Trans-cultural aspects of social anxiety disorder and related conditions: a Brazilian case series and a review of international clinical studies

Cross-cultural studies have much to teach clinicians and researchers alike about psychopathology in general and about social anxiety disorder (SAD) in particular. Unfortunately, little is known about the degree and the mechanisms through which cultural environment may influence clinical manifestations of SAD. OBJECTIVE: Our objective was to identify culture-related clinical patterns in SAD and related disorders. METHODS: We described socio-demographic and clinical characteristics of a sample of 62 adult outpatients with SAD seen at a university clinic for anxiety and depressive disorders in Rio de Janeiro, Brazil, and compared them with those reported in clinical samples from North America, Europe, Asia and Oceania identified through a systematic review in Medline, PsychINFO, and LILACS. RESULTS: Our comparison of trans-cultural features of SAD lends partial support to Heimberg's (1997) contention that the majority of socio-demographic features and symptoms of this disorder are relatively independent of geographic and cultural differences. CONCLUSION: Patients with SAD were almost universally characterized by: 1) a predominance of males in clinical samples; 2) early onset of the disorder; 3) high educational attainment; and 4) great frequency of comorbidities.

A five year follow-up study of 11 patients with bipolar disorder

OBJECTIVE: To study the long-term follow-up of patients with bipolar disorder (BPD). METHOD: Eleven outpatients with BPD type I were followed up naturalistically for five years at a university teaching hospital. The Clinical Global Impression Scale (BPD version) was used to evaluate the occurrence of affective episodes, and the Strauss-Carpenter Outcome Scale was used to evaluate social and occupational functioning. RESULTS: The majority of patients were symptomatic most of the time, with predominantly depressive episodes. Overall, patients remained euthymic a mean of 47.7% of the time. Despite a low rate of hospitalization, social and occupational functioning was poor in the majority of patients. A poor disease course with respect to work-related functioning was associated with fewer months of euthymia with a longer duration of depressive episodes. The total number of months of euthymia negatively correlated with the patient's age and disease duration. CONCLUSION: Despite the small sample size, the present findings appear to corroborate previous studies on the evolution of BPD. Most of the patients had a poor disease course, with long symptomatic periods, particularly depressive episodes, and significantly impaired social and occupational functioning.

Self-evaluated burden in adults with attention-deficit hyperactivity disorder (ADHD): a pilot study

OBJECTIVES: To investigate feasibility and easiness of administration of a brief and simple instrument addressing impairment associated with adult attention deficit hyperactivity disorder (ADHD) and if ADHD subtypes were correlated to specific profiles of self-reported impairment. METHODS: Thirty-five adults (19 men and 16 women; mean age of 31.74 years) diagnosed with ADHD according to DSM-IV with a semi-structured interview (K-SADS PL) were asked to fill out a Likert scale covering six different functional areas (academic, professional, marital, familiar, social and daily activities). Clinicians questioned patients about their understanding of the questionnaire and investigated their answers in more details to check consistency of their answers. RESULTS: No patient reported difficulties in understanding the questionnaire. Further questioning of patients' answers confirmed their choices in the six areas. Academic burden had the highest average score in the whole sample, followed by professional burden. Social area had the lowest average score in this sample.

Cardio-respiratory symptoms in panic disorder: a contribution from cognitive-behaviour therapy

Objective: To compare patients with panic disorder with agoraphobia treated with cognitive-behavioural therapy (CBT) associated with the medication with patients treated only with medication and verify the behaviour of the cardio-respiratory symptoms of both groups. Methods: Randomized sample in the Psychiatry Institute of the Federal University of Rio de Janeiro, divided in two groups of 25 participants each. Group 1 undertook 10 weekly sessions of CBT with one hour of duration each together with medication. Group 2, Control, were administered medication that only consisted of tricyclic anti-depressants and selective inhibitors of the re-uptake of serotonin. Evaluation instruments were applied at the beginning and to the end of the interventions. Results: According to the applied scales, group 1 showed statistically more significant results than group 2, with: reduction of panic attacks, cardio-respiratory symptoms, anticipatory anxiety, agoraphobia avoidance and fear of bodily sensations. Conclusion: Exposures (in vivo and interoceptive), especially for induction symptom exercises and relaxation, were considered essential to prepare patients with panic disorder to handle future cardio-respiratory symptoms and panic attacks with agoraphobia.

