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Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report

OBJECTIVES Ayahuasca (AYA), a natural psychedelic brew prepared from Amazonian plants and rich in dimethyltryptamine (DMT) and harmine, causes effects of subjective well-being and may therefore have antidepressant actions. This study sought to evaluate the effects of a single dose of AYA in six volunteers with a current depressive episode. METHODS Open-label trial conducted in an inpatient psychiatric unit. RESULTS Statistically significant reductions of up to 82% in depressive scores were observed between baseline and 1, 7, and 21 days after AYA administration, as measured on the Hamilton Rating Scale for Depression (HAM-D), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Anxious-Depression subscale of the Brief Psychiatric Rating Scale (BPRS). AYA administration resulted in nonsignificant changes in Young Mania Rating Scale (YMRS) scores and in the thinking disorder subscale of the BPRS, suggesting that AYA does not induce episodes of mania and/or hypomania in patients with mood disorders and that modifications in thought content, which could indicate psychedelic effects, are not essential for mood improvement. CONCLUSIONS These results suggest that AYA has fast-acting anxiolytic and antidepressant effects in patients with a depressive disorder.

Comparability between telephone and face-to-face Structured Clinical Interview for DSM-IV in assessing social anxiety disorder

PURPOSE This article evaluates the comparability of the telephone and in-person Structured Clinical Interview for DSM-IV (SCID) interviews in assessing patients with social anxiety disorder (SAD) as an independent anxiety diagnosis. DESIGN AND METHODS One hundred subjects were randomly selected and interviewed with the SCID, once by telephone and once in person (1-3 months later). FINDINGS The prevalence of SAD assessed with the telephone interviews was 56%, whereas the in-person prevalence was 52%, with no statistically significant difference. The test-retest kappa for the 200 interviews was .84, indication of excellent agreement. PRACTICE IMPLICATIONS These findings, along with the existing evidence of their validity, should encourage the use of SCID by telephone for SAD diagnostic interviews.

Study of the Discriminative Validity of the PHQ-9 and PHQ-2 in a Sample of Brazilian Women in the Context of Primary Health Care

PURPOSE This study aimed to assess the discriminative validity of the Brazilian version of the Patient Health Questionnaire (PHQ-9) and of its reduced version (PHQ-2). DESIGN AND METHODS The sample consisted of 177 women (60 cases of depression and 117 noncases). The SCID-IV was used as the gold standard. FINDINGS For the PHQ-9, a cutoff score equal to or higher than 10 proved to be the most adequate for the screening of depression, whereas the best cutoff score for the PHQ-2 was found to lie between 3 and 4. PRACTICE IMPLICATIONS The systematic use of these instruments in nursing and in the context of primary health care could favor the early detection of depression.

Social anxiety disorder women easily recognize fearfull, sad and happy faces: The influence of gender

BACKGROUND It has been suggested that individuals with social anxiety disorder (SAD) are exaggeratedly concerned about approval and disapproval by others. Therefore, we assessed the recognition of facial expressions by individuals with SAD, in an attempt to overcome the limitations of previous studies. METHODS The sample was formed by 231 individuals (78 SAD patients and 153 healthy controls). All individuals were treatment naïve, aged 18-30 years and with similar socioeconomic level. Participants judged which emotion (happiness, sadness, disgust, anger, fear, and surprise) was presented in the facial expression of stimuli displayed on a computer screen. The stimuli were manipulated in order to depict different emotional intensities, with the initial image being a neutral face (0%) and, as the individual moved on across images, the expressions increased their emotional intensity until reaching the total emotion (100%). The time, accuracy, and intensity necessary to perform judgments were evaluated. RESULTS The groups did not show statistically significant differences in respect to the number of correct judgments or to the time necessary to respond. However, women with SAD required less emotional intensity to recognize faces displaying fear (p=0.002), sadness (p=0.033) and happiness (p=0.002), with no significant differences for the other emotions or men with SAD. CONCLUSIONS The findings suggest that women with SAD are hypersensitive to threat-related and approval-related social cues. Future studies investigating the neural basis of the impaired processing of facial emotion in SAD using functional neuroimaging would be desirable and opportune.

