Time series analysis of suicide from a monthly perspective in the south of Brazil: an ecological study.

INTRODUCTION: Suicide is the cause of death of almost 800 thousand people worldwide every year. In Brazil, Rio Grande do Sul is one of the states with the highest suicide rates. This study aimed to assess whether there is a significant monthly time pattern of suicide in Rio Grande do Sul, by gender and age ranges, and whether suicide characteristics in the state are coherent with findings from previous studies. METHODS: All data were collected from official secondary sources maintained by the national Brazilian and Rio Grande do Sul governments, covering a period from 2015 to 2019. Data included suicide deaths and population, divided by gender and age range. Sum totals, frequencies, odds ratios, and time series analyses were performed. RESULTS: From 2015 to 2019, 6,287 people committed suicide in Rio Grande do Sul. Most of them were men and the most prevalent age band was from 50 to 59 years old. Men had higher suicide rates then women in all age ranges (p < 0.001) and in all months of the year, with an approximately 4-fold higher risk of committing suicide when compared to women. Men had a trending peak of suicide in January and December (p < 0.001), whereas women's suicide rates peaked in March and December (p = 0.001). CONCLUSION: There are monthly time trends and seasonal patterns of suicide rates in Rio Grande do Sul, varying by gender and age range. Gender differences occurred mainly in the first three months of the year, and the age pattern was more evident among individuals aged 60 years or older.

Evaluation of quality of life in adults with chronic health conditions: the role of depressive symptoms.

OBJECTIVE: The negative impact of depressive symptoms on quality of life has been the focus of increasing attention, yet this relation remains unstudied in samples from developing countries. The objective of this study was to determine whether the occurrence of depressive symptoms is associated with impaired quality of life and whether this association remains significant after adjustment for some variables. METHOD: A convenience sample was selected and the measures used were the WHOQOL-100, to assess quality of life, the Beck Depression Inventory, to screen for depressive symptoms, and the Economic Classification Criterion - Brazil, to evaluate socioeconomic status. RESULTS: One hundred nineteen healthy adults (community) and 122 adult patients (tertiary hospital) from Brazil were assessed. Depressive symptoms were negatively correlated with all the domains of quality of life, even after statistical control for age, socioeconomic status, and presence of chronic health conditions. Socioeconomic status was positively correlated with the social relationships and environmental domains of quality of life. CONCLUSION: Our findings indicate that depressive symptoms and socioeconomic status are important elements affecting the relationship between chronic health conditions and quality of life in Brazil.

The association of electroconvulsive therapy to pharmacological treatment and its influence on cytokines.

INTRODUCTION: A growing body of evidence shows that disturbances in the immune system are involved in the pathogenesis of depression. Although the immune-modulating effects of antidepressants have been described, few studies have addressed the functioning of the immune system in relation to electroconvulsive therapy (ECT). This study aims to investigate if the addition of ECT to pharmacotherapy is associated with changes in cytokine levels. METHODS: Adult inpatients were invited to participate in this study on admission to a psychiatric unit. Those with a diagnosis of depression by Mini-International Neuropsychiatric Interview were included. At treatment discharge, patients were retrospectively divided into those who used combined ECT and pharmacotherapy (31 subjects) and those who used only pharmacotherapy (68 subjects). Pro-inflammatory cytokines IL-2, IL-6, TNF-α, IFN-γ, and IL-17, and anti-inflammatory IL-4 and Il-10, were measured in blood samples collected at admission and discharge. A generalized estimating equation model and the post hoc Bonferroni test were performed for statistical analysis. RESULTS: The combination of ECT with pharmacotherapy was associated with a decrease of IL-6 and an increase of TNF-α. Depressive inpatients, as a whole group, had a decrease of IL-6 and an increase of IFN-γ. No significant results were found for IL-2, IL-4, Il-10 and IL-17. CONCLUSION: This study is clinically relevant because we highlight that, in agreement with the previous literature, IL-6 appears to be a useful marker in depression, and we show for the first time that its reduction is closely related to the use of ECT.

Time series analysis of suicide from a monthly perspective in the south of Brazil: an ecological study

Abstract Introduction: Suicide is the cause of death of almost 800 thousand people worldwide every year. In Brazil, Rio Grande do Sul is one of the states with the highest suicide rates. This study aimed to assess whether there is a significant monthly time pattern of suicide in Rio Grande do Sul, by gender and age ranges, and whether suicide characteristics in the state are coherent with findings from previous studies. Methods: All data were collected from official secondary sources maintained by the national Brazilian and Rio Grande do Sul governments, covering a period from 2015 to 2019. Data included suicide deaths and population, divided by gender and age range. Sum totals, frequencies, odds ratios, and time series analyses were performed. Results: From 2015 to 2019, 6,287 people committed suicide in Rio Grande do Sul. Most of them were men and the most prevalent age band was from 50 to 59 years old. Men had higher suicide rates then women in all age ranges (p < 0.001) and in all months of the year, with an approximately 4-fold higher risk of committing suicide when compared to women. Men had a trending peak of suicide in January and December (p < 0.001), whereas women's suicide rates peaked in March and December (p = 0.001). Conclusion: There are monthly time trends and seasonal patterns of suicide rates in Rio Grande do Sul, varying by gender and age range. Gender differences occurred mainly in the first three months of the year, and the age pattern was more evident among individuals aged 60 years or older.

