Mood disorders in eating disorder patients: Prevalence and chronology of ONSET.

OBJECTIVES: In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. METHOD: The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. RESULTS: Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS: Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION: Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

Smoking, Alcohol, Drug Use, Abuse and Dependence in Narcolepsy and Idiopathic Hypersomnia: A Case-Control Study.

STUDY OBJECTIVES: Basic experiments support the impact of hypocretin on hyperarousal and motivated state required for increasing drug craving. Our aim was to assess the frequencies of smoking, alcohol and drug use, abuse and dependence in narcolepsy type 1 (NT1, hypocretin-deficient), narcolepsy type 2 (NT2), idiopathic hypersomnia (IH) (non-hypocretin-deficient conditions), in comparison to controls. We hypothesized that NT1 patients would be less vulnerable to drug abuse and addiction compared to other hypersomniac patients and controls from general population. METHODS: We performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 450 adult patients (median age 35 years; 41.3% men) with NT1 (n = 243), NT2 (n = 116), IH (n = 91), and 710 adult controls. All participants were evaluated for alcohol consumption, smoking habits, and substance (alcohol and illicit drug) abuse and dependence diagnosis during the past year using the Mini International Neuropsychiatric Interview. RESULTS: An increased proportion of both tobacco and heavy tobacco smokers was found in NT1 compared to controls and other hypersomniacs, despite adjustments for potential confounders. We reported an increased regular and frequent alcohol drinking habit in NT1 versus controls but not compared to other hypersomniacs in adjusted models. In contrast, heavy drinkers were significantly reduced in NT1 versus controls but not compared to other hypersomniacs. The proportion of patients with excessive drug use (codeine, cocaine, and cannabis), substance dependence, or abuse was low in all subgroups, without significant differences between either hypersomnia disorder categories or compared with controls. CONCLUSIONS: We first described a low frequency of illicit drug use, dependence, or abuse in patients with central hypersomnia, whether Hcrt-deficient or not, and whether drug-free or medicated, in the same range as in controls. Conversely, heavy drinkers were rare in NT1 compared to controls but not to other hypersomniacs, without any change in alcohol dependence or abuse frequency. Although disruption of hypocretin signaling in rodents reduces drug-seeking behaviors, our results do not support that hypocretin deficiency constitutes a protective factor against the development of drug addiction in humans.

Alcohol and brief intervention for trauma victims

Objective:to describe the causes and severities of trauma in patients who met the criteria for alcohol abuse or dependence according to Mini International Neuropsychiatric Interview, and to display the pattern of alcohol consumption and subsequent changes one year after trauma.Methods:a transversal and longitudinal quantitative study carried out between November 2012 and September 2013 in the ED. Medical and nursing students collected blood samples, applied the J section of the Mini International Neuropsychiatric Interview (MINI) and submitted alcohol abusers and dependents to BI. One year after admission, patients were contacted and asked about their patterns of alcohol use and their reasons for any changes.Results:from a sample of 507 patients admitted to the ED for trauma, 348 responded to MINI, 90 (25.9%) being abusers and 36 (10.3%) dependent on alcohol. Among the abusers, the most frequent cause of injury was motorcycle accident (35.6%) and among the dependents it was predominantly interpersonal violence (22.2%). Positive blood samples for alcohol were identified in 31.7% of the abusers and 53.1% of the dependents. One year after trauma, 66 abusers and 31 dependents were contacted, and it was ascertained that 36.4% of the abusers and 19.4% of the dependents had decreased alcohol consumption. The main reported reason for the reduction was the experienced trauma.Conclusion:the motorcycle accident was the most common cause of injury. The detection of problematic alcohol use and implementation of BI are important strategies in the ED, however for alcohol abusers and dependents, BI was not the most reported reason for any changes in patterns of alcohol use.

Is avoidant disorder part of the social phobia spectrum in a referred sample of Brazilian children and adolescents?