Antidepressive, anxiolytic, and antiaddictive effects of ayahuasca, psilocybin and lysergic acid diethylamide (LSD): a systematic review of clinical trials published in the last 25 years

To date, pharmacological treatments for mood and anxiety disorders and for drug dependence show limited efficacy, leaving a large number of patients suffering severe and persistent symptoms. Preliminary studies in animals and humans suggest that ayahuasca, psilocybin and lysergic acid diethylamide (LSD) may have antidepressive, anxiolytic, and antiaddictive properties. Thus, we conducted a systematic review of clinical trials published from 1990 until 2015, assessing these therapeutic properties. Electronic searches were performed using the PubMed, LILACS, and SciELO databases. Only clinical trials published in peer-reviewed journals were included. Of these, 151 studies were identified, of which six met the established criteria. Reviewed studies suggest beneficial effects for treatment-resistant depression, anxiety and depression associated with life-threatening diseases, and tobacco and alcohol dependence. All drugs were well tolerated. In conclusion, ayahuasca, psilocybin and LSD may be useful pharmacological tools for the treatment of drug dependence, and anxiety and mood disorders, especially in treatment-resistant patients. These drugs may also be useful pharmacological tools to understand psychiatric disorders and to develop new therapeutic agents. However, all studies reviewed had small sample sizes, and half of them were open-label, proof-of-concept studies. Randomized, double-blind, placebo-controlled studies with more patients are needed to replicate these preliminary findings.

Instrumentos de avaliação do transtorno de ansiedade social

O transtorno de ansiedade social (TAS) e um disturbio de dificil diagnostico pelos clinicos, o que estimula o estudo e desenvolvimento de instrumentos que favorecam seu reconhecimento precoce e sistematico. Objetiva-se identificar na literatura indexada entre janeiro de 1999 e julho de 2004, artigos relativos a estudos psicometricos sobre instrumentos para avaliacao do TAS. Procedeu-se a busca sistematica nos indexadores PsycoInfo, Lilacs e Medline, utilizando-se as palavras-chaves: social phobia scale, social phobia validity, social phobia reliability e social anxiety, identificando-se 26 artigos. Para a analise, os estudos foram agrupados em dois conjuntos: a) onze relativos a Liebowitz Social Anxiety Scale (LSAS), e b) quinze relativos a outras escalas ja validadas ou em validacao. Dos estudos com a LSAS, seis trabalharam com a versao hetero-aplicada e quatro com a auto-aplicada, tendo identificado qualidades psicometricas satisfatorias quanto a validade no idioma original (ingles), e outros idiomas: frances, hebraico, turco e espanhol. Do mesmo modo, bons indices de fidedignidade foram encontrados e quanto a analise fatorial, o modelo de quatro fatores foi considerado o mais adequado. Dos estudos com outras escalas, sete trabalharam com instrumentos ja validados e oito com novas escalas, identificando valores satisfatorios quanto a validade e fidedignidade. As principais limitacoes verificadas nos estudos relacionaram-se a diversidade de padrao-ouro adotada, composicao amostral com ausencia de claros criterios de inclusao e exclusao, e pequeno numero de estudos com amostras nao-clinicas, dificultando o uso dos instrumentos para rastreamento na populacao geral Estudos futuros que visem aprimorar a validacao de criterio com base na analise fatorial e de cluster, parecem necessarios e oportunos.

Increased Amygdalar and Hippocampal Volumes in Young Adults with Social Anxiety

Background Functional neuroimaging studies have consistently shown abnormal limbic activation patterns in socially anxious individuals, but structural data on the amygdala and hippocampus of these patients are scarce. This study explored the existence of structural differences in the whole brain, amygdala, and hippocampus of subjects with clinical and subthreshold social anxiety compared to healthy controls. We hypothesized that there would be volumetric differences across groups, without predicting their direction (i.e. enlargement or reduction). Methods Subjects classified as having social anxiety disorder (n = 12), subthreshold social anxiety (n = 12) and healthy controls (n = 14) underwent structural magnetic resonance imaging scans. The amygdala and hippocampus were defined a priori as regions of interest and volumes were calculated by manual tracing. Whole brain volume was calculated using voxel-based morphometry. Results The bilateral amygdala and left hippocampus were enlarged in socially anxious individuals relative to controls. The volume of the right hippocampus was enlarged in subthreshold social anxiety participants relative to controls. No differences were found across groups in respect to total brain volume. Conclusions Our results show amygdalar and hippocampal volume alterations in social anxiety, possibly associated with symptom severity. The time course of such alterations and the cellular and molecular bases of limbic plasticity in social anxiety should be further investigated.