Novas perspectivas nas psicoterapias em gays e lésbicas / New perspectives on psychotherapies with gays and lesbians

INTRODUÇÃO: O estigma que gays e lésbicas sofrem configura uma questão de saúde pública. Frequentemente, a procura de psicoterapia por esses pacientes é motivada por fatores relacionados a dificuldades de relacionamento com o meio. Dessa forma, a psicoterapia é uma ferramenta valiosa para mitigar os efeitos deletérios do estresse de minorias e dos novos impactos psicossociais advindos da pandemia. MÉTODO: Foi realizada uma revisão narrativa da literatura indexada em bases de dados utilizando palavras-chaves obtidas a partir de vocabulários controlados e sinônimos. A amostragem foi por conveniência. RESULTADOS: Diferentes modelos de psicoterapias foram adaptados às necessidades das minorias sexuais, como protocolos baseados nas terapias interpessoal, psicodinâmica e cognitivo-comportamental. Os modelos atuais da identidade sexual incorporam conceitos como homonegatividade internalizada e estresse de minorias, com conflitos que podem ser descritos em estágios passíveis de intervenções psicoterápicas específicas. Adicionalmente, a pandemia de COVID-19 pareceu trazer à tona uma série de novos possíveis estressores para indivíduos pertencentes a minorias sexuais, como o isolamento social e o aumento no consumo de álcool. DISCUSSÃO: Diversos modelos de psicoterapia mostram resultados satisfatórios em gays e lésbicas. Os principais fatores relacionados ao êxito terapêutico são a adoção de uma postura não julgadora e em uma aliança terapêutica sólida. CONCLUSÃO: A psicoterapia apresenta-se como um tratamento de notável valor ao atenuar o possível sofrimento psíquico de gays e lésbicas, principalmente diante da intensificação do estresse de minorias durante a pandemia de COVID-19.

INTRODUCTION: The stigma suffered by gays and lesbians is a public health issue. Frequently, the demand of psychotherapy by these patients is motivated by factors related to relationship difficulties with the environment, which makes psychotherapy a valuable instrument to reduce the deleterious effects of minority stress and the new psychosocial impacts resulting from the pandemic. METHOD: A narrative review of literature indexed in databases was conducted using keywords obtained from controlled vocabularies and synonyms. The sampling was by convenience. RESULTS: Different models of psychotherapies have been adapted to the needs of sexual minorities, such as protocols based on interpersonal, psychodynamic and cognitive-behavioral therapies. Current models of sexual identity include concepts such as internalized homonegativity and minority stressors, with conflicts that can be described in stages amenable to specific psychotherapeutic interventions. The pandemic of COVID-19 seemed to bring out a number of new potential stressors for individuals belonging to sexual minorities, for exemple social isolation and increased alcohol consumption. DISCUSSION: Several models of psychotherapy demonstrate satisfactory results in gays and lesbians. The main factors related to therapeutic success are the adoption of a non-judgmental stance and in a solid therapeutic alliance. Minority stress, intensified during the COVID-19 pandemic, contributes to negative mental health outcomes. CONCLUSION: Psychotherapy presents itself as a treatment of notable value in alleviating the psychological suffering of gays and lesbians, especially in the face of intensified minority stress during the COVID-19 pandemic.

