Validity and reliability of the Brazilian version of the Cognitive Reserve Assessment Scale in Health

Objective: As the older population increases, it is important to identify factors that may reduce the risks of dementia in the general population. One such factor is the concept of cognitive reserve (CR). The present study analyzed the psychometric properties of the Cognitive Reserve Assessment Scale in Health (CRASH) in the Brazilian population. This scale was originally developed to measure CR in individuals with severe mental illness. We also investigated the relationship between the CRASH and clinical or sociodemographic variables. Methods: This study was conducted with 398 individuals. We assessed sociodemographic variables and depression, anxiety, and stress symptoms (Depression, Anxiety and Stress Scale [DASS-21]) using a web-based survey. We constructed a confirmatory factor analysis (CFA) model in order to test the goodness of fit of the factor structure proposed in the original CRASH study. Results: The McDonald's hierarchical ω for CRASH using CFA parameters was 0.61, and the Cronbach's alpha coefficient indicated good internal consistency when considering all items (alpha = 0.7). Conclusions: Our results suggest that CRASH can be used to assess CR in the general population in Brazil.

Validity and Reliability of the Brazilian Version of the Cognitive Reserve Assessment Scale in Health (CRASH).

OBJECTIVE: As the elderly population increases, it is important to identify factors that may reduce risks of dementia in the general population. One such factor is the concept of cognitive reserve (CR). The present study analyzed the psychometric properties of the Cognitive Reserve Assessment Scale in Health (CRASH) in the Brazilian population, which was originally developed to measure CR in individuals with severe mental illness. We also investigated the relationship between the CRASH and clinical or sociodemographic variables. METHODS: This study was conducted with 398 individuals. We assessed sociodemographic variables and depression, anxiety and stress symptoms (DASS-21), using a web-based survey. We constructed a confirmatory factor analysis (CFA) model in order to test the goodness of fit of the factor structure proposed in the original CRASH study. RESULTS: The McDonald's hierarchical ω for CRASH using CFA parameters was 0.61 and Cronbach's alpha coefficient indicated good internal consistency when considering all items (∝ = 0.7). CONCLUSIONS: Our results suggest that CRASH can be used to assess CR in the general population in Brazil.

Suicidal Behavior and Early Maladaptive Schemas and Schema Domains.

ABSTRACT: Suicidal behavior is a risk factor for suicide attempts. Identifying the factors that increase suicidal behavior risk is paramount for overall suicide prevention efforts. One model that may contribute to our understanding of the relationship between early life experiences and suicidal behavior is the schema theory. This study aimed to examine suicidal behavior, early maladaptive schemas (EMSs), and schema domains using a large Brazilian nonclinical sample. The study included 19,060 individuals. We assessed sociodemographic variables, suicidal behavior (Suicidal Behavior Questionnaire), and EMSs (Young Schema Questionnaire) using an online, Web-based survey. Our results showed that, when comparing participants with no ideation with those with serious suicide attempts, we found significant statistical differences in all EMSs (all p 's < 0.05), with higher scores in those with serious suicide attempts. Our results suggest that specific unmet emotional needs during childhood can affect mental health and result in serious suicide attempts in adulthood.

The relationship between objective and subjective cognitive performance to clinical features in bipolar disorder: A 6 years follow-up study

There is a consensus in the literature indicating that patients with Bipolar Disorder (BD) show cognitive impairments, especially in executive function, during both acute episodes and euthymia.1 An emerging body of knowledge indicates the importance of promoting functional recovery and improving cognitive deficits to achieve an adequate treatment of BD. However, the trajectories of cognitive deficits are still unclear. The neuroprogression hypothesis suggests that BD may present a progressive course with cognitive and functioning decline, which may be associated with mood episodes, length of the illness, early trauma,2 and biological rhythms disturbance, which may be a feature of BD.3 However, most of the evidence in this field came from cross-sectional studies, and the few existing longitudinal studies bring contrary results.4 A small number of studies assess the patient's perception of their cognitive function, which might be highly relevant to their everyday life.5 Therefore, the ideal study to assess the progression of cognition in BD might include objective as well as subjective measures from a longitudinal perspective.Thus, the purpose of the present study was to evaluate longitudinal cognitive performance in a sample of individuals with BD at baseline and after six years. All patients were in a depressive episode at baseline and euthymic at follow-up. We assessed subjective and objective cognitive difficulties in both points. We also investigated the relationship between psychosocial functioning, biological rhythms, and childhood trauma to cognition and the course of the illness. As far as we know, this is the first report using specific instruments to measure the relationship between these aspects to objective and subjective cognitive difficulties in a longitudinal BD sample. (AU)

