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Objective: To determine the diagnostic accuracy of the Addenbrooke’s Cognitive Examination Revised (ACE-R) as a cognitive screening tool for older adults with low levels of schooling and healthy aging, MCI and dementia in Brazil. Methods: All participants underwent neurological and psychiatric examinations and were administered a validated version of ACE-R. Results: A total of 85 participants were evaluated; most were females (84.7%, n = 72). The post hoc analysis showed statistical differences in ACE-R total scores between older adults with mild cognitive impairment (MCI) and controls (p < 0.001) and in subitem scores including verbal fluency, language, visuospatial skills and attention (p < 0.001). The visual-spatial skills subitem was the most strongly correlated with schooling level (r = 0.509, p < 0.001), whereas late, immediate recall and recognition memory were not influenced by schooling. The ACE-R had the best diagnostic accuracy in discriminating between MCI and controls = 0.69 (

Objectives To assess the prevalence of early trauma in individuals with onset of schizophrenia (SZ) at early (≤ 18 years) and adult (> 18 years) ages (EOP and AOP, respectively) and explore relationships between the onset of disease and clinical variables including traumatic events and psychotic and mood symptoms. Methods Subjects with SZ (n = 71) and EOP and AOP were compared for history of psychological trauma, sexual abuse, and physical punishment using the Early Trauma Inventory Self Report - Short Form (ETISR-SF). They were also compared for history of comorbidities and affective disorders using the Diagnostic Interview for Psychosis and Affective Disorders, the Positive and Negative Syndrome Scale, the Liebowitz Social Anxiety Scale, and the Calgary Depression Scale for Schizophrenia. Coefficients were calculated for correlations between scale results and disease duration. Results Early trauma was significantly associated with an early onset psychotic episode (r = -0.315, p < 0.01). General trauma and depressive symptoms in adulthood were also associated (r = 0.442, p < 0.01), as were social anxiety symptoms and early trauma (r = 0.319, p < 0.01). Total ETISR-SF scores and the physical abuse item were significantly higher in EOP than in AOP. In the hierarchical regression, PANSS scores were best predicted by a model including the duration of disease and age of first psychotic episode (R = 0.303). Conclusions Our results support the hypothesis that early trauma, including physical abuse, may play a relevant role in schizophrenia symptoms, such as an earlier psychotic occurrence, as well as features of other psychiatric disorders, such as greater severity of social anxiety and depression.

Objective: Decades of research have highlighted the involvement of the prefrontal cortex, anterior cingulated cortex, and limbic areas (amygdala) in panic disorder (PD). However, little attention has been given specifically to the inferior frontal gyrus. The current study aimed to investigate the neural substrates, including the inferior frontal gyrus, of both panic-related and negative conditions among individuals with PD and healthy controls. Methods: We examined 13 medication-free PD patients and 14 healthy controls with functional magnetic resonance imaging (fMRI) during exposure to negative and neutral pictures and a set of specific panic-related pictures. Results: Subtraction between the conditions indicated activation of the left amygdala region and the right inferior frontal gyrus in PD patients during the specific panic-related condition, whereas the left amygdalar region and left inferior frontal gyrus were activated during the negative condition in controls. Conclusion: These results suggest that in patients with PD, a prominent bottom-up process is involved in specific panic-related conditions, which might be associated with weak modulation of the left frontal area. These data add to our current understanding of the neural correlates of PD and can contribute to future clinical interventions targeting the functional reestablishment of these regions.