INTRODUCCIÓN: El estigma que sufren gays y lesbianas es un problema de salud pública. A menudo, la demanda de psicoterapia por parte de estos pacientes está motivada por factores relacionados con las dificultades de relación con el entorno, lo que convierte a la psicoterapia en un valioso instrumento para reducir los efectos deletéreos del estrés minoritario y los nuevos impactos psicosociales derivados de la pandemia. MÉTODO: Se realizó una revisión narrativa de la literatura indexada en bases de datos utilizando palabras clave obtenidas de vocabularios controlados y sinónimos. El muestreo fue por conveniencia. RESULTADOS: Se han adaptado diferentes modelos de psicoterapias a las necesidades de las minorías sexuales, como protocolos basados en terapias interpersonales, psicodinámicas y cognitivo-conductuales. Así, la psicoterapia afirmativa emerge como un modelo transteórico asociado a mejores resultados en salud mental que auxilia en la expresión de la identidad sexual de los individuos, aunque no se ajuste a la norma social. La pandemia de COVID-19 pareció generar una serie de nuevos factores estresantes para las personas pertenecientes a minorías sexuales. DISCUSIÓN: Varios modelos de psicoterapia demuestran resultados satisfactorios en gays y lesbianas. Los principales factores relacionados con el éxito terapéutico son la adopción de una postura libre de juicios y en una sólida alianza terapéutica. El estrés de las minorías, intensificado durante la pandemia de COVID-19, contribuye a los resultados negativos de salud mental. CONCLUSIÓN: La psicoterapia se presenta como un tratamiento de notable valor para aliviar el sufrimiento psicológico de gays y lesbianas, especialmente ante el estrés de las minorías intensificado durante la pandemia de COVID-19.

Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade.

Childhood trauma (CT) is a modifiable risk factor for lifetime suicide attempts (SA). However, the extent to which each type of CT increases SA risk is unclear. This study aimed to conduct a meta-analysis of longitudinal studies published in the last 10 years about the relationship between CT and lifetime SA risk. The PUBMED, PsycINFO, ISI, and EMBASE databases were searched for cohort studies that reported AS during follow-up and included an assessment of CT. A meta-analysis was conducted to identify potential effects of each type of CT on SA. Seven unique studies were included for review. Sexual (n=6, OR=3.73, 95%CI 2.94-4.75, p<0.001), physical (n=6, OR=4.11, 95%CI 2.30-7.33, p<0.001), and emotional abuse (n=3, OR=3.98, 95%CI 2.89-5.64, p<0.001), as well as physical neglect (n=2, OR=3.42, 95%CI 2.09-5.59, p<0.001), were associated with SA. Emotional neglect and a broken home were not significantly associated with further SA. The modes of CT that most contribute to SA in later life are physical, emotional, and sexual abuse and physical neglect, in descending order.

A implementação de psicoterapia on-line em um programa de residência médica em psiquiatria durante a pandemia de COVID-19 / The implementation of online psychotherapy in a medical residency program in psychiatry during the COVID-19 pandemic

O impacto da pandemia de SARS-CoV2 e as recomendações de reduzir a circulação de pessoas produziu uma série de mudanças no nosso cotidiano. Tratamentos tradicionalmente realizados face-a-face de forma presencial as psicoterapias sofreram forte impacto com riscos de abandono e interrupção. O objetivo deste artigo é apresentar um relato de experiência sobre o processo de implementação de psicoterapia on-line no ambulatório de psicoterapias do Serviço de Psiquiatria de um hospital escola durante a pandemia de SARS-CoV2, exibindo as principais adaptações realizadas nos procedimentos de comunicação, protocolos de atendimento e registros das sessões de psicoterapia. Tendo como foco a garantia da manutenção dos atendimentos durante períodos de distanciamento social foram criadas diretrizes para a realização de psicoterapia on-line com a elaboração de um manual norteador (Material suplementar) de procedimentos para continuidade dos atendimentos dentro dos parâmetros éticos e técnicos estabelecidos pelo serviço. O manual foi elaborado a partir da discussão entre supervisores e residentes, de forma que refletisse a realidade e as demandas comumente atendidas. As adaptações realizadas no ambulatório foram norteadas por quatro grandes objetivos: 1) manutenção e continuidade dos atendimentos; 2) diminuição de barreiras de comunicação entre psicoterapeuta-paciente; 3) manutenção de reuniões on-line e web conferência entre todos os membros da equipe e manutenção dos estudos e; 4) normatização de procedimentos durante as sessões de psicoterapia.(AU)

The impact of the SARS-CoV2 pandemic and the recommendations to reduce the movement of people and agglomerations produced a series of changes in our daily lives, changing the way various health services were provided. Treatments traditionally performed face-to-face such as psychotherapies suffered a strong impact with risks of abandonment and interruption. This paper is an experience report about the process online psychotherapy implementation in a Psychiatry School Hospital Service during the SARS-CoV2 pandemic, showing the adaptations in communication procedures, care protocols and records of psychotherapy sessions. With a focus on ensuring the maintenance of care during periods of social distancing, guidelines were created for online psychotherapy based on the preparation of a guiding manual (Supplementary material) of procedures so that care was performed within the parameters ethical and technical established by the service. The manual was created from the discussion between supervisors and residents, so that it reflected the reality and demands commonly met. The adaptations were guided by four major objectives: 1) maintenance and continuity of care, 2) reduction of communication barriers between psychotherapist-patient, 3) maintenance of online meetings and web conferences between all team members and maintenance of studies and 4) standardization of procedures during psychotherapy sessions.(AU)

