Mário Rodrigues Louzã

Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos

The criteria listed in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) from the American Psychiatric Association are the most used ones for the diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) being based on field studies with children and adolescents. The Adult Self-Report Scale (ASRS, version 1.1) was developed to adapt those symptoms to an adult life context. The present study consisted of a transcultural adaptation of the original instrument in English into a final version to be used in Brazil. Results indicated a satisfactory equivalence between versions, with some modifications being done after debriefing, supporting the importance of this step in studies like this.

Insight, cognitive dysfunction and symptomatology in schizophrenia

Lack of insight is frequent in schizophrenia and usually influences negatively both patient’s treatment and prognosis. This study aimed to investigate the relationship between insight, symptomatology and cognitive dysfunctions in schizophrenia using the PANSS five-factor model (modified from Gaag et al. in Schizophr Res 85:280–287, 2006). Forty patients diagnosed with chronic schizophrenia (DSM-IV) were evaluated with the scale to assess unawareness of mental disorder (SUMD), the PANSS and a neuropsychological battery. Spearman correlation and linear regression analyses were performed to investigate the relationship between clinical, neurocognitive and insight measures. The SUMD current and past awareness of symptoms score showed a correlation with WCST indices (correct answers and non-persevering errors). The negative and disorganization factor of the PANSS showed a positive correlation with current and past awareness of symptoms. However, when submitted to a linear regression model only the disorganization factor emerged as significant contributor for insight. Considering that the core items of the “disorganization factor” of the PANSS are related to cognition (e.g., poor attention, difficult in abstract thinking), insight is associated cognitive symptoms although no direct relationship between insight and neuropsychological tests was observed.

Conjugated estrogens as adjuvant therapy in the treatment of acute schizophrenia: a double-blind study

In a double-blind, placebo controlled study, conjugated estrogens (CE) (0.625 mg/day) were added to a fixed dosage of haloperidol (5 mg daily). Forty-four female inpatients with acute schizophrenia were included in the study and randomized to one of the groups; 40 patients completed the trial. They were followed for 28 days and evaluated periodically with the BPRS, Negative Symptoms Rating Scale, Simpson Angus Extrapyramidal Rating Scale and UKU rating scale. Hormonal concentrations (estradiol, estrone, progesterone, FSH, LH and prolactine) were measured at baseline and weekly throughout the trial. Both groups showed similar clinical improvement during the evaluation, although there was a trend for the CE group to show a better improvement than the placebo group (p < 0.10). Side effects and the use of anticholinergics were similar in both groups. Conjugated estrogens caused elevation only of estrone levels in the CE group; estradiol and prolactin showed a similar profile for both groups. Our negative findings regarding the antipsychotic effect of conjugated estrogens does not preclude, however, a possible efficacy of other estrogens, such as 17-beta-estradiol, in schizophrenia.

Do religious mediumship dissociative experiences conform to the sociocognitive theory of dissociation

Abstract Background: The religion Kardecism Spiritism accepts and fosters dissociative experiences such as spiritual incorporation, automatic writing and out-of-body experiences as part of its basic tenets. Mastery of these skills is valued and highly respected. Members undergo extensive formalized training under the guidance of experienced leaders who model socially appropriate religious behaviors. Method: One hundred and ten subjects at a prominent Kardecist Center in São Paulo, Brazil, were assessed with a variety of questionnaires and scales which addressed socialization, happiness, religiosity, mediumship (for the measurement of religious-related dissociative behavior and its formal training), temperament (the Tridimensional Personality Questionnaire; TPQ), and general dissociative experiences (the Dissociative Experiences Scale; DES). Results: Mediumship activity was associated with increased DES score in spite of good scores on socialization and adaptation. There was evidence for a positive association between mediumship training and the control of the religious-related dissociative experiences. Increased pathological dissociation was associated with younger age, less control of mediumship activity, poorer social support and more antecedent psychiatric symptomatology. Conclusions: These findings partially support the sociocognitive theory for religious-related non-pathological dissociation. The results of pathological dissociators suggest a co-existing but distinct sub-population whose pathological dissociative experiences were not caused by social modeling.