Years of accumulating research show high schizophrenia comorbidity with panic anxiety. Recent research has shown that auditory hallucinations have paroxysmal onset, concurrent with abrupt onset panic anxiety in patients with schizophrenia who hear voices. Fixed-dose adjunctive alprazolam or clonazepam (antipanic benzodiazepines) can substantially relieve positive and negative symptoms and panic in some schizophrenia cases. Clinical experience and limited research suggest a more uniform and pronounces benefit in patients with schizophrenia who also have panic premorbidly, concurrently, and/or with voices. Although more research is needed, there could be a distinct panic psychosis diagnosis. This is consistent with an evolutionary theory postulating five core psychoses. With appropriate medication and skilled psychotherapy, many can improve to their premorbid baseline and remain there for extended periods. Perhaps the major impediments to clinical improvement are the difficulty of diagnosing panic in psychosis, failure to use fixed dose and sufficient clonazepam, and limited use of skilled psychotherapy. [ Psychiatr Ann . 2018;48(12):561–565.]

Background Oxytocin is a peptide hormone that influences the integration of social cognition with behavior and affect regulation. Oxytocin also prominently directs the transition of neuronal GABA neurotransmission from excitatory to inhibitory after birth. The oxytocin receptor (OXTR) is linked to schizophrenia, a heterogeneous syndrome. Relationships of OXTR polymorphisms with specific clinical features could aid in evaluating any role of oxytocin in the pathogenesis of schizophrenia. Method Schizophrenia cases with rare missense coding OXTR single nucleotide variants (SNVs) were identified from a well-characterized sample of cases and controls who were assessed for symptoms, cognition and early life trauma. Results Five of 48 cases showed rare OXTR variants. Compared to the other cases they had less severe negative symptoms (deficits in emotional expression and motivation) and less severe general psychopathology scores (depression and anxiety). They demonstrated lower nonverbal (performance) than verbal intelligence due to deficient perceptual organization and slow processing speed. They also reported greater early trauma exposure (physical and sexual abuse and emotional trauma). Conclusion Cases carrying rare OXTR SNVs had less negative and affective symptoms than other cases, but similar psychotic symptoms, along with specific cognitive deficits. The clinical characterization of these cases occurred in association with environmental exposure to early trauma, especially sexual abuse, which may have influenced the expression of schizophrenia in subjects harboring specific SNVs in the OXTR.

Modafinil (MOD) is a wakefulness-inducing compound prescribed for treatment of excessive daytime sleepiness as a consequence of sleep disturbances such as shift work sleep disorder, obstructive sleep apnea, restless leg syndrome, or narcolepsy. While providing effective results in patients with sleepiness, MOD also produces positive outcomes in the management of fatigue associated with different conditions including depression, cancer, or tiredness in military personnel. Although there is clear evidence of the stimulant effects of MOD, current data also show that administration of this drug apparently induces positive neurobiological effects, such as improvement in memory. However, serious concerns have been raised since some reports have suggested MOD dependence. Taken together, these findings highlight the need to characterize the changes induced by MOD which have been observed in several neurobiological functions. Moreover, further work should follow up on the likely long-term effects of this drug if used for treatment of drowsiness and tiredness. Here, we review and summarize recent findings of the medical uses of MOD in the management of sleepiness and fatigue associated with depression or cancer as well as exhaustion in military personnel. We also discuss the available literature related with the cognitive enhancing properties of this stimulant, as well as what is known and unknown about MOD addiction.

