Mariana Torres

Serum brain-derived neurotrophic factor (BDNF) is not associated with response to electroconvulsive therapy (ECT): a pilot study in drug resistant depressed patients.

Refractory depression is a highly debilitating mental condition that originates major social and economic burden. About 50% of the patients experience a chronic course of illness and up to 20% show an insufficient response to drug treatments. Electroconvulsive therapy (ECT) is the most effective treatment method in refractory depression, although its mechanism of action is still unknown. Brain-derived neurotrophic factor (BDNF) is decreased in depressive episodes, and increases with antidepressant treatment, being suggested as a biomarker of response to ECT. We report the findings of a study on the effects of ECT on BDNF and clinical outcomes in a group of drug resistant depressive patients before and after ECT. The patients post-ECTs have shown an important improvement of depressive symptomatology on the HDRS (p=0.001), of psychotic features on the BPRS (p=0.001) and of the severity of illness on the CGI (p=0.001). There were no changes in the serum BDNF before and after the ECT treatment (p=0.89). These results do not support the hypothesis that the clinical improvement following ECT is due to changes in the BDNF.

Gender differences in the associations between childhood trauma and parental bonding in panic disorder

OBJECTIVE The aim of this study is to evaluate the association between childhood trauma and the quality of parental bonding in panic disorder compared to non-clinical controls. METHOD 123 patients and 123 paired controls were evaluated with the Mini International Neuropsychiatric Interview, the Childhood Trauma Questionnaire and the Parental Bonding Instrument. RESULTS The Parental Bonding Instrument and the Childhood Trauma Questionnaire were highly correlated. Panic disorder patients presented higher rates of emotional abuse (OR = 2.54, p = 0.001), mother overprotection (OR = 1.98, p = 0.024) and father overprotection (OR = 1.84, p = 0.041) as compared to controls. Among men with panic disorder, only mother overprotection remained independently associated with panic disorder (OR = 3.28, p = 0.032). On the other hand, higher father overprotection (OR = 2.2, p = 0.017) and less father warmth (OR = 0.48, p = 0.039) were independently associated with panic disorder among female patients. CONCLUSION Higher rates of different types of trauma, especially emotional abuse, are described in panic disorder patients as compared to controls. The differences regarding gender and parental bonding could be explained in the light of the psychodynamic theory.

The efficacy of milnacipran in panic disorder: an open trial.

The aim of this study is to evaluate the efficacy of milnacipran in the acute treatment of patients with panic disorder. Thirty-one patients who met Diagnostic and statistical manual of mental disorders-IV criteria for panic disorder with or without agoraphobia were included in the study. Patients were initially treated with milnacipran 25 mg twice daily and then 50 mg twice daily until the 10th week. The treatment outcome and panic disorder severity were determined by the Panic Disorder Severity Scale, Panic Inventory, Clinical Global Impression and Hamilton Anxiety Scale, all of which were applied during every evaluation interview. Quality of life (WHOQOL-bref) was evaluated at baseline and at the end of the study. Missing data were handled by using the last observation carried forward for all participants who had taken at least one dose of study medication. Intention-to-treat was used in the analyses. Pharmacological treatment resulted in a clinically and statistically significant mean reduction in all severity measures. Remission (Clinical Global Impression≤2) was obtained in 58.1% of the sample. Regarding WHOQOL, we found a significant improvement (P<0.05) across treatment in all the domains studied. Although results may be influenced by the open design of this pilot study and by the small sample size, our findings suggest that milnacipran may be effective for the treatment of panic disorder and justify further research.

Improvement of schizophrenia with electroconvulsive therapy and serum brain-derived neurotrophic factor levels: Lack of association in a pilot study.

WE ENCOUNTERED A patient with Williams syndrome who exhibited glove fetishism and committed recurrent theft of gloves. Williams syndrome is a congenital disorder characterized by mental retardation, congenital cardiovascular anomalies, and unique facial features (‘elfin face’). The cause of this syndrome is a micro-deletion of chromosome 7 (7q 11.23). The literature contains no previous reports of fetishism occurring in Williams syndrome. The patient was a 22-year-old man. Both the patient and his mother gave verbal informed consent to participate in this case report. His mother raised him independently from the age of 1 year, after her divorce. He began to exhibit developmental delay around the age of 1 year. At the age of 3, he was diagnosed with Williams syndrome by a pediatrician. As a child, he also displayed excessive friendliness and hyperactivity. Impulsivity and inattention were not prominent. The mother was very busy because of financial constraints and the family did not have regular opportunities to consult health professionals. At around 5 years of age, the patient saw a heroine on a children’s television program; she was wearing white gloves while fighting enemies. From this point, he was keen to collect gloves and photographs of gloves. At age 18, he watched a pornographic video in which a woman wearing gloves masturbated men to ejaculation. He started to visit prostitutes and requested that they wear gloves while stimulating him to ejaculation. At the age of 18, 19, 21, and 22 years, the patient assaulted women in order to rob them of their gloves. He was arrested by the police each time. The patient’s score on the Wechsler Adult Intelligence Scale– Revised (WAIS-R) at the age of 22 years indicated moderate intellectual disability (full-scale IQ < 40, verbal IQ = 51, performance IQ < 46). Medical assessment revealed distinctive features of Williams syndrome, such as elfin face, supravalvular aortic stenosis and excessive friendliness and hyperactivity. He was open about his sexual predilections, and exhibited neither defiant nor destructive attitudes. The diagnosis was confirmed by identifying the microdeletion of chromosome 7q (11.23). Patients with Williams syndrome have been reported to exhibit ‘persistence’ and ‘obsession’. This patient’s keen interest in gloves was consistent from early childhood. In addition to this cognitive profile unique to Williams syndrome, the family and social environment of the patient should be noted. The mother’s unavailability due to her work and the lack of professional support by health professionals created a difficult situation for the family, in which she had to raise a troubled child without assistance. Due to social isolation, the mother had been unable to provide the son with sufficient emotional support or the necessary discipline. This challenging environment created poor interpersonal relationships and ineffective judgment about socially acceptable behaviors. These disadvantages and the unique cognitive profile of Williams syndrome contributed to the transformation of the childhood obsession with gloves into inadequate adult sexual behavior.

Therapeutic relationship on the web: to face or not to face?

In this age of unprecedented expansion of media and information dissemination and sharing, the use of electronic means should be reconsidered. The use of new technologies should be studied to understand how it may affect the relationship between patient and therapist during psychotherapy or psychoanalytic treatments. This study offers a critical discussion of the effect of technologies on clinical practice, and vignettes are used to describe their impact on frame, anonymity, abstinence and therapeutic neutrality. Transfer and countertransference issues resulting from these changes are also discussed. The potential benefits of new technologies in psychotherapy are appreciated, but the authors draw attention to the need to reflect about the presence of the therapist in those technologies and the preservation of the therapeutic setting, so that a satisfactory progression of the work of the dyad is ensured. This study also discusses the use of technologies in the expansion of learning and application of the therapeutic technique to overcome geographic and time barriers, among others.