Alterações cognitivas na esquizofrenia: conseqüências funcionais e abordagens terapêuticas

CONTEXTO: Muitos pacientes com esquizofrenia apresentam prejuizos cognitivos significativos, especialmente em relacao a memoria, a atencao e ao funcionamento executivo. Esses prejuizos inevitavelmente tem um importante impacto sobre a consequencia funcional da doenca. OBJETIVO: Este artigo tem como foco os aspectos do funcionamento cognitivo na esquizofrenia, sua relacao com as consequencias funcionais e o efeito das medicacoes antipsicoticas sobre a cognicao. METODO: pesquisa de base de dados Medline/PubMed e Lilacs utilizando os termos esquizofrenia, cognicao, neuropsicologia, desfecho, funcionamento, tratamento. RESULTADOS: Apesar de um grande numero de pesquisas descrever alteracoes cognitivas na esquizofrenia, ainda nao ha uma concordância em relacao ao padrao desses deficits. Contudo, alteracoes cognitivas tem apresentado correlacao significante com o nivel de prejuizo funcional. Os antipsicoticos de segunda geracao parecem ter um impacto positivo na cognicao, entretanto, o significado dessa melhora cognitiva no desempenho funcional e social dos pacientes ainda nao e claro. Os resultados na area de reabilitacao neuropsicologica, apesar de discretos, mostram-se promissores. CONCLUSAO: A habilidade dos antipsicoticos de segunda geracao de melhorar dominios especificos da cognicao varia com o padrao de alteracoes apresentado por esses pacientes. Assim, estrategias para melhorar a cognicao de pacientes com esquizofrenia incluem o uso dos antipsicoticos de segunda geracao em associacao com as abordagens de reabilitacao neuropsicologica.

A Multicenter, Open-Label Trial to Evaluate the Quality of Life in Adults with ADHD Treated with Long-Acting Methylphenidate (OROS MPH): Concerta Quality of Life (CONQoL) Study.

The available literature provides few studies on the effectiveness of methylphenidate in improving quality of life in individuals with ADHD. Objective: To assess the effectiveness of Methyphenidate OROS formulation (OROS MPH) through QoL in adults with ADHD. Method: A 12-week, multicenter, open-label trial involving 60 patients was used. The measures used were Adult Self-Rating Scale, Adult ADHD Quality of Life Scale (AAQoL), State and Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression (CGI), and safety measures. A significance statistic level of 5% was adopted. Results: Analyses included 60 patients (66.7% male; M age = 31.1 years) for safety and 58 patients for effectiveness. All AAQoL subscales improved from baseline to Week 12 (p < .0001), as well as the Total AAQoL (p < .0001). A significant reduction on Clinical Global Impression–Improvement (CGI-I), HAM-D, STAI, and ASRS scores was observed (p < .0001). No serious adverse event was reported. Conclusion: Treatment of adult ADHD patients with OROS MPH improves QoL.

Painel brasileiro de especialistas sobre diagnóstico do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos

Present difficulties in the diagnosis of attention-deficit/hyperactivity disorder in adults have prompted Brazilian specialists involved in research in this area to make a consensus to be used in the country. A non-systematic preliminary review was repeatedly evaluated by all authors, who added new material, commented and corrected parts of the text for 6 months through electronic mail and a further meeting sponsored by the Brazilian Association of Attention-Deficit Disorder. The preliminary version was publicly presented during the annual congress of the Associacao Brasileira de Psiquiatria (Brazilian Association for Psychiatry) for appraisal and suggestions from participants in order to prepare the final version.Considerando-se as dificuldades atuais do diagnostico do transtorno do deficit de atencao/hiperatividade em adultos, foram reunidos especialistas brasileiros que fazem pesquisas nesta area, de modo a produzir diretrizes de consenso para uso no pais. Foi realizada uma revisao nao-sistematica preliminar e concebido um texto inicial, que foi repetidamente avaliado e editado pelos autores, com acrescimos e correcoes ao longo de 6 meses, atraves de correio eletronico e de uma reuniao posterior, patrocinada pela Associacao Brasileira do Deficit de Atencao. A versao preliminar foi apresentada publicamente durante o congresso anual da Associacao Brasileira de Psiquiatria, com comentarios e sugestoes dos participantes, para a redacao da versao final.

Maintenance treatment of severe tardive dyskinesia with clozapine: 5 years' follow-up.