The impact of the COVID-19 pandemic on Quality of Life among Local Residents in south of Brazil

INTRODUCTION: The impact of restrictive measures during the COVID-19 pandemic resulted in negative effects on the Quality of Life (QoL). It is important to evaluate this measure in a specific region with a homogeneous profile and with high rates of transmission during the pandemic in a developing nation as Brazil. OBJECTIVES: The objective of this study was to assess through an online self-reported questionnaire the impact of COVID-19 pandemic on QoL in a specific region in the South of Brazil, called "Vale do Taquari", in the initial stage of the COVID-19 outbreak. METHODS: This study was conducted with 325 individuals. We assessed sociodemographic variables and depression, anxiety, stress symptoms (Depression, Anxiety and Stress Scale-21 (DASS-21), sleep quality (The Pittsburgh Sleep Quality Index PSQI), post-traumatic stress symptoms (Impact of Event Scale-IES-R scale) and QoL (The World Health Organization quality of life assessment (WHOQOL-bref). RESULTS: Reduced psychological symptoms, better sleep quality, shorter duration of social isolation, not experiencing stressful situations during the pandemic, higher education and older age were associated with increased QoL. CONCLUSION: Our results could be used as a historical reference and help assist local authorities to define future intervention strategies, since we will probably need to deal with the deleterious effects of the pandemic even after its complete control.(AU)

INTRODUÇÃO: O impacto das medidas restritivas durante a pandemia de COVID-19 resultou em efeitos negativos na Qualidade de Vida (QV). É importante avaliar essa medida em uma região específica com perfil homogêneo e com altas taxas de transmissão durante a pandemia em uma nação em desenvolvimento como o Brasil. OBJETIVOS: o objetivo deste estudo foi avaliar, por meio de um questionário autoaplicável online, o impacto da pandemia de COVID-19 na QV em uma região específica do Sul do Brasil, denominada "Vale do Taquari", na fase inicial do Surto de COVID-19. MÉTODOS: Este estudo foi realizado com 325 indivíduos. Foram avaliadas variáveis sociodemográficas e sintomas de depressão, ansiedade e estresse (Depression, Anxiety and Stress Scale-21 (DASS-21), qualidade do sono (The Pittsburgh Sleep Quality Index PSQI), sintomas de estresse pós-traumático (Impact of Event Scale-IES-R scale) e QV (The World Health Organization quality of life assessment (WHOQOLbref). RESULTADOS: sintomas psicológicos reduzidos, melhor qualidade do sono, menor duração do isolamento social, não vivenciar situações estressantes durante a pandemia, ensino superior e idade avançada foram associados ao aumento da QV. CONCLUSÃO: Nossos resultados podem ser usados como referência histórica e ajudar as autoridades locais a definir futuras estratégias de intervenção, pois provavelmente precisaremos lidar com os efeitos deletérios da pandemia mesmo após seu controle total.(AU)

OBJETIVOS: El impacto de las medidas restrictivas durante la pandemia de COVID-19 resultó en efectos negativos en la Calidad de Vida (CV). Sería importante evaluar esta medida en una región específica con un perfil homogéneo y con altas tasas de transmisión durante la pandemia en un país en desarrollo como Brasil. El objetivo de este estudio fue evaluar, a través de un cuestionario autoadministrado en línea, el impacto de la pandemia COVID-19 en la CV en una región específica del sur de Brasil, denominada "Vale do Taquari", en la fase inicial del COVID-19. MÉTODOS: Este estudio se llevó a cabo con 325 individuos. Se evaluaron variables sociodemográficas y síntomas de depresión, ansiedad, estrés (DASS-21), calidad del sueño (The Pittsburgh Sleep Quality Index (PSQI), síntomas de trastorno de estrés postraumático (Impact of Event Scale-IES-R) y CV (WHOQOL-bref). RESULTADOS: reducción de síntomas psicológicos, mejor calidad del sueño, menor tiempo de aislamiento social, no experimentar situaciones estresantes durante la pandemia, educación superior y vejez se asociaron con un aumento de CV. CONCLUSIÓN: Nuestros resultados pueden ser se utiliza como referencia histórica y ayuda para ayudar a las autoridades locales a definir estrategias de intervención futuras, ya que probablemente tendremos que hacer frente a los efectos nocivos de la pandemia incluso después de su completo control.(AU)

