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Contains fulltext : 287762.pdf (Publisher’s version ) (Open Access) BACKGROUND: Poor social connections (eg, small networks, infrequent interactions, and loneliness) are modifiable risk factors for cognitive decline. Existing meta-analyses are limited by reporting aggregate responses, a focus on global cognition, and combining social measures into single constructs. We aimed to investigate the association between social connection markers and the rate of annual change in cognition (ie, global and domain-specific), as well as sex differences, using an individual participant data meta-analysis. METHODS: We harmonised data from 13 longitudinal cohort studies of ageing in North America, South America, Europe, Africa, Asia, and Australia. Studies were eligible for inclusion if they had baseline data for social connection markers and at least two waves of cognitive scores. Follow-up periods ranged from 0 years to 15 years across cohorts. We included participants with cognitive data for at least two waves and social connection data for at least one wave. We then identified and excluded people with dementia at baseline. Primary outcomes were annual rates of change in global cognition and cognitive domain scores over time until final follow-up within each cohort study analysed by use of an individual participant data meta-analysis. Linear mixed models within cohorts used baseline social connection markers as predictors of the primary outcomes. Effects were pooled in two stages using random-effects meta-analyses. We assessed the primary outcomes in the main (partially adjusted) and fully adjusted models. Partially adjusted models controlled for age, sex, and education; fully adjusted models additionally controlled for diabetes, hypertension, smoking, cardiovascular risk, and depression. FINDINGS: Of the 40 006 participants in the 13 cohort studies, we excluded 1392 people with dementia at baseline. 38 614 individual participants were included in our analyses. For the main models, being in a relationship or married predicted slower global cognitive decline (b=0·010, 95% CI 0·000-0·019) than did being single or never married; living with others predicted slower global cognitive (b=0·007, 0·002-0·012), memory (b=0·017, 0·006-0·028), and language (b=0·008, 0·000-0·015) decline than did living alone; and weekly interactions with family and friends (b=0·016, 0·006-0·026) and weekly community group engagement (b=0·030, 0·007-0·052) predicted slower memory decline than did no interactions and no engagement. Never feeling lonely predicted slower global cognitive (b=0·047, 95% CI 0·018-0·075) and executive function (b=0·047, 0·017-0·077) decline than did often feeling lonely. Degree of social support, having a confidante, and relationship satisfaction did not predict cognitive decline across global cognition or cognitive domains. Heterogeneity was low (I(2)=0·00-15·11%) for all but two of the significant findings (association between slower memory decline and living with others [I(2)=58·33%] and community group engagement, I(2)=37·54-72·19%), suggesting robust results across studies. INTERPRETATION: Good social connections (ie, living with others, weekly community group engagement, interacting weekly with family and friends, and never feeling lonely) are associated with slower cognitive decline. FUNDING: EU Joint Programme-Neurodegenerative Disease Research grant, funded by the National Health and Medical Research Council Australia, and the US National Institute on Aging of the US National Institutes of Health.

Objective Subjective well-being (SWB) is impaired in individuals with depressive disorders. The aim of this study was to assess individuals in the general population identified as having depression and compared to SWB of those with antidepressants use. Methods A household study with a probability sample (N = 3744) was conducted in Sao Paulo and Rio de Janeiro, Brazil, from 2007 to 2008. The Composite International Diagnostic Interview (CIDI) was used to diagnose depression and the Subjective Well-Being Inventory was used to attain the individual's perception of SWB. To estimate the association between SWB and diagnosis of depression, Poisson regression analyses were performed controlling the effects of sociodemographic variables, family history of mental health, other psychiatric diagnoses, and antidepressants use. Results In the general population, poor SWB was associated to psychiatric diagnosis (depression and others); the productive age; living alone (single; separated or widowed); lower schooling; higher income; history of mental illness in the family; the non-practice of religion and the use of antidepressants. In the exclusive population of patients diagnosed with depression, the poor SWB was associated only to marital status. Twenty two percent of the individuals with depression used antidepressants, and this was not associated to their perceived SWB. Limitation The main limitation of study was the use of psychotropic medication used as a proxy to identify individuals who made use of health services or received treatment. Conclusion The individuals diagnosed with depression in the general population had a poorer perception of their SWB, and that SWB was not associated to antidepressants use.

Objective: To compare mortality in older adults with and without mild or moderate cognitive impairment over 15 years of follow-up in a middle-income country, where little information on this subject is available. Methods: A total of 1,281 community-dwelling older adults were followed-up for a median of 13.3 years. We evaluated their cognitive impairment using the Mini-Mental State Examination, categorizing it as none (1.0 SD above cutoff means), mild (1.0 SD below cutoff means) or moderate (2.0 SD below cutoff means). The date of death was determined by reviewing death certificates. Cox’s proportional hazards models were used to evaluate the risk of mortality in participants with cognitive impairment. Results: Participants with mild or moderate cognitive impairment had a higher mortality risk than those without it in the unadjusted model, but these associations did not remain in the final model. After sex stratification, only men with moderate cognitive impairment had a higher mortality risk in the final model. Conclusion: The findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of older adults.

Background Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15–75) in two violence-prone cities. Methods The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15–75) in Sao Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence. Results Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for Sao Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In Sao Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30–59 year olds, but in 23–29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity. Limitations Cross-sectional design. Conclusions Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed.

Background: Cognitive impairment increases while physical activity decreases the mortality risk in the elderly. In this study, hypothesize that physical activity among the elderly with cognitive impairment is associated with a lower risk of all-cause mortality. Methods: We included a total of 147 community‐dwelling older adults with cognitive impairment from the baseline of the Bambui Cohort Study of Aging and followed‐up for a median of 9.6 years. We evaluated the physical activity by a self-reported question, which considers how many times participants either walk to exercise, or do gymnastics, or practice sports for at least 20-30 min in the previous 90 days. The date of death was computed by reviewing death certificates. We used Cox's proportional hazards models to evaluate the risk of mortality in those participants. Findings: Participants with cognitive impairment and non-physical activity had a higher risk for mortality in the unadjusted analysis (HR: 2.34; 95% CI: 1.02– 5.39), and the association remained in the final model (HR: 3.21; 95% CI: 1.29-7.99). Interpretation: This study found lower mortality risk among subjects with cognitive impairment but physically active as compared to non-active participants. Funding Statement: The funding is provided by Financiadora de Estudos e Projetos (FINEP), Conselho Nacional de Desenvolvimento Cientifico e Tecnologicos (CNPq), and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Prof. Blay, Prof. Firmo, Prof. Lima‐Costa, and Prof. Laks received grants from the National Council for Scientific and Technological Development (CNPq; Conselho Nacional de Desenvolvimento Cientifico e Tecnologico—305274/2014‐ 7). Prof. Castro-Costa currently receives research support from the Medical Research Council (MR/T037423/1). Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: The project was approved by the Ethical Committee of the Fundacao Oswaldo Cruz, Brazil.

