features as the independent ones. Patients with OCD displayed significantly lower levels of quality of life in all dimensions measured by the SF-36, except bodily pain. A model that included depressive symptoms, hoarding and employment status predicted 62% of the variance of the social functioning dimension of the quality of life of patients with OCD. Washing symptoms explained 31% of the variance of limitation due to physical health problems. Further, a series of models that included depressive, but not obsessive-compulsive symptoms, explained the remaining SF-36 dimensions. The severity of depressive and anxiety symptoms seems, therefore, to be powerful determinants of the level of quality of life in patients with OCD.
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Affiliation(s)
- Isabela S Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
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Abstract
In the DSM-IV-TR, specific impulse control disorders not elsewhere classified (ICD) have been designated following four principles: (1) through the addition of an adjective that emphasizes the aberrant character of an otherwise normal behaviour (e.g., pathological gambling); (2) by means of metaphors (such as in intermittent explosive disorder); (3) according to the presumably quintessential nature of their main signs and symptoms, such as impulsive (e.g., impulse control disorders not elsewhere classified), compulsive (e.g., compulsive shopping), or addictive (e.g., internet addiction); or (4) using Greek suffix mania (e.g., kleptomania, pyromania, and trichotillomania). Given this flagrant inconsistency, we argue that time has come to adopt a less arbitrary way of describing these disorders, at least until it becomes clearer whether they are really impulsive, compulsive or addictive or if the preoccupation with this distinction is valid. In keeping with DSM's emphasis on descriptive phenomenology rather than on unsupported theory, a less biased terminology is in order. Therefore, we would like to suggest: (1) the substitution of the term ICD by the more neutral expression 'volitional disorders not elsewhere classified'; (2) the use of the classical Greek suffix mania, already present in some DSM-IV-TR ICDs, as the main naming principle to be adopted in the DSM-V; and (3) the creation of compulsive, impulsive, and mixed subtypes of the 'volitional disorders not elsewhere classified', since they are beginning to be validated by treatment trials.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil.
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Lima AA, Fiszman A, Marques-Portella C, Mendlowicz MV, Coutinho ESF, Maia DCB, Berger W, Rocha-Rego V, Volchan E, Mari JJ, Figueira I. The impact of tonic immobility reaction on the prognosis of posttraumatic stress disorder. J Psychiatr Res 2010; 44:224-8. [PMID: 19793589 DOI: 10.1016/j.jpsychires.2009.08.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 07/29/2009] [Accepted: 08/04/2009] [Indexed: 11/30/2022]
Abstract
Tonic immobility is the last defense reaction to entrapment by a predator. In humans, peritraumatic tonic immobility was correlated with PTSD severity and poor response to treatment. This study compared the role of peritraumatic dissociation, panic physical symptoms and tonic immobility as predictors of response to standard pharmacotherapy for PTSD. Thirty-six PTSD patients underwent a naturalistic pharmacological treatment. The Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Clinical Global Impressions Severity of Illness item scores (CGI-S) were employed at baseline and endpoint to examine treatment outcome. Peritraumatic reactions were assessed using the Physical Reactions Subscale, the Peritraumatic Dissociative Experiences Questionnaire and four motor questions of the Tonic Immobility Scale. After controlling for confounders, tonic immobility was the best predictor of a poor response to treatment, either considering the PCL-C or the CGI-S scores. Tonic immobility seems to have a greater negative impact on PTSD prognosis than peritraumatic panic or dissociation. Additional translational and clinical research may inform about particular mechanisms underlying tonic immobility and open new avenues for prevention and treatment of PTSD.
