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Objective: To describe the initial steps in the development and validation of a new self-reported instrument designed to assess daily rhythms of mood symptoms, namely, the Mood Rhythm Instrument. Methods: A multidisciplinary group of experts took part in systematic meetings to plan the construction of the instrument. Clarity of items, their relevance to evaluation of mood states, and the consistency of findings in relation to the available evidence on the biological basis of mood disorders were investigated. The internal consistency of the questionnaire was evaluated through Cronbach’s alpha. Results: All of the items proposed in a first version were well rated in terms of clarity. The items more frequently rated as “rhythmic” were related to the somatic symptoms of mood. Their peaks in 24 hours were more frequent in the morning. The items associated with affective symptoms of mood were rated as less rhythmic, and their peak in 24 hours occurred more frequently in the afternoon and evening. Males and females behaved more similarly with respect to somatic than behavioral-affective items. The second version of the Mood Rhythm Instrument had a Cronbach’s alpha of 0.73. Conclusion: The proposed Mood Rhythm Instrument may be able to detect individual rhythms of cognitive and behavioral measures associated with mood states. Validation in larger samples and against objective measures of rhythms, such as actigraphy, is warranted.

Well-being is a useful screening method for the detection of mood disorders. Evidence associating psychological well-being with sleep-wake patterns exists, as well as associations with sleep-wake patterns, work-related parameters, and perceived self-efficacy. Despite the growing research regarding the relationship between these factors and mental health, there are few studies that analyze them together. OBJECTIVE: To investigate if the association between sleep-wake patterns and psychological well-being is mediated or moderated by perceived self-efficacy, work flexibility and work routines. MATERIAL AND METHODS: This cohort study was performed in southern Brazil. A sample of 987 individuals was analyzed (66.9% women; mean age = 43.9 years). Work routines parameters and work schedule flexibility were evaluated, most participants were farmers (46%) and most worked 7 days a week (69.1%). Munich Chronotype Questionnaire (MCTQ) was administered for evaluation of sleep-wake patterns, General Self-Efficacy Scale (GSE) for assessment the participants’ beliefs about how they coped with daily hassles, and World Health Organization Five-item Well-being Index (WHO-5) for evaluation of psychological well-being levels. Moderation and mediation models were tested. RESULTS: The moderation model showed influences of work end time on the relationship between sleep onset time and psychological well-being (R2 = 0.147; F = 24.16; p

There is consistent evidence suggesting a relationship between individuals' sleep-wake rhythms and well-being. The indiscriminate demands from daily working routines, which do not respect this individual physiological rhythm, might be mediating this phenomenon. The aim of the present study was to evaluate the relationship between the characteristics of sleep routines during working days and psychological well-being. This was a cross-sectional study on 825 individuals from rural communities from southern Brazil. The study protocol included a questionnaire on demographic characteristics, working routines, health complaints, and habits; the Munich Chronotype Questionnaire for sleep-wake rhythm and; the WHO-Five well-being index. Since sex has been shown to affect sleep circadian rhythm and well-being, analysis was performed on men and women separately. In the proposed hierarchical regression models, different factors contributed to well-being according to sex. Among men, sleep-wake and work-related variables did not predict well-being scores. Among women, later midpoints of sleep on working days (B = -1.243, SE B = 0.315, β = -0.220), working more days per week (B = -1.507, SE B = 0.494, β = 0.150), having longer working journeys (B = -0.293, SE B = 0.105, β = -0.166), earlier working journey midpoints (B = 0.465, SE B = 0.222, β = 0.115), and being exposed to less sunlight (B = 0.140, SE B = 0.064, β = 0.103) predicted worse well-being. For the subgroup of women with days free from work, we have found a correlation between later midpoints of sleep during the week with worse well-being (Pearson's r = -0.159, p = 0.045) while the same relationship was not significantly observed with the midpoint of sleep on non-working days (Pearson's r = -0.153, p = 0.054). Considering WHO-Five as categorical, based on proposed clinical cut-offs, among women working 7-d/week, those with worst well-being (WHO-Five 13) had the latest midpoint of sleep (F = 4.514, p = 0.012). Thus, the midpoint of sleep on working days represents the interaction between individuals' sleep-wake behavior and working routines. It plays an important role as a stress factor and may be a useful alternative variable related to chronodisruption.

