Personality disorder and substance related disorders: a six-month follow-up study with a Brazilian sample / Transtorno de personalidade e transtorno por uso de substâncias: experiência brasileira com seis meses de seguimento

ABSTRACT Objectives A few Brazilian researches correlate personality disorders (PD) and substance related disorders (SRD). The aim of the present study is to investigate the association between them, to evaluate the PD frequency among chemical dependents inpatients, this comorbidity association with social and demographic characteristics, used drug of choice, its impact on clinical evolution until the moment of their committal, the frequency of relapse, self-help group – and psychotherapic adherence among SRD patients six months following committal. Methods A 101 inpatients sample of chemical dependents was enrolled in 2 hospitals. The following instruments were applied: a questionnaire for social and demographic characteristics identification and drug use pattern, some questions from the sixth version of the Addiction Severity Index (ASI-6), the SCID-II questionnaire and specific questions concerning psychotherapic and self-help groups participation, and medication use. Results From these 101 patients, 55.4% were diagnosed with PD, being avoidant (14.9%), borderline (11.9%) and antisocial (8.9%) the more frequent ones found. PD patients had an earlier crack use in life (p = 0.038) and had also more previous treatments than the ones without PD (p = 0.005). Borderline PD patients were less worried to substance use problem (p = 0.003). After 6-months follow-up, no statistical significance was found between patients with and without PD regarding drug use or treatment adherence. Conclusion A high PD diagnosis was found in drug use inpatients. Patients diagnosed with SRD and PD need the identification of this comorbidity and of their personality characteristics in order to plan a more comprehensive and effective treatment.

RESUMO Objetivos Poucos estudos brasileiros correlacionam transtornos de personalidade (TP) com transtorno por uso de substâncias (TUS). O objetivo deste estudo é verificar a associação entre eles, avaliar a frequência dos TP na população de dependentes químicos internados, correlacionar com características sociodemográficas, drogas de escolha, frequência de recaída, aderência a grupos de autoajuda e psicoterapia em até seis meses após a alta hospitalar. Métodos Uma amostra de 101 pacientes internados em dois hospitais foi selecionada. Os seguintes instrumentos foram aplicados: um questionário para identificação de características sociodemográficas e padrão de uso de drogas, algumas questões da sexta versão do ASI-6 (Addiction Severity Index), o SCID-II e algumas questões específicas sobre participação em grupos de autoajuda e em psicoterapia, bem como o uso de medicações. Resultados Destes 101 pacientes, 55,4% foram diagnosticados com TP, sendo evitativa (14,9%), limítrofe (11,9%) e antissocial (8,9%) as mais frequentemente encontradas. Pacientes com TP demonstraram ter feito uso mais precoce de crack na vida (p = 0,038) e também tinham mais tratamentos anteriores do que aqueles sem TP (p = 0,005). Pacientes com TP limítrofe estavam menos preocupados com o problema de abuso de substâncias (p = 0,003). Após seis meses de seguimento, nenhuma diferença estatística significativa foi encontrada entre pacientes com e sem TP acerca do uso de drogas ou aderência ao tratamento. Conclusão Uma alta prevalência de TP foi encontrada em pacientes internados por TUS. Pacientes diagnosticados com TP e TUS necessitam a identificação da comorbidade e das características de sua personalidade, a fim de planejar um tratamento mais abrangente e eficaz.

Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”). Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder. .

Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder.

OBJECTIVE: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. METHODS: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for "patient" [or population], "intervention" [or exposure], "comparison" [or control], and "outcome"). RESULTS: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. CONCLUSIONS: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients

OBJECTIVE: Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD: In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6 percent). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbach's alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS: The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9 percent of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS: The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.

OBJETIVO: A Escala de Ansiedade Social de Liebowitz é um instrumento utilizado na avaliação da gravidade da fobia social. Tem sido amplamente usada em diferentes contextos e culturas, apresentando propriedades psicométricas variadas. O objetivo do artigo é investigar a consistência interna e a estrutura fatorial da escala. MÉTODO: A escala foi aplicada em uma amostra com 300 pacientes alcoolistas hospitalizados em três clínicas psiquiátricas na região Sul do Brasil, sendo 74 deles fóbicos sociais (24,6 por cento). O SCID-I/P, entrevista clínica semi-estruturada baseada no DSM-IV, foi usado para avaliação do diagnóstico de fobia social. A consistência interna foi medida pelo Alfa de Cronbach. Os dados foram submetidos à análise fatorial com estimativa de parâmetros por meio da análise do componente principal. Todos os itens do questionário de cargas fatoriais maiores ou iguais a 0,35 foram considerados na solução final da análise fatorial. RESULTADOS: O coeficiente de consistência interna foi de 0,95. Todos os itens mostraram coeficientes de correlação entre o item e a totalidade dos itens maiores do que 0,15, o menor índice aceitável. A análise fatorial resultou em cinco dimensões que correspondiam a 52,9 por cento da variância total. Os cinco fatores excluídos foram: fator I - falar em público; fator II - atividade em público; fator III - interação social com pessoa desconhecida; fator IV - atitude de discordância ou enfrentamento; e fator V - interação social em atividade de lazer. CONCLUSÕES: A escala mostrou-se confiável e estruturalmente válida quando utilizada em populações de pacientes alcoolistas. A possibilidade de rastreamento da fobia social através do uso do instrumento pode ser de grande utilidade na identificação de prováveis casos entre alcoolistas.

Social anxiety disorder in 300 patients hospitalized for alcoholism in Brazil: high prevalence and undertreatment.

BACKGROUND: Although the frequency of social phobia is high among alcoholic patients, this anxiety disorder is often neglected because treatment tends to be focused exclusively on alcohol dependence. METHODS: A total of 300 hospitalized alcoholic patients were interviewed using Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and Liebowitz Social Anxiety Scale as well a questionnaire to check the use of medication for social phobia among alcoholics and the relationship between social phobia and alcohol use. RESULTS: A prevalence of 30.6% was found for specific phobia, 24.7% for social phobia, 22.2% for anxiety disorder induced by alcohol, 19.3% for generalized anxiety disorder, 5% for obsessive-compulsive disorder, 4.6% for posttraumatic stress disorder, and 2% for panic disorder with agoraphobia. Social phobia preceded alcohol dependence in 90.2% of the patients. The frequency of the use of medication for social phobia among social phobic alcoholics was 20.3%. CONCLUSIONS: The study confirms the high prevalence of anxiety disorders among alcoholics, particularly of social phobia. It also suggests that social phobia precedes alcohol dependence but shows that the use of medication for social phobia is still infrequent. Further studies are required to check if the failure to identify this comorbidity can make the recovery of alcoholics even more difficult.

Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients.

OBJECTIVE: Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD: In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6%). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbach's alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS: The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9% of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS: The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.