El impacto de la pandemia de SARS-CoV2 y las recomendaciones para reducir el movimiento de personas ha producido una serie de cambios en nuestra vida cotidiana. Los tratamientos tradicionalmente realizados en psicoterapias presenciales sufrieron un fuerte impacto con riesgos de abandono e interrupción. El propósito de este artículo es presentar un informe de experiencia sobre el proceso de implementación de la psicoterapia online en el ambulatorio de psicoterapia del Servicio de Psiquiatría de un hospital escuela durante la pandemia de SARSCoV2, mostrando las principales adaptaciones realizadas en los procedimientos de comunicación, protocolos asistenciales y registros de sesiones de psicoterapia. Con el foco en asegurar el mantenimiento de la atención durante los períodos de distanciamiento social, se crearon pautas para la realización de la psicoterapia en línea a partir de la elaboración de un manual guía (Material Complementario) de procedimientos para que las exploraciones asistenciales se realizaran dentro de los parámetros éticos y técnicos establecidos por el servicio. Las adaptaciones realizadas en el ambulatorio se basaron en cuatro objetivos principales: 1) mantenimiento y continuidad de la atención; 2) reducción de las barreras de comunicación entre psicoterapeuta-paciente; 3) mantenimiento de reuniones en línea y conferencias web entre todos los miembros del equipo y mantenimiento de estudios y; 4) estandarización de los procedimientos durante las sesiones de psicoterapia.(AU)

Combining ECT with pharmacological treatment of depressed inpatients in a naturalistic study is not associated with serum BDNF level increase.

BACKGROUND: BDNF blood levels are reduced in MDD. They can be increased with pharmacologic treatment and ECT, but it is not clear whether the combination of treatments promotes an additional increase. The present study aims to evaluate whether combined treatment promotes an increase in BDNF, restoring the level to that of non-depressed controls. METHODS: Ninety-nine adult inpatients were invited to participate in this naturalistic prospective cohort study between May 2011 and April 2013. Diagnosis was made by MINI, and the symptoms were evaluated at admission and at discharge by HDRS-17. Those inpatients with a diagnosis of depression were included and divided into two groups: those who underwent combined ECT and medication (31 subjects) and those who used only pharmacotherapy (68 subjects). Serum BDNF was measured in blood samples collected at admission and discharge. One hundred healthy blood donors without any psychiatric diagnosis were included as a control group. RESULTS: There were no significant differences in serum BDNF levels between the combined and pharmacological groups at admission and at discharge, and no significant variation in BDNF occurred in any group during the treatment. There were no interactions between time and treatment groups nor significant time effects or treatment group effects for BDNF in the Generalized Estimating Equation Model (GEE). The control group had significantly higher serum BDNF levels in comparison with each of the treatment groups at admission and discharge (p = 0.00). CONCLUSION: Combination of ECT with pharmacological treatment did not result in increased serum BDNF levels and did not restore levels to that of controls.

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure.

BACKGROUND: Spirituality may influence how patients cope with their illness. OBJECTIVES: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. METHODS: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. RESULTS: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. CONCLUSION: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient's care may lead to an improvement in adherence patterns in the complex heart failure management.

The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI).

BACKGROUND: The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE: To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS: Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> or = 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS: Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS: Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.

A troca de psicoterapeuta e o impacto na condição global de pacientes em ambulatórios de residência em psiquiatria / The change of psychotherapist and the impact on the overall condition of patients in outpatient clinics in psychiatry

O processo de troca de psicoterapeuta durante o tratamento em psicoterapia de orientação analítica, em geral, caracteriza-se por ser prejudicial e até mesmo traumático em boa parte dos casos. Porém, trata-se da realidade assistencial em hospitais universitários, em virtude da necessidade de rodízio de atendimentos pelos médicos residentes em formação psiquiátrica durante seu treinamento em psicoterapia e de psiquiatras realizando especialização em psicoterapia. Este trabalho visa revisar este tema pouco abordado na literatura através da proposição de possíveis cenários de como a troca de terapeuta pode ser encarada pelo paciente, ilustrando com algumas vinhetas clínicas. Concluímos que o tema precisa ser expandido para avaliar o melhor encaminhamento para esse contexto clínico, institucional e socioeconômico, visto não haver consenso teórico e técnico que norteiem a abordagem mais adequada e menos traumática para o paciente.(AU)