Evaluation of the psychometric properties of the Social Phobia Inventory in university students

OBJECTIVE The aim of the study was to study the psychometric properties of the Social Phobia Inventory (SPIN) in its version for the context of Brazilian adults. METHODS A sample of Brazilian university students from the general population (n = 2314) and a sample of university students identified as cases (n = 88) and noncases (n = 90) of social phobia were assessed, using as a parameter the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The different instruments were applied individually in the presence of a rater. RESULTS The SPIN showed adequate internal consistency (.63-.90) and concurrent validity with different instruments of auto- and hetero-evaluation of social phobia. Discriminative validity showed 0.84 to 0.86 sensitivity and 0.84 to 0.87 specificity for cutoff notes between 19 and 21. Factorial analysis showed the presence of a variable number of factors as a function of the different samples. CONCLUSIONS The version of the SPIN studied is quite adequate for use in the context of Brazilian university students, favoring the screening of social phobia. However, further studies using more diverse samples are needed.

Social phobia in Brazilian university students: Prevalence, under-recognition and academic impairment in women

BACKGROUND Despite the fact that public speaking is a common academic activity and that social phobia has been associated with lower educational achievement and impaired academic performance, little research has examined the prevalence of social phobia in college students. The aim of this study was to evaluate the prevalence of social phobia in a large sample of Brazilian college students and to examine the academic impact of this disorder. METHODS The Social Phobia Inventory (SPIN) and the MINI-SPIN, used as the indicator of social phobia in the screening phase, were applied to 2319 randomly selected students from two Brazilian universities. For the second phase (diagnostic confirmation), four psychiatrists and one clinical psychologist administered the SCID-IV to subjects with MINI-SPIN scores of 6 or higher. RESULTS The prevalence of social phobia among the university students was 11.6%. Women with social phobia had significantly lower grades than those without the disorder. Fear of public speaking was the most common social fear. Only two of the 237 students with social phobia (0.8%) had previously received a diagnosis of social phobia and were under treatment. LIMITATIONS Social phobia comorbidities were not evaluated in this study. The methods of assessment employed by the universities (written exams) may mask the presence of social phobia. This was not a population-based study, and thus the results are not generalizable to the entire population with social phobia. CONCLUSION Preventive strategies are recommended to reduce the under-recognition and the adverse impact of social phobia on academic performance and overall quality of life of university students.

Recognition of facial expressions by alcoholic patients: a systematic literature review

Background Alcohol abuse and dependence can cause a wide variety of cognitive, psychomotor, and visual-spatial deficits. It is questionable whether this condition is associated with impairments in the recognition of affective and/or emotional information. Such impairments may promote deficits in social cognition and, consequently, in the adaptation and interaction of alcohol abusers with their social environment. The aim of this systematic review was to systematize the literature on alcoholics’ recognition of basic facial expressions in terms of the following outcome variables: accuracy, emotional intensity, and latency time. Methods A systematic literature search in the PsycINFO, PubMed, and SciELO electronic databases, with no restrictions regarding publication year, was employed as the study methodology. Results The findings of some studies indicate that alcoholics have greater impairment in facial expression recognition tasks, while others could not differentiate the clinical group from controls. However, there was a trend toward greater deficits in alcoholics. Alcoholics displayed less accuracy in recognition of sadness and disgust and required greater emotional intensity to judge facial expressions corresponding to fear and anger. Conclusion The current study was only able to identify trends in the chosen outcome variables. Future studies that aim to provide more precise evidence for the potential influence of alcohol on social cognition are needed.