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Introdução: Alucinações musicais representam uma forma especial de alucinações auditivas complexas, caracterizadas pela falsa percepção de tons musicais, ritmos ou melodias. As principais patologias associadas às alucinações musicais são: anormalidades auditivas crônicas, o uso de medicamentos; transtornos mentais e doenças neurológicas. Método: Relato de caso. CEP n. 81725024.9.0000.5263, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, IPUB, UFRJ. Apresentação do caso: Apresentamos o caso de uma paciente de 59 anos com transtorno bipolar há dezessete anos que apresentou pela primeira vez alucinações musicais somente treze anos após o início da doença. Posteriormente, contudo, essa forma especial de alucinação tornou-se recorrente e passou a estar associada a cada novo episódio afetivo que ela iria apresentar. Discussão: As alucinações musicais são raramente encontradas no transtorno bipolar e no presento caso clínico, no que se refere às alucinações musicais, houve uma boa resposta terapêutica, relacionada ao uso de um antipsicótico e a medidas comportamentais. Um aspecto peculiar do caso foi que, na depressão, essas alucinações consistiam em músicas tristes, e, na mania, em músicas alegres.

Abstract Objective In the DSM-III and the DSM-IV, bipolar disorder (BD) is classified as a mood disorder and diagnosis requires presence of a mood change, i.e., euphoria or irritability. In contrast, DSM-5 states that there must be some increase in energy or motor activity in addition to the mood change. Our aim was to identify which types of symptoms (i.e., mood or energy/activity-related symptoms) are the most informative in a manic episode. Methods Symptoms of manic episodes in 106 outpatients with BD were assessed in a naturalistic study using the Young Mania Rating Scale (YMRS) between November 2002 and November 2015. The scale items were divided into three groups according to clinical criteria: mood, energy/activity, and other. For comparisons between groups, the Samejima graded response model from Item Response Theory (IRT) and the Test Information Function (TIF) were computed. Chi-square tests were used to verify the association between the groups of symptoms by comparing the area under the curve of the TIF results. Results The information accounted for by energy/activity represents 77% of the proportion of the total TIF; about 23% is related to mood and other groups of symptoms. These proportions are statistically different (χ2[1] = 30.42, p < 0.001) Conclusion On average, changes in energy/activity tend to be more informative than mood changes during the manic phases of BD.

ABSTRACT Objective: Expand knowledge on the role and efficacy of carbamazepine (CBZ) in bipolar disorder (BD), based on original studies. Methods: The authors performed a systematic review of the scientific literature on the efficacy of CBZ in BD, using the PubMed/MEDLINE, Web of Science (ISI), and SciELO databases. The search terms were: (“carbamazepine”) AND (“bipolar” OR “mania” OR “manic”). There was no restriction on the year of publication. Results: A total of 27 articles were selected. Among the selected articles, 14 evaluated the use of CBZ in the manic phase of BD, two in the depressive phase of BD, and 11 in the maintenance phase of BD. In the studies on the manic phase of BD, CBZ proved superior to placebo (PLA). As for the depressive phase of BD, there were two studies, both with small samples. In the maintenance phase, CBZ was inferior to lithium, and no studies compared CBZ to PLA. Conclusion: The results of the clinical studies suggest that CBZ is effective for the treatment of the manic phase. Regarding the treatment of acute depression and maintenance of BD, the results of the studies indicate that there is not enough data demonstrating the effectiveness of CBZ.

Abstract Humanity is sporadically subjected to leaders with deviant behavior, ego problems, or psychiatric disorders, potentially leading to social instability. Bipolar disorder is not common in all populations, but, coincidentally, studies suggest that it affected two sovereigns that were contemporaries, King George III of England, who died 201 years ago, and Queen Maria I of Portugal, who died 205 years ago. They lived during a time when Europe was in turmoil with the French Revolution and Napoleonic Wars, which also coincided with the rise of psychiatry. Both monarchs were forced to have prince regents rule in their place, due to their emotional decline, and they shared the same medical consultant, Francis Willis.

ABSTRACT Objective D. Maria I, queen of Portugal, was the mother of João VI and grandmother of Pedro IV of Portugal and I of Brazil. She became the first monarch of Brazil, where she became known as “Maria, the madwoman”. We aimed to try to identify the mental disorder she suffered from. Methods We conducted a review of biographies about D. Maria I and scientific articles that discussed her case. Results The sparse information about her mental illness strongly indicates that she had several depressive and manic episodes, which were accompanied by psychotic symptoms. Conclusion Her probable psychiatric diagnosis is that of bipolar disorder.

