Adriana Cardoso

The effects of dehydroepiandrosterone (DHEA) in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses: a systematic review.

International interest on the benefits of using the steroid hormone Dehydroepiandrosterone (DHEA) on various aspects of human health, including the regulation of mood, is increasing. This study aimed to review the scientific literature on the use of DHEA in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses. PubMed, ISI Web of Knowledge and Virtual Health Library (VHL) databases were independently searched by two researchers using the following terms: depression, treatment, DHEA, and mood. Clinical studies were considered eligible when subjects were treated with DHEA and psychological assessments of depression were conducted. No time limits or language for this research were imposed. One 183 references were identified, and 22 references were selected to compose this review. Significant improvements related to the use of DHEA in patients with depression were observed, in addition to improvements in depressive symptoms in patients with schizophrenia, anorexia nervosa, HIV and adrenal insufficiency. No significant improvements were observed regarding depressive symptoms in patients with fibromyalgia; the results observed in patients with autoimmune diseases and healthy individuals remain contradictory. Although the selected studies demonstrated good methodological applications, most studies consisted of small samples, and only 3 studies were conducted in a young population. Therefore, we concluded that the studies published to date indicate promising results regarding the use of DHEA in the treatment of depression and depressive symptoms, especially in depression that is mild or resistant to conventional therapy.

The utilization of unified protocols in behavioral cognitive therapy in transdiagnostic group subjects: A clinical trial.

BACKGROUND The practicing of protocols based on behavioral cognitive therapy (CBT) have been frequently used in the last decades and adapted to better manage the necessities of patients and providers. OBJECTIVES The goal is to build a treatment that is evidence-based - for that reason the unified protocol for multiple emotional disorders (transdiagnostics) have been utilized to simplify treatment - without losing scientific traits. The main goal of this study is to evaluate the unified protocol in groups of patients with depression and anxiety disorders. MATERIALS AND METHODS In a pool of 48 subjects, divided in two groups, one was submitted to 12 intervention sessions of the unified protocol while the other was solely given medication. MINI, BAI and BDI were the instruments used at the beginning and at the end of treatment. RESULTS The results were highly significant (p<0.001) in as much as with the improvement of anxiety and depressive disorders as it was in the group which was treated with the unified protocol compared with the group which was only given medication LIMITATIONS Limitations of this study were the number of sample participants and the non-randomization of subjects in both groups. CONCLUSION Group therapy has not been largely implemented though it is deemed very useful for treatments when the unified protocol is used in transdiagnostic patients. Not only does it allow for emotional stabilizing and socialization but it also enables subjects with an altruistic feeling amongst themselves.

Executive Function Impairments in Patients with Depression

Depression, the most prevalent psychiatric disorder, has a lifelong risk of 20% and is related to high rates of death among the patients. Thus, this study aims to conduct a systematic review of changes in executive functions of adult patients diagnosed with depression. We found 1381 articles; however, only 28 were selected and recovered. The inclusion criteria was the assessment of executive functions with at least one neuropsychological test, and articles that evaluated primarily adult individuals with depression, without comparison to other psychiatric disorders. Although most of the studies (25 out of 28 analyzed) have shown deficits in some executive subcomponents, these findings are not conclusive because they used different parameters of assessment. Moreover, many variables were not controlled, such as the different subtypes of the disorder, the high level of severity, comorbidity and the use of drugs. Most studies showed different deficits in executive functions in depressed patients, but further longitudinal studies are needed in order to confirm these findings.

Cross-cultural adaptation and evaluation of the psychometric properties of the Brazilian version of the Video Game Addiction Test

BackgroundA recurring complaint in psychological and psychiatric clinics involves problems associated with the use of video games. The aim of this research was to assess the translation and back-translation of the Video Game Addiction Test (VAT), its construct and convergent validity, its reliability based on internal consistency and retest methods of the instrument. Material and methodsFifty-five subjects were recruited for the cross-cultural and semantic adaptation of the VAT. For the evaluation of the psychometric parameters, 384 students were recruited to complete the VAT, the Internet Addiction Test (IAT), the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory and the Game Addiction Scale (GAS). A subgroup of participants (n?=?76) took part in a follow-up study and completed the scale twice to determine its test-retest stability. ResultsThe process of the verbal understanding analysis emphasized the ease of understanding for the participants. The scale demonstrated excellent internal consistency (Cronbachs alpha?=?.92) and a strong positive correlation with the GAS (r?=?.883). ConclusionIn the Brazilian Portuguese context, the VAT was observed to have good semantic understanding, internal consistency and psychometric validity. The Video Game Addiction Test (VAT) consists of 14 items divided into five criteria.The semantic understanding of the items in Brazilian Portuguese was excellent.The scale had good results for internal consistency and temporal stability.The instrument can be used in the assessment of video game addiction.