Saúde mental de pais durante a pandemia da COVID-19 / Parental mental health during COVID-19 pandemic

OBJETIVO: Investigar a saúde mental de pais com filhos pequenos durante a pandemia de COVID-19. MÉTODOS: Foram utilizados questionários elaborados pelo Google Forms, no qual foram aplicados os dados sociodemográficos, e as escalas EADS-21, IES-R, PSQI-BR e WHOQOL-BREF. As análises estatísticas foram realizadas no software estatístico SPSS 21.0 para Windows. Para descrição da amostra, foram utilizadas análises descritivas. Em todos os testes, foi considerada a significância estatística de 0,05. Os 327 participantes foram divididos em três grupos: voluntários sem filhos (Grupo 1), com filhos entre 0 e 6 anos (Grupo 2) e com filhos de 7 anos ou mais (Grupo 3), dos quais todos eram residentes da região Sul do Brasil. RESULTADOS: Os grupos com maior vulnerabilidade em relação à sua saúde mental é o de participantes sem filhos e com filhos de 0 a 6 anos, com maiores escores para as escalas de depressão, ansiedade e estresse, e estresse pós-traumático, em comparação com o grupo com filhos de 7 anos ou mais. CONCLUSÕES: Mesmo que os dados mostrem que todos os grupos estão dentro da normalidade para as escalas aplicadas, faz-se necessário atentar para a saúde mental da população em maior sofrimento psíquico, seja a partir de estratégias desenvolvidas por profissionais de rede de saúde (SUS) e/ou da assistência social (SUAS), seja por projetos municipais/estaduais na busca pela promoção da saúde mental na rede.

OBJECTIVE: Explore the mental health of parents with young children during the COVID-19 pandemic. METHODS: We used questionnaires prepared by Google Forms, applying sociodemographic data, and also the EADS-21, IES-R, PSQI-BR and WHOQOL-BREF scales were applied. Statistical analyzes were performed using SPSS 21.0 statistical software for Windows. To describe the sample, descriptive analyzes were used. In all tests, a statistical significance of 0.05 was considered. Of the 327 participants, they were divided into three groups: volunteers without children (Group 1), with children aged 0 to 6 years (Group 2), and with children aged 7 or over (Group 3). All volunteers were residents from South of Brazil. RESULTS: The groups with the greatest vulnerability in relation to their mental health are those of participants without children and parents with children aged 0 to 6 years, with higher scores for the depression, anxiety and stress, and post traumatic stress symptoms, compared to parents with children aged from 7 years or more. CONCLUSION: even though the data show that all groups are within the normal range for the scales applied, it is necessary to pay attention to the mental health of the population in greater psychological distress, either from strategies developed by health professionals (SUS) and/or or social assistance (SUAS), either by municipal/state projects in the search for the promotion of mental health.

Impact of the COVID-19 pandemic on mental health among local residents in South of Brazil: during pandemic times, youth sleep matters.