Introdução: O transtorno bipolar (TB) e o transtorno obsessivo-compulsivo (TOC) são altamente comórbidos. Esta comorbidade está associada a impacto clínico significativo. Este artigo revisa os dados disponíveis sobre aspectos epidemiológicos, características clínicas e opções de tratamento da comorbidade TB-TOC. Métodos: Foi realizada revisão bibliográfica não sistemática na base de dados PUBMED, no idioma inglês. As seguintes palavras-chave foram incluídas na busca: obsessive-compulsive disorder, bipolar disorder, comorbidity. Resultados: Entre as amostras de pacientes com TB, a prevalência de TOC comórbido foi estimada em cerca de 17%. Entre as amostras de pacientes com TOC, a prevalência de TB foi estimada em, aproximadamente, 18%. Os dados sobre a validade diagnóstica da comorbidade são limitados. Os pacientes com TB-TOC parecem apresentar curso episódico dos sintomas obsessivo-compulsivos (SOC) com maior frequência do que os pacientes com TOC sem TB. A comorbidade parece estar associada à maior número total de episódios depressivos e à ocorrência mais frequente de comportamentos suicidas. Conteúdos obsessivos de simetria, agressão, religiosidade e acumulação parecem ser mais frequentes em pacientes com TB-TOC. O uso de estabilizadores do humor é a principal estratégia de tratamento. Conclusão: A prevalência da comorbidade parece ser relevante. O TB-TOC pode estar associado à caracteristicas clínicas particulares. Os dados sobre a validade diagnóstica da comorbidade são inconclusivos. A estabilização do humor é o primeiro objetivo no manejo clínico.

RESUMO Objetivo Realizar uma revisão sistemática investigando a metacognição no transtorno bipolar (TB). Os objetivos secundários incluem explorar os correlatos clínicos e sociodemográficos da metacognição no TB e como a metacognição varia de acordo com o estado afetivo, estabelecer uma comparação com outros transtornos mentais e investigar se as intervenções metacognitivas no TB são eficazes ou não. Métodos Realizou-se uma revisão sistemática da literatura científica sobre a metacognição em pacientes com TB. Foram buscados estudos clínicos originais sobre o tema nas bases de dados Medline, ISI , PsycINFO e SciELO. Os termos de busca empregados foram: “metacognition” OR “metacognitive” OR “metamemory” AND “bipolar” OR “mania” OR “manic” . Resultados Foram selecionados nove artigos. A metacognição parece estar mais prejudicada no TB do que em controles e menos prejudicada do que na esquizofrenia. Por sua vez, parece não haver diferença entre bipolares e deprimidos unipolares quanto à capacidade metacognitiva. Maior nível educacional e maior duração da doença parecem estar associados a uma melhor capacidade metacognitiva, enquanto a maior gravidade dos sintomas de TB está associada a uma pior metacognição. O treinamento metacognitivo em pacientes com TB é uma perspectiva clínica promissora. Conclusão Os estudos sobre metacognição no TB são escassos, mas a literatura existente indica possíveis fatores clínicos e sociodemográficos associados a pior metacognição no transtorno, sugerindo também que intervenções terapêuticas metacognitivas podem ser clinicamente relevantes para o manejo do TB.

ABSTRACT Objective: Discussing the psychiatric diagnosis of Alberto Santos-Dumont, considered in Brazil to be the inventor of the airplane, who was admitted to psychiatric institutions several times and committed suicide. Methods: A narrative review was carried out on the psychopathological manifestations he presented, based on some of the most important biographies about the aviator. No scientific article on the topic was found. Results: Depressive episodes were well characterized. Behavioral changes that suggest manic episodes have also been reported. Conclusion: He probably suffered from bipolar disorder.

Abstract Introduction Although bipolar disorder (BD) is traditionally included among mood disorders, some authors believe that changes in energy and motor activity, rather than mood changes, represent the true cardinal symptoms in mania and depression. The aim of the current study was to identify which cluster of the Hamilton Depression Rating Scale (HAM-D) better distinguishes between mania, depression and euthymia. Method A group of 106 patients with BD were followed for 13 years and repeatedly assessed with the HAM-D as well as with other clinical scales. To perform a comparison, HAM-D items were classified according to clinical criteria into three clusters: energy/activity symptoms, mood symptoms, and other symptoms. Item response theory (IRT) analyses were performed to provide a test information curve for those three clusters. We measured the prevalence of one cluster of symptoms over the other two throughout the latent trait. Results Considering HAM-D items individually, the IRT analysis revealed that there was a mixture of mood and energy/activity symptoms among the most discriminative items, both in depression and in euthymia. However, in mania, only energy/activity symptoms – i.e., general somatic symptoms and retardation – were among the most informative items. Considering the classification of items, both in depression as in mania, the energy/activity cluster was more informative than the mood cluster according to the IRT analysis. Conclusion Our data reinforce the view of hyperactivity and motor retardation as cardinal changes of mania and depression, respectively.