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Affiliation(s)
- Alessandra A Lima
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Brazil
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Prazeres AM, Fontenelle LF, Mendlowicz MV, de Mathis MA, Ferrão YA, de Brito NFC, Diniz JB, Gonzalez CH, Quarantini LC, Marrocos RP, Miguel EC. Olfactory reference syndrome as a subtype of body dysmorphic disorder. J Clin Psychiatry 2010; 71:87-9. [PMID: 20129009 DOI: 10.4088/jcp.09l05040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rocha-Rego V, Fiszman A, Portugal LC, Garcia Pereira M, de Oliveira L, Mendlowicz MV, Marques-Portella C, Berger W, Freire Coutinho ES, Mari JJ, Figueira I, Volchan E. Is tonic immobility the core sign among conventional peritraumatic signs and symptoms listed for PTSD? J Affect Disord 2009; 115:269-73. [PMID: 18845342 DOI: 10.1016/j.jad.2008.09.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 08/29/2008] [Accepted: 09/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies suggested the importance of peritraumatic reactions as predictors of PSTD symptoms severity. Despite mounting evidence that tonic immobility occurs under intense life threats its role as predictor of PTSD severity remains by and large understudied. The objective of this study was to investigate the role of peritraumatic reactions (tonic immobility, panic and dissociation) as predictors of PTSD symptoms severity. METHODS Participants were 32 victims of urban violence with PTSD diagnosed through the SCID-I. In order to evaluate PTSD symptoms at baseline, we used the Post-Traumatic Stress Disorder Checklist-Civilian Version. To assess peritraumatic reactions we employed the Physical Reactions Scale, the Peritraumatic Dissociative Experiences Questionnaire and Tonic Immobility questions. As confounding variables, we considered negative affect (measured by the Positive and Negative Affect Schedule-Trait Version), sex and time elapsed since trauma. RESULTS Tonic immobility was the only predictor of PTSD symptoms severity that kept the statistical significance after controlling for potential confounders. LIMITATIONS This study was based on a relatively small sample recruited in a tertiary clinic, a fact that may limit the generalizability of its findings. The retrospective design may have predisposed to recall bias. CONCLUSIONS Our study provides good reason to conduct more research on tonic immobility in PTSD with other samples and with different time frames in an attempt to replicate these stimulating results.
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Affiliation(s)
- Vanessa Rocha-Rego
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil.
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Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, Figueira I. Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:169-80. [PMID: 19141307 PMCID: PMC2720612 DOI: 10.1016/j.pnpbp.2008.12.004] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 12/15/2008] [Accepted: 12/15/2008] [Indexed: 12/17/2022]
Abstract
The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, even when treated with this class of drugs, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. The aim of this study was to address this limitation by systematically reviewing the options left for the treatment of PTSD when patients do not respond satisfactorily to or tolerate SSRIs. A systematic review covering all original articles, letters and brief reports published in any language until October 2008 was conducted through searches in the ISI/Web of Science, PubMed and PILOTS databases. The search terms included the pharmacological class of each agent or its generic name plus "PTSD" or "stress disorder" in the title, in the abstract or as a keyword. Sixty-three articles were selected, covering the following categories: antipsychotics, anticonvulsants, adrenergic-inhibiting agents, opioid antagonists, benzodiazepines and other agents. None of the identified agents reached the level A of scientific evidence, 5 reached level B, 7 level C and 13 level D. The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD, although these drugs could alleviate some associated non-specific symptoms, such as insomnia or anxiety. Further controlled clinical trials and meta-analysis are needed to guide clinicians in their search of effective pharmacological alternatives to antidepressants in PTSD.
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Affiliation(s)
- William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Brazil.