INTRODUCTION: Social isolation has been associated with poor sleep quality and mental health problems during the COVID-19 pandemic. However, most studies have investigated heterogeneous samples subjected to varying social distancing policies and did not focus on a single local profile subject to homogeneous prevention policies. OBJECTIVES: To evaluate the impact of the COVID-19 pandemic on mental health and sleep quality in a specific region in the South of Brazil where the populations have similar culture and local governments have adopted similar social distancing policies. METHODS: This study was conducted with 327 individuals aged 18-72 years, living in the Vale do Taquari area, Brazil. We assessed sociodemographic variables with a standardized protocol, symptoms of depression, anxiety, and stress with the Depression, Anxiety and Stress Scale-21 (DASS-21), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and post-traumatic stress symptoms with the Impact of Event Scale (IES-R), using a web-based online survey. RESULTS: Our results showed that sleep dysfunction moderated the effects of age on psychological symptoms, indicating that younger participants who had poorer sleep quality had worse mental health. Furthermore, participants with more perceived stress during the pandemic and more sleep dysfunction reported more symptoms of anxiety and post-traumatic stress. CONCLUSION: Psychological symptoms were not related to social isolation duration but were related to the subjective perception that the pandemic interfered with life and generated stressful situations. These results may help governments make important decisions about protection and isolation measures in future waves of COVID-19 infection.

Impact of the COVID-19 pandemic on mental health among local residents in South of Brazil: during pandemic times, youth sleep matters

Abstract Introduction Social isolation has been associated with poor sleep quality and mental health problems during the COVID-19 pandemic. However, most studies have investigated heterogeneous samples subjected to varying social distancing policies and did not focus on a single local profile subject to homogeneous prevention policies. Objective To evaluate the impact of the COVID-19 pandemic on mental health and sleep quality in a specific region in the South of Brazil where the populations have similar culture and local governments have adopted similar social distancing policies. Methods This study was conducted with 327 individuals aged 18-72 years, living in the Vale do Taquari area, Brazil. We assessed sociodemographic variables with a standardized protocol, symptoms of depression, anxiety, and stress with the Depression, Anxiety and Stress Scale-21 (DASS-21), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and post-traumatic stress symptoms with the Impact of Event Scale (IES-R), using a web-based online survey. Results Our results showed that sleep dysfunction moderated the effects of age on psychological symptoms, indicating that younger participants who had poorer sleep quality had worse mental health. Furthermore, participants with more perceived stress during the pandemic and more sleep dysfunction reported more symptoms of anxiety and post-traumatic stress. Conclusion Psychological symptoms were not related to social isolation duration but were related to the subjective perception that the pandemic interfered with life and generated stressful situations. These results may help governments make important decisions about protection and isolation measures in future waves of COVID-19 infection.

Peripheral blood levels of brain-derived neurotrophic factor in patients with post-traumatic stress disorder (PTSD): A systematic review and meta-analysis.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) plays a crucial role in the survival, differentiation, growth, and plasticity of the central nervous system (CNS). Post-traumatic stress disorder (PTSD) is a complex syndrome that affects CNS function. Evidence indicates that changes in peripheral levels of BDNF may interfere with stress. However, the results are mixed. This study investigates whether blood levels of BDNF in patients with post-traumatic stress disorder (PTSD) are different. METHODS: We conducted a systematic search in the major electronic medical databases from inception through September 2019 and identified Observational studies that measured serum levels of BDNF in patients with PTSD compared to controls without PTSD. RESULTS: 20 studies were eligible to be included in the present meta-analysis. Subjects with PTSD (n = 909) showed lower BDNF levels compared to Non-PTSD controls (n = 1679) (SMD = 0.52; 95% confidence interval: 0.18 to 0.85). Subgroup meta-analyses confirmed higher levels of BDNF in patients with PTSD compared to non-PTSD controls in plasma, not serum, and in studies that used sandwich ELISA, not ELISA, for BDNF measurement. Meta-regressions showed no significant effect of age, gender, NOS, and sample size. CONCLUSIONS: PTSD patients had increased serum BDNF levels compared to healthy controls. Our finding of higher BDNF levels in patients with PTSD supports the notion that PTSD is a neuroplastic disorder.

Emotional memory in bipolar disorder: Impact of multiple episodes and childhood trauma.

