Mauro Barbosa Terra

Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients

OBJECTIVE Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6%). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbachs alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9% of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.

Transtornos de ansiedade: um estudo de prevalência e comorbidade com tabagismo em um ambulatório de psiquiatria

OBJETIVOS: Este estudo tem por objetivo investigar a presenca de transtornos de ansiedade e tabagismo entre pacientes atendidos em um ambulatorio de psiquiatria. METODOS: Realizou-se um estudo transversal em um ambulatorio de psiquiatria em Porto Alegre, no qual se aplicou SCID-I em 84 pacientes, para examinar a ocorrencia de transtornos de ansiedade e dependencia a nicotina; tambem se utilizou o Teste de Fagerstrom para identificar o grau de dependencia nicotinica. Excluiram-se pacientes com esquizofrenia, outros transtornos psicoticos e retardo mental. RESULTADOS: Verificou-se frequencia de 75% para os transtornos de ansiedade, sendo mais frequentes fobia especifica e transtorno de ansiedade generalizada (TAG) com 26,2% cada um. Tabagistas representaram 21,43% da amostra, e a maior parte destes obteve escore leve para o grau de dependencia. Constatou-se associacao entre ter TAG e ser tabagista, e a chance dos pacientes com TAG fumarem e 5,2 vezes em relacao aos que nao tem esse transtorno de ansiedade. CONCLUSOES: Os transtornos de ansiedade tem uma frequencia elevada entre pacientes ambulatoriais, sendo importante sua identificacao. A frequencia de tabagismo entre pacientes com transtorno de ansiedade e alta, apresentando importante associacao com TAG, e por isso deve tambem ser foco de atencao no tratamento desses pacientes.

Do alcoholics anonymous groups really work? Factors of adherence in a Brazilian sample of hospitalized alcohol dependents

This study was designed to determine factors affecting adherence to Alcoholics Anonymous (AA) groups. This cohort involved 300 alcoholics committed to three hospitals in Porto Alegre, Brazil. They were interviewed again in their homes after six months. The SCID-I and a questionnaire focusing on patient relationship with AA groups were used. The responses obtained through the questionnaire were independently evaluated by two researchers. AA adherence was below 20%. The main factors reported by patients as reasons for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. Although AA is considered an effective intervention for alcoholism, its adherence rate was excessively low. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.

IMPACT OF ALCOHOL INTOXICATION AND WITHDRAWAL SYNDROME ON SOCIAL PHOBIA AND PANIC DISORDER IN ALCOHOLIC INPATIENTS

PURPOSE To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV) and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval). RESULTS Only 1 (2.4%) patient presented panic disorder throughout life, and 9 (21.9%) had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39%) alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.

Convergent validation study of the Contemplation Ladder for application via telephone in tobacco users

objective: This work was designed to validate the Portuguese version of the Contemplation Ladder, whose purpose is to assess the motivational phase to quit smoking among tobacco users using a telephone service. method: A cross-sectional study was conducted in a nationwide drug use information hotline. In order to assess the convergent validation, the correlation between the Contemplation Ladder and the URICA Scale was calculated, which was previously validated. results: The study included 271 tobacco users. Statistically significant correlations were found between the Contemplation Ladder scores and the scores of the URICA precontemplation (r=-0.16; p<0.01), action (r=0.15; p<0.01) and maintenance (r=0.18; p<0.01) subscales. The correlation between the URICA Scale compound score and the Contemplation Ladder was also significant (r=0.31; p<0.01). conclusion: The results of our study suggest that the Contemplation Ladder can be an efficient substitute for the URI CA scale (whose application lasts at least 20 minutes), without submitting the interviewee to a heavy load of questions. The study presented evidences of convergent validity for the Contemplation Ladder when applied via telephone in tobacco users.

Predictors of Relapse in 300 Brazilian Alcoholic Patients: A 6-Month Follow-Up Study

Three hundred alcoholic patients were interviewed at hospitalization and again 3 and 6 months thereafter in Porto Alegre, Brazil, from March 2002 to January 2004. Assessment included the SCID-I to check for the presence of Axis I mental disorders, a questionnaire focusing on patient relationship with AA groups, and specific questions about participation in psychotherapy. A logistic regression analysis was performed to determine predictive variables for relapse or abstinence 6 months after discharge. Previous treatment for alcohol dependence (OR = 3.65; CI: 1.77–7.05) and being single (OR = 2.39; CI: 1.06–5.42) proved to be associated with relapse, whereas adherence to AA (OR = 0.31; CI: 0.15–0.66), presence of a comorbid depressive disorder (OR = 0.46; CI: 0.23–0.92), and probably adherence to psychotherapy (OR = 0.52; CI: 0.26–1.04) could be associated with abstinence. These findings reinforce the importance of psychotherapy and AA groups for alcoholics to remain abstinent for longer. The greater adherence to treatment observed among depressive alcohol dependents can be explained by the fact that this is a comorbid condition that acts as a protective factor against relapse.

