J. Landeira-Fernandez

Efficacy and safety of electroconvulsive therapy in the treatment of bipolar disorder: a systematic review.

Objectives: To evaluate the efficacy and safety of electroconvulsive therapy (ECT) in bipolar disorder (BPD). Methods: Clinical trials on the treatment of BPD with ECT were systematically reviewed. A comprehensive search of MEDLINE, PsycINFO, and ISI Web of Science databases was conducted in March 2010. Results: A total of 51 articles met our selection criteria. Only 3 controlled or comparative prospective trials addressed the treatment of mania with ECT. In these studies, which had small samples, ECT was superior to simulated ECT, lithium, or the combination of lithium and haloperidol. We did not find any controlled or comparative prospective trial on the efficacy of ECT in bipolar depression. In the 4 retrospective studies that compared ECT with antidepressants, no difference was observed between them. In 9 of 10 trials that compared bipolar with unipolar depressed patients, ECT was equally efficacious for both groups of patients. Of the 6 studies of patients with BPD that performed a comparison between pre-ECT versus post-ECT, only 1 study showed a worsening in cognition after the treatment. Conclusions: There are no studies with adequate methodology on the treatment of BPD with ECT. The lack of scientific evidence contrasts with broad anecdotal clinical experience that suggests that ECT is an important tool in the treatment of BPD, especially in more severe or refractory cases. The marked stigma associated with ECT and the lack of large financial support may account for the paucity of ECT research.

Development and validation of a short-form version of the Brazilian state-trait anxiety inventory

The Brazilian State-Trait Anxiety Inventory has been widely used to measure state (STAI-S) and trait (STAI-T) components of anxiety. The present work developed and evaluated a short version of the STAI-S and STAI-T in a large sample of Brazilian subjects. The first study selected short-form scales. The second one employed factor analyses to investigate whether each of the two short-form scales presented a well-defined and balanced structure with both anxiety-present and anxiety-absent factors. Results indicated that the STAI-S and STAI-T could be reduced to six items (STAI-S-6 and STAI-T-6, respectively) without sacrificing their psychometric properties. The findings suggest that STAI-S-6 and STAI-T-6 may be employed in situations where time restraints make the use of full-length forms unfeasible.

Comparação do desempenho entre calouros e formandos no Provão de Psicologia 2000

The Psychology National Course Exam accomplished by all of the last year students (seniors) in the year of the 2000 revealed a high correlation between the rank attributed to each course and its application/openings ratio (r = 0,69; p < 0,001). Therefore, it might be possible that the Psychology 2000 National Course Exam employed to rank all the Brazilian psychology courses is sensitive to general student differences imposed by the college entrance exam. To verify this possibility, 386 psychology first year students (freshmen) took the multiple-choice portion of the Psychology 2000 national exam. The freshmen were distributed among 4 courses selected according to its course rank (A, B, C and E). The results revealed that, in fact, coming freshmen students presented performance differences according to the course rank. Senior performance increment in relation to freshmen was differentiated among the four courses with different ranks. Senior students from courses ranked as A and B presented a larger increment in relation to senior students from courses ranked C and E. An item analysis revealed different validity degrees among the 39 multiple-choice questions. A re-analysis of the results, considering only 20 items that presented good validity, indicated an absence of performance difference among the coming freshmen distributed among the 4 courses. On the other hand, senior students from the different courses presented performance differences in accordance to the course rank. Finally, an analysis of the specific contents of each one of the 39 items of Psychology 2000 Course National Exam revealed a deficit in academic education among senior students in basic psychology subjects related to experimental psychology, scientific methodology and measurement and psychological evaluation.

O Provão de Psicologia: objetivos, problemas, conseqüências e sugestões

The Brazilian Federal Government, through the Ministry of Education, devised the National Course Examination in order to evaluate the several Brazilian undergraduate courses and point out possible academic education deficiencies. The first Psychology National Course Examination was carried in 2000 and since then it has being annually carried out for all Psychology senior students. The purpose of the present work is to argue whether the two main purposes of this form of evaluation - to discriminate the different courses of Psychology and to point out deficiencies in Psychology education - are being reached. Initially we present some problems found in the first Psychology National Course Examination and possible consequences of these problems. Finally, we put forward some suggestions that might improve the purposes of this type of Psychology academic evaluation.

O insight no transtorno bipolar: uma revisão sistemática

Objectives To conduct a systematic review to understand which factors are related to insight in bipolar disorder (BD), how insight varies depending on affective state and to establish a comparison between BD and other mental disorders. Methods We performed a systematic review of the scientific literature on insight in BD patients. Clinical studies on the topic were searched in the Medline, SciELO and ISI databases. The search terms used were: “insight” OR “Awareness” AND “bipolar“ OR “mania”. Results Fifty-five articles were selected. Insight in BD is more compromised than in unipolar depression, but less than in schizophrenia. A lower level of insight is related to the presence of psychotic symptoms and cognitive disorders. Moreover, insight impairment is associated with lower adherence to treatment. On the other hand, a greater preservation of insight may be associated with increased suicidal ideation. Finally, the manic phase is characterized by a lower level of insight than the depressive phase or euthymia. Conclusion Insight is greatly impaired in BD, especially during mania. Several clinical factors seem to influence the level of insight.