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de Jesus Mari J, Patel V, Kieling C, Anders M, Jakovljevi M, Lam LC, Lotaief F, Mendlowicz MV, Okulat G, Sathyanarayana Rao TS, Tamam L, Tyrer P, Herrman H. The 5/95 Gap on the dissemination of mental health research: The World Psychiatric Association (WPA) task force report on project with editors of low and middle income (LAMI) countries. Afr J Psychiatry (Johannesbg) 2009; 12:33-39. [PMID: 19517045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The World Psychiatric Association (WPA) Task Force and a small group previously convened by the WPA publications committee initiated three activities between 2006-2008 that aimed to respond to the need for greater support for psychiatry journals in LAMI countries. In a joint venture with participants from the Global Mental Health Movement the Task Force editors from LAMI countries in Africa, Asia, Eastern Europe and Latin America were contacted to identify potential journals to target for indexation (Medline and ISI). The committee analyzed the editors' applications on the following criteria: a) geographical representativeness; b) affiliation to a professional mental health society; c) regular publication of at least 4 issues per year over the past few years; d) comprehensive national and international editorial boards; e) publication of original articles, or at least abstracts, in English; f) some level of current indexation; g) evidence of a good balance between original and review articles in publications; and h) a friendly access website. The committee received 26 applications (11 from Latin America, 7 from Central Europe, 4 from Asia and 4 from Africa), and selected 8 journals, 2 from each geographical area, on the basis of the overall scores obtained for the items mentioned, to participate in an editors meeting held in Prague in September 2008. The aims of the committee are twofold: a) to concentrate support for those selected journals; and b) to assist all LAMI mental health editors in improving the quality of their journals and fulfilling the requirements for full indexation. This report summarizes the procedures conducted by the committee, the assessment of the current non-indexed journals, and offers suggestions for further action.
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Cabizuca M, Marques-Portella C, Mendlowicz MV, Coutinho ESF, Figueira I. Posttraumatic stress disorder in parents of children with chronic illnesses: A meta-analysis. Health Psychol 2009; 28:379-88. [DOI: 10.1037/a0014512] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The pharmacodynamic properties of fluvoxamine maleate include the modulation of different populations of serotonergic, dopaminergic, and sigma receptors and/or transporters, a complex pattern of activity that may account for its efficacy in the treatment of obsessive-compulsive disorder (OCD). Nevertheless, its pharmacokinetic profile and its pattern of side effects may hinder a rapid dose escalation, a therapeutic strategy that might be utterly desirable in patients with OCD. In preclinical studies, the maximum plasma concentration and bioavailability of an extended-release (CR) formulation of fluvoxamine were, respectively, 38% and 16% lower than those of the standard (ie, non-CR) formulation. Recently, the US Food and Drug Administration approved the fluvoxamine CR formulation for the treatment of OCD in adults. This approval was based on the results of a double-blind, placebo-controlled study with 253 OCD patients in which fluvoxamine CR showed a consistently earlier onset of therapeutic effects than other selective serotonin reuptake inhibitors, as reported in previous studies. The use of the CR formulation of fluvoxamine allowed a particularly aggressive dosing strategy at the beginning of the titration phase, ie, treatment could be started with a single dose of fluvoxamine CR 100 mg at bedtime, while keeping the occurrence of side effects and the rate of compliance at levels comparable to those reported for the use of immediate-release fluvoxamine.
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Affiliation(s)
- Lídia Ordacgi
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
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Fontenelle LF, Mendlowicz MV. The Wernicke-Kleist-Leonhard "short-circuiting": a missing link between attention deficit hyperactivity disorder, Tourette syndrome, and obsessive-compulsive disorder? Med Hypotheses 2008; 71:418-25. [PMID: 18511213 DOI: 10.1016/j.mehy.2008.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 02/18/2008] [Accepted: 03/27/2008] [Indexed: 11/16/2022]
Abstract