Alcohol Use Disorder Identification Test (AUDIT): explorando seus parâmetros psicométricos

OBJETIVO: O presente estudo teve como objetivo conhecer evidências de validade e precisão do Alcohol Use Disorder Identification Test (AUDIT). MÉTODOS: Contou-se com uma amostra de conveniência (não probabilística) de 547 estudantes universitários de Fortaleza (CE), com idade média de 21,6 anos (dp = 4,86; amplitude de 18 a 53), a maioria do sexo masculino (51,5%), solteira (91,4%) e católica (62,5%). Os participantes responderam ao AUDIT e a perguntas demográficas. Procurando conhecer a estrutura fatorial, além de estatísticas descritivas, realizou-se uma Análise de Componentes Principais. Adicionalmente, a fim de avaliar a precisão do instrumento, efetuaram-se cálculos de alfa de Cronbach (consistência interna), correlações de r de Pearson e coeficiente de correlação intraclasse - ICC (precisão teste-reteste). RESULTADOS: De acordo com a análise de componentes principais com rotação oblimin, a estrutura bifatorial do AUDIT mostrou-se coerente, com todos os itens apresentando saturações satisfatórias, superior a |0,40|, tendo o Fator 1 explicado 47,5% da variância total com alfa de 0,84 e o Fator 2 explicado 11,6% da variância total com alfa de 0,69. Os resultados do teste-reteste indicaram correlação forte entre os dados obtidos na primeira (t1) e segunda (t2) aplicação (r tt = 0,94, p < 0,01), sem diferença significativa de médias nos dois tempos (m t1 = 0,37, dp = 0,49; m t2 = 0,34, dp2= 0,47; p > 0,05), com ICC satisfatório (0,96). CONCLUSÕES: Os achados apoiaram a adequação psicométrica do AUDIT, com as análises fatoriais exploratórias apontando como mais satisfatória a estrutura com dois fatores, bem como atestaram sua boa estabilidade temporal.

Modelling and verifying smell-free architectures with the Archery language

Architectural (bad) smells are design decisions found in software architectures that degrade the ability of systems to evolve. This paper presents an approach to verify that a software architecture is smellfree using the Archery architectural description language. The language provides a core for modelling software architectures and an extension for specifying constraints. The approach consists in precisely specifying architectural smells as constraints, and then verifying that software architectures do not satisfy any of them. The constraint language is based on a propositional modal logic with recursion that includes: a converse operator for relations among architectural concepts, graded modalities for describing the cardinality in such relations, and nominals referencing architectural elements. Four architectural smells illustrate the approach.

Cerebral calcifications and schizophreniform disorder

OBJECTIVES: Discuss pathophysiological aspects of cerebral calcifications (CC) and highlight its importance related to the occurrence of neuropsychiatric syndromes. METHOD: Single case report. RESULT: Man 52 years old, 20 years after going through a total thyroidectomy, starts showing behavioral disturbance (psychotic syndrome). He was diagnosed as schizophrenic (paranoid subtype) and submitted to outpatient psychiatric treatment. During a psychiatric admission to evaluate his progressive cognitive and motor deterioration, we identified a dementia syndrome and extensive cerebral calcifications, derived from iatrogenic hypoparathyroidism. CONCLUSION: The calcium and phosphorus disturbances, including hypoparathyroidism, are common causes of CC. Its symptoms can imitate psychiatric disorders and produce serious and permanent cognitive sequelae. The exclusion of organicity is mandatory in any psychiatric investigative diagnosis in order to avoid unfavorable outcomes, such as in the present case report.

Psychometric properties of assessment instruments for autism spectrum disorder: a systematic review of Brazilian studies

Objective To systematically review the scientific literature on the psychometric properties of international instruments for the assessment of autism spectrum disorder (ASD) in the Brazilian population. Methods A search of bibliographic references was conducted in six electronic databases: PsycINFO, PubMed, IndexPsi, Lilacs, Capes (theses and dissertations) and SciELO. The studies were selected by two independent researchers. Results The procedure identified 11 studies of the Brazilian population that encompassed six ASD assessment tools. Given the information provided, the adaptation of the M-CHAT, a screening instrument, was the best conducted. All steps of the adaptation process were described and the changes made to the final version of the instrument were presented, which was not addressed in other studies. In terms of reliability, all of the instruments that assessed internal consistency showed adequate values. In addition, the ADI-R and the CARS adaptations also satisfactorily contemplated inter-rater reliability and test-retest indices, respectively. Finally, all studies aiming to validate instruments showed evidence of validity and sensitivity, and specificity values above 0.90 were observed in the ASQ, ADI-R and ABC. Conclusion Considering both the psychometric aspects and the copyright information, the screening instrument that currently appears to be best indicated for clinical and research use is the M-CHAT. It was also noticed that there are still no specific ASD diagnostic tools available for use in Brazil. This lack of diagnostic instruments consists in a critical situation for the improvement of clinical practice and the development of research in this area.

