Editorial

Editorial para edição número 4

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

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

Theory of Mind Impairments in Women With Cocaine Addiction

OBJECTIVE This study investigates the Theory of Mind performance of female cocaine-dependent users (CDUs) and possible associations between theory of mind performance and features of cocaine use. METHOD Sixty women controlled for age, education, individual income, and IQ participated in this study: 30 in the CDU group and 30 in the healthy control group. Participants were assessed for theory of mind with the Reading the Mind in the Eyes Test (RMET), a test of understanding of first-order and second-order false beliefs, and the Hinting task. Drug use parameters, clinical symptoms, and neuropsychological functioning were also assessed. RESULTS Analyses of covariance indicated Theory of Mind impairments in negative mental states within the RMET and second-order false-belief understanding of Theory of Mind stories. In addition, Theory of Mind impairment was associated with drug use characteristics, including craving and number of hospitalizations. CONCLUSIONS High-demand Theory of Mind is suggested to be impaired in CDU women, and the deficits appear to be related to drug addiction severity. We found associations between Theory of Mind deficits and worse clinical and social outcomes

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

A influência dos traços de personalidade nas habilidades de coping de indivíduos com transtorno de humor bipolar

Background: Bipolar disorder is marked by alterations in coping skills which in turn impacts the disease course. Personality traits are associated with coping skills and for this reason it has been suggested that personality traits of patients with BD may have influence over their coping skills. Objective: To investigate possible associations between coping skills and personality in individuals with bipolar disorder (BD). Method: Thirty-five euthymic subjects with BD were compared with 40 healthy controls. Coping skills were evaluated using Ways of Coping Checklist Revised and Brief-COPE. Personality traits were assessed by Neo Personality Inventory. MANCOVA was used for between groups comparison. Result: Regarding coping, individuals with BD reported more frequent use of emotion-focused strategies than problem-focused strategies, and high levels of neuroticism and low levels of extroversion and conscientiousness on personality measures. Neuroticism influenced negatively the use of problem-focused strategies, and positively emotion-focused coping. Conscientiousness influenced the use of problem-focused strategies in both groups. There was a significant difference between emotion focused coping and personality traits between BD and control groups. Discussion: Personality traits seem to modulate coping skills and strategies in BD which may be took into account for further interventions.Contexto: O transtorno de humor bipolar (THB) é marcado por estratégias de enfrentamento, ou coping, que determinam comportamentos que podem influenciar negativamente o curso da doença. Traços de personalidade são altamente associados com estratégias de coping, portanto se faz a hipótese de que traços de personalidade influenciem as estratégias de coping de portadores de THB. Objetivo: Este estudo buscou investigar associações entre traços de personalidade e estratégias de coping em pacientes com THB. Método: Trinta e cinco participantes eutímicos diagnosticados com THB e 40 controles saudáveis participaram deste estudo. Estratégias de coping foram avaliadas com a Ways of Coping Checklist Revised and Brief – COPE – e traços de personalidade foram avaliados com o Neo Personality Inventory. Resultado: Participantes com THB possuíram padrão de estratégias de coping significativamente mais baseados na emoção. Em termos de traços de personalidade, participantes com THB tiveram significativamente mais características de neuroticismo e reduzidas características de extroversão e consciência. Foram encontradas associações positivas entre índices de neuroticismo e estratégias de coping baseadas em emoções e associações negativas com estratégias baseadas no problema. Conclusão: Traços de personalidade são fundamentais para as estratégias de coping de pacientes com THB, portanto traços de personalidade devem ser considerados alvos terapêuticos para a psicopatologia.Universidade de São Paulo Medical School Institute and Department of PsychiatryPontifical Catholic University of Rio Grande do SulUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryUNIFESP, Department of PsychiatrySciEL

Influence of personality traits in coping skills in individuals with bipolar disorder