A profissionalização da Psicologia, no Brasil, ocorreu em meio a embates entre diferentes profissionais envolvidos com suas aplicações, na primeira metade do século XX. Parte desses embates estava circunscrita às aplicações clínicas dos métodos e técnicas psicológicas, elementos que circulavam entre a Psicologia, a Psiquiatria e a Psicanálise. Nessa direção, esta pesquisa lança luz historiográfica a práticas e conhecimentos psicológicos que circularam nos Arquivos de Neuro-Psiquiatria, entre 1943 e 1962. Os resultados sugerem a presença de métodos e técnicas psicológicas para lidar com quadros clínicos variados, sendo prevalente a apropriação de teorias psicodinâmicas. Nota-se, portanto, apropriações clínicas da neuropsiquiatria que auxiliam em uma compreensão ampliada de embates científico-profissionais quando da regulamentação da formação e da profissão de psicólogo, no país. In Brazil, the professionalization of Psychology is a consequence of debates among different professions involved into its applications during the first half of the 20th century. Part of this debate was limited to the clinical applications of psychological methods and techniques; elements connected to Psychology, Psychiatry, and Psychoanalysis. In this regard, this study highlights psychological practices and knowledges in circulation in the “Arquivos de Neuro-Psiquiatria”, between 1943 and 1962. The results show the use of psychological methods and techniques to address different conditions, and a strong appropriation of psychodynamic theories. Clinical appropriations of Neuropsychiatry that helps to a better comprehension of the scientific and professional debates are noteworthy, connected to the institutionalization of the training and the profession of Psychologist, in the country. Au Brésil, la professionnalisation de la Psychologie s’est produite au milieu des conflits entre différents professionnels de la santé mentale au cours de la première moitié du XXème siècle. Une partie de ces conflits était limitée aux applications cliniques des méthodes et techniques psychologiques qui circulaient entre Psychologie, Psychiatrie et Psychanalyse. Ainsi, cette recherche met en évidence les pratiques et connaissances psychologiques qui ont circulé dans les «Arquivos de Neuro-Psiquiatria» (1943-1962). Les résultats suggèrent l’utilisation de méthodes et techniques psychologiques, principalement de théories psycho-dynamiques, pour traiter différents états cliniques. On remarque donc que des appropriations cliniques de neuropsychiatrie aident à comprendre les conflits scientifiques-professionnels de la réglementation de la profession de psychologue au Brésil. La profesionalización de la Psicología en Brasil se dio en la primera mitad del siglo XX, en medio de enfrentamientos entre diferentes profesionales involucrados con su aplicación. Parte de estos enfrentamientos se limitaba a las aplicaciones clínicas de los métodos y técnicas psicológicas, elementos que circulaban entre la Psicología, la Psiquiatría y el Psicoanálisis. Teniendo esto en cuenta, esta investigación ilumina historiográficamente las prácticas y los conocimientos psicológicos que circularon en los Archivos de Neuropsiquiatría, entre 1943 y 1962. Los resultados sugieren la presencia de métodos y técnicas psicológicas para manejar cuadros clínicos variados, prevaleciendo la apropiación de teorías psicodinámicas. Se observan, por lo tanto, apropiaciones clínicas de la neuropsiquiatría que ayudan para una comprensión ampliada de los enfrentamientos científico-profesionales en el momento de la reglamentación de la formación y la profesión de psicólogo en el país. Die Professionalisierung der brasilianischen Psychologie ist das Ergebnis von Debatten zwischen Vertretern unterschiedlicher Theorien, die in der ersten Hälfte des 20. Jahrhunderts stattfanden. Ein Teil dieser Debatten betraf die klinische Anwendung psychologischer Methoden und Techniken, sowie Aspekte der Psychologie, Psychiatrie und Psychoanalyse. Die vorliegende Studie beleuchtet die psychologischen Praktiken und das psychologische Wissen, welche zwischen 1943 und 1962 ihren Niederschlag in den „Arquivos de Neuro-Psiquiatria“ fanden. Die Ergebnisse unserer Untersuchung zeigen auf, dass der Einsatz dieser psychologischen Methoden und Techniken zum Ziel hatte, unterschiedliche klinische Krankheitsbilder zu behandeln, wobei psychodynamische Theorien eine bedeutende Rolle spielten. Die Tatsache der damaligen Hinwendung zur Neuropsychiatrie führt ebenfalls zu einem besseren Verständnis des wissenschaftlichen und professionellen Diskurses zur Institutionalisierung der Ausbildung und des Berufes des Psychologen in Brasilien.