Posttraumatic stress disorder: prevalences, comorbidities and quality of life in a community sample of young adults

Objectives To verify the prevalence of current posttraumatic stress disorder (PTSD) in young adults, the occurrence of comorbidities and its association with quality of life. Methods This is a cross-sectional population-based study. The targeted population consisted on individuals aged 18 to 24 years old, who lived in the urban area of Pelotas-RS, Brazil. Cluster sampling was applied. PTSD and its comorbidities were assessed using the Mini International Neuropsychiatric Interview (MINI 5.0), whereas quality of life was evaluated with the eight domains of the Medical Outcomes Survey Short-form General Health Survey (SF-36). Results A total of 1,762 young adults were selected. The prevalence of PTSD was 2.1% and current episode of depression was the most prevalent comorbidity (71.9%). The individuals with PTSD had lower scores in all domains of quality of life. Conclusion These findings indicate that PTSD is associated with other psychopathologies, especially depression, and it has a substantial impact over quality of life in a sample of young adults.

A skin-picking disorder case report: a psychopathological explanation

We describe the case of a 44-year-old woman, without known previous psychiatric history, hospitalized after a significant hemorrhage caused by self-inflicted deep facial dermal lesions (with muscle exposition). Psychopathological possible explanations of this case, as in similar reviewed ones, are related to frustration, aggression, and impulsivity.

Assessing treatment response to prophylactic lithium use in patients with bipolar disorder

ABSTRACT Objetive To identify potential clinical and epidemiological predictors of long-term response to lithium treatment. Methods A total of 40 adult outpatients followed in an university hospital, with confirmed diagnosis of bipolar disorder and with history of lithium use for at least a six months period, had their response to this medication assessed through the use of a standardized instrument. The ALDA scale is based on retrospective clinical data, in our study assessed through a thoroughly reviewed of the medical charts, and is used to evaluate the clinical improvement with the treatment (Criterion A), corrected by the acknowledgement of possible confounding factors, such as duration of the treatment, compliance and concomitant use of additional medications (Criterion B), in order to estimate the response that can be specifically attributable to lithium. Results Our study found an inverse relation between the number of mood episodes with psychotic symptoms and lithium treatment outcome. Conclusion The results reinforce the hypothesis that lithium seems to be less efficacious in patients with bipolar disorder who present psychotic symptoms.

Psicomotricidade e intervenção precoce no Centro de Desenvolvimento da Criança Torrado da Silva do Hospital Garcia da Orta

Nota: Os anexos referidos no índice do trabalho não foram fornecidos.

Exposición prenatal al alcohol y síndrome de hiperactividad con déficit de la atención: un abordaje conductual, farmacológico y bioquímico. Alcohol prenatal exposure and attention deficit with hyperactivity disorder: behavioral, pharmacological and biochemical approaches.