Abstract: Drug-induced tardive dyskinesia (TD) affects approximately 20% to 30% of schizophrenic patients. Although it is usually mild, from 1% to 8% of patients may develop severe TD. Second-generation antipsychotics have demonstrated a lower risk of inducing TD. However, despite the advances brought by second-generation antipsychotics, the treatment strategies for TD remain problematic, given both the lack of an established therapeutic choice and the need for long-term use of antipsychotics in the treatment of schizophrenia. Clozapine is an atypical antipsychotic with minimal risk of inducing TD. Furthermore, it has been suggested that clozapine might actually improve the symptoms of TD. Accordingly, we evaluated the effects of clozapine on severe TD over 5 years. Seven patients meeting Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for chronic exacerbated schizophrenia (mean age 28.5 ± 10.2 years) and presenting severe TD, defined as Abnormal Involuntary Movements Scale score above 13, were treated with clozapine and followed up for 5 years. Extrapyramidal Symptoms Rating Scale assessment was performed in all patients at baseline, after 6 months and 3 and 5 years. Mean Extrapyramidal Symptoms Rating Scale scores decreased 83% after 3 years and 87.5% after 5 years. Mean dose for all patients was 428 ± 269 mg/d after 5 years. Results from this open-label study suggest that clozapine may be a further option for the treatment of TD over long term.

Higher morbidity risk for schizophrenia in males: Fact or fiction? ☆

Male to female ratios in published annual incidence rates for schizophrenia range from 0.70 to 3.47. These variations between studies are attributed to differences in sampling, diagnostic criteria, design characteristics, and methods of calculation, which limit the quality of the studies. In an effort to overcome these shortcomings, we collected a comprehensive sample of 392 consecutive first admissions with a diagnosis of schizophrenia or a similar disorder out of a population of 1.5 million in a central region of western Germany. In this large representative sample, no significant gender differences in the incidence of schizophrenia could be detected regardless of different diagnostic definitions.

Patterns of regional gray matter loss at different stages of schizophrenia: A multisite, cross-sectional VBM study in first-episode and chronic illness

Background: Structural brain abnormalities in schizophrenia have been repeatedly demonstrated in magnetic resonance imaging (MRI) studies, but it remains unclear whether these are static or progressive in nature. While longitudinal MRI studies have been traditionally used to assess the issue of progression of brain abnormalities in schizophrenia, information from cross-sectional neuroimaging studies directly comparing first-episode and chronic schizophrenia patients to healthy controls may also be useful to further clarify this issue. With the recent interest in multisite mega-analyses combining structural MRI data from multiple centers aiming at increased statistical power, the present multisite voxel-based morphometry (VBM) study was carried out to examine patterns of brain structural changes according to the different stages of illness and to ascertain which (if any) of such structural abnormalities would be specifically correlated to potential clinical moderators, including cumulative exposure to antipsychotics, age of onset, illness duration and overall illness severity. Methods: We gathered a large sample of schizophrenia patients (161, being 99 chronic and 62 first-episode) and controls (151) from four previous morphometric MRI studies (1.5 T) carried out in the same geographical region of Brazil. Image processing and analyses were conducted using Statistical Parametric Mapping (SPM8) software with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) algorithm. Group effects on regional gray matter (GM) volumes were investigated through whole-brain voxel-wise comparisons using General Linear Model Analysis of Co-variance (ANCOVA), always including total GM volume, scan protocol, age and gender as nuisance variables. Finally, correlation analyses were performed between the aforementioned clinical moderators and regional and global brain volumes. Results: First-episode schizophrenia subjects displayed subtle volumetric deficits relative to controls in a circumscribed brain regional network identified only in small volume-corrected (SVC) analyses (p < 0.05, FWE-corrected), including the insula, temporolimbic structures and striatum. Chronic schizophrenia patients, on the other hand, demonstrated an extensive pattern of regional GM volume decreases relative to controls, involving bilateral superior, inferior and orbital frontal cortices, right middle frontal cortex, bilateral anterior cingulate cortices, bilateral insulae and right superior and middle temporal cortices (p < 0.05, FWE-corrected over the whole brain). GM volumes in several of those brain regions were directly correlated with age of disease onset on SVC analyses for conjoined (first-episode and chronic) schizophrenia groups. There were also widespread foci of significant negative correlation between duration of illness and relative GM volumes, but such findings remained significant only for the right dorsolateral prefrontal cortex after accounting for the influence of age of disease onset. Finally, significant negative correlations were detected between life-time cumulative exposure to antipsychotics and total GM and white matter volumes in schizophrenia patients, but no significant relationship was found between indices of antipsychotic usage and relative GM volume in any specific brain region. Conclusion: The above data indicate that brain changes associated with the diagnosis of schizophrenia are more widespread in chronic schizophrenia compared to first-episode patients. Our findings also suggest that relative GM volume deficits may be greater in (presumably more severe) cases with earlier age of onset, as well as varying as a function of illness duration in specific frontal brain regions. Finally, our results highlight the potentially complex effects of the continued use of antipsychotic drugs on structural brain abnormalities in schizophrenia, as we found that cumulative doses of antipsychotics affected brain volumes globally rather than selectively on frontal-temporal regions.