Background: Depression is a mental disorder that affects a large part of the world's population. DHEA is a hormone that has long been attributed to the ability to improve depressive symptoms. However, few studies were conducted with depression individuals not resulting from other medical conditions. Objective: To investigate whether DHEA is more effective than placebo in the treatment of depressive symptoms in subjects with depression not resulting from other psychiatric or medical comorbidities. Methods: An electronic search was carried out using the keywords Dehydroepiandrosterone (Mesh) AND Depression (Mesh) in the following databases: Medical Literature databases Analysis and Retrieval System Online (Medline), Excerpta Medical Database (EMBASE), Latin American and Caribbean Health Sciences (LILACS) and the Cochrane Library through their website for relevant publications until June 2018. Only randomized clinical trials were included. The critical appraisal of the articles was performed using the Risk of Bias Tool from Cochrane Collaboration. Results: The meta-analysis applied in this review pointed to a significant effect in favor of treatment with DHEA compared to placebo. Conclusion: DHEA may be one more effective alternative between the drugs used in the treatment of depression.

Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings.

Objective: To investigate the prevalence of psychiatric disorders among women in ambulatory treatment for polycystic ovary syndrome (PCOS) and to correlate its clinical and demographic aspects with mental disorders. Methodology: Seventy-two patients in ambulatory treatment at the Endocrinal and Gynaecological Institute of the Federal University of Rio de Janeiro were evaluated using Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria by means of MINI (Mini International Neuropsychiatric Interview, version 4.4). Polycystic ovary syndrome was confirmed according to the ultrasonographic criteria of Adams and by clinical parameters. Results: Forty-one patients (57%) presented at least one psychiatric diagnosis. Among them, the prevalence of mood disorder reached 78%. The most prevalent diagnostics were major depression (26.4%) and bipolar disorder (11.1%). Conclusion: A high prevalence of mental disorders was observed, especially major depression and bipolar disorder. The data obtained regarding the relationship between PCOS and mood disorders in a Brazilian sample is in accordance with recent research findings in the same area.

Our objective was to explore the dose-response relationship in patients with panic disorder and social anxiety disorder comorbidity (DSM-IV). After 1 week of no-drug washout, 36 such patients were assigned to a double-blind controlled comparison of the effects of 30 mg and 60 mg of tranylcypromine, and were followed up for 12 weeks. The main instrument used to measure the number of panic attacks was the Sheehan Panic and Anticipatory Anxiety Scale. The primary outcome measure for social anxiety disorder symptoms was the mean change from baseline in the Liebowitz Social Anxiety Scale (LSAS). After 12 weeks of treatment, panic attacks were reduced 69.6% from baseline in the 30-mg group (n=19) compared with a 74.8% reduction in the 60-mg group (n=17). Twelve patients (70.6%) of the higher dose group and 14 patients (68.4%) of the lower dose were completely free of panic attacks. There was no difference in efficacy between the tranylcypromine groups in the panic disorder symptoms. The 60-mg dose was more efficacious as measured by the LSAS scores, showing a significant difference in relation to the lower group. Mean change from baseline in LSAS total score (mean+/-SD) for 30-mg group was 17.9+/-14.7 and for the 60-mg group was 35.0+/-14.8. The social anxiety symptom scale showed a two-fold greater change with the 60-mg dose, and the 30-mg dose group could be considered the equivalent of a placebo control group. Tranylcypromine--60 mg daily--was found effective in the treatment of panic disorder and social anxiety disorder comorbidity.

A sample of outpatient women (n = 56) in treatment for depression were sequentially evaluated using the Arizona Sexual Experience Scale (ASEX), Rey Auditory-Verbal Learning Test, Hamilton Depression Rating Scale and a semi-structured questionnaire. A larger number of abortions in the sample patients with sexual dysfunction (SD) were observed and also a correlation between a higher number of abortions and a higher intensity of the majority of the ASEX symptoms. The SD sample showed the lowest verbal memory performance, indicated by the smaller average recall of number of words immediately after submission to a list of distracting words (SD: 6.7 versus Preserved Sexual Function—PSF: 9.3 P = 0.001) and registered 30 min after the test (SD: 6.6 versus PSF: 9.6 P = 0.002). The immediate recall of a larger number of words was associated with better performance of all ASEX functions.

