Gabriela Bezerra de Menezes

Psychiatric comorbidity in a Brazilian sample of patients with binge-eating disorder

We compared sociodemographic characteristics and psychiatric status in obese Brazilian patients who did (n=32) and did not (n=33) meet DSM-IV criteria for binge-eating disorder (BED). The samples mean age was 35.0 years (+/-10.5), with 92.3% of individuals being female and 41.5% having some higher education. Obese binge eaters (OBE) were significantly more likely than obese non-binge eaters to meet criteria for a current diagnosis of any axis I disorder, any mood disorder and any anxiety disorder. Specifically, OBE patients were characterized by significantly higher rates of current and lifetime histories of major depressive disorder. Similar to patients from developed countries, Brazilian patients with BED display increased rates of psychiatric comorbidity, particularly mood and anxiety disorders.

A sociodemographic, phenomenological, and long-term follow-up study of patients with body dysmorphic disorder in Brazil.

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 < 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.

Sexual Function and Dysfunction in Brazilian Patients With Obsessive-compulsive Disorder and Social Anxiety Disorder

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.

Resistência ao tratamento nos transtornos de ansiedade: fobia social, transtorno de ansiedade generalizada e transtorno do pânico

OBJECTIVES: Anxiety disorders are common psychiatric conditions that cause significant disability, poor quality of life and enormous social cost. Although treatments with demonstrable efficacy are available a great number of patients fail to respond or remains with clinically significant residual symptoms after treatment. The objective of this study is to review aspects related to treatment resistance and pharmacological strategies to deal with anxiety disorders resistant to treatment. METHOD: Narrative review. RESULTS: We discuss conceptual aspects related to treatment resistance or refractoriness, predictors of poor treatment outcome, and finally, some strategies to deal with anxiety disorders (including social anxiety disorder, generalized anxiety disorder and panic disorder) that do not respond to standard therapeutic interventions. CONCLUSION: Treatment resistance in anxiety disorders remains a challenge to clinical practice going from non standardized concepts of response and resistance to a paucity of controlled studies concerning therapeutic strategies.

Asperger Syndrome, Obsessive-Compulsive Disorder, and Major Depression in a Patient with 45,X/46,XY Mosaicism

Background: Although previous reports have described the association of autism, mental retardation, and schizophrenia with a missing Y chromosome, we are not aware of any case showing an association between this particular chromosomal abnormality and Asperger syndrome. Method: We report the case of a male patient with a combination of Asperger syndrome, obsessive-compulsive disorder and 45,X/46,XY mosaicism. During the follow-up, this individual has also developed a severe episode of major depression, which was successfully treated with electroconvulsive therapy. Results: To the best of our knowledge, this is the first case in which a 45,X/46,XY mosaicism was described in association with Asperger syndrome, either alone or associated with other psychiatric disorders. Diagnostic and therapeutic aspects of this unique case are presented and discussed. Conclusions: Our findings suggest that a missing Y chromosome may play an etiological role in some cases of Asperger syndrome.

Early-onset social anxiety disorder in adults: clinical and therapeutic features

OBJECTIVE To investigate possible differences in clinical and treatment response in patients suffering from early-onset (< 18 years) and late-onset (> or =18 years) social anxiety disorder. METHODS Patients diagnosed with social anxiety disorder of early-onset (n = 47; 75.8%) were compared to those diagnosed with late-onset social anxiety disorder (n = 15; 24.2%) in terms of age, mode of onset, subtype, psychiatric comorbidities (according to the Structured Clinical Interview for DSM-IV), symptom severity and response (assessed according to the Clinical Global Impression scale) after at least ten weeks of drug treatment. The statistical analyses included chi2 tests with Yates correction or Fishers exact test, as well as Students t-test or Mann-Whitney test. The level of statistic significance adopted was 5%. RESULTS Patients presenting early-onset phobic symptoms more frequently: were inactive (chi2 = 4.28; df = 1; p = 0.04); suffered from the generalized subtype of social phobia (chi2 = 6.53; df = 1; p = 0.01); and presented psychiatric comorbidity (chi2 = 6.71; df = 1; p = 0.01). No differences were observed between the groups in severity of symptoms and therapeutic response. CONCLUSION The findings suggest the existence of a possible social anxiety disorder subtype characterized by early onset of symptoms, higher rates of absenteeism, a wider range of social phobia symptoms and psychiatric complications.