RESUMO No início da graduação, a compreensão sobre saúde e doença do aluno depende de seus conhecimentos e experiências prévias, bem como do grau de contato com a prática médica e a realidade que envolve esse tema. Neste estudo, pretende-se compreender qual é a visão de saúde e doença que permeia a mente dos futuros médicos e traçar que relações são estabelecidas entre a noção de saúde e doença com as experiências pessoais e profissionais do aluno ao longo da graduação. Foi realizado um estudo qualitativo, utilizando-se um questionário psicossocial e entrevista semiestruturada com alunos do primeiro, terceiro e sexto ano de um mesmo ano letivo da Universidade Federal de São Paulo (Unifesp-EPM). O material foi submetido à análise de conteúdo. As experiências e características pessoais de cada participante, assim como as experiências curriculares e extracurriculares e o currículo oculto influenciam tanto a visão que possuem de saúde e doença quanto a escolha profissional. Nota-se certo esfriamento na relação médico-paciente e uma postura de maior desconfiança em relação aos pacientes ao longo da graduação. Os alunos têm o conhecimento de uma visão mais global e humana dos pacientes, mas não conseguem colocá-la em prática. Observa-se que essa problemática está vinculada ao fato de terem dificuldade de entrar em contato com os aspectos emocionais despertados na relação médico-paciente. ABSTRACT Medical students’ views on health and illness in the early stages of their degree course depend on their knowledge and past experiences as well as the amount of contact with medical practice and the reality surrounding this issue. The aim of this study was to understand the view of health and illness in the minds of future doctors and to delineate the relationships established between the notion of health and illness, the school curriculum, personal experiences, and the social and professional students’ trajectory throughout the course. A qualitative study was conducted, with a psychosocial questionnaire and semi-structured interviews used on students in the first, third, and sixth year at the Federal University of São Paulo (Unifesp-EPM) in 2008. The material was subjected to content analysis, identifying the experiences and personal characteristics of each participant, as well their curricular and extracurricular experiences, and determining how the hidden curriculum influences both their views on health and illness as well as their career choice. A certain coldness may be noted in the doctor-patient relationship, as well as a greater distrust of patients. Graduating students demonstrated a need to protect feelings aroused by their experiences of the medical course. It is clear that students are aware of a more global and human view of their patients, however, it seems that they know this merely cognitively and are emotionally unable to put it into practice. This issue may be linked to the fact that they experience difficulties dealing with the emotional aspects of the doctor-patient relationship.

Background The association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. Methods PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive–compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. Results Six studies were included in the meta-analysis; of these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR) =2.76; 95% confidence interval (CI) 1.26 to 6.02; Log OR =1.013; P=0.011). The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR =3.51; 95% CI 1.97 to 6.24; Log OR =1.255; P

This chapter addresses anxiety disorders in late life, especially generalized anxiety disorder, which is highly prevalent and overloads health services. In addition, anxious patients usually have cognitive and social functioning decline, leading to a poorer quality of life. Despite this, it is a less studied topic than geriatric depression. Neurobiological research shows the involvement of the HPA axis, and basal cortisol levels are higher in those patients. The presentation of the symptoms is usually different in comparison with younger adults, and it is frequently comorbid with other psychiatric and physical diseases, complicating its management. The treatment should involve medicines, such as SSRIs and psychotherapy, especially cognitive behavioral therapy.

Background Both diabetes and depression increase the mortality risk in the elderly. In this study, we evaluated mortality risk associated with the comorbidity between depression and diabetes. We also assessed the moderating role of inflammation in the mortality risk in this population. Methods We included a total of 1,183 community-dwelling older adults, divided into four groups: "neither diabetes nor depression"; "diabetes only"; "depression only," and "both diabetes and depression," and followed-up for a median of 13.5 years. We evaluated the inflammatory status by the high-sensitivity C-reactive protein (hs-CRP) levels. Date of death was computed by reviewing death certificates. We used Cox's proportional hazards models and additive interactions to evaluate the risk of mortality in the subject groups and the moderating effect of hs-CRP. Results Participants with both diabetes and depression had higher death risk (hazard ratio [HR]: 2.33; 95% confidence interval [CI]: 1.59-3.42) than those with each condition alone (HR diabetes: 2.08 95% CI: 1.56-2.76 HR depression: 1.26; 95% CI: 1.03-1.54). High level of hs-CRP, indicative of high inflammatory status, significantly moderated the risk of mortality in subjects with both diabetes and depression (Bonferroni-adjusted p = 0.0116). Conclusions The coexistence of diabetes and depression symptoms is associated with the highest death risk in this population. This risk is moderated by inflammatory status.

Objectives: To assess the prevalence of elder abuse and to investigate potential sociodemographic, health behavior, and medical correlates. Design: Cross-sectional data were collected in face-to-face assessments. Setting: Sao Paulo and Rio de Janeiro, Brazil. Participants: Individuals aged 60 to 75. Measurements: Information on elder abuse was obtained using the Brazil-adapted, nine-item Hwalek-Sengstock Elder Abuse Screening Test. Sampling design–adjusted descriptive statistics and logistic regression were used in analyses. Results: The overall prevalence of abuse was 14.4% (n = 46/259, 95% confidence interval (CI) = 9.82–20.61) in Sao Paulo and 13.3% (n = 27/197, 95% CI = 8.76–19.74) in Rio de Janeiro. Unadjusted analyses indicated that poor education, low physical activity, unemployment, heart disease, and psychiatric problems were associated with abuse, but in adjusted analyses, self-reported elder abuse was significantly associated only with psychiatric problems (Sao Paulo: OR = 4.48, 95% CI = 1.75–11.45; Rio de Janeiro: OR = 21.61, 95% CI = 6.39–73.14). Conclusion: Elder abuse is prevalent in Sao Paulo and Rio de Janeiro, but whether concomitants of abuse are cause, effect, or both is unclear because this was a cross-sectional study. These findings highlight the importance of the problem, as well as the need to develop measures to increase awareness, facilitate prevention, and fight against abuse of elderly adults.