Background: Mood disorders are considered related to anxiety disorders and their association may determine clinical course and prognosis. We aimed to describe with retrospective methodology the demographic, clinical, and treatment features in a group of panic disorder comorbid with bipolar I disorder (PD–BI) patients who were been treated for at least 3 year-period and compare them with bipolar I (BI) patients who were treated during the same period. Method: We compared the demographic and clinical data of 26 PD–BI, 28 BI, and 25 panic disorder (PD) outpatients without history of comorbidity with mood disorder were diagnosed and treated for at least 3 years in the Federal University of Rio de Janeiro. Results: PD group have a higher educational level, are more married, and are more economically active. In the PD–BI and BI patients the disorders started earlier. They also turn out to have an equivalent pattern in the presence of drug abuse episodes, moderate or severe depressive episodes, psychotic episodes, suicide attempts, maniac episodes, mixed episodes, use of fewer days of antidepressants and benzodiazepines, and use of more days of antipsychotics and mood stabilizers. The PD–BI and the BI groups had a higher frequency of depressive episodes and psychotic episodes. Limitations: It is a retrospective data description based on a naturalistic treatment. The sample has a small size and the some data could be different in a large sample. Conclusion: PD–BI patients have demographic, clinical and therapeutic features similar to BI and the data support its validation as a special severe bipolar I disorder subgroup. © 2007 Elsevier B.V. All rights reserved.

OBJECTIVE: Our aim was to identify the personality traits in patients with panics disorder, major depression and with both disorders (comorbidity). METHOD: Diagnoses were made with the Structured Clinical Interview for DSM-IV before the treatment, and the personality evaluation with the Maudsley Personality Inventory was made during the follow-up. Four groups were analyzed: a control group (n = 30), a major depression without panic disorder group (n = 45); a panic disorder without major depression group (n = 56) and a comorbidity group (n = 21), with major depression and panic disorder, simultaneously. RESULTS: All disorder groups had significantly higher neuroticism means when compared to the control group. The highest mean was in the comorbidity group, followed by the major depression group and the panic disorder group. The difference of neuroticism means between the comorbidity group and the panic disorder group also reached statistical significance. The lowest extraversion mean was in the comorbidity group, followed by the major depression group, the panic disorder group, and the control group. Compared to normal controls, extraversion was significantly low in the comorbidity and major depression groups. CONCLUSION: In our sample, there was a continuum of personality traits between panic disorder and major depression and, the co-occurrence of these disorders was associated with accentuated personality traits. OBJETIVO: Identificar os traços de personalidade presentes em pacientes com transtorno do pânico, depressão maior e comorbidade. MÉTODO: Os diagnósticos foram feitos com o Structured Clinical Interview para o DSM-IV antes do início do tratamento, e a avaliação dos traços de personalidade com o Maudsley Personality Inventory foi feita durante o acompanhamento desses pacientes. Quatro grupos foram comparados: um grupo controle (n = 30), um grupo de depressão maior sem transtorno do pânico (n = 45); um grupo de transtorno do pânico sem depressão maior (n = 56) e um grupo de comorbidade (n = 21), com transtorno do pânico e depressão maior, simultaneamente. RESULTADOS: Todos os grupos de pacientes tiveram médias de neuroticismo significativamente maiores quando comparados ao grupo controle. A maior média foi no grupo de comorbidade, seguida pelas dos grupos de depressão maior e transtorno do pânico. A diferença de neuroticismo entre o grupo de comorbidade e de transtorno do pânico também foi estatisticamente significativa. Entre os grupos de pacientes, a menor média de extroversão foi a do grupo de comorbidade, seguida pelas de depressão maior e transtorno do pânico. Quando comparados ao grupo controle, apenas os grupos de comorbidade e depressão maior tiveram extroversão significativamente mais baixa. CONCLUSÃO: Na nossa amostra, houve uma continuidade de traços de personalidade entre o transtorno do pânico e a depressão maior, e a sobreposição de sintomas de pânico-agorafobia e de depressão estava associada a traços de personalidade acentuados.