Second-generation antidepressants in social anxiety disorder: meta-analysis of controlled clinical trials

RationaleA growing number of controlled clinical trials suggest that different second-generation antidepressants (SGA) may be effective in the treatment of social anxiety disorder (SAD).ObjectivesThe aim of the present study is to evaluate the effectiveness of SGA in SAD and to investigate possible differences in their efficacy.MethodsWe performed a systematic review and meta-analysis of all double-blind, randomized, controlled clinical trials involving second-generation antidepressants in adult patients with SAD published on PubMed/MEDLINE, PsycINFO, and Current Controlled Trials databases until July 2009. Our analyses were based on changes in Liebowitz Social Anxiety Scale (LSAS), Clinical Global Impression (CGI), and standardized mean difference (SMD).ResultsTwenty-seven controlled clinical trials, comprising ten different SGA, were selected. When comparing the reduction of LSAS scores, the group receiving active drugs showed a significantly greater reduction compared to those observed in the placebo group [pooled weighted mean −11.9 (IC 95% −14.5 to −9.4)]. The combined relative risk (RR) for the different drugs revealed a 62% increase in treatment response (final CGI ≤2) for those using SGAs, compared to those receiving placebo [RR 1.62 (95% CI 1.44–1.81)]. The combined SMD for the SGAs was −0.43 (IC 95% −0.49 to −0.37).ConclusionSecond-generation antidepressants are efficacious treatment for patients with SAD. However, our results do not suggest differences of efficacy among different drugs.

An updated review of antidepressants with marked serotonergic effects in obsessive–compulsive disorder

Introduction: Since the recognition of the effectiveness of clomipramine in treating obsessive–compulsive disorder (OCD), a number of recent empirical studies have confirmed a key role of the serotonergic (5-HT) system in the pathophysiology of OCD. The current study presents a review of the existing double-blind studies testing 5-HT antidepressants in OCD. Areas covered: A systematic review was performed to identify double-blind, placebo-controlled, randomized clinical trials investigating the efficacy of antidepressants with marked 5-HT effects [clomipramine, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, desvenlafaxine, duloxetine, mirtazapine, agomelatine, vortioxetine and vilazodone] in the short-term treatment of OCD. The search provided 29 studies investigating eight different 5-HT antidepressants. While the findings show reliable efficacy of clomipramine and SSRIs in the treatment of OCD symptoms, no double-blind studies were identified investigating the efficacy of desvenlafaxine, duloxetine, mirtazapine, agomelatine, vortioxetine or vilazodone. Expert opinion: While our results support the effectiveness of older antidepressants with marked 5-HT effects in OCD, it also suggests that newer agents should be tested more comprehensively.

A review on predictors of treatment outcome in social anxiety disorder

OBJECTIVE This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD). METHODS A systematic review of trials identified through databases of ISI, Medline, PsycInfo, Cochrane, LILACS, Current Controlled Trials, and in references of previously selected articles published in English up to December 2010. In our literature search, we used the words prediction/predictors and social anxiety disorder or social phobia. RESULTS Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD. CONCLUSIONS Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.

The psychiatric facet of hyperhidrosis: demographics, disability, quality of life, and associated psychopathology.

We compared the sociodemographic and psychiatric features of treatment-seeking patients with (n=17) and without (n=29) primary hyperhidrosis (HYH) attending an outpatient dermatological clinic. Subjects were assessed with a structured clinical questionnaire, the Mini International Neuropsychiatric Interview, as well as the Screening for Abnormal Olfactory Experiences (to assess for symptoms of olfactory reference syndrome), the Obsessive-Compulsive Inventory-Revised, the Social Phobia Inventory, the Beck Depression and Anxiety Inventories, the Skindex-16 (a quality of life measure for patients with skin diseases), and the Sheehan Disability Scale. Patients with HYH were more frequently younger (p=0.003), unmarried (p=0.004), employed (p=0.019), more educated (p<0.0001), and better paid (p=0.001) than non-HYH patients. However, they also reported greater disabilities and impairments in work/school (p=0.05) and social life (p=0.014) domains, worse quality of life in emotional (p=0.003) and functioning (p>0.001) dimensions, and they had a greater frequency of comorbid social anxiety disorder (p=0.019). Conversely, non-HYH patients had greater severity of obsessive-compulsive neutralization symptoms (repeating compulsions, counting, and having lucky/unlucky numbers) (p=0.034). In conclusion, patients with HYH are characterized by differential sociodemographic and psychopathological characteristics, with major disability, marked impairment in quality of life, and increased rates of social anxiety disorder. (Journal of Psychiatric Practice 2014;20:316–323)