The diagnosis of avoidant disorder was deleted from the Diagnostic and Statistical Manual of Mental disorders - fourth edition (DSM-IV) based on a `committee decision' suggesting that avoidant disorder is part of the social phobia spectrum. The objective of the present study was to examine the nature of this clinical association in a referred sample of Brazilian children and adolescents. We assessed a referred sample of 375 youths using semi-structured diagnostic interview methodology. Demographic (age at admission to the study and sex) and clinical (level of impairment, age at onset of symptoms and pattern of comorbidity) data were assessed in subsamples of children with avoidant disorder (N = 7), social phobia (N = 26), and comorbidity between both disorders (N = 24). Although a significant difference in the male/female ratio was detected among groups (P = 0.03), none of the other clinical variables differed significantly among subjects that presented each condition separately or in combination. Most of the children with avoidant disorder fulfilled criteria for social phobia. Thus, our findings support the validity of the conceptualization of avoidant disorder as part of the social phobia spectrum in a clinical sample.

Performance perceptive dans l’autisme : du facteur «g» au facteur «p»

La perception est de plus en plus reconnue comme fondamentale à la compréhension du phénotype autistique. La première description de l’autisme, par Kanner en 1947, fait état d’un profil cognitif hétérogène caractérisé par des habiletés exceptionnelles à l’intérieur de domaines spécifiques de la perception (ex., la musique). L’accumulation des observations cliniques sur la présence de particularités perceptives a mené à l’élaboration d’études empiriques permettant d’objectiver des surfonctionnements dans le traitement élémentaire de l’information perceptive dans l’autisme. Parallèlement, des études cognitives suggèrent la présence d’une « intelligence différente » chez les personnes autistes. Celle-ci serait caractérisée par une dissociation entre des performances à différents tests d’intelligence fortement corrélés ensemble chez les personnes typiques. Le potentiel intellectuel des personnes autistes serait sous-estimé lorsque mesuré par l’échelle de Wechsler, plutôt que des mesures d’intelligence fluide comme les Matrices Progressives de Raven. Avec l’appui d’études en imagerie cérébrale, ces résultats suggèrent une relation unique entre la perception et l’intelligence chez cette population clinique. Étant donné l’accumulation de preuves sur 1) la présence d’atypies perceptuelles, 2) le rôle différent de la perception dans l’intelligence et 3) l’importance des comportements répétitifs et intérêts restreints dans le phénotype autistique (DSM-5), le premier volet de cette thèse s’est intéressé à la relation entre les performances perceptives des personnes autistes et celle des personnes ayant un développement typique, au-delà de ce qui est expliqué par l’intelligence. À l’aide de modèles de régression linéaire, les résultats démontrent un profil de covariation spécifique à l’autisme pour les habiletés plurimodales. Contrairement aux personnes ayant un développement typique, ces associations persistent au-delà de ce qui est expliqué par l’intelligence générale ou par l’efficacité générale des systèmes perceptifs. Ce profil de covariation résiduelle propre aux personnes autistes suggère la présence d’un facteur plurimodal spécifique à ce groupe clinique : le facteur « p ». Le deuxième volet de cette thèse s’est intéressé à la prévalence des habiletés exceptionnelles au niveau individuel, la relation les forces perceptives et les talents, ainsi qu’aux facteurs de prédisposition en lien avec le développement d’habiletés exceptionnelles. Les forces perceptives des personnes autistes furent évaluées à l’aide de tâches expérimentales sensibles à la détection de surfonctionnements perceptifs, soit une tâche de discrimination de hauteurs sonores et une version modifiée du sous-test « Blocs » de l’échelle d’intelligence de Wechsler. Les talents furent évalués de manière clinique à l’aide de l’ADI-R (« Autism Diagnostic Interview-Revised »). Les données indiquent que 88.4 % des personnes autistes avec une intelligence dans la normale présentent au moins une habileté exceptionnelle (force perceptive ou talent). Les talents sont rapportés chez 62.5 % des cas et les forces perceptives se retrouvent chez 58 % des cas. La cooccurrence des forces perceptives entre les modalités perceptives est relativement peu fréquente (24 % à 27 %) et la présence d’un talent dans une modalité n’augmente pas les chances de présenter une force perceptive dans une même modalité. Une plus grande intelligence augmente les chances de présenter au moins un talent. En revanche, une intelligence plus faible, mais se situant tout de même dans les limites de la normale, est associée à un profil cognitif plus hétérogène avec des forces perceptives plus fréquentes. En somme, l’intelligence autistique serait caractérisée par un rôle plus important de la perception, indépendamment des surfonctionnements perceptifs. Cette particularité cognitive se manifesterait par la présence d’un facteur plurimodal, « p », spécifique à l’autisme. Théoriquement, le facteur « p » reflèterait des modifications innées (ou « hardwired ») dans l’organisation corticale des microcircuits responsables de l'encodage des dimensions perceptives élémentaires. En revanche, une faible association intermodale entre les forces perceptives suggère que des modifications corticales sont essentielles, mais non suffisantes pour le développement d’habiletés exceptionnelles. Par des processus de plasticité, des modifications corticales auraient des répercussions sur le phénotype autistique en offrant une base plus « fertile » pour le développement d’habiletés exceptionnelles, voire savantes, lorsque la personne autiste serait exposée à des expériences de vie avantageuses. Par ailleurs, les résultats de cette thèse, combinés à la littérature existante sur l’intelligence et l’apprentissage des personnes autistes, nous amènent à réfléchir sur les approches d’évaluation et d’intervention les mieux adaptées au fonctionnement spécifique de cette population clinique.