The process of changing psychotherapist during treatment in analytically oriented psychotherapy is often harmful and even traumatic in most cases. However, this is the reality of care in university hospitals, due to the need for rotation of care by medical residents in training during their qualification in psychotherapy and psychiatrists performing specialization in psychotherapy. This paper aims to review this little addressed theme in the literature by proposing possible scenarios of how the therapist change can be viewed by the patient, illustrating with some clinical vignettes. We conclude that the theme needs to be expanded to evaluate the best referral to this clinical, institutional and socioeconomic context, since there is no theoretical and technical consensus that guides the most appropriate and least traumatic approach for the patient.(AU)

El proceso de cambio de terapeuta durante el tratamiento en psicoterapia de orientación analítica, en general, se caracteriza por ser perjudicial e, incluso, traumático en gran parte de los casos. Sin embargo, se trata de la realidad asistencial en hospitales universitarios, en virtud de la necesidad de rotación en la atención por parte de los residentes en formación en psicoterapia y psiquiatras que realizan especialización en psicoterapia. Este trabajo busca revisar este tema poco analizado en la literatura a través de la proposición de posibles escenarios de cómo el cambio de terapeuta puede ser tomado por el paciente, ilustrando algunos casos clínicos. Concluimos que el asunto necesita ser ampliado para evaluar cuál sería el mejor camino para este contexto clínico, institucional y socioeconómico, una vez que no hay consenso teórico y técnico que orienten hacia un abordaje más adecuado y menos traumático para el paciente.(AU)

Propriedades psicométricas do protocolo de sistema diagnóstico Operationalization of Psychodynamic Diagnosis 2 (OPD-2) em pacientes com transtorno mental grave em psicoterapia / Psychometric properties of the Operationalization of Psychodynamic Diagnosis 2 (OPD-2) diagnostic system protocol in patients with severe mental disorder undergoing psychotherapy

INTRODUCTION: In order to expand the descriptive classification of symptoms in mental disorders, and to bring empirical consistency to psychodynamic/psychoanalytic models, a multiaxial instrument called Operationalized Psychodynamic Diagnosis (OPD-2) has been developed, allowing psychotherapy research to encompass the complexity of the relationships between conditions and factors that determine the phenomena of mental pathologies, from a psychodynamic point of view. METHODOLOGY: Longitudinal naturalistic study with 80 outpatients with severe mental disorders, who were treated with a) psychodynamic psychotherapy, b) interpersonal psychotherapy and c) cognitive behavioral psychotherapy. All patients were interviewed at baseline and after six months, according to OPD-2's criteria. They all also completed two self-report measures (WHOQOL-BREF and SCL-90R) to evaluate symptoms and quality of life at each assessment point. RESULTS: According to OPD-2's axis I, better personal resources, psychosocial support, and introspective capacity significantly correlated with fewer symptoms in the BDI's and SCL-90's measures. Also, symptoms' reduction and quality of life's domains significantly correlated with items that assessed OPD-2's "desire for care versus autarchy" and "identity" conflicts. There was also a significant correlation between all items that evaluate structural functioning according to OPD-2 and the SCL-90R's psychotic index. Regarding predictive validity analysis, we observed mean differences in the structural functioning of patients with a history of suicide attempt and previous history of hospitalization. DISCUSSION: results support that OPD-2's criteria significantly correlates with data from validated self-report measures. When administered by trained raters, OPD-2 displayed good quality in assessing patients' conflicts and structural issues. This evidence suggests that the Brazilian version of OPD-2 is a valid and reliable instrument in evaluating psychodynamic properties and can be a useful tool within the clinical and research contexts. (AU)

Evaluating psychiatric case-control studies using the STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) statement.

CONTEXT AND OBJECTIVE: Case-control studies are important in developing clinical and public health knowledge. The STROBE statement (STrengthening the Reporting of OBservational Studies in Epidemiology) was developed to establish a checklist of items that should be included in articles reporting observational studies. Our aim was to analyze whether the psychiatric case-control articles published in Brazilian journals with CAPES Qualis rating B1/B2 in 2009 conformed with the STROBE statement. DESIGN AND SETTING: Descriptive study on psychiatric papers published in Brazilian journals, within the Postgraduate Medical Program on Psychiatry, at Universidade Federal do Rio Grande do Sul. METHODS: All psychiatric case-control studies from Brazilian Qualis B1/B2 journals of psychiatry, neurology and public health in 2009 were analyzed. The four most specific items of the STROBE statement were used to evaluate whether these studies fitted within the case-control parameters: 1) selection of cases and controls; 2) controlling for bias; 3) statistical analysis; and 4) presentation of results. RESULTS: Sixteen case-control studies were identified, of which eleven (68.75%) were in psychiatry-focused journals. From analysis using the STROBE statement, all of the articles conformed with item 1; two (12.5%) completely conformed with item 2; none completely conformed with item 3; and only three (18.8%) conformed with item 4. CONCLUSION: The case-control studies analyzed here did not completely conform with the four STROBE statement items for case-control design. In view of the inadequate methodology of the published studies, these findings justify focusing on research and methodology and expanding the investigations on adherence of studies to their designs.