Autobiographical memory is essential to ground a sense of self-identity, contributing to social functioning and the development of future plans, and being an essential source for the psychiatric interview. Previous studies have suggested loss of autobiographical episodic specificity in unipolar depression, but relatively fewer investigations have been conducted in bipolar disorder (BD) patients, particularly across different mood states. Similarly, there is a scarcity of systematic investigations about mood-congruent and mood-dependent memory in relation to autobiographical memory in BD. Considering this, a total of 74 patients with BD (24 in euthymia, 26 in mania, and 24 in depression) responded with autobiographical memories to cue words belonging to four categories: mania, depression, BD, and neutral. Episodic specificity was scored according to the Autobiographical Interview, with high intra- and inter-rater reliability. Results indicated that patients in mania generally re-experience more episodic details than those in depression. Depressed bipolar patients reported fewer details of perception and less time integration of memories than those in euthymia or mania. Words linked to depression and BD induced greater episodic re-experiencing than neutral words, just as words about BD provided greater episodic re-experiencing and more details of emotion/thoughts than words about mania. Words linked to depression provoked more time details about the recalled episodes than words on BD or neutral themes. No mood-congruent or mood-dependent effects were observed. Current findings may improve the ability of clinicians to conduct psychiatric interviews and the diagnosis of BD, with special attention to how memory details are generated across different mood states of the condition. Additionally, interventions to foster autobiographical recollection in BD may be developed, similar to what has already been done in the context of schizophrenia.

The growth of the literature about neuroimaging of major depressive disorder (MDD) over the last several decades has contributed to the progress in recognizing precise brain areas, networks, and neurotransmitter processes related to depression. However, there are still doubts about the etiology and pathophysiology of depression that need answering. The authors did a nonsystematic review of the literature using PubMed database, with the following search terms: “major depressive disorder,” “neuroimaging,” “functional imaging,” “magnetic resonance imaging,” “functional magnetic resonance imaging,” and “structural imaging,” being selected the significant articles published on the topic. Anterior cingulate cortex, hippocampus, orbitomedial prefrontal cortex, amygdala basal ganglia, and the cerebellum were the main affected areas across the selected studies. These areas respond to particular neurotransmitter systems, neurochemicals, hormones, and other signal proteins; even more, the evidence supports a distorted frontolimbic mood regulatory pathway in MDD patients. Despite the positive findings, translation to treatment of MDD remains illusory. In conclusion, this article aims to be a critical review of the neuroimaging correlates of depression in clinical research with the purpose to improve clinical practice.

In this article the authors intend to review in an intelligible and comprehensive way the historical roots of Formal Thought Disorders. Early descriptions of thought disorders date back to the XIX century with Esquirol, but it was in the first half of the XX century that several authors introduced the main features of the actual concept of Formal Thought Disorders. Emil Kraepelin described akataphasia (inability to find the appropriate expression for a thought) in patients with dementia praecox (a term that some years later was replaced by schizophrenia). Bleuler and Kretschmer also identified in schizophrenic patients a generalized “loosening of associations” and Carl Schneider described several Formal Thought Disorders such as derailment, fusion, omission, suspension and driveling. At the end of the XX century Nancy Andreasen studied the classical descriptions regarding Formal Thought Disorders, reclassified them and also introduced a scale to assess them. Although the specificity of these symptoms in schizophrenia and psychosis has been a source of controversy among the different authors, the importance given to their presence in these mental disorders is universal. We defend that it is crucial that these historical and conceptual elements are grasped in order to assess Formal Thought Disorders for clinical and research purposes.

Objective: To evaluate whether having general insight into bipolar disorder and its symptoms is affected by the mood state of the patient, using the Insight Scale for Affective Disorders, a hetero-application scale for people with mood disorders.Methods: Ninety-five patients with bipolar disorder were evaluated and divided into different groups according to the mood state presented during assessment (i.e., euthymia, mania and depression). Sociodemographic and clinical data (Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impressions Scale) were recorded. Insight was evaluated using the Insight Scale for Affective Disorders.Results: Patients with bipolar disorder in mania show less insight about their condition than patients in depression or euthymia, and less insight about their symptoms than patients with depression, with the exception of awareness of weight change.Conclusions: Loss of insight during mania may have important implications for treatment compliance and adherence and needs to be taken into account in the clinical management of people with bipolar disorder.

Objective: To evaluate how well symptom rating scales differentiate bipolar disorder (BD) episode types. Methods: One hundred and six patients with BD were followed for 13 years. At each visit, the following clinical scales were administered: Young Mania Rating Scale (YMRS), Hamilton Depression Scale (HAM-D) and Clinical Global Impressions scale for use in bipolar illness (CGI-BP). To perform a comparison between the affective states of BP, three time points in each patient’s follow-up period were chosen for evaluation: the most severe manic episode, the most severe depressive episode, and the euthymic period with least symptoms. Canonical discriminant analyses (CDA) were performed to identify which symptoms best discriminated episodes. Results: CDA revealed HAM-D was worse than YMRS and CGI-BP to discriminate mood states. The items evaluating increased motor activity in YMRS (2, increased motor activity/energy) and HAM-D (9, agitation) were the best to distinguish mania, depression, and euthymia. In contrast, HAM-D item 8 (retardation) and the HAM-D and YMRS items related to mood symptoms were less important and precise. Conclusion: Higher levels of energy or activity should be considered a core symptom of mania. However, our results do not confirm the association between a decrease in energy or activity and depression. HAM-D probably does not assess motor activity adequately.