Social anxiety disorder (SAD) patients may have self-referential ideas and share other cognitive processes with paranoid delusional disorder (PDD) patients. From an evolutionary perspective, SAD may derive from biologically instinctive social hierarchy ranking, thus causing an assumption of inferior social rank, and thus prompting concerns about mistreatment from those of perceived higher rank. This naturalistic longitudinal study followed four patients with initial SAD and later onset of PDD. These four patients show the same sequence of diagnosed SAD followed by diagnosed PDD, as is often retrospectively described by other PDD patients. Although antipsychotic medication improved psychotic symptoms in all patients, those who also had adjunctive serotonin-specific reuptake inhibitors for SAD had much more improvement in both psychosis and social functioning. From an evolutionary perspective, it can be conjectured that when conscious modulation of the SAD social rank instinct is diminished due to hypofrontality (common to many psychotic disorders), then unmodulated SAD can lead to paranoid delusional disorder, with prominent ideas of reference. Non-psychotic SAD may be prodromal or causal for PDD.

Our aim was to describe the clinical features of 35% CO2-induced panic attacks in patients with panic disorder (PD) (Diagnostic and Statistical Manual and Mental Disorders, Fourth Edition) and compare them with the last spontaneous panic attack in patients with PD who had not had a panic attack after the 35% CO2 challenge test. We examined 91 patients with PD submitted to the CO2 challenge test. The test consisted of exhaling as fully as possible, took a fast vital capacity breath, held their breath for 8 seconds, exhaled, and then repeated the fast vital capacity breath, again holding for 8 seconds. The patients inhaled the 35% CO2/65% O2 mixture or atmospheric compressed air, randomly selected in a double-blind design. Scales were applied before and after the test. A total of 68.1% (n = 62) patients with PD had a panic attack (responders) after the CO2 test (chi2(1) = 25.87, P = .031). The last spontaneous panic attack and the symptom profile from the patients with PD who had not had a panic attack after the test (n = 29, 31.9%) were described to compare. The responders had more respiratory symptoms (chi2(1) = 19.21, P.001), fulfilling the criteria for respiratory PD subtype (80.6%); the disorder started earlier (Mann-Whitney, P.001), had a higher familial prevalence of PD (chi2(1) = 20.45, P = .028), and had more previous depressive episodes (chi2(1) = 27.98, P.001). Our data suggest that there is an association between respiratory PD subtype and hyperreactivity to a CO2 respiratory challenge test. The responders may be a subgroup of respiratory PD subtype with future diagnostic and therapeutic implications.

Background Schizobipolar disorder is considered related to both schizophrenia and bipolar disorder. We aimed to describe with retrospective methodology the demographic, clinical, and treatment features in a group of schizobipolar disorder patients who have been treated for at least a 5-year period and compare them with bipolar I and schizophrenic patients who were treated during the same period. Method We compared the demographic and clinical data of 61 schizobipolar, 57 bipolar I, and 55 schizophrenic outpatients who were diagnosed and treated for at least 5 years in the outpatient clinic in the Federal University of Rio de Janeiro. Results The schizobipolar disorder patients had a profile similar to the bipolar I patients but are significantly different from schizophrenic patients in educational level, marital status, occupation, drug and alcohol abuse episodes, presence of depressive, mixed and maniac episodes, family history of bipolar I and mood disorders, and use of medications. Only the age of onset, suicide attempts, and family history of suicide are not significantly different among the groups. The schizophrenic patients used antipsychotics for more days and the schizobipolar and bipolar I used more antidepressants and mood stabilizers. 37 (60.6%) schizobipolar patients had their diagnosis changed to bipolar disorder by their physician in different periods during the period studied. Limitations It is a retrospective data description based on a naturalistic treatment. The family history was collected from the patient and whenever possible from one first-degree relative. Conclusion Schizobipolar disorder patients have demographic, clinical and therapeutic features similar to bipolar I patients and data support its definite inclusion in the bipolar spectrum group.