Teoria do Apego: conceitos básicos e implicações para a psicoterapia de orientação analítica / Theory of Attachment: basic concepts and implications for psychoanalytic psychotherapy

A Teoria do Apego (TA) descreve como os primeiros vínculos de um indivíduo podem moldar as expectativas futuras dele sobre si e sobre o mundo e descreve também formas com as quais a terapia pode remodelar essas expectativas. Apesar de possuir alguns pontos de divergência com ideias freudianas e kleinianas, essa teoria apresenta também muitas convergências com ideias de psicanalistas como Fairbairn e Winnicott. Assim, o objetivo deste artigo é discorrer sobre os preceitos básicos da TA, sobre suas semelhanças e diferenças com outras escolas da psicodinâmica e sobre suas implicações para a psicoterapia de orientação analítica. Nessa última parte, será apresentado um caso que ilustra conceitos dessa teoria.(AU)

Attachment Theory (AT) describes how an individual's first relationships can shape his/her future expectations about his/herself and about others and it also describes how these expectations can be remodeled through psychotherapy. Despite AT may differ from Freudian and Kleinian ideias, this theory also holds similarities with ideas from psychoanalysts as Fairbairn and Winnicott. Therefore, this study aims to discuss basic concepts about AT, similarities and differences regarding AT and other psychodynamic schools and its implications for psychodynamic psychotherapy. During this last part, a clinical case that illustrates AT concepts will be described.(AU)

Brazilian validation of the Quality of Life Instrument/spirituality, religion and personal beliefs.

OBJECTIVE: To analyze the psychometric properties of the World Health Organization's Quality of Life Instrument--Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB). METHODS: The WHOQOL-SRPB, the Brief Spiritual/Religious Coping Scale (Brief-SRCOPE Scale), the WHOQOL-BREF and the Beck Depression Inventory (BDI) were consecutively applied in a convenience sample of 404 patients and workers of a university hospital and workers of a university, in the city of Porto Alegre, Southern Brazil, between 2006 and 2009. The sample was stratified by sex, age, health status and religion/belief. The retest of the two first instruments was conducted with 54 participants. Exploratory factorial analyses of the WHOQOL-SRPB with the method of main components were performed, without limiting the number of factors, and requiring eight factors concomitantly with the WHOQOL-BREF items. RESULTS: The Brazilian Portuguese version of the WHOQOL-SRPB (General SRPB-Domain) showed construct validity, with a discriminatory validity between believers and non-believers (t = 7.40; p = 0.0001); concurrent criterion-related validity, distinguishing depressed individuals from non-depressed ones (t = 5.03; p = 0.0001); convergent validity with the WHOQOL-BREF (physical r = 0.18; psychological r = 0.46; social r = 0.35; environmental r = 0.29; global r = 0.23; p = 0.0001) and with the SRPB-Domain of the WHOQOL-100 (r = 0.78; p = 0.0001); and convergent/discriminatory validity with the brief SRCOPE Scale (with positive SRCOPE r = 0.64; p = 0.0001/negative SRCOPE r = -0.03; p = 0.554). Excellent test-retest reliability (t = 0.74; p = 0.463) and internal consistency (α = 0.96; intrafactorial correlation 0.87 > r > 0.60; p = 0.0001) were observed. The exploratory factorial analyses performed corroborated the eight-factor structure of the WHOQOL-SRPB multicenter study. CONCLUSIONS: The Brazilian Portuguese version of the WHOQOL-SRPB showed good psychometric qualities and use valid and reliable in Brazil. It is suggested that new studies be conducted with specific populations, such as different religions, cultural groups and/or diseases.

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure / Associação entre Espiritualidade e Adesão ao Tratamento em Pacientes Ambulatoriais com Insuficiência Cardíaca

Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

Resumo Fundamento: A espiritualidade pode influenciar a maneira com que os pacientes lidam com sua doença. Objetivos: Avaliamos a possibilidade de a espiritualidade influenciar a adesão ao tratamento de pacientes ambulatoriais com insuficiência cardíaca. Métodos: Estudo transversal com pacientes ambulatoriais com insuficiência cardíaca, cuja adesão ao tratamento multidisciplinar foi avaliada. Os pacientes foram avaliados sobre qualidade de vida, depressão, religiosidade e espiritualidade, utilizando questionários validados. Foram obtidas correlações entre adesão e variáveis psicossociais de interesse. Modelos de regressão logística exploraram preditores independentes de adesão. Resultados: Cento e trinta pacientes (idade 60 ± 13 anos; 67% masculinos) foram entrevistados. Observou-se adequado escore de adesão em 38,5% dos pacientes. Nem a depressão ou a religiosidade foram correlacionados à adesão, quando avaliados separadamente. É interessante notar que quando a espiritualidade foi avaliada por ambos, o somatório total de score (r = 0,26; p = 0,003) e os domínios específicos, ela estava positivamente correlacionada à adesão. Por fim, a combinação de espiritualidade, religiosidade e crenças pessoais mostrou-se um preditor independente de adesão quando ajustado às características demográficas, clínicas e a instrumentos psicossociais. Conclusão: Espiritualidade, religiosidade e crenças pessoais foram as únicas variáveis consistentemente associadas à adesão em relação à medicação em uma coorte de pacientes ambulatoriais com insuficiência cardíaca. Nossos dados sugerem que abordar adequadamente esses aspectos no cuidado com o paciente pode auxiliar a melhorar o padrão de adesão no complexo tratamento da insuficiência cardíaca.

Field-test validation of the brazilian version of the Paediatric Asthma Quality of Life Questionnaire.

OBJECTIVE: To assess the psychometric properties of the official Brazilian Portuguese-language version of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) in a representative group of Brazilian children and adolescents with asthma. METHODS: A total of 125 individuals with asthma, aged 8-17 years and being monitored at a pediatric pulmonology outpatient clinic in the city of Porto Alegre, Brazil, completed the PAQLQ. Validity was assessed by means of convergent validity (correlation between PAQLQ domains and those of the Pediatric Quality of Life Inventory (PedsQL) 4.0. Reliability was assessed by determining internal consistency (Cronbach's alpha coefficient), reproducibility (intraclass correlation coefficient), sensitivity to change (effect size), and discriminatory power (floor/ceiling effects). RESULTS: The mean age was 11 years, and 75 (60%) of the participants were male. The mean PAQLQ total score was 5.1, with floor/ceiling effects < 10%. Correlations between PAQLQ domains and the PedsQL 4.0 domains were acceptable (r = 0.37-0.40). The Cronbach's alpha coefficient for the total score was 0.93, ranging from 0.72 to 0.88 for the domains. The overall effect size was 0.60 (range: 0.45-0.60), whereas the overall intraclass correlation coefficient was 0.80 (range: 0.66-0.79). CONCLUSIONS: The official Brazilian Portuguese-language version of the PAQLQ showed good psychometric performance, confirming its cultural adequacy for use in Brazil.

Pesquisa em psicoterapia psicanalítica de adultos: uma revisão sistemática de ensaios clínicos / Research in psychoanalytic psychotherapy for adults: a systematic review of clinical trials

O objetivo deste estudo é reunir os ensaios clínicos que envolveram alguma modalidade de Psicoterapia Psicanalítica publicados no período compreendido entre julho de 2008 e julho de 2013. Pretendemos identificar quais as modalidades contempladas, qual a população mais estudada, quais os fatores de interesse mais estudados, que localidades apresentam maior produção e quais os principais resultados encontrados. A revisão foi realizada em julho de 2013, através das bases de dados PsycINFO, Embase e Pubmed. Foram selecionados 27 estudos. O número de ECRs em PP encontrado nesta revisão pode ser considerado pequeno, o que possivelmente reflete uma preferência por outros delineamentos de pesquisa na avaliação dos resultados das técnicas psicanalíticas. A pesquisa em PP parece ser veiculada predominantemente através de periódicos acessados muitas vezes apenas por outros pesquisadores. Porém, o difícil acesso pode não ser a única razão por trás da reconhecida dissociação entre academia e prática clínica: a linguagem utilizada nos artigos encontrados nesta revisão pressupõe amplo conhecimento de termos de uso restrito de pesquisadores. Acreditamos que esta revisão pode ser útil para uma geração de terapeutas e pesquisadores que desejam trabalhar em sincronia com o avanço do conhecimento científico.(AU)

This systematic review aims at gathering all the psychoanalytic psychotherapy clinical trials published in the period between July 2008 and July 2013. We intend to identify which modalities were contemplated, the most studied population, the most studied factors of interest, the locations with higher production and the main results. The search was conducted in July 2013 on the following databases: Embase, Pubmed, and PsycINFO. Twenty-seven studies were selected. The number of RCTs in PP found in this review can be considered small, which may reflect a preference for other research designs in evaluating the results of psychoanalytic techniques. Research in PP seems to be conveyed predominantly through journals which are often only accessed by other researchers. However, the difficult access may not be the only reason behind the recognized dissociation between academia and clinical practice: the language used in the articles found in this review requires extensive knowledge of terms of restricted use by researchers. We believe that this review may be useful for a generation of therapists and researchers who wish to work in synchrony with the advancement of scientific knowledge.(AU)

Validity of the Brazilian version of WHOQOL-BREF in depressed patients using Rasch modelling.

