Marcos Hortes N. Chagas

Effects of psychotropic drugs used in the treatment of anxiety disorders on the recognition of facial expressions of emotion: Critical analysis of literature

Deficits in recognition of facial expressions of emotion (RFEE) play a central role in the manifestation of anxiety disorders (AD). We systematically reviewed the literature to determine effects of drugs used in AD treatment on RFEE, based on outcomes of accuracy rate, reaction time, and intensity. Electronic databases, including Pubmed, PsycINFO, and Scielo, were used without time constraints. Twenty-six clinical/experimental studies on healthy subjects, focusing on 11 drugs, published in English, Portuguese, and Spanish, were selected. We found that increased recognition of happiness was associated with acute use of citalopram, fluoxetine, duloxetine, and reboxetine. Increased and decreased recognition of negative emotions were associated with the use of selective serotonin and/or norepinephrine reuptake inhibitors, respectively. Benzodiazepine favored recognition of negative emotions. Differences in reaction time were rarely observed. Stimuli with distinct emotion intensities produced similar effects. Specific changes occurred in RFEE depending on the drug, its administration route and dose, and emotion valence. Evidences indicate significant effects on emotional processing relevant to clinical practice, particularly in treating patients with emotional disorders.

Addressing Mobile Usability and Elderly Users: Validating Contextualized Heuristics

Diverse heuristic sets were proposed in order to evolve Heuristic Evaluation for new contexts, as contexts related to the elderly and mobile devices. However, heuristics for evaluation of mobile usability regarding elderly users still need aditional validations. For this reason, our study aimed to enhance the validation of a heuristic set proposed by Al-Razgan et al. for evaluation of mobile usability regarding elderly users. Results showed that the major part of heuristics proposed by Al-Razgan et al. matches with traditional heuristics of Nielsen, while a few remain valuable for evaluations in this context. Also, after validations, we found evidences that the heuristics of Al-Razgan et al. have a great coverage of usability problems of mobile applications used by the elderly, as detected from test with users.

Comparison of DSM-IV and DSM-5 dementia criteria among older people living in a community sample

Dementia is a clinical syndrome characterized by cognitive decline and functional impairment that is now a leading cause of disability and mortality. Recently, the American Psychiatric Association introduced new criteria for the diagnosis dementia under the new label of “major neurocognitive disorder” (NCD). The new DSM‐5 diagnosis of major NCD demands evidence of significant decline in any cognitive domain in addition to functional impairment. This represents a departure from the DSM‐IV criteria for dementia, which required impairments in memory and at least one other higher cortical function. Nonetheless, it is unclear how these changes will affect the prevalence estimates of dementia in the community, and whether this will have implications for planning and policy. This study aims to determine the prevalence of dementia (DSM‐ IV) and major NCD (DSM‐5) in a community sample of older Brazilians and to evaluate the level of agreement between these 2 sets of criteria.

Convergent validity of the Brazilian version of the Theory of Mind Task Battery for the assessment of social cognition in older adults

Social cognition is an individual’s ability to differentiate his/her own mental state from the mental state of another person and recognize the desires, beliefs and feelings of this person1. The 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recommends the use of facial emotion recognition tasks and theory of mind to evaluate social cognition2. The interest in appropriate Theory of Mind (ToM) tasks for use on older adults increased with the inclusion of social cognition among the criteria for the diagnosis of dementia in the DSM-52. Our research group recently published the translation and crosscultural adaptation of the Brazilian version of the Theory of Mind Task Battery (ToM TB) in this journal3. Thus, the objective of this study was to investigate the convergent validation of the ToM TB in a sample of community-dwelling older adults in the community. The study was conducted in the city of São Carlos, which is located in the state of São Paulo, Brazil. Data collection was performed by a psychologist and gerontologist, who had undergone training exercises for the administration of the instruments. All participants signed a statement of informed consent. The ToM TB is composed of nine different situations arranged in order of increasing difficulty, with the total score ranging from 0 to 154. For convergent validation, the Brazilian version of Reading the Mind in the Eyes Test (RMET) was applied and the correlation between it and the ToM TB was calculated. The RMET consists of 36 figures of eyes and the participant must choose the word that best describes the feeling shown in the figure among four options5. The sample was composed of 20 participants (8 men and 12 women) selected randomly from the list of adults older than 60 years registered at a family health unit. The exclusion criteria were severe cognitive decline, and auditory or visual deficits that could interfere with performance tasks. Mean age was 68.6 years (SD: ±7.61), mean schooling was 3.55 years (SD: ±2.63) and the majority (55%) was married. The score on the Mini Mental State Examination6 was 22.65 (SD: ±5.38). On the RMET, mean number of correct guesses was 14.95 (SD: ±4.62), with a minimum score of 6 and maximum of 22. For the ToM TB, the total score was 8.85 (SD: ±3.56), with a minimum score of 1 and maximum of 14. With regard to convergent validity, Pearson’s correlation coefficient between the ToM TB and RMET was 0.715 (p < 0.001), indicating a strong correlation between the instruments. There was no significant correlation between schooling and the ToM TB (rho = 0.200; p = 0.399) as well as between schooling and RMET (rho = 0.337; p = 0.146) (Figure 1). The existence of an instrument for the assessment of theory of mind validated for older adults may contribute to future studies and assist in the clinical evaluation of older adults with neurocognitive disorders, as impaired social cognition is currently one of the criteria for the diagnosis of dementia. The small sample may be considered a limitation of the study. However, the minimum sample calculated for a strong correlation coefficient of 0.7, with two-tailed test and 80% test power was 13 individuals, demonstrating that the present sample was suitable for the purposes of the study. Other limitation of the study is that despite the RMET be used by several studies for ToM assessment, a recent study suggested that the RMET measures emotion recognition rather than ToM ability7. Considering the aim and the results of the study, we conclude that the Brazilian version of the ToM TB is a valid instrument for evaluating theory of mind in the older adults.