INTRODUÇÃO: A Esquizofrenia é transtorno psiquiátrico crônico grave que acarreta importantes déficits psicológicos, sociais e vocacionais. Os antipsicóticos clássicos são amplamente usados como tratamento, mas comumente produzem respostas incompletas, toxicidade e efeitos extrapiramidais. A clozapina foi importante aquisição na terapia antipsicótica. Mostrou-se com eficácia legítima em 30-61% das psicoses e baixa incidência de efeitos adversos. MÉTODOS: Relato da experiência clínica de 56 pacientes com Esquizofrenia Refratária incluídos no programa de fornecimento gratuito da clozapina pela Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul em convênio com o Hospital de Clínicas de Porto Alegre. RESULTADOS: A média dos escores da Brief Psychiatric Rating Scale (BPRS) foi inicialmente 77,9 (DP=16,1) e, após noventa e três meses de tratamento, 41,1 (DP=16,2). Dois pacientes abandonaram o programa e um foi excluído por agranulocitose. Houve quatro internações. DISCUSSÃO: Apesar de sua comprovada eficácia e aplicabilidade, a clozapina não está livre de efeitos adversos: hipotensão ortostática, taquicardia, visão turva, xerostomia, hipersalivação, constipação e sedação são comuns. As alterações hematológicas ocorrem em 0,05 a 2,8% dos casos. Ainda, o alto custo restringe seu uso. CONCLUSÕES: Houve melhora significativa e mantida dos pacientes que participaram do programa. Doenças com maior tempo de evolução obtiveram menor resposta, provavelmente relacionada a alterações neurofisiológicas e neuroquímicas. Vale ressaltar a importância do início precoce do tratamento e a necessidade da participação do Estado, no sentido de oferecer suporte psicossocial e financeiro para a otimização do tratamento desses pacientes.