Social perception gaze patterns, symptom severity and resting brain function measured using Arterial Spin Labelling

Autistic spectrum disorder (ASD) is characterised by qualitative alterations in reciprocal social interactions. Some recent studies show alterations in gaze patterns during social perception and rest-functional abnormalities in the ‘social brain network’. This study investigated: i) social perception gaze patterns in children with ASD and controls, ii) the relationship between autism clinical severity and social perception gaze patterns, iii) the relationship between resting cerebral blood flow (rCBF) and social perception gaze patterns. Methods: Nine children with ASD and 9 children with typical development were studied. Eye-tracking was used to detect gaze patterns during presentation of stimuli depicting social scenes. Autism clinical severity was established using the Autism Diagnostic Interview Revised (ADI-R). Arterial spin labelling MRI was used to quantify rCBF. Results: The ASD group looked less at social regions and more at non-social regions than controls. No significant correlation was found between ASD clinical severity and social perception gaze patterns. In the ASD group, gaze behaviour was related to rCBF in the temporal lobe regions at trend level. Positive correlations were found between temporal rCBF and gaze to the face region, while negative correlations were found between temporal rCBF and gaze to non-social regions. Conclusions: These preliminary results suggest that social perception gaze patterns are altered in children with ASD, and could be related to temporal rCBF.

A behavioral comparison of male and female adults with high functioning autism spectrum conditions

Autism spectrum conditions (ASC) affect more males than females in the general population. However, within ASC it is unclear if there are phenotypic sex differences. Testing for similarities and differences between the sexes is important not only for clinical assessment but also has implications for theories of typical sex differences and of autism. Using cognitive and behavioral measures, we investigated similarities and differences between the sexes in age- and IQ-matched adults with ASC (high-functioning autism or Asperger syndrome). Of the 83 (45 males and 38 females) participants, 62 (33 males and 29 females) met Autism Diagnostic Interview-Revised (ADI-R) cut-off criteria for autism in childhood and were included in all subsequent analyses. The severity of childhood core autism symptoms did not differ between the sexes. Males and females also did not differ in self-reported empathy, systemizing, anxiety, depression, and obsessive-compulsive traits/symptoms or mentalizing performance. However, adult females with ASC showed more lifetime sensory symptoms (p = 0.036), fewer current socio-communication difficulties (p = 0.001), and more self-reported autistic traits (p = 0.012) than males. In addition, females with ASC who also had developmental language delay had lower current performance IQ than those without developmental language delay (p<0.001), a pattern not seen in males. The absence of typical sex differences in empathizing-systemizing profiles within the autism spectrum confirms a prediction from the extreme male brain theory. Behavioral sex differences within ASC may also reflect different developmental mechanisms between males and females with ASC. We discuss the importance of the superficially better socio-communication ability in adult females with ASC in terms of why females with ASC may more often go under-recognized, and receive their diagnosis later, than males.