According to the Wernicke-Kleist-Leonhard (WKL) School of Psychiatry, human actions could be categorized into spontaneous, expressive, reflex, and reactive. The so-called short-circuit movements represent a pathological exaggeration of immediate reactions to sensory impressions, such as sudden or threatening stimuli. "Short-circuiting" was deemed of utmost importance for the diagnoses of several WKL endogenous psychoses, such as hyperkinetic motility psychosis, periodic catatonia, and proskinetic catatonia. We suggest that short-circuit movements may be an under-reported behavioral phenotype that may cut across different phenotypes of non-psychotic DSM-IV-TR disorders, such as attention deficit hyperactivity disorder (ADHD), Tourette's syndrome (TS), and obsessive-compulsive disorder (OCD). Several features of a neuropsychiatric syndrome seen in the coarse frontal lobe disease ("complex psychomotor release phenomena") may provide a neurological working model for "short-circuiting" in ADHD, TS, and OCD. Further, short-circuit movements may be associated with different degrees of serotonergic, dopaminergic, and glutamatergic dysfunctions. Indeed, although there are a growing number of studies reporting successful treatment of short-circuit movements with topiramate and other glutamatergic antagonists, treatment response to drugs based on serotonergic or dopaminergic mechanisms of action is more uncertain and, sometimes, detrimental, leading to an aggravation of pathological behavior. A resurgence of the interest on the descriptive psychopathology of the WKL short-circuit movements could provide a new conceptual framework for the studies on the neurobiology of volitional disorders.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
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Maia DB, Marmar CR, Mendlowicz MV, Metzler T, Nóbrega A, Peres MC, Coutinho ES, Volchan E, Figueira I. Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder. J Affect Disord 2008; 107:259-63. [PMID: 17888517 PMCID: PMC3974924 DOI: 10.1016/j.jad.2007.08.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 08/15/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND To measure the serum lipid composition of a sample of Brazilian police officers with and without PTSD regularly exposed to potentially traumatic situations. METHODS A cross-sectional survey was conducted with 118 active duty male police officers. Serum concentrations for total cholesterol, LDL-C, HDL-C, and triglycerides were enzymatically determined. Body mass index (BMI) was obtained for each participant. RESULTS Officers with PTSD exhibited significantly higher serum total cholesterol, LDL-C and triglycerides levels than those without PTSD. Total cholesterol and triglycerides, but not LDL-C, remained associated with PTSD diagnosis after controlling for confounding influences (i.e. socio-demographics, BMI, and tobacco, alcohol and medication use). LIMITATIONS The sample size was small. A nutritional interview was employed instead of established scales to assess alimentary habits, tobacco or alcohol consumption. A self-report screening tool was used to assess the prevalence of PTSD. CONCLUSIONS The association between PTSD and abnormal serum lipid profile and a tendency to exhibit higher BMI suggests that individuals with PTSD may be at increased risk for developing metabolic syndrome, a condition that by itself could account for many of the most serious PTSD-related physical health problems.
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Affiliation(s)
- Deborah Bezerra Maia
- Institute of Psychiatry, Universidade Federal of Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil.
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Fiszman A, Mendlowicz MV, Marques-Portella C, Volchan E, Coutinho ES, Souza WF, Rocha V, Lima AA, Salomão FP, Mari JJ, Figueira I. Peritraumatic tonic immobility predicts a poor response to pharmacological treatment in victims of urban violence with PTSD. J Affect Disord 2008; 107:193-7. [PMID: 17719650 DOI: 10.1016/j.jad.2007.07.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/09/2007] [Accepted: 07/11/2007] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tonic immobility is the last defense against predation in animals and is characterized by paralysis and analgesia. In humans, it has only been reported in women victims of sexual abuse. OBJECTIVE This study evaluated the prevalence of peritraumatic tonic immobility (PTI) in patients with PTSD and investigated its association with response to treatment. METHOD Victims of urban violence with PTSD diagnosed through the SCID-IV (n=23) underwent a naturalistic pharmacological treatment according to the recommended guidelines for PTSD. The Post-Traumatic Stress Disorder Checklist--Civilian Version (PCL-C) and the Clinical Global Impressions (CGI) Severity scores were applied at baseline and endpoint. PTI was assessed using the Tonic Immobility Scale. RESULTS PTI was reported by both genders in 43% of the sample. Patients with PTI responded significantly poorly to treatment than those without it, either considering the PCL-C or the CGI scores. LIMITATIONS This study probed PTI retrospectively and was based on a small sample recruited in a tertiary clinic. CONCLUSIONS We have expanded the scope of the two previous investigations on PTI by showing its occurrence also in men and during non-sexual violence. In addition, the finding of a significant relationship between PTI and poor response to treatment of PTSD indicates that PTI may carry a prognostic value in this disorder and suggests that PTI should be routinely assessed in traumatized patients.
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Affiliation(s)
- Adriana Fiszman
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-FRJ), Brazil.
