Challenges and technology in the cognitive psychotherapy of childhood ADHD: one-year follow-up of monozygotic twins

The authors describe the follow-up of monozigotic twins treated with cognitive therapy for attention deficit hyperactivity disorder.A escolha do caso deve-se a quatro principais motivos: (1) a alta complexidade do caso dificulta o diagnóstico, a abordagem psicofarmacológica e psicoterápica; (2) as dificuldades logísticas comuns aos profissionais e pacientes do Sistema Único de Saúde (SUS), como dificuldades econômicas e assistenciais, que dificultam o tratamento; (3) a importância da combinação tecnológica de diferentes modelos de terapias cognitivas na abordagem do TDAH, fundamental para alguns casos; (4) e a importância da viabilização proporcionada pelo Programa de Residência quando permite a busca por auxílio externo, em termos de supervisão, o que potencializa a capacitação do residente

Social cognition and Theory of Mind: controversies and promises for understanding major psychiatric disorders

The term social cognition generally refers to the mental operations that underlie social interactions including the perception and interpretation of the intentions, dispositions, and behaviors of others and the generation of a response to these behaviors. Social cognition has been considered a valuable and promising field that strives to understand the nature and outcome of major mental disorders. This article discusses the concept of social cognition and its relationship to Theory of Mind (ToM). Theory of Mind in autistic spectrum disorders has been studied since the 1980s, and cognitive impairments in these disorders may be restricted to ToM deficits because other cognitive domains and nonsocial intelligence are preserved. This article addresses the issues of human ontogeny, reviews the main findings from research on schizophrenia and bipolar disorder, and summarizes the tools commonly used in the assessment of these illnesses.Universidade Federal de São Paulo (UNIFESP)Pontifícia Universidade Católica do Rio Grande do SulUNIFESPSciEL

Impacto de estresse na infância na psicopatologia

OBJECTIVE: Advances in our knowledge of mental disorder (MD) genetics have contributed to a better understanding of their pathophysiology. Nonetheless, several questions and doubts persist. Recent studies have focused on environmental influences in the development of MDs, and the advent of neuroscientific methodologies has provided new perspectives. Early life events, such as childhood stress, may affect neurodevelopment through mechanisms such as gene-environment interactions and epigenetic regulation, thus leading to diseases in adulthood. The aim of this paper is to review the evidence regarding the role of the environment, particularly childhood stress, in the pathophysiology of MD. METHODOLOGY: We reviewed articles that evaluated environmental influences, with a particular focus on childhood trauma, brain morphology, cognitive functions, and the development of psychopathology and MD. RESULTS AND CONCLUSION: MRI studies have shown that exposure to trauma at an early age can result in several neurostructural changes, such as the reduction of the hippocampus and corpus callosum. Cognitive performance and functioning are also altered in this population. Finally, childhood stress is related to an increased risk of developing MD such as depression, bipolar disorder, schizophrenia and substance abuse. We conclude that there is robust evidence of the role of the environment, specifically adverse childhood experiences, in various aspects of MD.OBJETIVO: Avanços no conhecimento da genética dos transtornos mentais (TM) contribuíram para um melhor entendimento de suas bases fisiopatológicas. No entanto, dúvidas e questões ainda persistem. Estudos recentes têm se concentrado nas influências do ambiente no desenvolvimento de TM, e o advento de metodologias neurocientíficas oferece novas perspectivas. Eventos precoces de vida, como estresse na infância, podem ser capazes de alterar o neurodesenvolvimento através de mecanismos como interação gene-ambiente e regulação epigenética, resultando em patologias na idade adulta. O objetivo deste artigo é revisar as evidências referentes ao papel do ambiente, em especial o estresse na infância, na fisiopatologia de TM. METODOLOGIA: Revisamos artigos que avaliam as influências ambientais, com um foco especial no trauma na infância, na morfologia cerebral, nas funções cognitivas e no desenvolvimento de psicopatologias e TM. RESULTADOS E CONCLUSÃO: Estudos com ressonância magnética demonstram que a exposição a traumas em uma idade precoce pode levar a diversas alterações neuroestruturais, como a diminuição do hipocampo e do corpo caloso. O desempenho e o funcionamento cognitivo também são alterados nessa população. Por fim, o estresse na infância está ligado a um maior risco de desenvolver TM como depressão, transtorno bipolar, esquizofrenia e abuso de substâncias. Concluímos que existem evidências sólidas quanto à importância do ambiente, especificamente das experiências adversas na infância, em diversos aspectos dos TM.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Recognition and Intervention in Individuals in at-Risk Mental StatesUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUniversidade Federal do Rio Grande do Sul Laboratory of Molecular PsychiatryPontifícia Universidade Católica do Rio Grande do Sul Nucleus of Studies and Research in Trauma and StressUNIFESP, Department of Psychiatry Recognition and Intervention in Individuals in at-Risk Mental StatesUNIFESP, Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesSciEL

"Life Chart" retrospectivo: instrumento para assinalar graficamente a presença e a evolução do impacto funcional de episódios afetivos maníacos e depressivos