El Trastorno por Déficit de Atención con Hiperactividad (ADHD) es un síndrome conductual de origen orgánico, que se manifiesta principalmente en niños. Está caracterizado por distracción moderada a severa, períodos de atención breve, hiperactividad, inestabilidad emocional e impulsividad. Los tratamientos se basan "paradójicamente" en psicoestimulantes. Las sustancias mas empleadas son metilfenidato y anfetamina. La sintomatología indica un mal funcionamiento en los circuitos dopaminérgicos que sería el resultado de factores genéticos como ambientales, ya que es común encontrar ADHD en niños expuestos prenatalmente al alcohol. Los modelos animales son importantes para estudiar patologías de etiología desconocida, en este sentido, estudios de nuestro laboratorio indican que ratones deficientes en p35 son hiperactivos y responden paradojalmente a psicoestimulantes. Cdk5/p35 participa en el desarrollo neuronal, liberación de vesículas, señales dopaminérgicas, etc. Además resultados preliminares indican que la experiencia prenatal con una dosis etílica moderada durante la gestación tardía, es suficiente para incrementar los patrones de actividad locomotora, semejantes a los descriptos en los modelos animales de ADHD. De acuerdo a estas consideraciones hipotetizamos que la exposición etílica prenatal a dosis moderadas y durante un periodo acotado de la gestación tardía, resulta en un patrón conductual similar al descripto en modelos de ADHD. Asimismo, drogas psicoestimulantes pueden revertir dichos efectos. Por otra parte, proponemos que estas alteraciones son consecuencia de los efectos ocasionados por el insulto etílico sobre el equilibrio en el funcionamiento del sistema de neurotransmisión dopaminérgio mesolímbico/cortical. Teniendo en cuenta que la etiología del ADHD aun no se conoce, el desarrollo de modelos animales, que recapitulen características clínicas de este trastorno, constituye una herramienta muy poderosa para el estudio de los mecanismos celulares y moleculares que subyacen a este síndrome, por lo tanto, en este proyecto nos proponemos obtener evidencias acerca de las alteraciones originadas a partir de efectos deletéreos de la exposición etílica prenatal, que recapitulan el desarrollo de fenotipos conductuales y bioquímicos descriptos en modelos para ADHD. Específicamente nos proponemos determinar, por medio de experimentos conductuales, si la exposición a distintas dosis moderadas de alcohol durante un periodo acotado de la gestación tardía, son suficientes para generar alteraciones conductuales características de ADHD y establecer si metilfenidato y anfetamina, son capaces de revertirlas. Evaluar, mediante métodos bioquímicos, si este modelo involucra cambios en algunos de los componentes claves de la neurotransmisión dopaminérgica, tales como niveles de dopamina y sus metabolitos, niveles de expresión de tirosina-hidroxilasa, de receptores y transportador de dopamina, del complejo cdk5/p35, entre otros. Esperamos recapitular características análogas a las observadas en sujetos diagnosticados con ADHD y que el tratamiento con psicoestimulantes re-establezca los niveles de conducta normales. Mediante ensayos bioquímicos, esperamos encontrar mayores niveles de dopamina en tejido estriatal, acompañados con un aumento en los niveles de sus metabolitos y mediante western blot y ensayos de actividad esperamos encontrar mayor nivel de expresión en D1, menor de DAT y alteraciones en la normal actividad y expresión de cdk5/p35, que podrían explicar los resultados comportamentales esperados. Dada la alta prevalencia de ADHD y que estos jóvenes pacientes son medicados con psicoestimulantes, junto con la poca información sobre las respuestas neuroadaptativas del cerebro inmaduro, es importante investigar los mecanismos que subyacen las alteraciones neurofisiológicas de este trastorno. Estos abordajes experimentales resultan centrales para el desarrollo de terapias mas eficientes para el tratamiento de este síndrome.

REVISANDO LOS CONTENIDOS EN LENGUA: Hacia una semántica integradora. Transferencia y capacitación. REVIEWING CONTENTS IN LANGUAGE: Toward an integrative semantics. Transference and training.

En el trabajo se sistematiza la información semántica a fin de que ella sea la articuladora y eje de otros contenidos abordados en la enseñanza de la lengua materna. Así, en primer lugar se sistematizarán conceptos y perspectivas semánticas, para luego establecer relaciones con otros niveles lingüísticos, como lo son la Morfología y la Sintaxis, sin descuidar los aportes de la semántica a los procesos de producción y comprensión textuales. Realizaremos estudios para sistematizar y asignar al contenido un lugar dominante e integrador en el proceso de enseñanza-aprendizaje de la lengua materna, sin pretender desdibujar otras temáticas. Planteamos tareas cuyo punto culminante es la capacitación de docentes y experimentación de las propuestas didácticas en tres cursos de lengua en una institución educativa de la ciudad de Córdoba, cuyo examen, de ser positivo, permitirá la replicación y transferencia de esas prácticas a otras instituciones. Como objetivos generales, destacamos colaborar con la integración de los contenidos que se dictan en Lengua Materna, tomando como eje la naturaleza semántica del lenguaje; contribuir con la formación de los estudiantes en las dimensiones de la comprensión y producción textuales; promover la reflexión y el incremento del caudal léxico -y del lenguaje en general-, por parte de los estudiantes; contribuir con la capacitación y formación de los docentes en las temáticas abordadas, a través de acciones concretas; corroborar que la formación de los alumnos podrá tornarse más significativa en la medida en que se trabajen 'formas' lingüísticas atravesadas por contenidos. El marco teórico está constituido por los aportes de diferentes líneas, los que, compatibilizados, permitirán acceder a un abordaje integral del 'contenido' lingüístico. Más precisamente, consideramos las conceptualizaciones de autores tales como Coseriu (1986) para la delimitación semántica, sus conceptos y operaciones, al que completamos con la perspectiva de Lyons (1986, 1997); para las relaciones entre Morfología, seguimos a Ramírez Sáinz (2008) ; el vínculo sintaxis- semántica será abordado desde la perspectiva de la Gramática Generativa (Demonte,V. 1991; D'Introno, 2001; Fernández Lagunilla, M y Anula Rebollo,A, 1995; los aportes de la comprensión serán considerados desde De Beaugrande-Dresller (1997). Otros autores de referencia son Lakoff y Jhonsson (1998).