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Laks J, Fontenelle LF, Chalita A, Mendlowicz MV. Absence of dementia in late-onset schizophrenia: a one year follow-up of a Brazilian case series. Arq Neuropsiquiatr 2008; 64:946-9. [PMID: 17221001 DOI: 10.1590/s0004-282x2006000600011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 08/01/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive deficits of late-onset schizophrenia (LOS) patients have been reported as stable, although some prospective studies show that a sub-group develop a significant cognitive decline. Data on LOS from developing countries are scarce. OBJECTIVE To evaluate the cognitive performance of Brazilian patients with LOS over the course of one year. METHOD Thirteen LOS patients were evaluated at baseline and after one year with the Mini-Mental State Examination (MMSE), the CAMCOG, the Positive and Negative Symptoms Scale, the Pfeffers Activities of Daily Living (ADL), and the Neuropsychiatric Inventory (NPI). RESULTS Cognition and activities of daily living remained stable over the course of one year [baseline MMSE= 21.31 (4.87) and CAMCOG=80.31 (16.68); end-point MMSE=20.77 (3.86) and CAMCOG=82.92 (14.42) (Z=-0.831; p=0.40); baseline ADL=4.31 (5.65); end-point ADL= 5.92 (3.86) (Z=-0.831; p=0.40)]; end-point NPI=10.54 (10.69) (Z=-0.737; p=0.46]. CONCLUSION Like patients from developed countries, Brazilian patients with LOS do not seem to develop dementia, at least over the course of one year.
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Affiliation(s)
- Jerson Laks
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Souza GGL, Mendonça-de-Souza ACF, Barros EM, Coutinho EFS, Oliveira L, Mendlowicz MV, Figueira I, Volchan E. Resilience and vagal tone predict cardiac recovery from acute social stress. Stress 2007; 10:368-74. [PMID: 17853065 DOI: 10.1080/10253890701419886] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Previous studies showed that heart period decreases during and recovers after an acute stress. We investigated if individual predispositions and emotional priming influence heart period recovery after a speech stress task. Psychometric scales and resting cardiac vagal tone were used to measure individual traits. The presentation of a sequence of either pleasant or unpleasant pictures, as emotional primers, preceded the speech stress. Heart period was measured throughout the experiment. Stress induced tachycardia irrespective of emotional priming or traits. In the recovery period, participants with higher resting cardiac vagal tone or presenting higher resilience significantly reduced the heart acceleration. Furthermore, these traits interacted synergistically in the promotion of the recovery of heart period. Pleasant priming also improved recovery for participants with lower negative affect. In conclusion, the stress recovery measured through heart period seemed dependent upon individual predispositions and emotional priming. These findings further strengthen previous observations on the association between greater cardiac vagal tone and the ability to regulate emotion.
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Affiliation(s)
- G G L Souza
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Mendonça-de-Souza ACF, Souza GGL, Vieira A, Fischer NL, Souza WF, Rumjanek VM, Figueira I, Mendlowicz MV, Volchan E. Negative affect as a predisposing factor for cortisol release after an acute stress--the impact of unpleasant priming. Stress 2007; 10:362-7. [PMID: 17853064 DOI: 10.1080/10253890701379999] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Glucocorticoids have a key role in stress responses. There are, however, substantial differences in cortisol reactivity among individuals. We investigated if affective trait and mood induction influence the reactivity to psychological stress in a group of 63 young adults, male (n=27) and female (n=36), aged ca. 21 years. On the experimental day the participants viewed either a block of pleasant or unpleasant pictures for 5 min to induce positive or negative mood, respectively. Then, they had 5 min to prepare a speech to be delivered in front of a video-camera. Saliva samples were collected to measure cortisol, and questionnaire-based affective scales were used to estimate emotional states and traits. Compared to basal levels, a cortisol response to the acute speech stressor was only seen for those who had first viewed unpleasant pictures and scored above the average on the negative affect scale. There were no sex differences. In conclusion, high negative affect associated with exposure to an unpleasant context increased sensitivity to an acute stressor, and was critical to stimulation of cortisol release by the speech stressor.