The objective of this study was to examine the prevalence and characteristics of adult psychotropic medication use in São Paulo, Brazil. Information on lifetime and 12-month psychotropic medication use, and psychiatric status was obtained from a representative sample of 2000 adults aged 18-65 years in São Paulo, Brazil. Lifetime and 12-month use of psychotropic medications was 16.8 and 7.1%, respectively. Of the 22.8% of patients with current psychiatric problems, 29.5% reported lifetime use and 15.8% (5.6% of the sample) reported 12-month use (anxiolytics: 2.7%, antidepressants: 1.8%, alternative medicines: 0.9%, antipsychotics: 0.4%, mood stabilizers: 0.4%, hypnotics: 0.3%; multiple class use occurred). The most frequent prescribers were psychiatrists and general practitioners. Determinants of use included identification as a psychiatric case (four-fold increased odds), being female (three-fold increase), age (4-5% per additional year), and lower odds if married. Education, employment status, and birth in São Paulo were not associated with use. Income did not affect anxiolytic use, but antidepressant and alternative medicine use was associated with higher income. These results show that psychotropic drug use was comparatively low. Only 15.8% of patients with psychiatric problems reported recent psychotropic use. Comparable with other studies, use was greater among women and increased with age.

Purpose of review This review highlights the key recent issues and novel findings on anxiety disorders in older adults. Studies of the epidemiology, medical and psychiatric comorbidity, neurobiology, and treatment of anxiety in the elderly are discussed. Recent findings Overall prevalence studies of anxiety symptoms or disorders in older adults indicate that, although less common than in younger adults, they are relatively common in late life. We examine the prevalence of specific anxiety disorders in the elderly, as mechanisms, outcomes, and treatment response may vary by type of anxiety disorder. Physical and psychiatric comorbidity are common. Certain anxiety disorders, such as generalized anxiety disorder, have demonstrated a positive impact following acute coronary syndrome. Regarding treatment, small effect sizes and incomplete response are typical, posing a challenge when treating this age group. Summary The epidemiology, neurobiology, and treatment of anxiety conditions in late life have recently received more attention in the medical literature. Areas in need of further investigation include neurobiology, clinical presentation, management, and treatment, as we do not know whether procedures indicated for younger cohorts hold for older adults.

The aim of this study is to investigate the impact of psychiatric morbidity, depression, cognitive deficit, number of self-reported illnesses and socio-demographic variables on the WHOQOL-Bref domain scores. WHOQOL-Bref domain scores are substantially affected by psychiatric morbidity and income. Depression, the number of self-reported illnesses and the female gender also explain the variability of other domains to a lesser extent. O objetivo deste estudo é o de investigar o impacto da morbidade psiquiátrica, depressão, comprometimento cognitivo, número de doenças autorreferidas e variáveis sociodemográficas nos escores do WHOQOL-Bref. Os escores dos domínios do WHOQOL-Bref estão associados à morbidade psiquiátrica e renda. A depressão, o número de doenças autorreferidas e o sexo feminino também explicam a variabilidade nos outros domínios, porém em menor grau.

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

Psychotherapy is an efficacious and long used type of care. However, information available in specialized literature shows that this area has been little studied. The objective of this study is to determine the prevalence of use of outpatient psychotherapy by adult population, their related factors, and funding sources through systematic review, including qualitative and quantitative analyses of original articles with cross-sectional design and population-based sampling. Between January 1970 and December 2007, 3 databases were searched. A total of 2240 articles were identified, and 6 studies fulfilled the inclusion criteria. These studies investigated the prevalence of use of outpatient psychotherapy either in the moment or for 12 months or throughout life. Some of them investigated sociodemographic and health characteristics of users, costs, and treatment-funding sources. Studies' restricted number and different characteristics did not enable a meta-analysis. Six studies on the prevalence of use of outpatient psychotherapy were identified, thus revealing lack of data on this issue.

This study describes the prevalence and pattern of tobacco use among the elderly in Brazil and establishes its association with socio-demographic characteristics, other substance use and depression.The analyses were performed in 400 individuals aged 60 years and over who participated in the first Brazilian national alcohol survey (BNAS) in 2000.Nearly 60% of the sample had ever smoked, of them one in three were still smoking at the time of the interview. Most (94.3%) of the tobacco users were smoking everyday and 34.3% consuming more than 20 cigarettes a day. Only 1% of the former smokers had received support to quit. Over half of the current users (65%) would use free treatment to quit if it existed in Brazil, and just under half of them (47.4%) would consider quitting if cigarettes' price were higher. Currently, tobacco users were more likely to be men and alcohol abusers. Prevalence of depression was high regardless participant smoking status (33.0% among non-smokers, 34.7% among current smokers and 39.3% among former smokers). There was no significant association between smoking and depression.This study found a disturbingly high proportion of tobacco users among the elderly in Brazil. According to the Global Burden of Disease project, tobacco has the highest mortality risk of all substance use categories, especially for the elderly. This study shows there is an urgent need to develop smoking cessation interventions targeted specifically to the elderly.

Objectives To investigate public stigma relating to Alzheimer disease (AD) and variables correlated with this outcome. Design Cross-sectional study. Setting City of Sao Paulo, Brazil. Participants A representative sample of 500 individuals aged 18–65 years, living within the community. Measurements Subjects were interviewed to assess three dimensions of stigma (stereotypes, prejudice, and discrimination). Stigma was considered present in this study when all three domains were simultaneously fulfilled. Results The 41.6% of the participants expressed stereotypes; 43.4% prejudice; and 35.5% discrimination. Among the whole sample, 14.8% endorsed the stigma definition criterion adopted for this study. Those with fewer years of education were 2.32 times as likely to stigmatize persons carrying AD. Stigma was unaffected by other sociodemographic variables, experience of mental illness, emotional reactions, or general information about AD. Conclusions Dimensions of stigma were highly prevalent in relation to AD. Interventions are needed to reduce the negative effects of stigm.

Objective To assess public stigma in relation to individuals with depression and possible factors associated with this phenomenon. Methods A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of Sao Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with depression (according to DSM-IV and ICD-10). This was followed by a structured questionnaire that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette. Results Individuals with depression were perceived as potentially dangerous by 56% of interviewees. In addition, 49% of the sample perceived them as capable of arousing negative reactions, and 41%, as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly positive in nature. Those who identified the vignette as a mental illness were the ones who more often perceived dangerousness, stigma and discrimination. Conclusion This study indicated that individuals with depression face a substantial amount of stigma, pointing to the need to gain in-depth knowledge about its impact on the experiences of these individuals, as well as to implement anti-stigma programs that focus on this disorder in the Brazilian context.