Objective: To briefly review how the main monist and dualist currents of philosophy of mind approach the mind-body problem and to describe their association with arguments for and against a closer dialog between psychoanalysis and neuroscience.Methods: The literature was reviewed for studies in the fields of psychology, psychoanalysis, neuroscience, and philosophy of mind.Results: Some currents are incompatible with a closer dialog between psychoanalysis and neurosciences: interactionism and psychophysical parallelism, because they do not account for current knowledge about the brain; epiphenomenalism, which claims that the mind is a mere byproduct of the brain; and analytical behaviorism, eliminative materialism, reductive materialism and functionalism, because they ignore subjective experiences. In contrast, emergentism claims that mental states are dependent on brain states, but have properties that go beyond the field of neurobiology.Conclusions: Only emergentism is compatible with a closer dialog between psychoanalysis and neuroscience.

Objetivos Realizar uma revisão sistemática para compreender que fatores estão relacionados a uma maior ou menor consciência de morbidade no transtorno bipolar (TB), como o insight varia em função do estado afetivo e estabelecer uma comparação com outros transtornos mentais. Métodos Realizou-se uma revisão sistemática da literatura científica sobre o insight em pacientes com TB. Foram buscados estudos clínicos originais sobre o tema nas bases de dados Medline, ISI e SciELO. Os termos de busca empregados foram: “insight” OR “awareness” AND “bipolar” OR “mania” OR “manic”. Resultados Foram selecionados 55 artigos. O insight no TB parece ser mais prejudicado do que na depressão unipolar, porém menos do que na esquizofrenia. Com relação ao TB, um menor nível de insight está relacionado à presença de sintomas psicóticos e de alterações cognitivas. Além disso, um comprometimento do insight está associado a uma menor adesão ao tratamento. Por outro lado, uma maior preservação do insight pode estar associada a maior ideação suicida. Finalmente, a fase maníaca cursa com um nível inferior de insight quando comparada à fase depressiva ou de eutimia. Conclusão No TB, o insight está significativamente prejudicado, especialmente na mania. Diversos fatores clínicos parecem influenciar o nível de insight.

INTRODUCTION: Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.

BACKGROUND: Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES: To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS: A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), the Positive and Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). In addition, participants completed a self-report visual analog mood scale (VAMS). Patients were divided into three groups (euthymia, mania, and depression) and compared with regard to VAMS results. RESULTS: Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION: Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome.

The saccadic movement is an important behavioral measure used to investigate several cognitive processes, including attention and sensorimotor integration. The present study aimed at investigating changes in beta coherence over frontal, motor, occipital, and parietal cortices during the performance of two different conditions of a prosacadic paradigm. The conditions involved a different pattern of stimulus presentation: a fixed and random stimulus presentation. Twelve healthy volunteers (three male, mean age of 26.25 (SD=4.13) performed the task, while their brain activity pattern was recorded using quantitative electroencephalography. The results showed an interaction between factors condition and moment for the pair of electrode C3/C4. We observed a main effect for moment to CZ/C4, FZ/F3, and P3/PZ. We also found a main effect for condition to FZ/F4, P3/P4, and O1/O2. Our results demonstrated an important role of the inter-connection of the two hemispheres in visual search and movement preparation. The study demonstrates an automation of action and reduction of the focus of attention during the task. We also found that the inter-hemispheric beta coherence plays an important role in the differentiation of the two conditions, and that beta in the right frontal cortex is able to differentiate the conditions, demonstrating a greater involvement of procedural memory in fixed condition. Our results suggest a neuronal specialization in the execution of prosacadic paradigm involving motor task sequence.