INTRODUÇÃO: A Esquizofrenia é transtorno psiquiátrico crônico grave que acarreta importantes déficits psicológicos, sociais e vocacionais. Os antipsicóticos clássicos são amplamente usados como tratamento, mas comumente produzem respostas incompletas, toxicidade e efeitos extrapiramidais. A clozapina foi importante aquisição na terapia antipsicótica. Mostrou-se com eficácia legítima em 30-61% das psicoses e baixa incidência de efeitos adversos. MÉTODOS: Relato da experiência clínica de 56 pacientes com Esquizofrenia Refratária incluídos no programa de fornecimento gratuito da clozapina pela Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul em convênio com o Hospital de Clínicas de Porto Alegre. RESULTADOS: A média dos escores da Brief Psychiatric Rating Scale (BPRS) foi inicialmente 77,9 (DP=16,1) e, após noventa e três meses de tratamento, 41,1 (DP=16,2). Dois pacientes abandonaram o programa e um foi excluído por agranulocitose. Houve quatro internações. DISCUSSÃO: Apesar de sua comprovada eficácia e aplicabilidade, a clozapina não está livre de efeitos adversos: hipotensão ortostática, taquicardia, visão turva, xerostomia, hipersalivação, constipação e sedação são comuns. As alterações hematológicas ocorrem em 0,05 a 2,8% dos casos. Ainda, o alto custo restringe seu uso. CONCLUSÕES: Houve melhora significativa e mantida dos pacientes que participaram do programa. Doenças com maior tempo de evolução obtiveram menor resposta, provavelmente relacionada a alterações neurofisiológicas e neuroquímicas. Vale ressaltar a importância do início precoce do tratamento e a necessidade da participação do Estado, no sentido de oferecer suporte psicossocial e financeiro para a otimização do tratamento desses pacientes.INTRODUCCIÓN: La Esquizofrenia es un trastorno psiquiátrico crónico grave que ocasiona importante déficit psicológico, social y vocacional. Los antipsicóticos clásicos son ampliamente usados como tratamiento, pero comunmente producen respuestas incompletas, toxicidad y efectos extrapiramidales. La clozapina fue importante adquisición en la terapia antipsicótica. Mostró legítima eficacia en 30-61% de las psicosis y baja incidencia de efectos adversos. MÉTODOS: Relato de la experiencia clínica de 56 pacientes con Esquizofrenia Refractaria incluídos en el programa de suministro gratuito de clozapina por la Secretaría de Salud y Medio Ambiente del Estado de Rio Grande do Sul en convenio con el Hospital de Clínicas de Porto Alegre. RESULTADOS: La media de los escores da Brief Psychiatric Rating Scale (BPRS) fue inicialmente 77,9 (DP=16,1) y, después de noventa y tres meses de tratamiento, 41,1 (DP=16,2). Dos pacientes abandonaron el programa y uno fue excluído por agranulocitosis. Hubo cuatro internaciones. DISCUSIÓN: A pesar de su comprobada eficacia y aplicabilidad, la clozapina no está libre de efectos adversos: hipotensión ortostática, taquicardia, visión turbia, xerostomia, hipersalivación, constipación y sedación son comunes. Las alteraciones hematológicas ocurren en 0,05 a 2,8% de los casos. Aún, el alto costo restringe su uso. CONCLUSIONES: Hubo mejoría significativa y estable de los pacientes que participaron del programa. Enfermedades con mayor tiempo de evolución obtuvieron menor resultado, probablemente relacionada a alteraciones neurofisiológicas y neuroquímicas. Vale resaltar la importancia del inicio precoz del tratamiento y de la necesidad de participación del Estado, en el sentido de ofrecer soporte psicosocial y financiero para la optimización del tratamiento de estos pacientes.INTRODUCTION: Schizophrenia is a chronic severe psychiatric disease causing major psychological, social and working deficiencies. Typical neuroleptics are widely used, but often produce incomplete responses, toxicity and adverse effects on motricity. Clozapine was a significant development. It is effective in treating 30-61% of the psychotic symptoms with minimal adverse effects. METHODS: Clinical experience of 56 patients with refractory schizophrenia under treatment at the Psychiatry Service of the Hospital de Clínicas de Porto Alegre, included in the program to supply clozapine free of charge, promoted by the Department of Health and the Environment of the State of Rio Grande do Sul. RESULTS: The mean score for the Brief Psychiatric Rating Scale (BPRS) was initially 77.9 (SD=16.1) and, at the end, 41.1 (SD=16.2). Two patients left the program and one was excluded because he developed agranulocytosis. There were 4 hospitalizations. DISCUSSION: Despite its well-established efficacy and applicability, clozapine is not free from adverse effects: postural hypotension, tachycardia, cloudy vision, dry eyes, hypersalivation, constipation and sedation frequently occur. Hematological alterations occur in 0.05-2.8%. CONCLUSIONS: There was a significant and lasting improvement of the symptoms in the patients enrolled. Diseases with a longer evolution had worse responses, probably related to neurochemical and neurophysiological damage. The importance of early treatment and the need for State intervention, offering psychosocial and financial support to optimize the treatment of this population should be highlighted.

Sleepiness is a major public health problem associated with motor vehicle crashes, occupational accidents, decreased productivity, and interpersonal problems. It can be influenced by many factors, including the individual's circadian rhythm. The objective of this study is to assess the correlation between the morningness/eveningness dimension and daytime sleepiness in medical school students. This is a cross-sectional study; 310 subjects (123 women and 187 men, M age 20.5 ± 1.9 yr.) completed a questionnaire on use of drugs, diagnostic diseases, sleeping habits, the Morningness/Eveningness Questionnaire and the Epworth Sleepiness Scale. The only variable related to daytime sleepiness was the morningness/eveningness dimension ( r = –.18, p = .002). Questions with higher coefficients of discrimination between the morning and the evening chronotype were “Lying down to rest in the afternoon when circumstances permit” (.61), “Sitting and reading” (.53), and “As a passenger in a car for an hour without a break” (.53). The implications of the findings are discussed.

Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47±1.89 years). The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder was 22.19%; and of insomnia, 28.15%. Difficulty initiating sleep (OR=3.45), difficulty maintaining sleep (OR=7.61), falling asleep later (OR=1.99) and waking up earlier (OR=1.91) were associated with suspicion of psychiatric disorder. As a group, the variables difficulty initiating sleep, difficulty maintaining sleep, falling asleep after 11 pm, and waking up before 6 am presented an odds ratio of 5.96 for positivity in the screening for psychiatric disorder. Furthermore, difficulty maintaining sleep (OR=2.24) was associated with "being female," and falling asleep later (OR=0.43) was associated with "being male". These results underscore the importance of determining in what cases difficulty sleeping may have severe clinical repercussions or affect performance. Estudos epidemiológicos têm mostrado alta prevalência de transtorno psiquiátrico em pessoas com insônia. Realizamos estudo transversal em amostra de estudantes de medicina, com o objetivo de avaliar a associação entre insônia e positividade na triagem para transtorno psiquiátrico; 302 estudantes foram incluídos (184 homens e 118 mulheres; média da idade = 20.47±1,89 anos). A associação foi testada através da análise de regressão logística. A prevalência de teste positivo na triagem para transtorno psiquiátrico foi 22,19%; e de insônia, 28,15%. Dificuldade para iniciar o sono (OR=3,45), dificuldade para manter o sono (OR=7,61), dormir tarde (OR=1,99) e levantar cedo (OR=1,91) foram as variáveis associadas à possibilidade de transtorno psiquiátrico. Quando consideradas em conjunto, as variáveis "dificuldade em iniciar o sono", "dificuldade em manter o sono", "dormir após 23 h" e "acordar antes das 6 h" apresentaram razão de chance de 5,96 para positividade na triagem para transtorno psiquiátrico. Além disso, dificuldade em manter o sono (OR=2,24) foi associada ao sexo feminino; e dormir tarde (OR=0,43), ao sexo masculino. Esses resultados enfatizam a importância de determinar em que caso a dificuldade com o sono pode ter repercussões clínicas severas ou afetar o desempenho.

Depression is a serious and prevalent disease among adolescents. Identifying possible factors involved with its genesis and presentation is an important task for researchers and clinical practitioners. The individual's chronotype and social jetlag have been associated with depression in different populations. However, information on this is lacking among adolescents. The objective of this cross-sectional study was to examine the relationship between chronotype (midpoint of sleep) and social jetlag with the presence of depression symptoms in young students. We assessed 351 students aged 12-21 years old. They answered a questionnaire on demographic characteristics, the Munich Chronotype Questionnaire (MCTQ) and the Beck Depression Inventory (BDI). Demographic characteristics (age, sex and classes' schedule) and circadian rhythmic variables for school and free days (sunlight exposure, sleep duration, midpoint of sleep and social jetlag) were taken as factors and the presence of at least mild depression symptoms as outcome. In univariate analysis, girls (χ(2) = 5.01, p ≤ 0.05) and evening students (χ(2) = 6.63, p ≤ 0.05) were more frequently present among the depressed. Also, the depression group was significantly delayed for both midpoints of sleep during school (t = 2.84, p ≤ 0.01) and free days (t = 2.20, p ≤ 0.05). The two groups did not differ in relation to their social jetlag hours (t = -0.68, p = 0.501) neither subjects with two or more hours of social jetlag were more frequent among the depressed (χ(2) = 1.00, p = 0.317). In multivariate analysis, the model that best explained our outcome (R(2) = 0.058, F = 2.318, p ≤ 0.05) included sex (β = -0.12, p ≤ 0.05) and the midpoint of sleep on school days (β = -0.21, p ≤ 0.001) as significant predictor variables. A sleep phase delay (later midpoints of sleep for school and free days) was associated with higher levels of depression. However, we were not able to detect similar relationship with the social jetlag hours. This could be attributed to the fact that our sample showed a smaller amount of social jetlag, possibly because even during free days a social routine, this time parents' rules, limited the observation from what could be a natural tendency to sleep later and over. Yet, even when considering the group with more social jetlag, we did not find an association. Perhaps, this variable will only manifest its effect if it is maintained for longer periods throughout life. Additionally, when considering all the variables together, the midpoint of sleep on school days was pointed as the predictor of greatest weight for depression, together with the factor sex. Young girls, possibly earlier types, who are required to study in the evening have more chances of presenting depression symptoms. This study explicit some peculiar characteristics of the assessment of chronobiological variables in the young, such as the presence of an imposed social routine also during free days. Therefore, the expression of chronotype under the influence of the weekly social schedule (midpoint of sleep on school days) could be a more useful marker to measure the stress produced from the mismatch between external and inner rhythms rather than social jetlag. This also reinforces the importance of reconsidering the weekly routine imposed on young people.