Misinterpretation in major surveys of alcohol use disorder as described by DSM-IV (Hasin et al, 2007) has raised serious questions regarding the extent of alcohol use disorder, and the relationship between alcohol abuse and alcohol dependence. While the adverse social, physical and mental effects of alcohol misuse are well known (Council on Scientific Affairs, 1996), there is little information on the determinants of alcohol abuse (societal impact) and alcohol dependence (physiological impact). We therefore examined their separate and combined associations with demographic, social and health characteristics in a representative community-resident sample aged 60 years and over. We hypothesised that, while for each of the three groups (those with alcohol abuse, those with alcohol dependence, and those with both) there would be associated demographic characteristics, abuse would be more closely associated with social characteristics, dependence with health characteristics, and the combined presence of abuse and dependence with both social and health characteristics.

Background: We carried out a qualitative synthesis of international literature to provide insight into the patient’s experience as a means to help clinicians recognize symptoms of anorexia nervosa. Method: International publications from 1990 to 2005 were searched for relevant qualitative investigations, and meta-ethnography was employed to identify common themes across studies. Databases included were PubMed, ISI, PsycINFO, EMBASE, LILACS and SciELO. Results: 24 studies were included from a total of 3,415 papers. The second-order interpretation process using reciprocal translation allowed the identification of two concepts: (1) symptom identification (disease representation, self-concept, development of anorexia) and (2) disease interpretation (positive aspects, negative aspects, areas of life affected). Third-order constructs emerged revealing the disease as connected with identity and control. Conclusion: Knowledge of patients’ efforts to interpret the illness as a part of their own identity and sense of control have a key role in physician understanding of the disorder by allowing physicians to bring structure to the patients’ lives generally and to their help-seeking behavior specifically. The study has some limitations. Most of the results come from B-grade studies (as classified by the Critical Appraisal Skills Programme) that used qualitative methodology, implying the need for caution in data interpretation. Moreover, study populations were almost exclusively female, and no comparison was attempted concerning the severity of the condition between studies.

Objective The objective of this study is to examine the religious characteristics of older subjects and the associations of these characteristics to the use of tobacco, alcohol, and depression. Methods Data from a multistage random sample were used to examine associations between religiosity and health behaviors (tobacco use, alcohol) and depression among elderly house hold residents aged 60+ in Rio Grande do Sul, Brazil. Survey measures included sociodemographic characteristics, four aspects of religiosity, tobacco use, alcohol abuse and dependence, depression, life style, social context, functional status, and health conditions. Results After controlling for demographic, social connections, health behavior, functional status, and health conditions, evangelical affiliation reduced the odds of being a current tobacco user by 51%. Those reporting affiliation as Afro-Brazilian and not having a religion had, respectively, a 74% and 124% increased risk. All other religious domains protect against tobacco use. Not having a religion affiliation and the experience of a religious change increased the risk of alcohol misuse by 88% and 31%, respectively. In contrast, orienting-motivating force increased the odds of depression by 38%. Participating in social religious activities had reduced the risk of depression by 16%. Conclusion Several aspects of religiosity reduced the odds of being a tobacco user. Not having a religion and the experience of a religious change increased the risk of alcohol misuse. However, the domain orienting-motivating force increased the odds, and participating in social religious activities had reduced the risk of a depressive state.

This study proposes to investigate the life contexts and experiences of motherhood among homeless adolescents and their relation with the “uncertainty reduction” theory. A total of 21 teens, living in eight temporary shelters in the city of Sao Paulo, were intentionally selected. In-depth, face-to-face semi-structured interviews were subsequently conducted. The study was performed by means of qualitative methodology. Six themes emerged in the content analysis with the agreement of judges: “circulation” or domestic instability; incapacity to rely on one’s own parents and relatives; the street as a solution; fear of theft of the child; need for support; motherhood as hope and search for identity. Motherhood acquires the function of giving meaning to existence and opens a window of opportunity for reorganizing their lives around more stable bonds. The results suggest that the reduction in uncertainty could partly explain the relevant role of motherhood in these teens.

Little is known about public conceptions of mental disorders in Latin America and the Caribbean. The aim of this article is to assess how the population identifies symptoms of schizophrenia and the causes attributed to this disorder in the city of Sao Paulo, Brazil. A household survey was carried out in 2002 with a probabilistic sample of 500 individuals, residents of Sao Paulo with ages ranging from 18 to 65. Vignette describing in colloquial language an individual with schizophrenia (according to DSM-IV and ICD-10) was presented together with a structured questionnaire with questions about the vignette. The symptoms of schizophrenia were identified by 23.4% as depression. The term schizophrenia was used in only 2.2% of the responses. A bit more than half of the respondents believed it was a mental illness. The main causes attributed were “drug use” and “isolation”. Factors most influencing responses about causes were years of schooling and identification as a mental illness. Medical–scientific concepts are used less in Sao Paulo than in other countries. The main causes attributed by the public relate to psychosocial stress. Causes of biological or moral nature are considered less relevant.

OBJECTIVE: To describe how the population of the city of São Paulo identifies alcohol dependence, which causes they attribute to this disorder and what is reported regarding stigma perception, risk of violence and emotional reactions. METHOD: Cross sectional study involving a probabilistic sample of 500 individuals in São Paulo aged 18 to 65 years. A structured questionnaire was used and started with a vignette describing an individual with alcohol dependence according to the DSM-IV and ICD-10, followed by a questionnaire divided into various sections examining the causes, stigma, risk of violence and emotional reactions to the case presented in the vignette. RESULTS: Less than 20% of the subjects reported to believe this was a mental illness. The causes considered most relevant were psychosocial ones, followed by moral causes. Alcohol dependence was associated with a high risk of violence and stigma by the part of others. In contrast, reactions declared by the subjects about their probable attitude were mostly positive. CONCLUSION: Alcohol dependence is seen as a psychosocial and moral problem. Negative images predominate regarding individuals with this disorder.

Introduction: Geriatric depression is under-diagnosed and often mistaken for other diseases that are common in the elderly. Its detection, using a screening scale translated into the local language, is relevant to the care provided at general outpatient clinics. Objective: To study the validity of the Geriatric Depression Scale (GDS) in general outpatient clinics. Methods: The GDS was first translated into Portuguese and compared with the diagnosis of depression achieved by the SCID-CV (Structured Clinical Interview for DSM-IV clinician version axis disturbances) performed by a psychiatrist who was blind to the GDS results. Data were analyzed using the ROC curve to determine the cut-off point. Results: A total of 484 patients were evaluated, 210 of whom were classified as depressive and 274 as non-depressive. The ROC curve determined the cut-off point at 12, with 87% sensitivity and 73% specificity. In the logistic regression, no sociodemographic variable presented an association with depression....