Validity and reliability assessment of the Brazilian version of the game addiction scale (GAS)

BACKGROUND The uncontrolled use of video games can be addictive. The Game Addiction Scale (GAS) is an instrument that was developed to assess this type of addiction. The GAS consists of 21 items that are divided into the following seven factors: salience, tolerance, mood modification, relapse, withdrawal, conflict and problems. This study assessed the convergent validity and reliability of the GAS according to measures of internal consistency and test-retest stability. MATERIAL AND METHODS Three hundred and eighty four students completed the GAS, the Internet Addiction Test (IAT), the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI) and the Video Game Addiction Test (VAT). A subgroup of the participants (n=76) completed the GAS again after 30days to determine test-retest stability. RESULTS The GAS demonstrated excellent internal consistency (Cronbachs alpha=0.92), was highly correlated with the VAT (r=0.883) and was moderately correlated with the BDI (r=0.358), the LSAS (r=0.326) and the IAT (r=0.454). CONCLUSION In the Brazilian Portuguese population, the GAS shows good internal consistency. These data indicate that the GAS can be used to assess video game addiction due to its demonstrated psychometric validity.

Depression as a comorbidity in Behcet's syndrome.

Behcets syndrome (BD) is a controversial, chronic, and episodic condition that is autoimmune in origin and causes systemic vasculitis in the arteries and genital veins. BD is consistently associated with depression, with an incidence of 86% upon the first appearance of symptoms and disorders of the disease. However, few studies have looked at depression and other psychiatric disorders, such as anxiety, in the context of comorbidity with BD. The aim of this review is to identify articles that focus on the relation between BD and depression as a comorbidity. The studies found revealed a consistently high incidence of depression in the BD population, even when compared with other chronic pathologies including Rheumatoid Arthritis and Psoriasis, although there was a limitation in the use of scales and other tools for assessment and control of comorbid symptoms, moreover there are no studies linking the drugs used in the BD treatment of each patient and the symptoms present in each case. This review clearly shows the lack of research in which depression scores are analyzed in relation to the medications used by individual patients. Additionally, the use of additional scales is necessary to increase the knowledge about the nature and consequences of depression as comorbidity of BD.

Dehydroepiandrosterone (DHEA) for Depression: A Systematic Review and Meta-Analysis

BACKGROUND Depression is a mental disorder that affects a large part of the worlds population. DHEA is a hormone that has long been attributed to the ability to improve depressive symptoms. However, few studies were conducted with depression individuals not resulting from other medical conditions. OBJECTIVE To investigate whether DHEA is more effective than placebo in the treatment of depressive symptoms in subjects with depression not resulting from other psychiatric or medical comorbidities. METHODS An electronic search was carried out using the keywords Dehydroepiandrosterone (Mesh) AND Depression (Mesh) in the following databases: Medical Literature databases Analysis and Retrieval System Online (Medline), Excerpta Medical Database (EMBASE), Latin American and Caribbean Health Sciences (LILACS) and the Cochrane Library through their website for relevant publications until June 2018. Only randomized clinical trials were included. The critical appraisal of the articles was performed using the Risk of Bias Tool from Cochrane Collaboration. RESULTS The meta-analysis applied in this review pointed to a significant effect in favor of treatment with DHEA compared to placebo. CONCLUSION DHEA may be one more effective alternative between the drugs used in the treatment of depression.

High functioning autism disorder: marital relationships and sexual offending

Objective: To describe the implications of social inability as a factor that can contribute to sexual abuse in the marriage relationship of people with high-functioning autism spectrum disorder (ASD). Case description: A 30-year-old male sought medical attention complaining of being “very nervous” and have difficulties in family relationships. He was diagnosed with high-functioning ASD based on the DSM-5. Married for over 4 years with a woman diagnosed with histrionic personality disorder (HPD), he asked for her to accompany him in the sessions and help him describe difficulties they had during sexual intercourse. His wife reported feeling raped in all of her sexual relations with the patient, especially when he could not understand that she did not want sex. Comments: The case study leads us to believe that the social and communicative disability is a complicating factor that can contributes to the occurrence of sexual abuse in marital relationships with individuals with ASD. Social skills training, psychotherapy, and traditional medical therapies should be considered to minimize the risk of occurrence of cases of sexual abuse by individuals with high-functioning ASD against the spouses themselves.

Cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese

INTRODUCTION The internet has proven to be a valuable resource for self-care, allowing access to information and promoting interaction between professionals, caregivers, users of health care services and people interested in health information. However, recurring searches are often related to excessive health anxiety and a phenomenon known as cyberchondria can have impacts on physical and mental health. Within this background, a Cyberchondria Severity Scale has been developed to differentiate healthy and unhealthy behavior in internet searches for health information, based on the following criteria: compulsion, distress, excesses, and trust and distrust of health professionals. OBJECTIVE To conduct cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese, because of the lack of an appropriate instrument for Brazil. METHODS This study was authorized by the original author of the scale. The process was divided into the following four steps: 1) initial translation, 2) back-translation, 3) development of a synthesized version, and 4) experimental application. RESULTS Translation into Brazilian Portuguese required some idiomatic expressions to be adapted. In some cases, words were not literally translated from English into Portuguese. Only items 7, 8, 12, 23 and 27 were altered, as a means of both conforming to proper grammar conventions and achieving easy comprehension. The items were rewritten without loss of the original content. CONCLUSION This paper presents a translated version of the Cyberchondria Severity Scale that has been semantically adapted for the Brazilian population, providing a basis for future studies in this area, which should in turn contribute to improved understanding of the cyberchondria phenomenon in this population.

PS247. High relapse rate after efficacious ultra-long term treatment of panic disorder with clonazepam or paroxetine