Fobia social e transtorno de pânico: relação temporal com dependência de substâncias psicoativas

INTRODUCTION: The objective of this study is: 1) to determine the prevalence of panic disorder and social phobia in patients hospitalized due to the use of psychoactive substances; 2) to determine the temporal relation between the beginning of these anxiety disorders and the beginning of the use of psychoactive substances. METHODS: The psychiatric diagnoses were made by means of semi-structured clinical interviews (SCID-I), based on DSM-IV criteria. A questionnaire was developed by the authors for the purpose of studying the temporal relation between the beginning of the disorder due to psychoactive substances and the beginning of panic disorder and social phobia. RESULTS: Only 1 (2 %) patient had panic disorder before using psychoactive substances. Most of the patients suffering from panic disorder fulfilled the criteria for the diagnosis of anxiety disorder induced by use of the substance: 11 (22.9 %) of them had panic attacks only while under the effect of drugs or during the withdrawal syndrome, i.e., secondarily to the use of drugs. Sixteen (33.3 %) of the patients had social phobia, and in all of them, the social phobia began before the use of psychoactive substances. CONCLUSIONS: The findings confirmed the high frequency of social phobia in psychoactive substance-dependent patients and they reinforce the self-medication hypothesis in this comorbidity, since that kind of phobia tends to precede the use of drugs. As for panic disorder, in our sample it appears to derive from a complication of the use of psychoactive substances.

Personality disorder and substance related disorders: a six-month follow-up study with a Brazilian sample

Objetivos Poucos estudos brasileiros correlacionam transtornos de personalidade (TP) com transtorno por uso de substâncias (TUS). O objetivo deste estudo e verificar a associacao entre eles, avaliar a frequencia dos TP na populacao de dependentes quimicos internados, correlacionar com caracteristicas sociodemograficas, drogas de escolha, frequencia de recaida, aderencia a grupos de autoajuda e psicoterapia em ate seis meses apos a alta hospitalar. Metodos Uma amostra de 101 pacientes internados em dois hospitais foi selecionada. Os seguintes instrumentos foram aplicados: um questionario para identificacao de caracteristicas sociodemograficas e padrao de uso de drogas, algumas questoes da sexta versao do ASI-6 (Addiction Severity Index), o SCID-II e algumas questoes especificas sobre participacao em grupos de autoajuda e em psicoterapia, bem como o uso de medicacoes. Resultados Destes 101 pacientes, 55,4% foram diagnosticados com TP, sendo evitativa (14,9%), limitrofe (11,9%) e antissocial (8,9%) as mais frequentemente encontradas. Pacientes com TP demonstraram ter feito uso mais precoce de crack na vida (p = 0,038) e tambem tinham mais tratamentos anteriores do que aqueles sem TP (p = 0,005). Pacientes com TP limitrofe estavam menos preocupados com o problema de abuso de substâncias (p = 0,003). Apos seis meses de seguimento, nenhuma diferenca estatistica significativa foi encontrada entre pacientes com e sem TP acerca do uso de drogas ou aderencia ao tratamento. Conclusao Uma alta prevalencia de TP foi encontrada em pacientes internados por TUS. Pacientes diagnosticados com TP e TUS necessitam a identificacao da comorbidade e das caracteristicas de sua personalidade, a fim de planejar um tratamento mais abrangente e eficaz.

Consumo de substâncias psicoativas em uma amostra de adolescentes e sua relação com o comportamento sexual

OBJECTIVE: To evaluate the consumption of psychoactive substances and the pattern of sexual behavior in high school students in the city of Serafina Correa - RS, with a population of approximately 15,000 inhabitants. METHOD: The sample of this cross-sectional study consisted of all students of both sexes who were attending high school in the city. Questionnaires were used to check the socio-demographic variables, sexual behavior, and drug use. RESULTS: The sample consisted of 453 students of which 261 (57.62%) were female. The drug most often used was alcohol (82.34%), followed by tobacco (12.58%), marijuana (6.62%), and cocaine (5.30%). Regarding the sexual behavior of adolescents, it was observed that 247 (54.5%) reported having had sexual intercourse. We found an association between the adolescent having already used drugs in general (p < 0.001), alcohol (p < 0.001), or smoking (p = 0.023) and having had sexual intercourse. CONCLUSION: The study provides information on the use of drugs and characteristics of sexual behavior of adolescents of this city and may be useful for developing an intervention program to reduce risk factors for drug addiction, including education for the promotion of health.

Internal consistency and factor structure of the adherence scale for alcoholics anonymous

The objective of the article was to estimate the internal consistency and factor structure of the Adherence Scale for Alcoholics Anonymous Groups. The scale was applied to 257 alcoholic patients who had been admitted for treatment in 3 hospitals in Porto Alegre, about 6 months earlier. The scale was produced based on an adaptation of the Drug Attitude Inventory Scale. Internal consistency was measured using Cronbach alpha. Data were subjected to a principal component analysis. The coefficient of internal consistency was 0.71. All items showed corrected item-total correlation coefficients above 0.29. Questionnaire items with factor loading of 0.57 or above were considered in the final factor solution. The factor analysis resulted in 2 dimensions which corresponded to 67.01% of the total variance. This scale appears to be a valid instrument for use in a population of alcoholic patients.