OBJECTIVE: Recent studies suggest that, when combined with pharmacotherapy, structured psychotherapy may modify the course of bipolar disorder. However, there are few studies that have examined the effects of cognitive behavioral group therapy on the course of this disorder. The aim of the present study was to evaluate the effectiveness of 14 sessions of cognitive behavioral group therapy, combined with pharmacotherapy, on the treatment of patients with bipolar disorder, and to compare our results against those from the use of pharmacotherapy alone. METHOD: Forty-one patients with bipolar I and II disorder participated in the study and were randomly allocated to one of two treatment groups; thirty-seven patients remained in the study until its completion. Mood and anxiety symptoms were measured in all subjects. Statistical analysis was used to investigate if the groups differed with respect to demographic characteristics and the scores recorded in the pre- and post-treatment stages, as well as during treatment (intra/inter groups). RESULTS: Patients showed statistically similar population characteristics. The association of cognitive behavioral group therapy and pharmacological treatment proved to be effective. Patients who had undergone cognitive behavioral group therapy presented fewer symptoms of mania, depression and anxiety, as well as fewer and shorter mood change episodes. CONCLUSION: Cognitive behavioral group therapy sessions substantially contributed to the improvement of depression symptoms.OBJETIVO: Estudos recentes sugerem que uma psicoterapia estruturada aplicada junto com a farmacoterapia pode alterar o curso do transtorno afetivo bipolar. Entretanto, poucos estudos investigam os resultados da terapia cognitivo-comportamental em grupo sobre este transtorno psiquiátrico. O objetivo desta pesquisa foi avaliar a eficácia de 14 sessões de terapia cognitivo-comportamental em grupo concomitante à farmacoterapia para bipolares e comparar com a farmacoterapia sozinha. MÉTODO: Quarenta e um pacientes com transtorno bipolar I e II participaram do estudo e foram alocados aleatoriamente para um dos dois grupos; trinta e sete preencheram todas as escalas. Os sintomas de humor e ansiedade de todos os participantes foram avaliados. A análise estatística foi utilizada para investigar se os grupos diferiam com relação aos dados demográficos e entre os escores pré-, durante e pós-tratamento (intra/intergrupos). RESULTADOS: Os participantes dos dois grupos mostraram-se similares nas características demográficas. A adição da terapia cognitivo-comportamental em grupo ao tratamento farmacológico foi efetiva. O grupo da terapia cognitivo-comportamental em grupo apresentou menos sintomas de mania, depressão e ansiedade, bem como uma redução na frequência e duração dos episódios de humor. CONCLUSÃO: As sessões de terapia cognitivo-comportamental em grupo foram especialmente importantes na melhora dos sintomas depressivos.

OBJETIVO: Revisar sistematicamente os principais estudos clínicos sobre o tratamento farmacológico do transtorno bipolar e fazer uma análise crítica de seus aspectos metodológicos. MÉTODO: Realizou-se uma busca nas bases de dados Medline, ISI e PsycINFO, utilizando-se os seguintes termos de busca: "bipolar", "randomized", "placebo" e "controlled". Foram selecionados estudos clínicos randomizados, duplo-cegos e controlados por placebo sobre o tratamento farmacológico do transtorno bipolar. Além disso, de acordo com os nossos critérios, as amostras deveriam ser de no mínimo 100 pacientes e a substância testada deveria ser usada como monoterapia. RESULTADOS: 34 artigos se adequaram aos critérios de seleção. Todas as substâncias atualmente indicadas para mania, depressão bipolar e para o tratamento de manutenção foram mais eficazes que o placebo em pelo menos um estudo. Todavia, esses estudos tiveram amostras altamente selecionadas, altas taxas de abandono e baixas taxas de resposta clínica. CONCLUSÃO: Os modernos estudos clínicos sobre o tratamento farmacológico do transtorno bipolar apresentam algumas importantes limitações metodológicas. Assim, seus resultados devem ser considerados com cautela.OBJECTIVE: To review systematically the main clinical trials on the pharmacological treatment of bipolar disorder and to make a critical analysis of their methodological aspects. METHOD: A search in Medline, ISI and PsycINFO databases was conducted, using the following search terms: "bipolar", "randomized", "placebo" e "controlled". Randomized, double-blind, placebo-controlled clinical trials on the pharmacological treatment of bipolar disorder were selected. Besides, according to our criteria, samples had to consist of at least 100 patients and experimental drug had to be used as monotherapy. RESULTS: 34 articles met our selection criteria. All drugs currently indicated for mania, bipolar depression and maintenance treatment of bipolar disorder were more effective than placebo in at least one clinical trial. However, these studies had highly selected samples, high dropout rates and low response rates. CONCLUSION: Modern clinical trials on pharmacological treatment of bipolar disorder have important methodological limitations. So, their results should be taken with caution.

The Brazilian State-Trait Anxiety Inventory has been widely used to measure state (STAI-S) and trait (STAI-T) components of anxiety. The present work developed and evaluated a short version of the STAI-S and STAI-T in a large sample of Brazilian subjects. The first study selected short-form scales. The second one employed factor analyses to investigate whether each of the two short-form scales presented a well-defined and balanced structure with both anxiety-present and anxiety-absent factors. Results indicated that the STAI-S and STAI-T could be reduced to six items (STAI-S-6 and STAI-T-6, respectively) without sacrificing their psychometric properties. The findings suggest that STAI-S-6 and STAI-T-6 may be employed in situations where time restraints make the use of full-length forms unfeasible.O inventário brasileiro de ansiedade traço-estado tem sido amplamente utilizado para medir os componentes de ansiedade, estado (STAI-S) e traço (STAI-T). O presente trabalho desenvolveu e avaliou uma versão simplificada de STAI-S e STAI-T em uma grande amostra de sujeitos brasileiros. O primeiro estudo selecionou as escalas de forma curta. O segundo estudo empregou análises fatorais para investigar se cada uma dessas duas escalas simplificadas apresentou uma estrutura bem definida e equilibrada com fatores de ansiedade-presente e ansiedade-ausente. Resultados indicaram que o STAI-S e o STAI-T poderiam ser reduzidos para seis itens (STAI-S-6 e STAI-T-6, respectivamente) sem comprometer suas propriedades psicométricas. Estes resultados sugerem que STAI-S-6 e STAI-T-6 podem ser empregados em situações onde restrições de tempo tornam inviável a utilização de formulários completos.