CONTEXTO: Entre os instrumentos utilizados, em pesquisa e na prática clínica, para representar e detalhar o curso longitudinal do transtorno bipolar, o Life Chart tem sido o mais utilizado. Além de ser comprovadamente de fácil aplicação, possui fidedignidade em relatar o histórico clínico do paciente. OBJETIVO: Apresentar o Life Chart Retrospectivo em sua versão em português. MÉTODOS: Foram realizadas tradução e retradução, revisão e avaliação de equivalência semântica, idiomática, experimental ou cultural e conceitual. RESULTADOS: Estão apresentados em forma de gráfico. CONCLUSÃO: A partir do desenvolvimento dessa versão do Life Chart para o português, os estudos realizados no Brasil podem fazer uso dos mesmos parâmetros de registro que os estudos internacionais.BACKGROUND: A life chart is a widely used instrument both in research and clinical practice to document the longitudinal course of bipolar disorder, being easy to apply and accuratly reports the clinical history. OBJECTIVE: The goal of this paper is to present the Brazilian Portuguese version of the Retrospective Life Chart. METHODS: Translation and retrotranslation, review, and semantic, language, cultural and conceptual equivalence were done. RESULTS: Results are presented in graphic format. DISCUSSION: The Portuguese version of Life Chart will allow that studies conducted in Brazil to use the same parameters that are used in international research

Childhood maltreatment and coping in bipolar disorder

A personal history of childhood maltreatment has been associated with unfavorable outcomes in bipolar disorder (BD). The impact of early life stressors on the course of BD may be influenced by individual differences in coping skills. The coping construct relies on neurocognitive mechanisms that are usually influenced by childhood maltreatment. The objective of the present study was to verify the association between childhood maltreatment and coping skills in individuals with BD Type 1. Thirty female euthymic outpatients with BD Type 1 were evaluated using the Childhood Trauma Questionnaire and two additional instruments to measure their coping preferences: Ways of Coping Questionnaire (coping strategies) and Brief COPE (coping styles). Reports of physical abuse (B = .64, p < .01) and emotional abuse (B = .44, p = .01) were associated with the use of maladaptive strategies that focused on emotional control. Adaptive strategies and styles of coping, such as focusing on the problem, were chosen less frequently by women who had experienced emotional neglect (B = .53, p < .01) and physical abuse (B = -.48, p < .01) in childhood. The small sample size in the present study prevented subgroup analyses. The sample did not include male BD participants. Our results indicate that early traumatic events may have a long-lasting deleterious influence on coping abilities in female BD patients. Future prospective studies may investigate whether the negative impact of childhood maltreatment over the course of BD is mediated by individual differences in coping abilities.Pontifícia Universidade Católica do Rio Grande do SulUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

DÉFICITS NA MEMÓRIA DE TRABALHO EM IDOSOS COM DEPRESSÃO MAIOR:: UMA REVISÃO SISTEMÁTICA

Geriatric depression is related with cognitive impairments, but how this is connected to specific Working Memory deficits is still unknown. Hence, the aim of this study is to systematically review the literature about the associations between Working Memory impairments and major depression in the elderly. Thus we performed a systematic review, considering published articles in major international databases between 2000 and 2011. After exclusion criteria, 17 articles were fully reviewed. There is evidence that there is indeed an association between depression in elderly and Working Memory impairments. In addition, some articles found that such deficits are sustained even after mood symptoms remission.Alguns estudos observaram declínio neuropsicológico em idosos deprimidos, todavia nem todos os aspectos da cognição estariam envolvidos. Particularmente a Memória de Trabalho (MT) seria uma das funções mais afetadas. Portanto o objetivo deste artigo é apresentar quais são as evidências sobre prejuízos na MT em idosos portadores de depressão maior. Através de uma revisão sistemática de artigos publicados entre 2000-2011 nas bases de dados Medline, PsycINFO, Cochrane, Scielo, Lilacs e Web of Science (ISI), publicados em inglês, português e espanhol, buscou-se as seguintes palavras chaves: working memory, depression and elderly or elder or aginig or aged or ageing. Após análise, seguindo critérios de inclusão e exclusão, foram analisados 17 artigos. A maioria destes evidenciando prejuízos significativos da MT em participantes depressivos. Prejuízos que parecem permanecer mesmo após a remissão dos sintomas.&nbsp

Translation and content validation of the Childhood Trauma Questionnaire into Portuguese language