International interest on the benefits of using the steroid hormone Dehydroepiandrosterone (DHEA) on various aspects of human health, including the regulation of mood, is increasing. This study aimed to review the scientific literature on the use of DHEA in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses. PubMed, ISI Web of Knowledge and Virtual Health Library (VHL) databases were independently searched by two researchers using the following terms: depression, treatment, DHEA, and mood. Clinical studies were considered eligible when subjects were treated with DHEA and psychological assessments of depression were conducted. No time limits or language for this research were imposed. One 183 references were identified, and 22 references were selected to compose this review. Significant improvements related to the use of DHEA in patients with depression were observed, in addition to improvements in depressive symptoms in patients with schizophrenia, anorexia nervosa, HIV and adrenal insufficiency. No significant improvements were observed regarding depressive symptoms in patients with fibromyalgia; the results observed in patients with autoimmune diseases and healthy individuals remain contradictory. Although the selected studies demonstrated good methodological applications, most studies consisted of small samples, and only 3 studies were conducted in a young population. Therefore, we concluded that the studies published to date indicate promising results regarding the use of DHEA in the treatment of depression and depressive symptoms, especially in depression that is mild or resistant to conventional therapy.

Introduction Attachment theory offers an evolutionary explanation for the occurrence of panic states. The distance between a mother and child causes the sensation of fear. The experience of feared annihilation, an intense fear reaction (panic), is presented as a threat to the individual’s cohesiveness, disrupting the mental representation of self-consciousness, specifically self-unity. Alterations in self-consciousness in schizophrenia are so important that they are mostly included among Kurt Schneider’s first-ranked symptoms. Hypotheses Based on clinical trials, case reports, and brain imaging and pharmacological studies, a paradigm is proposed to explain the relationship between panic anxiety and psychosis. Conclusion The psychosis-anxiety pathophysiology explanation needs further investigation into the brain areas that integrate self-monitoring with fear areas, but it seems possible to note the importance of the anterior cingulate cortex.

Background Social Anxiety Disorder (SAD) is mainly characterized by an individual's intense concern about other people's opinion of the individual. Notably, among those with severe anxious symptoms, we can often observe self-referential feelings. Objective Faced with little research directed toward the exploration of psychotic symptoms in SAD patients, we will approach the topic by describing three cases. Discussion Three explanations seem possible for the psychotic manifestations in SAD. The first one depends on the individual's ability or inability to challenge the impression of being criticized by people. A second possibility would be the stressor and perpetuating role of SAD, which would make individuals more likely to present with more severe mental disorders such as delusional disorder (DD). The third explanation would be the possibility that SA is caused by a primary thought abnormality (psychotic self-reference) in some cases, instead of an affective disturbance (anxious insecurity), which led to intense concern about others' opinions. We also observed that antipsychotics did not produce significant improvement in any of the three cases. This result may be related to dopaminergic circuits and the D2 receptor hypoactivity. Conclusion The differentiation between delusion and anxious concern may be inaccurate and may change throughout the disorder's evolution. New diagnostic subcategories or the enlargement of the social anxiety diagnostic is proposed to overcome the current diagnostic imprecision. There seems to be a symptomatic spectrum between SAD and DDs.

Studies have demonstrated the vulnerability of anxiety disorder patients to challenge tests. Our aim was to observe if panic disorder (PD) patients and generalized social anxiety disorder (GSAD) and performance social anxiety disorder (PSAD) patients respond in a similar way to the induction of anxiety symptoms and panic attacks by an oral caffeine challenge test. We compared 28 PD patients, 25 GSAD patients, 19 PSAD, and 26 control subjects after a 480-mg caffeine test. The patients had not received psychotropic drugs for at least a 4-week period. In a randomized double-blind experiment performed in two occasions 7 days apart, 480 mg of caffeine and a caffeine-free solution were administered and anxiety scales were administered before and after each test. A panic attack was induced in 17 (60.7%) PD patients, 4 (16.0%) GSAD patients, and 10 (52.6%) PSAD patients, during the caffeine test. None of the control subjects had a panic attack after the caffeine intake. Neither patients nor any control subject had a panic attack after drinking the caffeine-free solution. Our data suggest that there is an association between PD and PSAD hyperreactivity to an oral caffeine challenge test. The PD and PSAD patients had a higher number of induced panic attacks, some specific anxiety symptoms, and a more severe anxiety response than GSAD patients and normal volunteers.