O presente trabalho investigou experimentalmente os limiares nociceptivos e a percepção subjetiva de dor no transtorno de pânico (TP). Trinta e sete pacientes com TP foram voluntariamente submetidos a um Teste Pressor ao Frio (TPF), em que uma de suas mãos era mergulhada em um banho termostatizado de água fria (7ºC) por um período máximo de três minutos. A latência de retirada da mão da água foi utilizada como um índice de dor aguda, enquanto a experiência subjetiva de dor foi avaliada por meio do Questionário McGill de Dor e de uma escala visual analógica. Os resultados indicaram latências similares de retirada da mão em comparação a 37 sujeitos-controle sadios, mas uma experiência subjetiva de dor significantemente maior nos pacientes com TP. Esse padrão de resultados não apenas confirma a utilidade do teste de pressor ao frio para a indução e estudo experimental da dor aguda em laboratório, mas também sugere uma importante associação entre dor e ansiedade.The present study experimentally investigated the nociceptive threshold and the subjective pain perception in panic disorder (PD). Thirty seven PD patients were voluntarily submitted to a cold pressor test (CPT) in which one of their hands was dipped into a thermostatized cold water bath (7ºC) for a maximum period of three minutes. Acute pain experience was assessed by measuring the hand retrieval latency, whereas the subjective pain experience was evaluated through McGill Pain Questionnaire and a pain visual analog scale. As compared to 37 healthy control-subjects, results indicated similar hand retrieval latencies but a significantly higher subjective pain experience in PD patients. Such pattern of results not only indicates the usefulness of the cold pressor test to induce and experimentally study pain in laboratory settings, but also suggests an important anxiety-pain association.

OBJECTIVE: To study the long-term follow-up of patients with bipolar disorder (BPD). METHOD: Eleven outpatients with BPD type I were followed up naturalistically for five years at a university teaching hospital. The Clinical Global Impression Scale (BPD version) was used to evaluate the occurrence of affective episodes, and the Strauss-Carpenter Outcome Scale was used to evaluate social and occupational functioning. RESULTS: The majority of patients were symptomatic most of the time, with predominantly depressive episodes. Overall, patients remained euthymic a mean of 47.7% of the time. Despite a low rate of hospitalization, social and occupational functioning was poor in the majority of patients. A poor disease course with respect to work-related functioning was associated with fewer months of euthymia with a longer duration of depressive episodes. The total number of months of euthymia negatively correlated with the patient's age and disease duration. CONCLUSION: Despite the small sample size, the present findings appear to corroborate previous studies on the evolution of BPD. Most of the patients had a poor disease course, with long symptomatic periods, particularly depressive episodes, and significantly impaired social and occupational functioning.OBJETIVO: Estudar a evolução de longo prazo do transtorno bipolar (TB). MÉTODO: Onze pacientes com TB do tipo I foram acompanhados de forma naturalística em um ambulatório universitário por cinco anos. Foram utilizadas a Escala de Impressão Clínica Global (versão TB), para a avaliação dos episódios afetivos, e a Escala de Evolução Strauss-Carpenter, para a avaliação do funcionamento sócio-ocupacional. RESULTADOS: A maioria dos pacientes esteve sintomática a maior parte do tempo, apresentando predominantemente quadros depressivos. Em média, os pacientes ficaram em eutimia durante 47,7% do tempo. Apesar do baixo índice de hospitalização, a maioria dos pacientes apresentou funcionamento deficiente quanto às atividades sociais e ocupacionais. Pior evolução quanto à vida ocupacional foi associada a menor número de meses em eutimia e a maior duração dos episódios depressivos. O número total de meses em eutimia se correlacionou negativamente com a idade e a duração da doença. CONCLUSÃO: Apesar do tamanho reduzido da amostra, nossos resultados parecem corroborar os da literatura. A maioria dos pacientes apresentou evolução desfavorável, com longos períodos sintomáticos, especialmente com episódios depressivos, e importante comprometimento sócio-ocupacional.