OBJECTIVE: The Childhood Trauma Questionnaire is a self-applied instrument for adolescents and adults to assess childhood abuse. The objective was to translate, adapt and validate the questionnaire content into a Portuguese language version called Questionário sobre Traumas na Infância. METHODS: The translation and adaptation into Portuguese was carried out in five steps: (1) translation; (2) back translation; (3) correction and semantic adaptation; (4) content validation by professional experts (judges); and (5) a final critical assessment by the target population using a verbal rating scale. RESULTS: The translated and adapted 28-item Portuguese version of the scale and instructions produced an instrument called Questionário sobre Traumas na Infância. In the assessment by the target population, 32 adult users of the Brazilian Unified Health System answered the questionnaire and showed good understanding of the instrument (mean=4.86&plusmn;0.27) in the verbal rating scale. CONCLUSION: The questionnaire's Portuguese version proved to be easily understandable showing good semantic validation. Nevertheless, further studies should address other psychometric characteristics of this instrument.OBJETIVO: O Childhood Trauma Questionnaire é um instrumento auto-aplicável em adolescentes e adultos que investigam história de abuso e negligência durante a infância. O objetivo do trabalho foi de traduzir, adaptar e validar o conteúdo do questionário para uma versão em português denominada Questionário Sobre Traumas na Infância. MÉTODOS: O processo de tradução e adaptação envolveu cinco etapas: (1) tradução; (2) retradução; (3) correção e adaptação semântica; (4) validação do conteúdo por profissionais da área (juízes) e (5) avaliação por amostra da população-alvo, por intermédio de uma escala verbal-numérica. RESULTADOS: As 28 questões e as instruções iniciais traduzidas e adaptadas criaram o Questionário Sobre Traumas na Infância. Na avaliação pela população-alvo, 32 usuários adultos do Sistema Único de Saúde responderam a avaliação, com boa compreensão do instrumento na escala verbal-numérica (média=4,86&plusmn;0,27). CONCLUSÕES: A versão mostrou ser de fácil compreensão obtendo-se adequada validação semântica. Entretanto, ainda carece de estudos que avaliem outras qualidades psicométricas

Cocaine use disorder in females is associated with altered social decision-making: a study with the prisoner's dilemma and the ultimatum game

BACKGROUND Chronic cocaine use is associated with cognitive deficits, including poor performance on neuropsychological tasks of memory, executive functions, theory of mind and decision-making. However, the relationship between cocaine use disorder and social decision-making remains unclear. This is particularly relevant given the fact that many cocaine abusers present impairments in social functioning. In this sense, game theory paradigms have been helping to comprehend the behavior of psychiatric patients when they directly engage in social situations, which may better approximate many of their real-life choices. METHODS The present study investigated social decision-making in individuals with or without cocaine use disorder, examining their behavior in the Prisoner's Dilemma and in the Ultimatum Game. Thus, 129 females diagnosed with cocaine use disorder and 55 females with no history of substance abuse were recruited and performed both social decision-making tasks. Additional assessments included information about demographics, patterns of substance consumption and executive function performance. RESULTS Females with cocaine use disorder opted more often to not defect in the Prisoner's Dilemma, while in the Ultimatum Game they frequently chose to accept the first and unfair offer as responders. These effects were more pronounced within females with long-term history of cocaine use. Associations between cocaine use disorder and altered social decision-making were independent from demographic and executive function variables. CONCLUSIONS The influence of cocaine use disorder on social decision-making was detected in both game paradigms, resulting in more cooperative behavior in the Prisoner's Dilemma and higher acceptance rate of unfair offers in the Ultimatum Game. Further studies should focus on investigating these associations to shed light on the putative biopsychosocial factors underlying the observed effects

Corticotropin releasing factor in the bed nucleus of the stria terminalis in socially defeated and non-stressed mice with a history of chronic alcohol intake

Stress exposure has been identified as one risk factor for alcohol abuse that may facilitate the transition from social or regulated use to the development of alcohol dependence. Preclinical studies have shown that dysregulation of the corticotropin releasing factor (CRF) neurotransmission has been implicated in stressrelated psychopathologies such as depression and anxiety, and may affect alcohol consumption. The bed nucleus of the stria terminalis (BNST) contains CRF-producing neurons which seem to be sensitive to stress. In this study, adult male C57BL/6 mice previously defeated in resident-intruder confrontations were evaluated in the elevated plus-maze and tail suspension test. Mice were also tested for sweet solution intake before and after social stress. After having had continuous access to ethanol (20% weight/volume) for 4 weeks, control and stressed mice had CRF type 1 (CRFR1) or type 2 (CRFR2) receptor antagonists infused into the BNST and then had access to ethanol for 24 h. In separate cohorts of control and stressed mice, we assessed mRNA levels of BNST CRF, CRFR1 and CRFR2 Stressed mice increased their intake of sweet solution after ten sessions of social defeat and showed reduced activity in the open arms of the elevated plus-maze. When tested for ethanol consumption, stressed mice persistently drank significantly more than controls during the 4 weeks of access. Also, social stress induced higher BNST CRF mRNA levels. The selective blockade of BNST CRFR1 with CP376,395 effectively reduced alcohol drinking in non-stressed mice, whereas the selective CRFR2 antagonist astressin2B produced a dose-dependent increase in ethanol consumption in both non-stressed controls and stressed mice. The 10-day episodic defeat stress used here elicited anxiety- but not depressive-like behaviors, and promoted an increase in ethanol drinking. CRF-CRFR1 signaling in the BNST seems to underlie ethanol intake in non-stressed mice, whereas CRFR2 modulates alcohol consumption in both socially defeated and non-stressed mice with a history of chronic intake