OBJECTIVE: To assess the validity of the Brazilian version of the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-BREF) in adults with major depression, using Rasch modelling. METHODS: Study analyzing data from the baseline sample of the Longitudinal Investigation of Depression Outcomes in Brazil, including a total of 208 patients with major depression recruited in a primary care service in Porto Alegre (Southern Brazil), in 1999. The Center for Epidemiological Studies Depression Scale was used to assess intensity of depression; the WHOQOL-BREF to assess generic quality of life; and the Composite International Diagnostic Interview version 2.1 for the diagnosis of depression. RESULTS: In the Rasch analysis, the four domains of WHOQOL-BREF showed appropriate fit to this model. Some items needed adjustments: four items were rescored (pain, finances, services, and transport); two items (work and activity) were identified as having dependency of responses, and one item was deleted (sleep) due to multidimensionality. CONCLUSIONS: The validation of the WHOQOL-BREF Brazilian version using Rasch analysis complements previous validation studies, evidencing the robustness of this instrument as a generic cross-cultural quality of life measure.

Evaluating psychiatric case-control studies using the STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) statement / Avaliando estudos de caso-controle em psiquiatria utilizando o STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) statement

CONTEXT AND OBJECTIVE: Case-control studies are important in developing clinical and public health knowledge. The STROBE statement (STrengthening the Reporting of OBservational Studies in Epidemiology) was developed to establish a checklist of items that should be included in articles reporting observational studies. Our aim was to analyze whether the psychiatric case-control articles published in Brazilian journals with CAPES Qualis rating B1/B2 in 2009 conformed with the STROBE statement. DESIGN AND SETTING: Descriptive study on psychiatric papers published in Brazilian journals, within the Postgraduate Medical Program on Psychiatry, at Universidade Federal do Rio Grande do Sul. METHODS: All psychiatric case-control studies from Brazilian Qualis B1/B2 journals of psychiatry, neurology and public health in 2009 were analyzed. The four most specific items of the STROBE statement were used to evaluate whether these studies fitted within the case-control parameters: 1) selection of cases and controls; 2) controlling for bias; 3) statistical analysis; and 4) presentation of results. RESULTS: Sixteen case-control studies were identified, of which eleven (68.75%) were in psychiatry-focused journals. From analysis using the STROBE statement, all of the articles conformed with item 1; two (12.5%) completely conformed with item 2; none completely conformed with item 3; and only three (18.8%) conformed with item 4. CONCLUSION: The case-control studies analyzed here did not completely conform with the four STROBE statement items for case-control design. In view of the inadequate methodology of the published studies, these findings justify focusing on research and methodology and expanding the investigations on adherence of studies to their designs. .

CONTEXTO E OBJETIVO: Estudos de caso-controle são importantes no desenvolvimento do conhecimento clínico e de saúde pública. O STROBE statement (STrengthening the Reporting of OBservational Studies in Epidemiology) foi criado para estabelecer uma lista de itens que devem estar presentes na descrição de estudos observacionais. Nosso objetivo é analisar a adequação de artigos caso-controle psiquiátricos publicados em periódicos brasileiros Qualis B1/B2 CAPES em 2009 utilizando o STROBE statement. TIPO DE ESTUDO E LOCAL: Estudo descritivo de artigos em psiquiatria publicados por periódicos brasileiros, realizado no Programa de Pós-Graduação em Medicina: Psiquiatria, na Universidade Federal do Rio Grande do Sul. MÉTODOS: Todos os estudos de caso-controle psiquiátricos em revistas brasileiras Qualis B1/B2 de psiquiatria, neurologia e saúde pública em 2009 foram analisados. Os quatro itens mais específicos do STROBE statement foram utilizados para avaliar se os estudos se ajustavam aos parâmetros de caso-controle: 1) seleção de casos e controles, 2) controle de vieses, 3) análise estatística e 4) apresentação dos resultados. RESULTADOS: Dezesseis estudos de caso-controle foram identificados, 68,75% (11) deles de periódicos de psiquiatria. Após a análise com base no STROBE statement, todos os artigos adequavam-se ao item 1; 12,5% (2) adequavam-se completamente ao item 2; nenhum ajustava-se completamente ao item 3; e somente 18,8% (3) estavam adequados em relação ao item 4. CONCLUSÃO: Os estudos de caso-controle avaliados aqui não se adequaram completamente aos quatro itens do STROBE statement para o desenho de caso-controle. Tendo em vista a inadequada metodologia dos estudos publicados, os achados justificam direcionar-se o foco para a pesquisa e metodologia, aumentando ...