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety

The current study investigated the longitudinal relationships between BI, life events, and anxiety in a sample of 102 behaviourally inhibited (BI) and 100 uninhibited (BUI) children aged 3 to 4 years. Children’s parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, and negative behaviour- dependent life events (i.e. life events that are related to the children’s own behaviours) in particular, and the impact of negative life events, were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the five year follow-up period. Experiencing more positive, behaviour-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behaviour-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems.

The relationship between challenging parenting behaviour and childhood anxiety disorders

Background: This research investigates the relationship between challenging parenting behaviour and childhood anxiety disorders proposed by Bögels and Phares (2008). Challenging parenting behaviour involves the playful encouragement of children to go beyond their own limits, and may decrease children’s risk for anxiety (Bögels & Phares, 2008). Method: Parents (n = 164 mothers, 144 fathers) of 164 children aged between 3.4 and 4.8 years participated in the current study. A multi-method, multi-informant assessment of anxiety was used, incorporating data from diagnostic interviews as well as questionnaire measures. Parents completed self-report measures of their parenting behaviour (n = 147 mothers, 138 fathers) and anxiety (n = 154 mothers, 143 fathers). Mothers reported on their child’s anxiety via questionnaire as well as diagnostic interview (n = 156 and 164 respectively). Of these children, 74 met criteria for an anxiety disorder and 90 did not. Results: Fathers engaged in challenging parenting behaviour more often than mothers. Both mothers’ and fathers’ challenging parenting behaviour was associated with lower report of child anxiety symptoms. However, only mothers’ challenging parenting behaviour was found to predict child clinical anxiety diagnosis. Limitations: Shared method variance from mothers confined the interpretation of these results. Moreover, due to study design, it is not possible to delineate cause and effect. Conclusions: The finding with respect to maternal challenging parenting behaviour was not anticipated, prompting replication of these results. Future research should investigate the role of challenging parenting behaviour by both caregivers as this may have implications for parenting interventions for anxious children.

Associação entre depressão na vida adulta e trauma psicológico na infância

Objetivos: Avaliar a associação entre depressão (DSM IV) na vida adulta e trauma psicológico na infância em uma amostra clínica de pacientes do ambulatório do Hospital de Clínicas de Porto Alegre (HCPA). Por trauma na infância considerou-se abuso sexual, maus tratos, exposição a violência e perdas, por morte ou separação da criança de seus pais, antes dos 18 anos de idade. Métodos: Em um estudo caso controle, foram avaliados pacientes deprimidos (n = 90) e pacientes não deprimidos (n = 50). Através do M.I.N.I. e M.I.N.I plus (Mini International Neuropsychiatric Interview / Brazilian Version 5.0.0.) avaliou-se a presença de depressão e comorbidades. Utilizou-se as escalas Screening Survey of Children's Exposure to Community Violence Richters & Martinez, 1993 Modified by Osofsky, 1995 and Zeannah, 1996 e a Familial Experiences Interview 1988 de Naomi Ogata para avaliar traumas na infância. Resultados: encontrou-se uma maior prevalência de abuso sexual (P = 0,018), história de maus tratos físicos por parte dos pais ou cuidadores (P = 0,005) e exposição à violência (P = 0,007) no grupo de pacientes deprimidos em relação ao grupo de pacientes não deprimidos. Quanto a perdas na infância não se encontrou diferença entre os dois grupos. Quando estas variáveis foram controladas para potenciais fatores confundidores (sexo, etnia, estado civil, doença mental na família, e renda per capita), somente a exposição a múltiplos episódios de violência e história de maus tratos físicos por parte dos pais ou cuidadores se mantiveram como variáveis independentes. Conclusões: Nossos achados, à semelhança de outras pesquisas, encontraram uma associação entre traumas psicológicos na infância e depressão na vida adulta, sugerindo que múltiplos estressores, em maior ou menor grau, na infância, se encontram associados a depressão na vida adulta.