Living with the elderly is related to a better performance in the recognition of facial expressions of emotion among older individuals

Background: Cohabitation with the elderly may bring benefits to social relationships and exert an influence on the recognition of facial expressions of emotion. Objective: Compare emotion recognition skills between a cohabitation group (CHG) of older adults who live with a dependent elderly individual and a non-cohabitation group (NCHG) of older adults who do not live with an elderly individual. Methods: Interviews were conducted with 62 older adults in the CHG and 56 in the NCHG. The two groups were similar with regard to gender, age, schooling, degree of dependence, cognitive performance, and depressive symptoms. A dynamic task with six emotions (anger, disgust, happiness, surprise, sadness, and fear) and four levels of intensity was administered to evaluate the recognition of facial emotions. Results: The CHG performed better than the NCHG regarding the correct identification of emotions, specifically surprise (60%), disgust (60%, 80%, and 100%), fear (80%), and sadness (80% and 100%). Discussion: Cohabitation with an elderly individual seems to offer benefits to older adults in terms of recognizing facial expressions of emotion. Luchesi BM et al. / Arch Clin Psychiatry. 2018;45(4):82-7

Facial Recognition of Happiness Is Impaired in Musicians with High Music Performance Anxiety

Introduction Music performance anxiety (MPA) can be defined as a lasting and intense apprehension connected with musical performance in public. Studies suggest that MPA can be regarded as a subtype of social anxiety. Since individuals with social anxiety have deficits in the recognition of facial emotion, we hypothesized that musicians with high levels of MPA would share similar impairments. Objective The aim of this study was to compare parameters of facial emotion recognition (FER) between musicians with high and low MPA. Methods 150 amateur and professional musicians with different musical backgrounds were assessed in respect to their level of MPA and completed a dynamic FER task. The outcomes investigated were accuracy, response time, emotional intensity, and response bias. Results Musicians with high MPA were less accurate in the recognition of happiness (p = 0.04; d = 0.34), had increased response bias toward fear (p = 0.03), and increased response time to facial emotions as a whole (p = 0.02; d = 0.39). Conclusion Musicians with high MPA displayed FER deficits that were independent of general anxiety levels and possibly of general cognitive capacity. These deficits may favor the maintenance and exacerbation of experiences of anxiety during public performance, since cues of approval, satisfaction, and encouragement are not adequately recognized.

Early interventions for the prevention of PTSD in adults: a systematic literature review

Background Secondary interventions are implemented within a short interval following the occurrence of traumatic events with the purpose of preventing the onset of PTSD. Objective Analyze the results of studies that assessed post-trauma interventions in adults aimed at preventing the onset of PTSD or symptoms related to PTSD. Methods We performed literature searches using the search expression [(Early intervention OR secondary prevention) AND (Post traumatic stress disorder OR PTSD)] for articles published until October 2016. Among the references found, 29 fulfilled the selection criteria established for the review. Data were divided and analyzed according to the type of intervention: pharmacological or psychological. Results Psychological measures used in the studies lack homogeneity regarding the type of intervention and the assessment of intervention outcomes. Pharmacological interventions were less frequent and findings require replication, together with an expansion in the types of substances investigated. In general, many of the studies reviewed suggest that both pharmacological and psychological interventions are effective in the prevention of PTSD. Discussion Future trials should be focused on determining the best interventions for the secondary prevention of PTSD. The combination of psychological and pharmacological interventions for post-trauma patients poses opportunities and challenges that remain unexplored.

Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): transcultural adaptation of the Brazilian version

Background DSM-5 introduced some modifications on Posttraumatic Stress Disorder (PTSD) criteria. The instruments developed for the assessment of aspects related to PTSD needed a reformulation, as was the case of the Posttraumatic Stress Disorder Checklist (PCL). Objectives To present the process of transcultural adaptation of the three forms of the PCL-5 to Brazilian Portuguese, as well as its face validity. Methods The procedure involved independent translations, a synthesis version, back translation by an independent translator, evaluation by the original author, analysis by an expert committee, and a pretesting study (10 subjects with/without experience of a traumatic situation). The last two steps formed the face validity procedure. Results The synthesis version was approved by the original author and the agreement percentage by the expert committee was excellent, with only two items showing < 90%. The pretesting study showed that the Brazilian version was well understood and linguistically and culturally accepted by the participants, which did not make significant suggestions for changes. Discussion Transcultural adaptation of the PCL-5 for Brazilian Portuguese followed a rigid and standardized procedure. Therefore, after having its face validity assessed by an expert committee and by the target population, it is apt to be used.

Effects of a Health Education program on cognition, mood and functional capacity

Objective: Assess the effect of a Health Education (HE) program on cognition, mood and functional capacity of participants in a University of The Third Age (U3A). Method: Controlled clinical trial. The HE Program consisted of 10 sessions with group dynamics, including orientations on disease prevention and cognitive stimulation exercises, lasting four months. Intervention Group (IG) n=13; and Control Group (CG) n=15. All were assessed at the start and end of the study, using Addenbrook´s Cognitive Examination-Revised (ACE-R), Beck Depression and Anxiety Inventory (BDI/BAI) and Functional Independence Measure (FIM). Results: Significant improvements were observed for the IG when comparing the total ACE-R score (p=0.001) and memory domain (p=0.011) before and after the intervention. For the CG, improvement was found in the memory domain only (p=0.027). Conclusion: a HE intervention program benefits the improvement in cognitive performance, particularly the memory of adults and active elderly who participated in a U3A.Objetivo: Avaliar o efeito de um programa de Educacao em Saude (ES) na cognicao, humor e capacidade funcional de participantes de uma Universidade Aberta da Terceira Idade (UATI). Metodo: Ensaio clinico controlado. O programa de ES consistiu de 10 sessoes com dinâmicas de grupo, incluindo orientacoes sobre prevencao de doencas e exercicios de estimulacao cognitiva, durante quatro meses. Grupo Intervencao (IG) n=13; e Grupo Controle (CG) n=15. Todos foram avaliados no inicio e no final do estudo, utilizando-se o Addenbrook´s Cognitive Examination-Revised (ACE-R), o Inventario de Depressao e Ansiedade Beck (BDI/BAI) e a Medida de Independencia Funcional (FIM). Resultados: observou-se melhora significativa no IG ao comparar o escore do ACE-R (p=0,001) e do dominio memoria (p=0,011) antes e apos a intervencao. No CG, houve melhora apenas no dominio memoria (p=0,027). Conclusao: um programa de ES beneficia a melhoria do desempenho cognitivo, particularmente a memoria de participantes ativos de uma UATI.

Percepção da perda auditiva: utilização da escala subjetiva de faces para triagem auditiva em idosos

Presbycusis is a disorder present among the elderly. However, it is under-diagnosed, making it important to develop and enhance simple screening tools. OBJECTIVE The subjective faces scale has been proposed as a method to assess auditory self-perception among the elderly, and its correlation with audiological tests. METHODS We looked at elderly patients referred to the audiology service of a reference center for the care of the elderly in a public university hospital between February and November 2013. Patients were submitted to meatoscopy, tonal and vocal audiometry and the whisper test. They also answered the subjective faces scale. A total of 164 elderly individuals participated, and the average age was 77. RESULTS We found a good correlation between the subjective faces scale and audiometry thresholds (r = 0.66). Our results show that the faces and hearing loss correlate, with face 1 corresponding to normal hearing, face 2 to mild hearing loss, and face 3 to Grade I moderate hearing loss. When evaluating the psychometric qualities of the subjective faces scale, we found that faces 2 or 3 have good sensitivity and specificity, with the area under the ROC curve being 0.81. CONCLUSION The subjective faces scale seems to be a good, low-cost and easy to use supplementary tool for auditory screening in geriatric services.