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Affiliation(s)
- A C F Mendonça-de-Souza
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Fontenelle LF, Domingues AM, Souza WF, Mendlowicz MV, de Menezes GB, Figueira IL, Versiani M. History of trauma and dissociative symptoms among patients with obsessive-compulsive disorder and social anxiety disorder. Psychiatr Q 2007; 78:241-50. [PMID: 17453345 DOI: 10.1007/s11126-007-9043-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We aimed to compare the history of trauma and the profile and severity of dissociative symptoms of patients with obsessive-compulsive disorder (OCD) to those of patients with social anxiety disorder (SAD). Patients with OCD (n = 34) and patients with SAD (n = 30) were examined with the following instruments: Trauma History Questionnaire (THQ), Dissociative Experience Scale (DES), Obsessive-Compulsive Inventory (OCI), Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Patients with OCD reported significantly lower rates of exposure to traumatic events. Nevertheless, the severity of dissociative symptoms was not significantly different between the groups. Regression analyses showed that, while the OCI scores better predicted the variance on DES scores in the OCD sample, the LSAS and the BAI better predicted the variance on the DES among patients with SAD. Patients with OCD are probably less vulnerable to some types of traumatic experiences. Dissociative symptoms may cut across different anxiety disorders.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry of the Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rua Otávio Carneiro, 93 601 Rio de Janeiro, RJ, Brazil.
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Berger W, Figueira I, Maurat AM, Bucassio EP, Vieira I, Jardim SR, Coutinho ESF, Mari JJ, Mendlowicz MV. Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life. J Trauma Stress 2007; 20:637-42. [PMID: 17721969 DOI: 10.1002/jts.20242] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A cross-sectional survey for posttraumatic stress disorder (PTSD) was conducted with 234 Brazilian ambulance workers (180 men and 54 women) using a sociodemographic questionnaire, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Short Form Health Survey-36. Current prevalence rates for full and partial PTSD were 5.6% (men = 6.7%, women = 1.9%) and 15% (men = 13.3%, women = 20.4%), respectively. Male workers with full PTSD were more likely to be nonmarried (75% vs. 43%) and those with partial PTSD reported more emotional problems (65.2% vs. 30%) and medical visits (67% vs. 44%) than the controls. Workers with PTSD showed impairment in the physical and mental domains of the SF-36, whereas workers with partial PTSD had only the later compromised. The characteristics and the level of exposure to trauma of the study population may account for the low prevalence of PTSD.
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Affiliation(s)
- William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil
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Mendlowicz MV, Figueira I. [Intergenerational transmission of family violence: the role of post-traumatic stress disorder]. Braz J Psychiatry 2007; 29:88-9. [PMID: 17435938 DOI: 10.1590/s1516-44462007000100023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fontenelle LF, Nascimento AL, Mendlowicz MV, Shavitt RG, Versiani M. An update on the pharmacological treatment of obsessive-compulsive disorder. Expert Opin Pharmacother 2007; 8:563-83. [PMID: 17376013 DOI: 10.1517/14656566.8.5.563] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this article is to introduce the reader to an updated evidence-based drug treatment algorithm to be employed in patients with obsessive-compulsive disorder (OCD). Relevant studies were identified through a comprehensive review and classified according to the type of patients enrolled, the quality of the study design and the invasiveness, availability and complexity of the therapeutic approach. When ineffective, therapeutic trials with first-line strategies (such as the selective serotonin re-uptake inhibitors [SSRIs] and venlafaxine) should be followed by treatment approaches such as clomipramine, augmentation with antipsychotics or pindolol, SSRI megadoses or cognitive behavioral therapy. These therapeutic strategies are expected to help most patients with OCD. Additional approaches include intravenous clomipramine, oral morphine, 'heroic drug strategies', deep brain stimulation and functional neurosurgery. Independent studies are urgently needed to help identify the most promising drug treatment sequences for OCD.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro (IPUB/UFRJ), Icaraí, Niterói, RJ, Brazil.