Objective: The aim of this cross-sectional study was to examine the prevalence of psychological dependence on antidepressants in outpatients with panic disorder and elucidate demographic and clinical characteristics associated with this condition. Methods: This study was conducted in four outpatient clinics in Tokyo, Japan from April, 2014 to March, 2015. Subjects were eligible if they were outpatients aged 18 years or older and met the diagnostic criteria for panic disorder according to the International Classification of Diseases, 10th edition (ICD-10). The subjects received the following assessments: the Severity of Dependence Scale, Japanese Version (SDS), the Self-Report Version of Panic Disorder Severity Scale, Japanese Version (PDSS-SR), and the Quick Inventory of Depressive Symptomatology-Self Report, Japanese Version (QIDS-SR). The following information was also collected: age, sex, ethnicity, duration of illness, physical and psychiatric comorbidities, and details of prescribed psychotropic medications. Results: Eighty-four patients participated in this study; of these, 30 patients (35.7%) showed psychological dependence on benzodiazepines (i.e. a total score of ≥5 in the SDS). A multiple regression analysis showed that PDSS scores and illness duration were positively correlated with SDS total scores ([β=0.43, 95% confidence interval=0.09–0.35, p=0.002], [β=0.27, 95% confidence interval=0.002–0.02, p=0.019], respectively), while other factors failed to show any significant association. A binary regression model demonstrated that absence of remission (i.e. a total score of ≥ 5 in the PDSS) and longer duration of illness increased the risk of dependence on antidepressants (odds ratio=1.18, 95% confidence interval=1.02–1.38, p=0.028, odds ratio=1.02, 95% confidence interval=1.01–1.03, P=0.004, respectively). Conclusion: Approximately two-fifth of the patients with panic disorder receiving antidepressants fulfilled the criteria for psychological dependence on these drugs. The results underscore the need of close attention, especially to those who present severe symptomatology or have a chronic course of panic disorder. PS247 High relapse rate after efficacious ultra-long term treatment of panic disorder with clonazepam or paroxetine Antonio Nardi, Roman Amrein, Adriana Cardoso, Gisele Dias, Rafael Freire, Sergio Machado Federal Univ Rio de Janeiro, Brazil Abstract Objective: To describe the clinical and therapeutic features of 120 panic disorder (PD) patients treated for 3 years with clonazepam, paroxetine, or clonazepam + paroxetine and their followup for 6 years after the treatment. Method: A prospective open study with 120 PD patients randomized to 2 mg/day clonazepam or 40 mg/day paroxetine. Poor responders were switched after 8 weeks to combined treatment with ~2 mg/day clonazepam + ~40 mg/day paroxetine. Tapered withdrawal of the treatment was performed after 3 years. Efficacy, safety, and cumulative relapse and remission were studied over the following 6 years. Results: 94 patients completed 3 years treatment. All were free of panic attacks since at least one year before undergoing tapered drug withdrawal. In annually studied patients the relapse rates were similar after the 3 treatments with a marginal advantage of clonazepam over the combination and paroxetine at the first year after drug withdrawal. Cumulative relapses rate were 41%, 77%, and 94% at years 1, 4, and 6. 90% of the annually followed patients were during the 6 years of follow up in average in remission (partial: 54%, full: 36%); 73% were PA-free, 91% had a GCI-S score of 1, and 39% HAMA scores of 5–10; 33% needed drug treatment in each follow-up year. Both treatments displayed similarly high efficacy, but clonazepam was better tolerated. Results in patients studied at the end of follow-up only were similar, but somewhat less favorable: 88% were in remission, 72% were PA-free, 62% had a CGI-S score of 1 and 30% a HAMA of 5–10, with 39% needing PD treatment. Conclusion: PD is a chronic disorder, with many patients relapsing despite being asymptomatic at least one year after 3 years treatment. Paroxetine and clonazepam were associated with similar long-term prognoses but clonazepam was better tolerated.Objective: To describe the clinical and therapeutic features of 120 panic disorder (PD) patients treated for 3 years with clonazepam, paroxetine, or clonazepam + paroxetine and their followup for 6 years after the treatment. Method: A prospective open study with 120 PD patients randomized to 2 mg/day clonazepam or 40 mg/day paroxetine. Poor responders were switched after 8 weeks to combined treatment with ~2 mg/day clonazepam + ~40 mg/day paroxetine. Tapered withdrawal of the treatment was performed after 3 years. Efficacy, safety, and cumulative relapse and remission were studied over the following 6 years. Results: 94 patients completed 3 years treatment. All were free of panic attacks since at least one year before undergoing tapered drug withdrawal. In annually studied patients the relapse rates were similar after the 3 treatments with a marginal advantage of clonazepam over the combination and paroxetine at the first year after drug withdrawal. Cumulative relapses rate were 41%, 77%, and 94% at years 1, 4, and 6. 90% of the annually followed patients were during the 6 years of follow up in average in remission (partial: 54%, full: 36%); 73% were PA-free, 91% had a GCI-S score of 1, and 39% HAMA scores of 5–10; 33% needed drug treatment in each follow-up year. Both treatments displayed similarly high efficacy, but clonazepam was better tolerated. Results in patients studied at the end of follow-up only were similar, but somewhat less favorable: 88% were in remission, 72% were PA-free, 62% had a CGI-S score of 1 and 30% a HAMA of 5–10, with 39% needing PD treatment. Conclusion: PD is a chronic disorder, with many patients relapsing despite being asymptomatic at least one year after 3 years treatment. Paroxetine and clonazepam were associated with similar long-term prognoses but clonazepam was better tolerated. PS248 The Interaction Effects between Panic-Related Genes Polymorphisms and Panic Disorder on Cortical Thickness of Paralimbic Regions: A Preliminary Study Eun-Kyoung Kanga and Sang-Hyuk Leea,* aDepartment of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea * Corresponding author Abstract Background: Panic disorder(PD) has consistently showed high heritability. Polymorphisms of serotonin transporter linked promoter region (5-HTTLPR), 5-Hydroxytryptamine Receptor 1A(HTR1A), cathechol-O-methyltrasferase(COMT), and brainderived neurotrophic factor(BDNF), Regulators of G-protein signaling 2(RGS2) have been suggested to be associated with panic disorder. In addition, no imaging studies have examined the difference of cortical thickness between PD and Healthy control, and the interaction effects panic-related genes polymorphisms and the presence of panic disorder on cortical thickness of paralimbic regions such as temporal pole and insula.Background: Panic disorder(PD) has consistently showed high heritability. Polymorphisms of serotonin transporter linked promoter region (5-HTTLPR), 5-Hydroxytryptamine Receptor 1A(HTR1A), cathechol-O-methyltrasferase(COMT), and brainderived neurotrophic factor(BDNF), Regulators of G-protein signaling 2(RGS2) have been suggested to be associated with panic disorder. In addition, no imaging studies have examined the difference of cortical thickness between PD and Healthy control, and the interaction effects panic-related genes polymorphisms and the presence of panic disorder on cortical thickness of paralimbic regions such as temporal pole and insula.