Background: Quality of life (QoL) has not been a priority goal for patients with recurrent painful colic of renal lithiasis. Aim: To evaluate QoL in patients with recurrent painful symptoms due to renal colic. Methods: In this case-control study, 194 subjects (97 cases/97 controls) were matched according to age and gender. Cases were patients at an outpatient clinic with a confirmed diagnosis of nephrolithiasis with recurrent painful renal colic. The control group consisted of patients seen at an ophthalmology outpatient clinic for refraction symptoms. Main outcome measures: QoL was measured using the SF-36. Results: Average SF-36 dimension scores for cases and controls, respectively, were: physical function 70/95, role-emotional function 33.3/100, role limitations due to physical problems 25/100, bodily pain 41/84, general health status 52/82, vitality 45/80, social function 62.5/100 and mental health 52/84. All values were statistically different (p < 0.001). Using multiple linear regression, there was a statistically significant QoL drop in subjects with lithiasis. Low social and economic levels were associated with the following SF-36 domains: physical function, general health status, vitality and mental health. The influence of the diagnosis on role-physical and role-emotional domains. Analysis of the physical and mental components of the SF-36 Scale showed significantly lower averages between cases and controls: PCS (p < 0.001) and MCS (p < 0.001). Conclusion: The QoL of patients with painful recurrent symptoms due to renal colic was substantially impaired.

OBJETIVO: Identificar estudos sobre prevalência de abuso na terceira idade e analisar a qualidade dos estudos. MÉTODOS: Revisão sistemática estudos de base populacional em bases de dados eletrônicos (PubMed, LILACS, Embase, ISI, PsycInfo), referente aos anos de 1988 a 2005. Foram incluídos os estudos de base populacional e excluídos os estudos sem definição metodológica delineada e estudos realizados em clientela de serviços especializados. RESULTADOS: Foram encontrados 440 artigos, mas apenas 11 artigos foram selecionados. A maioria dos artigos foi de corte transversal, apenas dois apresentaram desenho longitudinal. Os estudos foram conduzidos em diversas regiões do mundo, sobretudo dos Estados Unidos e da Europa. Observou-se variação nas definições de abuso. Os estudos de prevalência encontraram coeficientes de abuso físico entre 1,2% (Holanda) e 18% (Finlândia). CONCLUSÕES: Existe substancial variação de prevalência entre os países, parecendo haver uma variável cultural importante. Como o número de idosos é crescente no mundo, são necessários mais estudos de base populacional representativos dessa faixa etária para melhor compreensão do fenômeno.

Background Knowledge about co-occurrence of the most frequent chronic pain symptoms with psychiatric morbidity in older people is very limited. Objective To study the association of psychiatric morbidity and painful physical conditions in people aged 60 years and over. Method Population-based random sample of 7,040 household residents, aged 60 years and over, in Brazil. Results The overall prevalence of pain conditions is 76%. Age-sex specific prevalence of chronic pain conditions such as back pain, joint, abdominal, chest, headaches, reported by respondents ranged from 11.6% up to 51.1%. In logistic regression models, chest pain, head pain, back pain, joint pain and abdominal pain emerged as predictors of psychiatric morbidity. The odds of psychiatric morbidity are also affected by income, ethnicity, origin (urban/rural), and marital status. Conclusion The association of chronic painful conditions and psychiatric morbidity in late life is statistically strong in this surveyed population. Copyright © 2007 John Wiley & Sons, Ltd.

OBJETIVO: Esta revisão sistemática teve como objetivo organizar o conjunto das informações disponibilizadas pelos estudos qualitativos sobre a vivência dos pacientes portadores de bulimia e transtorno da compulsão alimentar periódica. METODOLOGIA: Pesquisas foram conduzidas nas seguintes bases de dados: PubMed, ISI, PsycINFO, EMBASE, LILACS e SciELO, no período de 1990 a 2005. Critérios de inclusão: 1) artigos com foco principal na bulimia ou transtorno da compulsão alimentar periódica; 2) pesquisas originais em inglês, espanhol, francês ou português; 3) uso de qualquer método qualitativo, como entrevista, grupo focal ou observação de campo. Critérios de exclusão: artigos exclusivamente teóricos ou que utilizam população infantil ou da terceira idade. Utilizou-se a abordagem meta-etnográfica para sintetizar os dados. Cada estudo foi lido, e as categorias centrais de cada um foram comparadas e interpretadas com as categorias de todos os outros estudos. RESULTADOS: Foram incluídos 15 estudos de um total de 3.415 artigos. Sete temas centrais que se sobrepõem foram identificados: representação da doença; sentimentos negativos (medo, culpa, raiva, solidão, perda de controle); sentimentos positivos (auto-controle; poder; função do sintoma; relacionamentos interpessoais; história pessoal; contexto sociocultural; recuperação). CONCLUSÕES: Embora muitos aspectos sejam negativos, a experiência, como um todo, não é referida apenas como má. Alguns aspectos dos transtornos alimentares são sentidos como benéficos, segundo os pacientes. OBJECTIVE: The aim of this systematic review is to identify the scope of qualitative investigations on the life experience of patients with bulimia and binge eating disorder. METHODOLOGY: Searches were conducted using the following databases: PubMed, ISI, PsycInfo, Embase, LILACS and Scielo, for articles published between 1990 and 2005. Inclusion criteria were: 1) articles with main focus on bulimia or binge eating disorders; 2) original research reported in English, Spanish, French or Portuguese; 3) use of any qualitative method, such as interview, focal group or field observation. Exclusion criteria were exclusively theoretical articles and those assessing children or elderly subjects. A meta-ethnographic approach was used to synthesize the data. Each study was carefully read, and their thematic categories were interpreted and compared to the categories of all other studies. RESULTS: Fifteen studies were included of a total of 3,415 articles. Seven overlapping main themes were identified: illness representation; negative feelings (fear, guilt, anger, loneliness, loss of control); positive feelings (self-control, power); symptom function; interpersonal relationships; sociocultural context; recovery. CONCLUSIONS: Although many issues were negative, the overall experience was not reported as being only bad. Some aspects of eating disorders were considered beneficial by the patients.

Objective: To evaluate self-help interventions for patients with binge eating disorder (BED) and bulimia nervosa (BN), tested in randomized controlled trials, and compared with waiting list or any other type of control group. Methods: A systematic review including quality appraisal was conducted of randomized controlled trials, using self-help techniques in patients with BED and/or BN. Six databases were searched during the period between January 1994 and June 2004. Results: A total of 2686 articles were identified, 1701 abstracts were evaluated in detail and, nine studies fulfilled the inclusion criteria for this review. All studies indicated that patients treated with active interventions had a reduced number of binge eating episodes at end of treatment. Conclusion: The results support self-help interventions but shall be interpreted with caution. Because of the small number of studies using self-help techniques for BED and BN, further larger randomized, multi-center controlled studies that apply standardized inclusion criteria, evaluation instruments and self-help materials, are needed.