Background : Bipolar disorder is marked by alterations in coping skills which in turn impacts the disease course. Personality traits are associated with coping skills and for this reason it has been suggested that personality traits of patients with BD may have influence over their coping skills. Objective : To investigate possible associations between coping skills and personality in individuals with bipolar disorder (BD). Methods : Thirty-five euthymic subjects with BD were compared with 40 healthy controls. Coping skills were evaluated using Ways of Coping Checklist Revised and Brief-COPE. Personality traits were assessed by Neo Personality Inventory. MANCOVA was used for between groups comparison. Results : Regarding coping, individuals with BD reported more frequent use of emotion-focused strategies than problem-focused strategies, and high levels of neuroticism and low levels of extroversion and conscientiousness on personality measures. Neuroticism influenced negatively the use of problem-focused strategies, and positively emotion-focused coping. Conscientiousness influenced the use of problem-focused strategies in both groups. There was a significant difference between emotion focused coping and personality traits between BD and control groups. Discussion : Personality traits seem to modulate coping skills and strategies in BD which may be took into account for further interventions.Contexto : O transtorno de humor bipolar (THB) é marcado por estratégias de enfrentamento, ou coping, que determinam comportamentos que podem influenciar negativamente o curso da doença. Traços de personalidade são altamente associados com estratégias de coping, portanto se faz a hipótese de que traços de personalidade influenciem as estratégias de coping de portadores de THB. Objetivo : Este estudo buscou investigar associações entre traços de personalidade e estratégias de coping em pacientes com THB. Métodos : Trinta e cinco participantes eutímicos diagnosticados com THB e 40 controles saudáveis participaram deste estudo. Estratégias de coping foram avaliadas com a Ways of Coping Checklist Revised and Brief – COPE – e traços de personalidade foram avaliados com o Neo Personality Inventory. Resultados : Participantes com THB possuíram padrão de estratégias de coping significativamente mais baseados na emoção. Em termos de traços de personalidade, participantes com THB tiveram significativamente mais características de neuroticismo e reduzidas características de extroversão e consciência. Foram encontradas associações positivas entre índices de neuroticismo e estratégias de coping baseadas em emoções e associações negativas com estratégias baseadas no problema. Conclusão : Traços de personalidade são fundamentais para as estratégias de coping de pacientes com THB, portanto traços de personalidade devem ser considerados alvos terapêuticos para a psicopatologia

Decision-Making Under Risk and Theory of Mind in Adolescent Offenders in Provisional Deprivation of Liberty

INTRODUCTION: Delinquent behaviors are risky behaviors that increase during puberty and reach their highest peak in late adolescence. It has been proposed that poor decision-making and theory of mind (ToM) are key cognitive processes implicated with delinquency during adolescence, affecting evaluation of risks and impairing appreciation of social norms. Nevertheless, it is not yet clear whether adolescent offenders who are subjected to provisional deprivation of liberty due to conflict with the law (adolescents in conflict with the law [ACL]) might, in fact, present a specific profile with regard to these cognitive processes. OBJECTIVES: To assess deliberative decision-making and ToM among adolescents in conflict with the law and adolescents not in conflict with the law. METHODS: The sample comprised 62 participants: ACL (n = 29) and a control group (CG) (n = 33). ToM was assessed with the Reading the Mind in the Eyes Test (RMET) and decision-making was assessed with the Columbia Card Task (CCT). Substance use, callous-unemotional traits, childhood maltreatment, and intelligence quotient (IQ) were also assessed. RESULTS: ACL had more ToM errors for negative mental states in comparison to CG, but not for error rates concerning neutral and positive mental states. With regards to decision-making, our results suggest that ACL group members did not vary their behavior based on the available information and that the risk information had an opposite effect on the number of cards chosen (risk-taking behavior) when compared to CG. CONCLUSION: These findings have important implications for development of interventions for these adolescents, suggesting that they tend to learn little from negative outcomes and have reduced capacity to process negative emotions

Gender differences in progression to crack-cocaine use and the role of sexual and physical violence

Objective: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. Methods: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. Results: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p o 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p o 0.01). Conclusions: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics

Association Between Recent Cannabis Consumption and Withdrawal-Related Symptoms During Early Abstinence Among Females With Smoked Cocaine Use Disorder

BACKGROUND The effects of cannabis on clinical outcomes of treatment services for other drug use disorders remains unclear. The primary aim of the current study was to investigate the effects of recent cannabis consumption on the severity of cocaine withdrawal and depressive symptoms during a 3-week inpatient treatment program for women with cocaine use disorder. The second goal of this study was to test the effect of recent alcohol or tobacco use on the aforementioned outcomes. METHODS This was a longitudinal study with 2 assessment time points: at enrollment and upon discharge from a medically managed intensive inpatient unit. The sample was composed of 214 early abstinence females with cocaine use disorder. Cocaine withdrawal and depressive symptoms were measured using the Cocaine Selective Severity Assessment (CSSA) and the Beck Depressive Inventory (BDI-II). Recent substance use was evaluated using the Addiction Severity Index (ASI-6). RESULTS Patients with cocaine use disorder and with frequent recent cannabis use reported higher severity of cocaine withdrawal and depressive symptoms after 3 weeks of inpatient treatment. Neither recent alcohol nor tobacco use was associated with increased CSSA or BDI outcomes, suggesting these substances play a minor role compared to recent cannabis use in affecting withdrawal-related symptoms. CONCLUSIONS The assessment of recent cannabis use may help identify patients in need of additional treatment to manage severe cocaine withdrawal symptoms and depressive symptoms during early abstinence