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Garcia RF, Ordacgi L, Mendlowicz MV, de Freitas GR, Rosso ALZ, Nazar BP, Fontenelle LF. Treatment of Juvenile Parkinson Disease and the Recurrent Emergence of Pathologic Gambling. Cogn Behav Neurol 2007; 20:11-4. [PMID: 17356338 DOI: 10.1097/wnn.0b013e31802b6c34] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the recurrent emergence of pathologic gambling (PG) during the sequential treatment of a patient with Juvenile Parkinson disease (PD) with different dopamine agonists. METHOD Single case report. RESULTS A patient with Juvenile PD developed PG soon after beginning treatment with pergolide, a mixed D1/D2 dopamine agonist that is also supposed to exhibit D3 activity. This behavior remitted upon the discontinuation of the drug. A subsequent therapeutic trial with pramipexole, a dopamine agonist with preferential D3 dopamine receptor activity, resulted in the recurrence of PG. Remarkably, previous treatment with levodopa was not associated with this side effect. CONCLUSIONS These findings seem to confirm previous suggestions that dopaminergic hyperactivity plays an important role in the pathogenesis of PG. They further indicate that patients with PD may develop PG as a side effect of more than one dopamine agonist. There is still no consensus regarding the best strategy to deal with this potentially disturbing phenomenon.
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Affiliation(s)
- Rafael Ferreira Garcia
- Programa de Ansiedade e Depressão do Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
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Fontenelle LF, de Souza WF, de Menezes GB, Mendlowicz MV, Miotto RR, Falcão R, Versiani M, Figueira IL. Sexual function and dysfunction in Brazilian patients with obsessive-compulsive disorder and social anxiety disorder. J Nerv Ment Dis 2007; 195:254-7. [PMID: 17468686 DOI: 10.1097/01.nmd.0000243823.94086.6f] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We compared the history, the profile, and the severity of sexual symptoms of 31 patients with obsessive-compulsive disorder (OCD) to those of 26 patients with social anxiety disorder (SAD) by means of the Sexual Inventory of the Institute of Psychiatry of the Federal University of Rio de Janeiro, the Clinical Interview for the Diagnosis of DSM-IV Sexual Disorders, the Female Sexual Function Index, the International Index of Erectile Function, the Arizona Sexual Experience Scale, and the Sexual Behavior Inventory. Patients with OCD reported more difficulties to reach orgasm (p = 0.009), less frequent effective erections (p = 0.05), and a positive history of sexual abuse (p = 0.006) significantly more often than patients with SAD. Male patients with SAD reported not using contraceptive methods significantly more frequently than male patients with OCD (p = 0.007). Patients with OCD and patients with SAD exhibit different profiles of sexual behavior.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro, Rio de Janeiro, Brazil.
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Fontenelle LF, Lauterbach EC, Telles LL, Versiani M, Porto FH, Mendlowicz MV. Catatonia in Obsessive-compulsive Disorder: Etiopathogenesis, Differential Diagnosis, and Clinical Management. Cogn Behav Neurol 2007; 20:21-4. [PMID: 17356340 DOI: 10.1097/wnn.0b013e31802e3bc6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We describe the case of a patient who developed an episode of catatonia during the course of her life-long obsessive-compulsive disorder (OCD) and discuss issues related to the etiopathogenesis, differential diagnosis, and therapeutic management of this association. BACKGROUND Catatonia is conventionally considered a heterogeneous syndrome of motor dysregulation characterized by mutism, immobility, negativism, posturing (catalepsy), stereotypies, and echophenomena. The relationship between OCD and catatonia is still misunderstood and poses significant challenges to the diagnosis and treatment of patients with both conditions. METHOD Naturalistic follow-up of a single case. RESULTS A patient with OCD developed catatonia in concert with deteriorating mood, thought, and behavior. This atypical clinical presentation of individuals with OCD and the list of differential diagnosis raised during the patient's clinical assessment are discussed on 3 different levels: symptomatic presentation, comorbidity pattern, and pharmacodynamic mechanisms involved. CONCLUSIONS The development of a systematic therapeutic plan for patients with OCD and comorbid catatonia includes: the fine-tuning of the antiobsessional treatment; management of comorbid disorders that may engender catatonia; prompt discontinuation, and subsequent slow reintroduction of drugs deemed to trigger toxic reactions or to worsen comorbid disorders and, ultimately, the catatonia; and the implementation of specific anticatatonia measures.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil.