OBJETIVO: Realizar um estudo de concordância entre examinadores da versão adaptada de uma escala para a avaliação de interação mãe-bebê (Brown e colaboradores - 1975) MÉTODO: Quatorze puérperas e seus recém-nascidos participaram deste estudo. As observações, que duravam quinze minutos, foram filmadas na maternidade no segundo dia após o nascimento do bebê, durante a amamentação. Num momento sucessivo e isoladamente, dois avaliadores atribuíram escores para cada item de interação estabelecida entre a mãe e o recém nascido. Para tal fim, foi utilizada e submetida ao estudo de fidedignidade uma versão adaptada da escala de Brown e colaboradores.³ (1975). RESULTADOS: Nove entre os dez itens pertencentes à escala adaptada do estudo de Brown e colaboradores³ (1975) revelaram uma concordância excelente, o coeficiente Kappa acima de 0,85. O único item que apresentou uma concordância moderada (K= 0,59) foi 'mãe segura o bebê'.Os resultados obtidos indicam a estabilidade da escala adaptada e aplicada em ambiente hospitalar destinado às mães de baixa renda. CONCLUSÕES: Os dados trazidos por este estudo indicam que a utilização das categorias é um parâmetro fidedigno na avaliação da interação mãe-bebê. OBJECTIVE: To develop a study to assess the inter-rater reliability of a modified version of Brown's scale designed to investigate early mother-child interaction. METHOD: Fourteen postpartum women and their newborn babies took part in this study. The tape-recorded observations lasted 15 minutes, and they were performed on the second day after birth, during breast-feeding. In a successive and isolated moment, two evaluators scored each item of the interaction established between the mother and the newborn. In order to do so, a modified version of the scale of Brown and collaborators (1975), was used and submitted to a reliability study. RESULTS: Nine out of ten items of the modified scale revealed an excellent inter-rater agreement: The Kappa coefficient was 0.85 or higher. Only one item showed a moderate degree of agreement = 0.59, concerning "mother holds the baby." The results show that the modified scale is stable if used in a hospital setting for low-income mothers. CONCLUSIONS: The conclusion of this study indicates that categories are a reliable parameter to evaluate mother-baby interaction. OBJETIVO: Realizar un estudio de concordancia entre examinadores de la versión adaptada de una escala para la evaluación de la interacción madre-bebé (Brown y colaboradores - 1975). MÉTODO: catorce parturientas y sus recién nacidos participaron de este estudio. Las observaciones, que duraban quince minutos, fueron filmadas en la maternidad en el segundo día después del nacimiento del bebé, durante la amamentación. En un momento sucesivo e isoladamente, dos evaluadores atribuyeron escores para cada iten de interacción establecida entre la madre y el recién nacido. Para tal fin, fue utilizada y submetida al estudio de confiabilidad una versión adaptada de la escala de Browun y colaboradores (1975). RESULTADOS: nueve entre diez itens pertenecientes a la escala adaptada del estudio de Brown y colaboradores (1975) revelaron una concordancia excelente, el coeficiente Kappa arriba de 0,85. El único iten que presentó una concordancia moderada (K=0,59) fue "madre agarra el bebé" . Los resultados obtenidos indican la estabilidad de la escala adaptada y aplicada en ambiente hospitalar destinado a las madres de baja renta. CONCLUSIONES: los datos resultantes de este estudio indican que la utilización de las categorías es un parámetro fidedigno en la evaluación de la interacción madre-bebé.

Little is known about the use of psychotherapy to treat common mental disorders in a major city in a middle-income country. Our data come from in-home interviews with a stratified random sample of 2000 community residents aged 18 to 65 years in the city of São Paulo, Brazil. The information obtained included sociodemographic characteristics; psychotropic drugs; mental status; and lifetime, previous 12 months, and current use of psychotherapy. Logistic regression was used to examine determinants of use of psychotherapy. Of the sample, 22.7% met General Health Questionnaire-12 criteria for common mental disorders. Lifetime, previous 12 months, and current use of psychotherapy were reported by 14.6%, 4.6%, and 2.3% of the sample, respectively. Users typically were women, were more educated, had higher income, were not married, were unemployed, and had common mental disorders. Further analysis found that 47% (with higher education and income) paid out-of-pocket, and 53% used psychotropic medication. Psychotherapy does not seem to be the preferred treatment of common mental disorders.

OBJETIVO: Investigar a experiência de usuários de serviço público em uma breve intervenção psicoterápica de grupo, de orientação dinâmica. MÉTODOS: Dentre 52 pacientes que participaram de intervenção psicoterápica de grupo, em estudo de eficiência, 11 foram sorteados e submetidos a entrevistas retrospectivas em profundidade. O relato dos pacientes foi submetido à análise de conteúdo, segundo metodologia do Grounded Theory. RESULTADOS: A análise das entrevistas revelou que houve boa aceitação e avaliação positiva da intervenção psicoterápica por parte dos pacientes. Os principais achados foram a importância da interação entre os participantes e a trajetória terapêutica após o término da intervenção, na qual a maior parte dos pacientes deu seguimento à psicoterapia. CONCLUSÕES: A intervenção psicoterápica foi bem aceita pelos pacientes, produzindo resultados relevantes e estimulando a continuidade da psicoterapia. OBJECTIVE: To assess the experience of public service users in a time-limited psychotherapeutic group dynamic intervention. METHODS: Eleven patients were randomly selected from a group of 52 who had participated in an efficacy study and were interviewed in-depth. Their account was submitted to content analysis, according to the Grounded Theory methodology. RESULTS: In general, patients accepted well and positively evaluated the psychotherapy intervention. The main findings were the importance of patient's interaction with the group participants, and their therapeutic course after the intervention, when most of them carried on with psychotherapy. CONCLUSIONS: The psychotherapeutic intervention was well accepted among the patients, had a favorable outcome and stimulated them to proceed with psychotherapy.