CONTEXTO: A desatenção no transtorno de déficit de atenção e hiperatividade (TDAH) é principalmente associada à hipoatividade dopaminérgica mesocortical. Contudo, variações dopaminérgicas mesotalâmicas também afetam o controle da atenção e, possivelmente, originam alterações atencionais no TDAH. OBJETIVO: Elaboração de um modelo neurocomputacional a partir do conhecimento do funcionamento bioquímico dos sistemas dopaminérgicos mesocortical e mesotalâmico, a fim de investigar a influência dos níveis de dopamina na via mesotalâmica sobre o circuito tálamo-cortical e suas implicações nos sintomas de desatenção do TDAH. MÉTODO: Através de um conjunto de equações modelamos propriedades fisiológicas de neurônios talâmicos. A seguir, simulamos computacionalmente o comportamento do circuito tálamo-cortical variando os níveis de dopamina nas vias mesotalâmica e mesocortical. RESULTADOS: Em relação à via mesotalâmica, a hipoatividade dopaminérgica dificulta o deslocamento do foco de atenção, e a hiperatividade dopaminérgica acarreta desfocalização atencional. Quando tais situações são acompanhadas de hipoatividade dopaminérgica mesocortical, surge uma incapacidade em perceber estímulos, devido à competição sem vencedores entre regiões talâmicas pouco ativadas. A desatenção no TDAH também se origina em desequilíbrios dopaminérgicos na via mesotalâmica, que levam à focalização excessiva ou à desfocalização da atenção. CONCLUSÃO: O nosso experimento in silico sugere que no TDAH a desatenção relaciona-se com alterações dopaminérgicas, que não se restringem à via mesocortical.BAKGROUND: Inattention symptoms observed in patients with attention deficit hyperactivity disorder (ADHD) are mostly related to a hipoactivity in the mesocortical dopaminergic pathway. However, mesothalamic dopaminergic variations also affect the attentional control, and possibly lead to attention alterations in ADHD. PURPOSE: Elaborating a neurocomputational model from biochemical knowledge of mesocortical and mesotalamic dopamine systems, to investigate how different levels of mesothalamic dopamine influence the thalamocortical loop, leading to some attention deficits observed in ADHD. METHOD: First, we model physiological properties of thalamic neurons with a set of mathematical equations. Next, we simulate computationally the modeled thalamocortical loop under different levels of mesothalamic dopamine, and also the mesocortical dopaminergic decrease. RESULTS: Low levels of mesothalamic dopamine hinders the attentional shift and, high levels of such neuromodulator lead to distraction. When such alterations occur together with a decrease in the mesocortical dopamine level, the attention deficit turns into incapacity of perceiving environmental stimuli, due to a no winner competition between low activated thalamic areas. Inattention in ADHD also has its origins in dopaminergic disturbs throughout the mesothalamic pathway, which enhance a high focusing or do not allow the attention focus consolidation. CONCLUSION: In ADHD, the inattention is related to dopaminergic alterations that are not restricted to the mesocortical system.

INTRODUÇÃO: A disforia pré-menstrual (DPM), que acomete entre 3% e 8% das mulheres em idade fértil, representa uma forma mais grave de síndrome pré-menstrual, na qual predominam as alterações do humor e do comportamento. Acredita-se que haja algum tipo de ligação entre a DPM e os transtornos do humor. OBJETIVO: Estudar a eficácia dos antidepressivos na DPM. MÉTODOS: Foi realizada uma revisão dos ensaios clínicos controlados com antidepressivos no tratamento da DPM, utilizando-se as seguintes bases de dados: Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), psycINFO e Biblioteca Cochrane. RESULTADOS: A clomipramina, a fluoxetina, a sertralina, a paroxetina e a venlafaxina se mostraram superiores ao placebo em diversos estudos. DISCUSSÃO: As mulheres que sofrem de DPM possivelmente apresentam uma disfunção serotoninérgica. CONCLUSÃO: Alguns antidepressivos, especialmente os inibidores seletivos da recaptação da serotonina (ISRS), parecem ser eficazes no tratamento da DPM.INTODUCTION: Premenstrual dysphoria (PMD), which affects between 3% and 8% of women during reproductive years, represents a more severe type of premenstrual syndrome. Mood and behavior changes are predominant in PMD. It is believed that there is some kind of link between PMS and mood disorders. OBJECTIVE: Studying the efficacy of antidepressants in PMD. METHODS: We elaborated a review of controlled clinical trials with antidepressants in the treatment of PMD, using the following databases: Medline, LILACS, psycINFO and Cochrane Library. RESULTS: Clomipramine, fluoxetine, sertraline, paroxetine and venlafaxine were superior to placebo in various studies. DISCUSSION: Women with PMD possibly present a serotonergic dysfunction. CONCLUSION: Some antidepressants, specialy SSRIs, seem to be effective in the treatment of PMD.

Com o objetivo de examinar se existe uma uniformidade entre os diversos autores quanto aos conceitos e termos da psicopatologia descritiva, foi realizada uma revisão de alguns dos principais livros dessa área, tanto brasileiros como internacionais. Constatou-se que não há verdadeiramente uma linguagem comum: determinados conceitos são considerados por alguns autores mas ignorados por outros; um mesmo termo é utilizado com diferentes sentidos; e um mesmo conceito é designado por termos diferentes. Alguns pontos de divergência entre os diversos psicopatólogos são aqui exemplificados e discutidos.We elaborated a review of some of the main books of descriptive psychopathology, Brazilian and international ones, with the objective of examining if there is uniformity among the various authors about concepts and terminology. We observed that there is not truly a common language: some concepts are used by some authors but are ignored by others; a same term is utilized with different meanings; and a same concept is assigned by different terms. Here some points of divergence among the various authors are presented and discussed.