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Fontenelle LF, Telles LL, Nazar BP, de Menezes GB, do Nascimento AL, Mendlowicz MV, Versiani M. A sociodemographic, phenomenological, and long-term follow-up study of patients with body dysmorphic disorder in Brazil. Int J Psychiatry Med 2007; 36:243-59. [PMID: 17154152 DOI: 10.2190/b6xm-hlhq-7x6c-8gc0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The main characteristic of body dysmorphic disorder (BDD) is a preoccupation with an imagined defect in appearance in a normal-appearing person or an excessive preoccupation with appearance in a person with a small physical defect. In this non-controlled study, our objective was to describe the socio-demographic, phenomenological, and long-term outcome features of a Brazilian sample of patients with BDD. METHODS We performed a chart-review of the 166 patients who attended the Obsessions, Compulsions, and Impulsions Subprogram of the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, during the period between 1998 and 2005. RESULTS Twenty patients (12%) had clinically significant BDD. This sample was characterized by a predominance of female (n = 11; 55%), single or divorced (n = 18; 90%), and economically unproductive patients (n = 17; 85%). We found an average of 2.5 current imagined defects per patient. The most frequently reported body parts of excessive concern were the overall appearance, size or shape of the face (n = 7; 35%), the skin (n = 6; 30%), the hair (n = 6; 30%), the nose (n = 5; 25%), and the body build and weight (n = 5; 25%). Most individuals exhibited a chronic condition (n = 13; 65%) and kept the same concerns during the course of the disorder (n = 12; 60%). All patients displayed compulsive behaviors, including recurrent mirror checking (n = 14; 70%), camouflaging (n = 13; 65%), reassurance seeking by means of repetitive questioning of others (n = 9; 45%), and excessive use of cosmetics (n = 7; 35%). Two patients reported "do-it-yourself" surgeries. Seven patients had current suicidal ideation (35%). Six patients (30%) showed no insight over their dysmorphic beliefs. Fifteen patients (95%) exhibited psychiatric comorbidities, mostly obsessive-compulsive disorder (OCD) (n = 14, 70%) and major depressive disorder (n = 11; 55%). The majority of patients were treated naturalistically with serotonin reuptake inhibitors (n = 15; 75%), either solo or in association with antipsychotics (n = 10; 50%). Nevertheless, only 5 (25%) responded favorably to treatment during the long-term follow-up (CGI < or = 2). CONCLUSIONS BDD is a severe disorder that is frequently associated with other psychiatric conditions and responds poorly to treatment in the naturalistic setting. No significant trans-cultural variations were identified in the comparison between Brazilian, North American, and European samples.
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Figueira I, da Luz M, Braga RJ, Cabizuca M, Coutinho E, Mendlowicz MV. The increasing internationalization of mainstream posttraumatic stress disorder research: a bibliometric study. J Trauma Stress 2007; 20:89-95. [PMID: 17343266 DOI: 10.1002/jts.20183] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to quantify changes in the national contributions to research related to posttraumatic stress disorder (PTSD) from 1983 through 2002. Using the Web of Science database (Thomson Scientific, Philadelphia, PA), we classified articles according to the year of publication and the country of the authors. The number of publishing countries increased from 7 between 1983 and 1987 to 39 between 1998 and 2002. Meanwhile, the U.S. output share declined from 87.6% in the first period to 62.4%. Although the number of countries publishing on PTSD has steadily increased, research is still dominated qualitatively and quantitatively by developed countries. These findings suggest a growing international acceptance of this diagnostic category. However, the immaturity of PTSD research is demonstrated by the concentration of publications in a few countries.
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Affiliation(s)
- Ivan Figueira
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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