Kátia Petribú

Comorbid major depression in obsessive-compulsive disorder patients

Although major depressive disorder (MDD) has been consistently considered the most frequent complication of obsessive-compulsive disorder (OCD), little is known about the clinical characteristics of patients with both disorders. This study assessed 815 Brazilian OCD patients using a comprehensive psychiatric evaluation. Clinical and demographic variables, including OCD symptom dimensions, were compared among OCD patients with and without MDD. Our findings showed that prevalence rates of current MDD (32%) and lifetime MDD (67.5%) were similar for both sexes in this study. In addition, patients with comorbid MDD had higher severity scores of OCD symptoms. There was no preferential association of MDD with any particular OCD symptom dimension. This study supports the notion that depressed OCD patients present more severe general psychopathology.

AD8-Brazil: Cross-Cultural Validation of the Ascertaining Dementia Interview in Portuguese

Dementia is a global public health problem and detection in the primary care setting, particularly in developing countries, is challenging. The aim of this research was to produce the cross-cultural validation of the AD8 interview to the Brazilian Portuguese Language. The original version of the AD8 was submitted to translation, back-translation, and application of the questionnaire to 20 elderly informants for face validation. The AD8-Brazil was then evaluated in 109 community-dwelling elderly with a sociodemographic questionnaire, clinical examination, Mini Mental State Examination (MMSE), Katz Inventory of Activities of Daily Living (ADL), and Clinical Dementia Rating scale (CDR). The AD8-Brazil was compared with the other instruments and with the clinical diagnosis (DSM-IV) for criterion validation. There was significant agreement of AD8-Brazil with diagnosis of dementia (p < 0.001), MMSE (p = 0.047), and ADL (PFisher = 0.004). Also, the AD8-Brazil was able to differentiate the stages of dementia by CDR scale. The reliability was high (alpha = 0.818) and reproducibility analysis showed excellent inter-rater (kappa = 0.889) and test-retest consistency (kappa = 0.814). The AD8-Brazil showed excellent discrimination between CDR 0 and CDR > 0 (area under the curve 86.1%) and between CDR 0 and CDR 0.5 (area under the curve 76.9%). The administration of the questionnaire took 2.3 ± 0.1 minutes. The Brazilian version of the AD8 is a valid, reliable, quick, and easy screening instrument for dementia.

Avaliação da qualidade de vida em adolescentes: revisão da literatura

OBJETIVO: Revisar criticamente a disponibilidade de instrumentos de satisfacao com a vida utilizados para avaliar a qualidade de vida em adolescentes. METODO: Nesta revisao foram selecionados estudos que utilizavam escalas de satisfacao com a vida em adolescentes, exclusivamente. Foram excluidos estudos dirigidos a populacao em geral, ou que investigassem satisfacao na relacao com os pais, com cuidadores e com servicos de saude. Foram consultadas as bases eletronicas MedLine, Lilacs, PsycINFO, PubMed e Adolec, sendo incluida checagem manual das referencias bibliograficas dos artigos selecionados. RESULTADOS: Foram encontrados 22 estudos conforme os criterios de inclusao, verificando-se a existencia de nove escalas de satisfacao com a vida, sendo duas variacoes (abreviada e versao adolescente) da escala de um mesmo autor. Foi adicionada a selecao uma escala de qualidade de vida que continha avaliacoes de dominios de satisfacao com a vida. CONCLUSAO: As validacoes das principais escalas sao descritas, observando-se o reduzido numero de estudos transculturais disponiveis. O uso do conceito de qualidade de vida por meio de instrumentos de satisfacao com a vida e relativamente novo, e necessita de estudos mais abrangentes no que diz respeito a cultura e as diferentes realidades economicas.

Modificações da qualidade de vida sexual de obesos submetidos à cirurgia de Fobi-Capella

OBJECTIVES Examine changes in the quality of sexual life of men with morbid obesity offered by a reduction in body weight following Fobi-Capella gastroplasty. METHOD A quantitative, prospective, longitudinal, cross-sectional study was carried out on 21 men with morbid obesity between March 2005 and March 2007. Inclusion criteria were: aged 20 to 50 years, body mass index (BMI) = 40 kg/m(2) and failure in attempts of clinical treatment for obesity in the previous two years. Data collection from clinical records and the administering of a specific questionnaire on issues relating to sexual function was performed prior to and six months following surgery. Scores were analyzed with the help of the Epi-Info 6 program, using the Students t-test for paired samples. RESULTS The total score increased at the six-month post operative in 76.19%; remained unaltered in 14.29%; and decreased in 9.52%. Scores in areas related to erectile function and sexual relations increased in 71.42%; sexual desire increased in 52.38%; and orgasms increased in 28.57%. General sexual satisfaction increased in 57.14%. The average total score and scores on the domains of the questionnaire prior to and six months following surgery revealed statistically significant differences, except those relating to sexual desire and orgasm. CONCLUSION The quality of sexual life in morbid obese men improves following Fobi-Capella surgery. Favorable changes occurred in sexual function after these individuals underwent this type of bariatric surgery.