Abstract Introduction Affective state may influence insight, especially regarding mania. Nevertheless, studies have so far suggested that depression seems not to significantly impair insight. To the best of our knowledge, this study pioneers the evaluation of how insight variations in bipolar depression correlate with clinical variables. Method A group of 165 bipolar patients, 52 of whom had depressive episodes according to DSM-5 criteria, were followed during a year. All patients underwent clinical assessment, and insight was evaluated through the Insight Scale for Affective Disorders (ISAD). Repeated-measures ANOVA was calculated comparing scores on the four ISAD factors (insight into symptoms, the condition itself, self-esteem and social relationships) in order to investigate differences in insight according to different objects. Correlational analysis explored which clinical symptoms were linked to reduced insight. Results Worse total insight correlated with suicide attempt/ideation and fewer subsyndromal manic symptoms such as mood elevation, increased energy and sexual interest. Worse self-esteem insight was associated with not only suicide ideation/attempt but also with activity reduction and psychomotor retardation. Worse symptom insight also correlated with psychomotor retardation. Better insight into having an affective disorder was associated with more intense hypochondria symptoms. Finally, worse insight into having an illness was associated with psychotic episodes. Conclusion Our study found that symptoms other than psychosis – suicide ideation, psychomotor retardation and reduction of activity and work – correlate with insight impairment in bipolar depression.

RESUMO Objetivo: Traduzir e adaptar transculturalmente para o português do Brasil o instrumento Pediatric Confusion Assessment Method for the Intensive Care Unit para detecção de delirium em unidades de terapia intensiva pediátrica, incluindo algoritmo e instruções. Métodos: Utilizou-se a abordagem universalista para tradução e adaptação transcultural de instrumentos de aferição em saúde. Um grupo de especialistas em terapia intensiva pediátrica avaliou as equivalências conceitual e de itens. Em seguida, a avaliação da equivalência semântica consistiu de tradução do inglês para o português por dois tradutores independentes; conciliação em uma única versão; retradução por um nativo de língua inglesa; e consenso de seis especialistas quanto à compreensão de linguagem e de conteúdo, por meio de respostas do tipo Likert e Índice de Validade de Conteúdo. Finalmente, avaliou-se a equivalência operacional, aplicando-se um pré-teste em 30 pacientes. Resultados: A retradução foi aprovada pelos autores originais. As medianas das respostas do consenso variaram de boa a excelente, exceto na característica "início agudo" das instruções. Itens com Índice de Validade de Conteúdo baixo, relativos às características "início agudo" e "pensamento desorganizado", foram adaptados. No pré-teste, a expressão "acene com a cabeça" foi modificada para "balance a cabeça", para melhor compreensão. Não houve necessidade de outros ajustes, resultando na versão final para o português do Brasil. Conclusão: A versão brasileira do Pediatric Confusion Assessment Method for the Intensive Care Unit foi obtida segundo as recomendações internacionais, podendo ser utilizada no Brasil para o diagnóstico de delirium em crianças graves com 5 anos de idade ou mais, sem atraso de desenvolvimento cognitivo.

ABSTRACT Objective: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. Methods: Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. Results: Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. Conclusion: The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

Abstract Introduction In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far. Objective To evaluate the relationship between affective temperament and insight in bipolar disorder. Method A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales. Results In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder. Conclusion In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.

Abstract Introduction The objective of this study was to identify whether mixed states in bipolar disorder (BD) are associated with more frequent suicidal behavior when compared to manic/hypomanic and depressive episodes. Method We performed a systematic search of the scientific literature on the subject using the PubMed, ISI Web Of Science, PsycINFO and SciELO databases. The terms chosen for the search were (bipolar) AND (suicid*) AND (mixed). We selected original studies comparing suicidal behavior of patients in mixed states and suicidal behavior of patients in other BD phases. Results Sixteen papers fit the selection criteria. Twelve of the original 16 studies compared suicidal behavior in mixed states and pure mania, and the majority of these studies (n = 11) revealed that suicidal behavior was more frequent among individuals in mixed states. Five of the papers compared suicidal behavior between depressive and mixed phases of BD. One of these five papers reported more severe suicidal behavior in patients in mixed states and another described more frequent suicidal behavior in patients with pure depression. There were no significant statistical differences between groups in the remaining three of these five studies. Conclusion During acute BD episodes, suicidal behavior is more strongly associated with mixed states than with pure mania or hypomania. However, it was not possible to demonstrate that the association between suicidal behavior and mixed states is stronger than the association between suicidal behavior and depressive phases. The results hereby presented are worth considering in clinical practice to better evaluate suicide risk and to prevent suicide.