Avaliação de mecanismos de defesa em pacientes com transtorno do pânico, sua relação com gravidade, resposta ao tratamento e alteração pós tratamento

Os mecanismos de defesa representam uma dimensão importante da estrutura da personalidade e do funcionamento psicodinâmico, sendo uma das formas de medir como o indivíduo habitualmente responde aos estressores. O estudo dos mecanismos de defesa utilizados por pacientes com Transtorno do Pânico (TP) pode ter utilidade no entendimento e no tratamento desse transtorno. O objetivo deste trabalho é o de avaliar os mecanismos de defesa do ego, nos pacientes com TP, e sua associação com gravidade, resposta ao tratamento e alteração pós tratamento. Sessenta pacientes com TP e 31 controles participaram da primeira fase do trabalho. O Mini International Neuropsychiatric Interview foi usado para confirmar o diagnóstico de TP e estabelecer o diagnóstico de co-morbidades. A Impressão Clínica Global (CGI) foi usada para avaliar a gravidade do TP e o Defense Style Questionnaire (DSQ-40) foi usado para avaliar os mecanismos de defesa. Em uma segunda etapa, 33 pacientes com TP sintomáticos e 33 voluntários normais foram avaliados com os mesmos instrumentos, aplicados no início do estudo e após 16 semanas. Os pacientes receberam durante esse período tratamento farmacológico com sertralina. Ambos os estudos demonstraram que pacientes com TP utilizam mais defesas neuróticas e imaturas comparados ao grupo controle. Os pacientes com pânico grave (CGI>4) apresentaram maior co-morbidade com depressão atual e usaram mais defesas imaturas do que os pacientes com CGI< 4 (média=4.2 vs. 3.5; p<0.001). Após 4 meses de tratamento, houve diminuição no uso de defesas neuróticas (4.6 vs. 4.2; p=0.049) e imaturas (3.6 vs. 3.4 p=0.035) no grupo de pacientes. Pacientes que usavam mais defesas neuróticas e imaturas apresentaram pior resposta ao tratamento. Pacientes com TP usaram mais defesas mal-adaptativas quando comparados ao grupo controle, no basal e após 4 meses. O uso de defesas neuróticas e imaturas está associado à gravidade do TP e à pior resposta ao tratamento. Os mecanismos de defesa são, então, parte de uma maneira estável do indivíduo lidar com conflitos, mas também são influenciados pelo estado agudo da doença.

Análise do gene transportador de serotonina em pacientes deprimidos que tentaram o suicídio