Comorbidade no transtorno obsessivo-compulsivo

Epidemiological and clinical studies indicate that obsessive-compulsive disorder frequently occurs with comorbid disorders. Comorbidity with anxiety and mood disorders, substance abuse or dependence, somatoform, impulse control and tic disorders deserve special attention. In this paper a review of the concept, epidemiological findings, social and occupational functioning, and sequence of comorbid disorders in OCD is presented.

Quality of Life amongst Older Brazilians: A Cross-Cultural Validation of the CASP-19 into Brazilian-Portuguese

Introduction As population ageing becomes a global phenomenon the need to understand the quality of life of older people around the world has become increasingly salient. The CASP-19 is a well established measure of quality of later life. The scale is composed of 19 items which map onto the four domains of control (C), Autonomy (A), Self-Realisation (S) and Pleasure (P). It has already been translated to 12 languages and has been used in a number of national and international studies. However use of the scale outside of Europe has been very limited. The objective of this study was to translate and evaluate the use of the CASP-19 amongst older Brazilians. Methods The CASP-19 was translated from English to Portuguese, back-translated and submitted to an analysis of equivalence by a committee of judges. The scale was then administered to a sample of community dwelling older people in Recife, Brazil (n = 87), and tested for psychometric properties. The Control and Pleasure domains exhibited good internal consistency. By removing one item from each of the Autonomy and Self Realisation domains their internal consistency was improved. Results The mean age of the sample was 75.6±0.7 years, subjects were mainly female (52.9%), white (52.9%), who lived without a partner (54%), and had a monthly income varying from USD 340.00 to USD 850.00. Translation and cross-cultural adaptation permitted good understanding and applicability of final version. Psychometric analyses revealed that the removal of two items improved the internal consistency of the Autonomy and Pleasure domains. Confirmatory factor analyses suggest that a 16 item, four factor, model best fits the data. Conclusion In this small exploratory study the CASP-19 Brazil demonstrated good psychometric properties. It was easy to use for both participants and researchers. Hopefully future studies in Brazil will employ the scale so that more direct cross national comparisons can be made with older people in Europe and the US.

Cognitive dysfunction in post-traumatic obsessive–compulsive disorder

Objective: To investigate whether patients who develop obsessive–compulsive disorder (OCD) after posttraumatic stress disorder, i.e. post-traumatic OCD (PsT-OCD), display a distinctive neurocognitive pattern of dysfunction. Methods: Patients with PsT-OCD (n = 16), pre-traumatic OCD (PrT-OCD) (n = 18), non-traumatic OCD (NonT-OCD) (n = 67) and healthy controls (n = 17) had their performance compared on the following neuropsychological tests: the Wisconsin Card Sorting Test, the Iowa Gambling Task, the Wechsler Memory Scale Logical Memory, the Brief Visual Memory Test – Revised, and the Wechsler Abbreviated Scale for Intelligence. Results: Patients with OCD, as a group, were characterized by poor set-shifting abilities and impaired verbal and visuospatial memories. Impaired set-shifting abilities were found to correlate with the severity of obsessive–compulsive symptoms in all groups of patients with OCD, with the exception of PsT-OCD. Only patients with PsT-OCD were characterized by impaired visuospatial recognition, which was found to correlate with poor set-shifting abilities in this particular group of patients, but not in individuals with other types of OCD or in healthy controls. Conclusions: Our study suggests that PsT-OCD is associated with a distinctive pattern of neurocognitive dysfunction, thus providing support for a different subtype of OCD.