To the Editor: I present a patient with recurrent depression who experienced remission on a fixed daily dose of 150 mg of venlafaxine in the first episode and 15 mg of escitalopram in the second episode. Postural nystagmus appeared after discontinuation of treatment in each episode. Case report. Mr A, a 56-year-old married man, had a 6-year history of recurrent major depressive disorder (MDD) according to the DSM-5. His first episode had begun by January 2007 when he was 50 years old. His depressive symptoms began to appear slowly and were characterized by depressed mood, irritability, diminished interest and pleasure in his everyday activities, loss of appetite, lack of energy, poor concentration, early morning waking, and recurrent thoughts such as, “It is not interesting being alive.” These symptoms led to impaired work and social functioning. His parents and sister had a history of symptoms of depression. Extended-release venlafaxine was started with 37.5 mg/d and was increased gradually to 150 mg/d in 4 weeks with no adverse effects. The patient experienced important symptomatic relief by week 4 and reached remission in 8 weeks. Functionality was completely restored by August 2007. For the next 18 months, Mr A was on the same treatment regimen with full MDD remission. Remarkably, 10 days after completion of slow antidepressant discontinuation (ie, taper for 2 months), Mr A, who had no medical history of eye problems, started experiencing position vertical and lateral nystagmus, usually at its worst in the morning. The symptom was ameliorated during the day, almost disappearing by night. No other visual problem was related by the patient or detected. The symptom persisted for 3 weeks but disappeared slowly at the end of the fifth week. In January 2010, MDD reappeared, characterized by similar symptoms as previously described but with the emergence of symptoms of anxiety and fatigue (both severely worsening in the morning) and serious impairment of social functioning. Escitalopram was administered at 5 mg/d, reaching 15 mg/d in 3 weeks with no unwanted effects. After 6 weeks, depression had remitted. During follow-up (18 months), there was no relapse. After slow discontinuation of escitalopram for 6 weeks, the patient experienced nystagmus with the same characteristics as described earlier, disappearing by 4 to 5 weeks. The literature includes only 1 report of positional nystagmus associated with amitriptyline withdrawal.1 There is another case report of a patient who manifested signs of serotonin syndrome during an intravenous anesthetic with remifentanil and propofol. The patient displayed nystagmus, lower extremity clonus, and diaphoresis. At the time of surgery, the patient was being treated with 60 mg of fluoxetine for severe MDD. His symptoms resolved in the surgical care unit without incident. Investigators have shown that fluoxetine2,3 and sertraline4 can induce oculomotor abnormalities during sleep in depressed patients. It is suggested that these abnormalities are likely to be the result of increased availability of serotonin5,6 and secondary dopaminergic effects.7–9 As the use of antidepressants continues to increase, the incidence of withdrawal symptoms is also likely to increase. Patients treated with antidepressants should be questioned specifically during the discontinuation phase about the presence of this unwanted effect. It is important to recognize its clinical features as well as the benign course after a few weeks of follow-up.

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment.

INTRODUÇÃO: Diversos estudos evidenciam que as alterações fisiopatológicas, quando associadas ao estresse, podem influenciar a fisiologia renal e estão associadas ao aparecimento de doenças. Entretanto, não foi encontrado nenhum estudo que tivesse realizado investigação associando estresse e lesão renal aguda. OBJETIVO: Avaliar a associação entre os eventos vitais estressores e o diagnóstico de lesão renal aguda, especificando as classes de eventos mais estressores para esses pacientes, nos últimos 12 meses. MÉTODOS: Estudo caso-controle. Foi realizado no Hospital São Paulo da Universidade Federal de São Paulo e no Hospital dos Servidores do Estado de São Paulo. Foram incluídos pacientes com lesão renal aguda, sem doenças crônicas, assistidos em Centros de Terapia Intensiva ou semi-intensivas. Os Controles incluíram pacientes assistidos nos mesmos Centros de Terapia Intensiva, com outras doenças agudas, exceto lesão renal aguda e, também, sem doenças crônicas. Dos 579 pacientes inicialmente identificados, 475 responderam ao instrumento Social Readjustment Rating Scale (SRRS) e 398 pacientes foram pareados por idade e sexo (199 casos/199 controles). RESULTADOS: Constatou-se que a frequência dos eventos vitais estressores nos casos apresentava equivalência estatística aos controles. A regressão logística para examinar os efeitos combinados das variáveis independentes associados aos eventos estressantes evidenciou que: o aumento da idade e as classes econômicas AB intensificam a chance da presença do evento estressante em cerca de duas vezes; as classes socioeconômicas AB do Hospital São Paulo elevam a chance de evento estressante. CONCLUSÕES: O presente estudo não evidenciou que o grupo com lesão renal aguda estivesse associado à maior frequência de eventos estressores, mas idade e renda elevadas e, ainda, o tipo de centro clínico estão associados. INTRODUCTION: Several studies point out that pathophysiological changes related to stress may influence renal function and are associated with disease onset and evolution. However, we have not found any studies about the influence of stress on renal function and acute kidney injury. OBJECTIVE: To evaluate the association between stressful life events and acute kidney injury diagnosis, specifying the most stressful classes of events for these patients in the past 12 months. METHODS: Case-control study. The study was carried out at Hospital São Paulo, in Universidade Federal de São Paulo and at Hospital dos Servidores do Estado de São Paulo, in Brazil. Patients with acute kidney injury and no chronic disease, admitted to the intensive or semi-intensive care units were included. Controls included patients in the same intensive care units with other acute diseases, except for the acute kidney injury, and also with no chronic disease. Out of the 579 patients initially identified, 475 answered to the Social Readjustment Rating Scale (SRRS) questionnaire and 398 were paired by age and gender (199 cases and 199 controls). RESULTS: The rate of stressful life events was statistically similar between cases and controls. The logistic regression analysis to detect associated effects of the independent variables to the stressful events showed that: increasing age and economic classes A and B in one of the hospitals (Hospital São Paulo - UNIFESP) increased the chance of a stressful life event (SLE). CONCLUSIONS: This study did not show association between the Acute Kidney Injury Group with a higher frequency of stressful life events, but that old age, higher income, and type of clinical center were associated.