Introdução: Inúmeros estudos têm associado alterações no sistema serotoninérgico com doenças psiquiátricas como a depressão e os atos suicidas. O gene transportador da serotonina possui um papel central na regulação da função sináptica serotoninérgica e esse gene possui um polimorfismo na região promotora que se constitui em um gene candidato para estudos de associação do comportamento suicida. O objetivo deste trabalho foi verificar a associação entre a freqüência dos alelos “l” e “s” do polimorfismo 5-HTTLPR em pacientes com depressão maior segundo o DSM-IV que tentaram o suicídio e um grupo controle. Avaliamos também se há uma relação entre este polimorfismo e o comportamento suicida. Métodos: A amostra foi composta de 84 pacientes deprimidos que tentaram suicídio e 152 controles doadores voluntários do Banco de Sangue. A região promotora do gene 5-HTT contendo o polimorfismo 5-HTTLPR foi amplificada através do método da Reação em Cadeia da Polimerase (PCR). A avaliação diagnóstica destes pacientes foi feita através de entrevista psiquiátrica clínica e por entrevista diagnóstica padronizada breve Mini International Neuropsychiatric Interview (MINI) para adultos e uso da escala Suicide Intent Scale (SIS). Resultados: Não houve diferenças significativas na freqüência dos alelos e do genótipo nos sujeitos de pesquisa comparados ao grupo controle. Encontramos uma maior freqüência de alelo “s” e do genótipo SS e LS em pacientes deprimidos que tentaram o suicídio. A razão de chance (odds ratio) para o genótipo SS e LS contra o outro genótipo (LL) foi de 1,301 (95% I.C.= 0.737-2.296). A razão de chance (OR) para o alelo “s” em comparação com o alelo “l” foi de 1,38 (95% I.C.= 0.780-1.661).Conclusões: Nossos resultados sugerem que há um risco aumentado de suicídio nos pacientes deprimidos que possuem o genótipo SS e LS.

Suicidalidade em pacientes com transtorno de pânico e agorafogia: prevalência e fatores associados

Pós-graduação em Saúde Coletiva - FMB

Implicações de um programa de formação continuada na formação e atuação de professores de educação física atuantes no ciclo I

This work focused on research a course of continuing education for teachers of Physical Education, offered in a city of São Paulo in 2013. Adopting as a benchmark analysis of models of continuing education in teaching, investigative question that guided this study was: what are the implications of this formative process in the formation and performance of the participating teachers?. With this guiding question, four were the objectives we seek to respond to this analysis: first identify the profile of teachers as well as the participation and involvement of the same course developed; 2 map and analyze the manifestations of teachers throughout the course; 3 reflect on the role of teachers in relation to approaches and/or distances with the common physical education curriculum proposed by the municipality; 4 identify and analyze the reflections on the course conducted. The methodological approach was qualitative and eighteen participants were teachers of a school system in a city of São Paulo, active in cycle I (1 to 5 years) of primary school. Data collection was carried out in two phases, with the participants in the first stage seventeen teachers and three teachers in the second stage that in addition to acting in the cycle I also actively participated in the course. Data were obtained in phase one using a diagnostic interview recorded on voice recorder and transcripts of observations and recorded in video and voice recorder from sixteen meetings of the continuing education course conducted in 2013 and phase two included the observation of classes teachers in the 2nd half of 2013, ending with a final interview. Demonstrations of physical education teachers in the course, as well as the situations observed and interviews indicated that on the profile of teachers are in the age range 30-58 years to serve at least five years in schools and most (10) does not work elsewhere. Another observation is that most of the participating teachers when thes...

Public Speaking in Social Phobia: A Pilot Study of Self-Ratings and Observers' Ratings of Social Skills

Objectives: The aim of this pilot study was to investigate whether patients with social anxiety disorder (SAD) differ from controls in the quality of skill-related behaviors displayed during a speech and in overall behavioral adequacy as perceived by observers and by the patients themselves. Design: A total of 18 SAD patients and 18 controls were screened by a diagnostic interview and took part in a 3-minute speech of their own choosing. For each videotaped speech, observers rated the adequacy of the skill-related behaviors and overall performance adequacy. After the experiment, participants were asked to rate their own overall performance adequacy. Results: The results showed that SAD patients exhibited significantly worse voice intonation and fluency of the speech, however no differences were found in global self-ratings. Moreover, the performance evaluations of the SAD group were consistent with the observers, while the controls evaluated their performance lower than the observers. Conclusions: The results are inconsistent with the cognitive model, because patients with SAD did not underestimate their performance. Compared with spontaneous interactions, the clear rules established for such social situations as speeches may result in less cognitive distortion for SAD patients. (C) 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 68:397-402, 2012.