OBJETIVO: Determinar a prevalência dos transtornos depressivo-ansiosos entre mulheres atendidas em um ambulatório de menopausa. METODOLOGIA: Avaliamos, através da entrevista semi-estruturada Mini International Neuropsychiatric Interview, 86 mulheres que encontravam-se em tratamento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. RESULTADOS: A maioria das mulheres apresentava algum diagnóstico psiquiátrico (57%) sendo mais prevalentes o transtorno de ansiedade generalizada (34,9%) e a depressão maior (31,4%). O grupo com algum diagnóstico foi representado por mulheres mais jovens, casadas, com menor escolaridade e história familiar para transtornos psiquiátricos. CONCLUSÃO: Observamos uma grande prevalência de transtornos mentais entre mulheres em atendimento ambulatorial na menopausa em nosso estudo, em relação às mulheres em atendimento em outros ambulatórios segundo a literatura. Há também uma alta taxa de prevalência de comorbidades (55,5% dos pacientes com algum transtorno) complicadoras do transtorno primário, o que pode representar a evolução para pior prognóstico pela ausência de tratamento precoce e específico. OBJETIVE: To determine the prevalence of depressive and anxiety disorders in women receiving care in a menopause clinic. METHODS: Eighty-six women receiving care in the menopause clinic at Instituto de Ginecologia da Universidade Federal do Rio de Janeiro were assessed using the Mini-International Neuropsychiatric Interview. RESULTS: Most women had a psychiatric diagnosis (57%); generalized anxiety disorder (34.9%) and major depression (31.4%) were the most prevalent disorders. The group composed of subjects with any disorder was represented by young and married women, with lower schooling level and family history for psychiatric disorders. CONCLUSION: In our study, there was a high prevalence of psychiatric disorders in outpatient women receiving care in a menopause clinic, in relation to women receiving care in other outpatient clinics, as described in the literature. There was also a high prevalence of comorbid diseases (55.5% of patients with any disorder) complicating the primary disorder, which may compromise the prognosis due to lack of early specific treatment.

Background It has been proposed that all forms of bipolar disorder–perhaps all primary affective disorders–are best conceptualized as a spectrum of related illness, clinically overlapping but not necessarily genetically uniform illnesses. We aim to describe with retrospective methodology the demographic, clinical, and therapeutic response in a group of social anxiety disorder (SA) patients who improves while taking antidepressants and compare them with bipolar II (B-II) patients. Methods 57 SA outpatients (DSM-IV) were diagnosed and naturalistic efficacious treated with selective serotonin reuptake inhibitors (SSRI). Their demographic, clinical features and therapeutic response were compared with 41 DSM-IV bipolar II patients in their starting evaluations in our outpatient clinic in the Federal University of Rio de Janeiro, Brazil. Results There is a sub-group of SA patients who improves while taking antidepressants and presents a clear hypomanic phase. Their improvement is identical to a mild/moderate hypomaniac state. Without the antidepressant, the symptoms of SA return. The SA and B-II patients have a similar number of previous depressive episodes, alcohol abuse, suicide attempts, and family history for mood disorder. Limitations It is a retrospective data description based on a naturalist follow-up. Conclusion Some SA patients have demographic, clinical and therapeutic features similar to B-II patients and they might just be a Bipolar-III sub-group with a higher level of complains to social situations and without spontaneous hypomania during lifetime.