A análise de componentes principais é uma técnica de estatística multivariada utilizada para examinar a interdependência entre variáveis. A sua principal característica é a capacidade de reduzir dados, e tem sido usada para o desenvolvimento de instrumentos de pesquisas psiquiátricas e na classificação dos transtornos psiquiátricos. Esta técnica foi utilizada para estudar a estrutura fatorial do Questionário de Morbidade Psiquiátrica do Adulto (QMPA). O questionário foi composto de 45 questões de resposta sim/não que identificam sintomas psiquiátricos, uso de serviço e de drogas psicotrópicas. O questionário foi aplicado em 6.470 indivíduos maiores de 15 anos, em amostras representativas da população de três cidades brasileiras (Brasília, São Paulo e Porto Alegre). O estudo teve como objetivo comparar a estrutura fatorial do questionário nas três regiões urbanas brasileiras. Sete fatores foram encontrados que explicam 42,7% da variância total da amostra. O fator 1, Ansiedade/Somatização ("eigenvalue" (EV) = 3.812 e variância explicada (VE) = 10,9%); O fator 2, Irritabilidade/Depressão (EV = 2.412 e VE = 6,9%); O fator 3, Deficiência Mental (EV= 2.014 e VE = 5,8%); O fator 4, Alcoolismo (EV = 1.903 e VE = 5,4%); O fator 5, Exaltação do Humor (EV = 1.621 e VE = 4,6%); O fator 6, Transtorno de Percepção (EV = 1.599 e VE = 4,6%) e o fator 7, Tratamento (EV = 1.592 e VE = 4,5%).O QMPA apresentou estruturas fatoriais semelhantes nas três cidades. Baseados nos achados, são feitas sugestões para que algumas questões sejam modificadas e para a exclusão de outras em uma futura versão do questionário. Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptons and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasília, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue=3.81, 10.9%); Irritability/Depression (eigenvalue =2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue =1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/ Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

To the Editor: Despite wide-ranging clinical use of antidepressants to treat depression alone as well as depression associated with polycystic ovary syndrome (PCOS), there have been no reports to date on the use of serotonin reuptake inhibition with a successful outcome of both major depressive disorder (MDD) and PCOS symptomatology, such as oligomenorrhea/amenorrhea and hirsutism. Case report. Ms A, a 40-year-old married woman, had a 20-year history of recurrent MDD (DSM-IV). Her first episode began when she was 20 years old. Seven years ago, her depressive symptoms began to appear slowly, characterized by depressed mood, irritability, diminished interest in her usual activities, loss of appetite, weight loss, lack of energy, poor concentration, insomnia, and recurrent thoughts of death, such as “It would be nice not being alive.” These symptoms led to impaired work and social functioning. Her mother had a history of chronic depressive mood disorder. Ms A also had a 26-year history of PCOS, characterized by oligomenorrhea or amenorrhea, hirsutism, hyperandrogenism, and polycystic ovaries, confirmed by several laboratory tests and ultrasound, meeting the 2003 Rotterdam, or European Society for Human Reproduction/American Society for Reproductive Medicine (ESHRE/ASRM), criteria.1 Twenty years ago, her gynecologist suggested lifestyle changes such as exercises, nutritional guidance, low doses of oral contraceptive pills, cosmetic therapy, and laser therapy for hirsutism. With the use of oral contraceptive pills, Ms A experienced an improvement in her menstrual cycles, although she continued to have mood swings, irritability, and severe headaches, which were extremely distressing. She was switched to several oral contraceptive pills, but all showed severe side effects. She discontinued all oral contraceptive pills after a few months of use. In 2003, Ms A presented for treatment of MDD. Escitalopram—a selective serotonin reuptake inhibitor, not an oral contraceptive pill—was administered at 5 mg/d, with the dosage reaching 20 mg/d in 3 weeks. After 4 weeks of treatment, Ms A experienced clinically significant depressive symptomatic relief. Remission was achieved in 8 weeks. Over the next 18 months, she continued to receive escitalopram and experienced a return of regular menstrual cycles and improvement in hirsutism. She reported transient mild nausea at the beginning of treatment; no other side effects were reported. Remarkably, 2 months after antidepressant discontinuation, she started experiencing menstrual irregularity and hair growth. Ten months later, MDD recurred. During the next 4 years, she was on treatment with escitalopram at 20 mg/d and remained symptom-free. Meanwhile, she achieved notable menstrual cycle improvement and reduction in hirsutism. As Ms A was feeling well, she stopped taking the medication on her own and her menstrual complaints immediately recurred. She restarted escitalopram in 4 months, and her PCOS symptoms remitted again. This was the longest regular menstrual cycle period she had ever had with no use of oral contraceptive pills. Last year, her ultrasounds continued to show polycystic ovaries. Reports have revealed that hyperandrogenism, hormonal disturbances, obesity, ovarian dysfunction, hypothalamic pituitary abnormalities, and insulin resistance are implicated in the etiology of PCOS.2,3 Hormonal dysregulation is involved with both MDD and PCOS. As mood disorders and PCOS share some level of genetic and pathophysiologic mechanisms,4,5 the intervention on common metabolic changes can treat both conditions.

The health burden associated with comorbid depression and diabetes in older community residents in middle income countries is unclear.Data came from a statewide representative sample (N = 6963, age ≥ 60) in Brazil. Controlled polytomous logistic regression was used to determine whether four mutually exclusive groups (all possible combinations of the presence or absence of depression and diabetes) differed in sociodemographic characteristics, social resources, health behaviors, and selected health conditions.While 2.37% were expected to have comorbid depression/diabetes given sample base rates (depression: 20.92% [1457/6963]; diabetes: 11.35% [790/6959]), comorbidity was present in 3.62% (52.5% beyond expectation; P0.0001; OR = 1.58, 95% Confidence Interval 1.29-1.95). Depression without diabetes was reported by 17.3%, and diabetes without depression by 7.7%. In controlled analyses, the depression group had poorer socioeconomic status and health behaviors, and a greater likelihood of vascular, respiratory, and musculoskeletal problems than the diabetes group. Vascular, respiratory, and urinary problems were exacerbated in comorbid depression/diabetes; the comorbid group was also more likely to be female and younger.Cross-sectional design.To our knowledge, this is the first study that explicitly reports on all four possible depression/diabetes combinations in an older representative community-resident sample, using controlled analyses to identify unique associations with sociodemographic characteristics and other health conditions. The burden of comorbid depression/diabetes in Brazil, a middle income country, appears to be comparable to that found in higher income countries. So, similarly, depression without diabetes had a greater odds of adverse sociodemographic and health conditions than diabetes without depression; comorbid depression/diabetes was more likely in women and young elderly, and the odds of vascular, respiratory, and urinary conditions was increased significantly. Attention to comorbid depression/diabetes as a unique entity is needed.

OBJECTIVE: To assess public stigma in relation to people with schizophrenia and possible factors associated with this phenomenon. METHOD: A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of São Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with schizophrenia (according to DSM-IV and ICD-10 criteria). This was followed by questions that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette. RESULTS: People with schizophrenia were perceived as potentially dangerous by 74.2% of interviewees. In addition, 59.0% of the sample perceived them as capable of arousing negative reactions, and 57.2%, as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly pro-social in nature. The most important factors associated with these responses were: attribution of 'biological' causes and perceived dangerousness. CONCLUSION: This study indicated that beliefs related to public stigma towards people with schizophrenia are commonly held in São Paulo city. An important focus for future studies is to investigate the scope and impact of public stigma on the everyday experiences of people with schizophrenia in the Brazilian context.