COMT and MAO-A Polymorphisms and Obsessive-Compulsive Disorder: A Family- Based Association Study

Objective Obsessive-compulsive disorder (OCD) is a common and debilitating psychiatric illness. Although a genetic component contributes to its etiology, no single gene or mechanism has been identified to the OCD susceptibility. The catechol-O-methyltransferase (COMT) and monoamine oxidase A (MAO-A) genes have been investigated in previous OCD studies, but the results are still unclear. More recently, Taylor (2013) in a comprehensive meta-analysis of genetic association studies has identified COMT and MAO-A polymorphisms involved with OCD. In an effort to clarify the role of these two genes in OCD vulnerability, a family-based association investigation was performed as an alternative strategy to the classical case-control design. Methods Transmission disequilibrium analyses were performed after genotyping 13 single-nucleotide polymorphisms (eight in COMT and five in MAO-A) in 783 OCD trios (probands and their parents). Four different OCD phenotypes (from narrow to broad OCD definitions) and a SNP x SNP epistasis were also analyzed. Results OCD, broad and narrow phenotypes,were not associated with any of the investigated COMT and MAO-A polymorphisms. In addition, the analyses of gene-gene interaction did not show significant epistatic influences on phenotype between COMT and MAO-A. Conclusions The findings do not support an association between DSM-IV OCD and the variants of COMT or MAO-A. However, results from this study cannot exclude the contribution of these genes in the manifestation of OCD. The evaluation of broader spectrum phenotypes could help to understand the role of these and other genes in the pathophysiology of OCD and its spectrum disorders.

Psychometric evaluation of a Brazilian version of the impact of weight on quality of life (IWQOL-Lite) instrument.

PURPOSE The impact of weight on quality of life (IWQOL-Lite) is a self-administered instrument that assesses quality of life in obesity. It is composed of 31 items and five domains (physical function, self-esteem, sexual life, public distress, and work). The aim of the present study was to evaluate reliability (test-retest), internal structure, construct validity and discriminant validity. METHODS IWQOL-Lite scores were obtained from 89 people in a Weight Watchers institution (clinical sample) and 156 community volunteers (community sample). The participants were selected based on the same criteria: gender (female) and age (> 24 years), except for BMI. The community sample also completed the SF-36, a generic measure of health-related quality of life. RESULTS The Brazilian IWQOL-Lite demonstrated good test-retest reliability, internal consistency, discriminative validity and convergent validity. CONCLUSIONS The IWQOL-Lite is the first specific instrument validated in Brazil for assessing quality of life in obesity. The results reveal that IWQOL-Lite is an instrument with good psychometric properties. Nevertheless, in some cases results were dissimilar to those reported in earlier studies using the original American English.

Characterization of depressive syndrome in schizophrenic outpatients

OBJECTIVE: The authors carried out a cross-sectional study with the aim of characterizing and describing depressive pictures in schizophrenic patients seen at the Psychiatry Outpatient Clinic of the Federal University of Pernambuco (HC-UFPE). The patients had the diagnosis of schizophrenia confirmed on the basis of the operating criteria of the DSM-IV. METHODS: Those who where in the period of stabilization of the clinical picture were selected for the study defined according the following criteria:the last psychotic episode must be happened two months before at least, and during this period the alterations of the antipsychotics doses had been lower than 5 mg of haloperidol or equivalent doses of others neuroleptics. A total of one hundred and four patients took part. Following the identification of the depressive symptoms using the Calgary Depression Scale for Schizophrenia (CDSS), thirty-one patients (29.8%) fulfilled the diagnostic criteria described in the DSM-IV. Of these, 22.1% had the diagnosis of major depression and 7.7% of minor depression according the DSM-IV. Two groups were constituted: Group A, schizophrenics with a depressive syndrome, and Group B, schizophrenics without such a syndrome. An assessment was made of the distribution of the symptoms of the CDSS scores in both groups, the sociodemographic, clinical and therapeutic variables in relation to the frequency of the depressive syndrome, and the patients clinical course. For the investigation of certain clinical features, the following tools were used: problem list (psychosocial stressors) contained in axis IV of the DSM-IV intended to detect the presence of factors triggering the initial episode of schizophrenia and the Global Assessment of Functioning (GAF ¾ Axis V ¾ DSM-IV) to characterize the current functioning of the patients. CONCLUSIONS: The results obtained allowed the authors to draw the following conclusions: all the items that comprise the Brazilian version of the CDSS were statistically significant in characterizing the depressive syndrome; a comparison of the sociodemographic and therapeutic variables revealed no statistically significant differences between the two groups, and this was also the case with the majority of the clinical features. Statistically significant differences, however, were found in relation to the greater frequency of life events (psychosocial stressors) in triggering the first episode of schizophrenia and the higher incidence of affective disorders antecedents in family members (first and second degree) among the depressed patients. The mean duration of the depressive syndrome during follow-up of the patients was 5.30 months. The patients in whom there was a recurrence of the psychotic episode presented a delusional-hallucinatory clinical picture. This study seeks to contribute to the inclusion of the Postpsychotic Depressive Disorder (PSD) of Schizophrenia (DSM-IV), in the group of Schizophrenic Disorders.