BACKGROUND: Emotional memory is a critical amygdala-dependent cognitive function characterized by enhanced memory for emotional events coupled with retrograde amnesia. Our study aims to assess the influence of bipolar disorder (BD), trauma, and the number of mood episodes on emotional memory. METHODS: 53 subjects (33 euthymic patients with BD and 20 healthy controls) answered a clinical assessment, childhood trauma questionnaire (CTQ), and an emotional memory test composed of lists of nouns, including neutral words, one emotional (E), one preceding (E-1) and one following word (E + 1). We assessed for the influence of type, position, diagnosis, trauma, and number of mood episodes in word recall using generalized estimating equations. RESULTS: Controlling for neutral words, BD had a higher recall for E-1 (p = 0.038) and a trend for a higher recall of E (p = 0.055). There was no difference between patients with and without trauma. Patients with BD who suffered multiple mood episodes had a higher recall of E compared to patients with fewer episodes (p = 0.016). LIMITATIONS: Cross-sectional design and small sample size. CONCLUSION: Our results indicate dysfunction in emotional memory in patients with BD, particularly after multiple mood episodes. While we expected an impaired emotional memory, patients with BD showed an increased recall for emotional stimuli and events preceding them. Childhood trauma does not seem to interfere with emotional memory changes in patients with BD. Emotional memory enhancement seems to be a promising marker of progression in BD.

Contribuições e principais intervenções da terapia cognitivo comportamental no tratamento do transtorno bipolar / Contributions and Main Interventions of Cognitive-Behavioral Therapy in the Treatment of Bipolar Disorder

Este trabalho tem como objetivo averiguar as contribuições da Terapia Cognitivo- Comportamental no tratamento do Transtorno Bipolar e focar em aspectos específicos das intervenções realizadas no tratamento. O trabalho consiste em uma revisão narrativa sobre este tema. A busca bibliográfica foi realizada através dos sites pubmed e google acadêmico. Os resultados mostraram que a Terapia Cognitivo-Comportamental auxilia na prevenção de recaídas, em episódios de humor mais curtos, menor número de hospitalizações e menor variabilidade dos sintomas maníacos. Dentre as principais técnicas utilizadas, a psicoeducação parece ser a mais utilizada e eficaz no tratamento do Transtorno Bipolar. No entanto, a farmacoterapia ainda é considerada a principal escolha no tratamento.

This study aims to investigate the contributions of Cognitive-Behavioral Therapy in the treatment of Bipolar Disorder and to focus on specific aspects of the interventions performed in the treatment. This papper consists of a narrative review on this theme. The bibliographic search was conducted through the pubmed and google academic sites. The results showed that Cognitive-Behavioral Therapy assists in the prevention of relapses, shorter episodes of mood, fewer hospitalizations and less variability of manic symptoms. Among the main techniques used, psychoeducation seems to be the most used and effective in the treatment of Bipolar Disorder. However, pharmacotherapy is still considered the main treatment choice.

Adjunctive tianeptine treatment for bipolar disorder: A 24-week randomized, placebo-controlled, maintenance trial.

OBJECTIVE: The purpose of this study was to assess the efficacy and tolerability of tianeptine as an adjunctive maintenance treatment for bipolar depression. METHODS: This is a multicenter double-blind randomized placebo-controlled maintenance trial of adjunctive tianeptine 37.5 mg/day. Participants ( n=161) had a Montgomery-Asberg Depression Rating Scale ⩾12 at entry. After eight weeks of open-label tianeptine treatment, those who responded to tianeptine ( n=69) were randomized to adjunctive tianeptine ( n=36) or placebo ( n=33) in addition to usual treatment. Kaplan-Meier estimates and the Mantel-Cox log-rank test were used to evaluate differences in time to intervention for a mood episode between the tianeptine and placebo groups. We also assessed overall functioning, biological rhythms, quality of life, rates of manic switch and serum brain-derived neurotrophic factor levels. RESULTS: There were no differences between adjunctive tianeptine or placebo regarding time to intervention or depression scores in the 24-week double-blind controlled phase. Patients in the tianeptine group showed better performance in the letter-number sequencing subtest from the Wechsler Adult Intelligence Scale at the endpoint ( p=0.014). Tianeptine was well tolerated and not associated with higher risk for manic switch compared to placebo. CONCLUSION: Tianeptine was not more effective than placebo in the maintenance treatment of bipolar depression. There is preliminary evidence suggesting a pro-cognitive effect of tianeptine in working memory compared to placebo.