The reliability of self-assessment of affective state in different phases of bipolar disorder.

Abstract Some studies have indicated that the capacity of self-assessment of affective state is more compromised during mania than during depression. In the present study, we investigated whether the reliability of self-assessment in bipolar disorder varies as a function of actual affective state (i.e., euthymia, mania, or depression). Sixty-five patients with a diagnosis of type I and type II bipolar disorder were evaluated with regard to the occurrence of an affective syndrome using the Clinical Global Impressions Scale for use in bipolar illness, the Positive and Negative Syndrome Scale, and the Global Assessment of Functioning scale. In parallel, we applied the Analog Visual Mood Scale, a self-assessment tool to evaluate mood changes. The same individual prospectively completed the self-assessment scale in different affective states. During depression, the patients’ evaluation was significantly different from when they were in manic or euthymic mood states. However, when in mania, the patients evaluated their mood state similarly to when they were euthymic. The bipolar patients in mania but not in depression did not reliably evaluate themselves with regard to their affective state.

The relationship between obesity and quality of life in Brazilian adults

The incidence of obesity has reached epidemic proportions, affecting 30% of the adult population globally. During the last decade, the rising rates of obesity in developing countries has been particularly striking. One potential consequence of obesity is a decline in quality of life (QoL). Thus, the objective of the present study was to investigate the possible relationship between obesity, defined by body mass index (BMI), and QoL, evaluated using the short version of the World Health Organization Quality of Life (WHOQOL) scale in a Brazilian population. The sample consisted of 30 men and 30 women, divided into three groups according to BMI: normal weight, obese, and morbidly obese. All of the subjects responded to the WHOQOL inventories. The results indicated that the groups with lower BMIs had better QoL than the groups with higher BMIs. Being overweight interfered with QoL equally in both sexes, with no difference found between men and women. The results indicate the necessity of multidisciplinary care of obese individuals.

Alma, mente e cérebro na pré-história e nas primeiras civilizações humanas

Atualmente, o debate sobre a natureza da mente humana vem tomando novos rumos gracas ao desenvolvimento de diversos estudos, no campo das neurociencias, que investigam a localizacao das funcoes cerebrais. Esses trabalhos vem contribuindo para uma melhor compreensao dos substratos neurais das funcoes mentais, bem como da etiologia de diversos transtornos mentais. Entretanto, o conhecimento acumulado pela neurociencia nao ocorreu de forma subita. Na verdade, o estudo das relacoes entre o cerebro e a mente nao e recente. Da pre-historia aos dias atuais, surgiram varios tipos de questionamentos a respeito da possivel materialidade e localizacao das funcoes mentais humana. O presente trabalho apresenta, de forma historica, como populacoes pre-historicas, assim como as primeiras civilizacoes, localizadas no Egito, na Mesopotâmia, na India e na China, desenvolveram e utilizaram conceitos relacionados com a alma, a mente e o cerebro humano.Currently, the debate about the nature of the human mind is taking new directions through the development of several studies in the field of neuroscience which investigates the location of brain functions. These studies have contributed to a better understanding of the neural substrates of mental functions and the etiology of various mental disorders. However, the knowledge developed by neuroscience did not occur abruptly. Indeed, the study of mind-brain relationship is not new. From pre-history to the present days, various different types of inquiries have been made about the possible materiality and location of human mental functions. This paper presents, in a historic manner, how prehistoric populations as well as early civilizations located in Egypt, Mesopotamia, India, and China developed and employed concepts related to the soul, the mind and the human brain.

Latent structure of the symptomatology of hospitalized patients with bipolar mania.

Several studies have attempted to understand the dimensions of psychiatric symptoms in manic episodes, but only a few have been able to model the latent structure of mania in bipolar disorder patients using confirmatory factor analysis. The objective of the present study was to search for the best model of the symptomatology of hospitalized manic patients. To achieve this goal, 117 manic inpatients during a manic crisis participated in this research. Exploratory factor analysis was conducted followed by confirmatory factor analysis using an exploratory factor analysis solution and three other theory-based models. The exploratory factor analysis results revealed a six-factor structure: depression, suicide, insomnia, mania, psychosis, and anxiety. This solution also presented the best fit to the data when tested with confirmatory factor analysis. A five-factor solution, without suicide as a separate dimension, appeared to be more theoretically suitable. Another important finding was that anxiety was an independent dimension in mania. Some hypotheses are discussed in light of contemporary theories, and future studies should investigate this aspect further.

Efeito de um Programa de Treinamento da Memória de Trabalho em Adultos Idosos

The present study examined the effects of a Working Memory Training (WMT) in healthy elderly. Twenty participants comprised the final sample, eleven from the experimental group (WMT) and nine from the control group (socialization). Every subject underwent a neuropsychological evaluation pre and post-intervention. The meetings were held once a week, for three months. Results indicated that subjects in the experimental group improved cognitive functions related to concentrated attention, learning, short-term and episodic memory. Subjects in the control group also demonstrated, in a smaller number of variables, improvement in concentrated attention and episodic memory. WMT seems to have generated a transfer effect, especially to episodic memory, which is directly related to the subsystem of working memory (WM), suggesting that WMT may be useful in the context of the neuropsychology of aging.