a b s t r a c t The objective of the study is to evaluate whether intervening and testing in different rest-activity periods of the day would produce different measurements in animal behavior studies. Methodology: Thirty-five, 60-day-old male Wistar rats were submitted to an inescapable foot shock (IFS) stress model and behav- ioral tests (Light-Dark Box test). The animals received intervention and were tested in both light and dark phases, resulting in the following groups: control L (tested in the light), control D (tested in the dark), LL (IFS and tested in the light), LD (IFS in the light and tested in the dark), DL (IFS in the dark and tested in the light), and DD (IFS and tested in the dark). Results: The Light-Dark Box test showed that control L was not significantly different from other groups in any of the parameters. However, when comparing control D with the intervention groups, we observed a difference in the mean length of time spent in the light compartment (t = 2.56; p = 0.045). A significant difference in the number of crossings into the light compartment was only observed between the control D and the LL and LD groups (t = −2.608; p = 0.028; t = −2.571; p = 0.030, respectively). The latency time for the control D group was significantly lower than that of the DD group (t = −2.556; p = 0.043). Conclusions: These results show that behavior testing dur- ing the animal's period of highest activity (dark period) revealed differences caused by the intervention, whereas no differences were apparent when the control group was observed during the day.

The psychological well-being dimension and depressive symptoms are both important variables in an individual’s health. In this study, we evaluated the World Health Organization 5-item well-being index (WHO-Five) internal and external validities, and accuracy in detecting depression. A total of 1,128 individuals between 18 and 65 years old from a rural Brazilian population were included. Cronbach’s alpha and factor analysis were performed for internal validation. Demographic variables means were compared, receiver operating characteristic (ROC) curve was constructed, and sensitivity, specificity and positive and negative predictive values for different cutoff points were calculated for external validation and accuracy in detecting depression. Cronbach’s alpha was 0.83, and only one factor was responsible for 59% of common variances, with an eigenvalue of 2.96. Higher WHO-Five scores were associated with being man, from oldest age category and retired. It was also related to better general health self-perception and negative screening in the Beck Depression Inventory (BDI). Based on BDI, the area under the curve was 67.37. A sensitivity of 66/75% and a negative predictive value of 91/92% for cutoffs

Memory consists of several phases or processes that can be influenced by many factors, including the individual's circadian rhythm and the time of day at which tests are performed. The present objective was to evaluate the performance on memory tests of different chronotypes during the morning and the evening shifts. Subjects (21 men and 26 women, between the ages of 20 and 35 yr.) were evaluated for memory and metamemory differences in the morning and in the afternoon, using a battery of neuropsychological tests composed of the Word List with Emotional Content, Visual Memory, Scale–Semantic Memory, Digit Span, Word-Pairs Associated, Verbal Fluency Test, and Metamemory questionnaire. In the evening shift, there was a statistical difference among chronotypes on the Word List with Neutral Content and on the Verbal Fluency Test. In the morning, there were no statistically significant differences; however, the morning-type subjects had higher scores on the metamemory tests ( p < .01), while the evening-type subjects had higher scores in the afternoon ( p < .01). In spite of their perception, on Word-Pairs Associated and Word List with Emotional Content, the subjects, independently of their chronotype, showed better performance by the evening than by the morning shift. These results highlight the importance of controlling the shift of day and chronotype in studies with the objective of exploration of human performance.

Materials and methods Cross-sectional study conducted between April 2013 and December 2014. Sociodemographic data were evaluated and for the quality of life we used the WHOQOL BREF. Cronotypes and daily preferences sleep were investigated by Chronotype Questionnaire Munich (MCTQ ). Sleep quality was assessed by questionnaire Pittisburgh Sleep Quality Index. Physical examination was performed and venous blood was collected in fasting for 12 h for laboratory analysis.