Perceived childhood adversities: Impact of childhood trauma to estimated intellectual functioning of individuals with bipolar disorder.

Maltreatments in childhood may have implications for neurodevelopment that could remain throughout life. Childhood trauma seems to be associated with the onset of bipolar disorder (BD), and its occurrence might accentuate the overall disease impairments related to cognitive deficits in BD. We aimed to evaluate the effects of a history of childhood trauma to estimated intellectual functioning (IQ) of individuals with BD. We included 72 subjects with BD during euthymia. Participants underwent a clinical interview and were assessed through the Childhood Trauma Questionnaire (CTQ) and Wechsler Abbreviated Scale of Intelligence (WASI). Most prevalent trauma subtypes were emotional abuse and neglect (54.1%). A linear regression model that included perceived childhood trauma, family history of severe mental disorders, age at diagnosis and psychotic symptoms during the first episode as main factors showed that only childhood trauma had a significant effect in predicting estimated IQ. Therefore, the history of childhood trauma in individuals with BD may play a role in intellectual development, suggesting that adversities during development result in decreased general cognitive abilities. These results reinforce the need to promote early interventions to protect childhood and to promote the well-being of children, contributing to the growth of healthy adults.

Identifying cognitive subgroups in bipolar disorder: A cluster analysis.

BACKGROUND: Evidence has shown heterogeneity of cognitive function among patients with bipolar disorder (BD). Our study aims to replicate recent findings of cognitive subgroups, as well as we assessed subjective cognitive difficulties and functioning in each cluster. METHODS: Hierarchical cluster analysis was conducted to examine whether there were distinct neurocognitive subgroups based on neurocognitive battery. Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and Functioning Assessment Short Test (FAST) were used to assess subjective cognitive difficulties and functional impairment. RESULTS: We found three distinct subgroups: a first cluster with intact cognition (n = 30, 43.5%), a second cluster with selective cognitive impairment (n = 23, 33.3%), and a third cluster with globally cognitive impairment (n = 16, 23.3%). The intact group had more years of education (p < .001) and higher estimated IQ (p < .001) than globally and selectively impaired subgroups. Additionally, they were younger (p = .011), had an earlier age at bipolar diagnosis (p < .037) and earlier age of first hospitalization (p < .035) compared to individuals with globally cognitive impairment. LIMITATIONS: This is a cross-sectional design with a small sample including only patients from a tertiary hospital. CONCLUSION: Our results give support to the existence of a continuum of severity from patients without impairment to those with poor cognitive functioning. Patients in the intact group seem to have higher cognitive reserve than other two groups. However, they also experienced cognitive complaints and some degree of functional impairment. These findings suggest the importance of using a combo of instruments (e.g., objective and subjective cognitive measures plus functioning instruments) for a complete assessment of patients with BD.

Translation and cross-cultural adaptation of the Brazilian Portuguese version of the Emotional Memory Scale.

Background Emotional memory is an important type of memory that is triggered by positive and negative emotions. It is characterized by an enhanced memory for emotional stimuli which is usually coupled with a decrease in memory of neutral preceding events. Emotional memory is strongly associated with amygdala function and therefore could be disrupted in neuropsychiatric disorders. To our knowledge, there is no translated and culturally adapted instrument for the Brazilian Portuguese speaking population to assess emotional memory. Objective To report the translation and cross-cultural adaptation of a Brazilian Portuguese version of the Emotional Memory Scale, originally published by Strange et al. in 2003. Methods The author of the original scale provided 36 lists with 16 words each. Translation was performed by three independent bilingual translators. Healthy subjects assessed how semantically related each word was within the list (0 to 10) and what the emotional valence of each word was (-6 to +6). Lists without negative words were excluded (negative selection), most positive and most unrelated words were excluded (positive and semantic selection, respectively), and lists with low semantic relationship were excluded (semantic assessment). Results Five lists were excluded during negative selection, four words from each list were excluded in positive and semantic selection, and 11 lists were excluded during semantic assessment. Finally, we reached 20 lists of semantically related words; each list had one negative word and 11 neutral words. Conclusion A scale is now available to evaluate emotional memory in the Brazilian population and requires further validation on its psychometrics properties.