Memory bias and personality characteristics in college students with social anxiety disorder

Abstract Introduction Some individuals are more susceptible to recalling false information about events that never happened in their life. Nevertheless, there are several factors, such as personality characteristics, that appear to be related to memory performance. Social anxiety also provokes memory deficits for events that happen to other people, because these individuals tend to focus on their own inner selves rather than on external signs. Objective To investigate the influence of the personality characteristics of individuals with social anxiety disorder (SAD) on memory performance. Methods In this study, 183 university students had their memory tested using a complex emotional story about a mother and her son. Only subjects without clinical symptoms of depression and general anxiety (N = 148; 61 with SAD) were included in the study. Participants were compared for differences in personality characteristics using the Factorial Inventory of Personality and for SAD using the Social Phobia Inventory. Results The main results showed that memory performance of individuals with low percentile ranks in the personality characteristic dominance, i.e., those with low self-esteem, remembered more true information about the story than those with high scores when they did not have SAD. Conclusion The results are helpful to foster better understanding of the personality characteristics related to SAD, such as low dominance, which implies low self-esteem and difficulties with trust and with imposing themselves on others. The results could help development and improvement of techniques for therapeutic intervention.

Personality Inventory for DSM-5 (PID-5): cross-cultural adaptation and content validity in the Brazilian context / Inventário de Personalidade para o DSM-5 (PID-5): adaptação transcultural e validade de conteúdo para o contexto brasileiro

Abstract Objective To describe the process of cross-cultural adaptation of the Personality Inventory for DSM-5 (PID-5) to the Brazilian context. Methods Cross-cultural adaptation involved the steps of independent translation of the instrument, synthesis version, and back-translation. Analysis of content validity was conducted by a multidisciplinary expert committee and consisted of quantitative assessment of agreement indicators. The test was then applied to a target population. Results All the steps required for a cross-cultural adaptation were followed and satisfactory agreement values (≥ 4.75) were reached for most of the structures assessed. Most of the changes suggested by the experts were followed; these changes consisted primarily of adjustments to verb tense and agreement and the inclusion of letters and words to allow gender inflection. In the pre-test, no suggestions were made and the instrument was considered comprehensible. Conclusion The Brazilian version of the PID-5 was found to be adequate to the Brazilian context from semantic, idiomatic, cultural, and conceptual perspectives. The Brazilian version assessed here can be freely used, was approved by the publishers who hold the copyright on the instrument, and is considered the official version of the instrument. New studies are underway to determine the validity and reliability of the PID-5.

Resumo Objetivo Apresentar o processo de adaptação transcultural do Personality Inventory for DSM-5 (PID-5) para o contexto brasileiro. Métodos A adaptação transcultural envolveu as etapas de tradução independente, versão síntese e retrotradução. A validade de conteúdo foi realizada por um comitê multidisciplinar de especialistas, com avaliação quantitativa dos índices de concordância. Por fim, o pré-teste foi conduzido com a população-alvo. Resultados Todos os estágios da adaptação transcultural foram seguidos, e na maioria das estruturas avaliadas, os valores de concordância foram satisfatórios (≥ 4.75). Grande parte das sugestões de modificações feitas pelos especialistas foram acatadas, sendo as principais relacionadas a ajustes no tempo e concordância verbal e a inclusão de letras e palavras para permitir a flexão de gênero. No pré-teste nenhuma sugestão foi apresentada e o instrumento foi considerado compreensível. Conclusão A versão brasileira do PID-5 mostrou-se adequada ao contexto brasileiro sob as perspectivas semântica, idiomática, cultural e conceitual. A versão brasileira avaliada é de uso livre, foi aprovada pelas editoras responsáveis pelos direitos autorais do instrumento e é considerada oficial. Novos estudos estão sendo conduzidos para aprimorar a busca por evidencias de validade e confiabilidade.

Borderline personality disorder and bias in the recognition of facial expressions of emotion: a pathway to understand the psychopathology

Abstract Background The identification of facial emotions is a key skill as it promotes rapid and accurate recognition of emotions and enables better communication and greater social adaptation. More recent studies have suggested that impaired social interactions may be related to deficits in social cognition and therefore in the recognition of facial expressions, contributing to social disturbance among individuals with borderline personality disorder (BPD). Objective To present the results of an empirical study assessing the recognition of facial emotion expressions in women with BPD, having as reference a group of healthy women from the general population. Methods The subjects (40 female with BPD and 40 controls) were assessed with a dynamic task on a computer screen for recognition of facial expressions of emotion. Results The BPD group had a lower accuracy in perceiving emotions of fear and surprise and slowness in recognising happiness. Logistic regression analyses also identified an association between BPD and higher sensitivity in the recognition of anger. Discussion Women with BPD made more mistakes in the recognition of negative emotions, which can bias the behaviour and regulation of affective states, favouring in turn the emergence of some typical symptoms associated with BPD.

False memories in social anxiety disorder

Abstract Background False memories are memories of events that never occurred or that occurred, but not exactly as we recall. Events with emotional content are subject to false memories production similar to neutral events. However, individual differences, such as the level of maladjustment and emotional instability characteristics of Social Anxiety Disorder (SAD), may interfere in the production of false memories. Objectives This study aimed to assess the effect of emotion in memory performance for an event witnessed by participants with and without SAD. Methods Participants were 61 young adults with SAD and 76 without any symptoms of SAD who were randomly assigned to watch a story with or without emotional arousal. Participants answered a subjective scale of emotion about the story and a recognition memory test. Results Participants with SAD recovered more true memories and more false memories for the non-emotional version compared to the emotional version of the story. Overall, participants with SAD produced fewer false memories compared to those without SAD. Discussion This finding suggests that social anxiety may have a significant impact on emotional memory accuracy, which may assist in the development and improvement of techniques for therapeutic intervention.

Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): transcultural adaptation of the Brazilian version

Abstract Background DSM-5 introduced some modifications on Posttraumatic Stress Disorder (PTSD) criteria. The instruments developed for the assessment of aspects related to PTSD needed a reformulation, as was the case of the Posttraumatic Stress Disorder Checklist (PCL). Objectives To present the process of transcultural adaptation of the three forms of the PCL-5 to Brazilian Portuguese, as well as its face validity. Methods The procedure involved independent translations, a synthesis version, back translation by an independent translator, evaluation by the original author, analysis by an expert committee, and a pretesting study (10 subjects with/without experience of a traumatic situation). The last two steps formed the face validity procedure. Results The synthesis version was approved by the original author and the agreement percentage by the expert committee was excellent, with only two items showing < 90%. The pretesting study showed that the Brazilian version was well understood and linguistically and culturally accepted by the participants, which did not make significant suggestions for changes. Discussion Transcultural adaptation of the PCL-5 for Brazilian Portuguese followed a rigid and standardized procedure. Therefore, after having its face validity assessed by an expert committee and by the target population, it is apt to be used.

Avaliação do papel do sistema canabidiol em um modelo de lesão renal por isquemia/reperfusão em animais / Evaluation of the role of the cannabidiol system in an animal model of ischemia/reperfusion kidney injury

RESUMO Objetivo: Investigar os efeitos da administração de canabidiol em um modelo de isquemia/reperfusão renal em animais. Métodos: Foi induzida uma lesão renal, por meio de 45 minutos de isquemia renal seguida por reperfusão. Administrou-se canabidiol (5mg/kg) imediatamente após a reperfusão. Resultados: A isquemia/reperfusão aumentou os níveis de interleucina 1 e fator de necrose tumoral, o que foi atenuado pelo tratamento com canabidiol. Além disso, o canabidiol foi capaz de diminuir o dano oxidativo de lipídios e proteínas, mas não os níveis de nitrito/nitrato. A lesão renal após isquemia/reperfusão pareceu ser independente da expressão dos receptores canabidiol-1 e canabidiol-2, já que não houve aumento significante desses receptores após a reperfusão. Conclusão: O tratamento com canabidiol teve um efeito protetor contra a inflamação e o dano oxidativo em um modelo de isquemia/reperfusão renal. Esses efeitos parecem não ocorrer via ativação dos receptores canabidiol-1/canabidiol-2.

ABSTRACT Objective: This work aimed to investigate the effects of the administration of cannabidiol in a kidney ischemia/reperfusion animal model. Methods: Kidney injury was induced by 45 minutes of renal ischemia followed by reperfusion. Cannabidiol (5mg/kg) was administered immediately after reperfusion. Results: Ischemia/reperfusion increased the IL-1 and TNF levels, and these levels were attenuated by cannabidiol treatment. Additionally, cannabidiol was able to decrease lipid and protein oxidative damage, but not the nitrite/nitrate levels. Kidney injury after ischemia/reperfusion seemed to be independent of the cannabidiol receptor 1 and cannabidiol receptor 2 (CB1 and CB2) expression levels, as there was no significant increase in these receptors after reperfusion. Conclusion: The cannabidiol treatment had a protective effect against inflammation and oxidative damage in the kidney ischemia/reperfusion model. These effects seemed to be independent of CB1/CB2 receptor activation.

Associations between chronic pelvic pain and psychiatric disorders and symptoms

Background Chronic pelvic pain (CPP) is a complex condition wich is associated with emotional factors, specially depression and anxiety. Objectives To make a systematic review to provide a detailed summary of relevant literature on the association between CPP and different psychiatric disorders/symptoms. Methods A systematic review of articles in the international literature published between 2003 and 2014 was performed in the electronic databases PubMed, PsycINFO, LILACS, and SciELO using the terms (chronic pelvic pain) AND (psychiatry OR psychiatric OR depression OR anxiety OR posttraumatic stress OR somatoform). The searches returned a total of 529 matches that were filtered according to predefined inclusion and exclusion criteria. A total of 18 articles were selected. Results The investigations focused mainly on the assessment of depression and anxiety disorders/symptoms, with rather high rates (17-38.6%). Depression and anxiety symptoms were more prevalent among women with CPP compared to healthy groups. Comparisons between groups with CPP and with specific pathologies that also have pain as a symptom showed that depression indicators are more frequent in CPP. Depressive symptoms tend to be more common in CPP and have no particular association with pain itself, the core feature of CPP. Discussion Other aspects of CPP seem to play a specific role in this association. Anxiety and other psychiatric disorders require further investigation so that their impact on CPP can be better understood.

A influência dos papéis sociais na qualidade de vida de portadores de esquizofrenia / The influence of social roles in the quality of life of patients with schizophrenia

Considering the damage caused by schizophrenia and the world tendency to treat and include its patients in the community, it is essential to review the scientific literature concerning the influential factors associated with quality of life in this population. Method: A literature review was carried out aiming to describe which social roles influence the quality of life and which variables have been investigated. Results: We selected 17 studies, mostly from European countries, conducted after 2000. Almost all studies were of the cross-sectional type and assessed outpatient samples. In general, most studies reported a better quality of life associated with a greater number of social roles. The social roles appeared linked to the areas of quality of life and none of the studies used a specific instrument for social roles. Conclusions: The review reveals the necessity for more studies regarding quality of life and social roles in schizophrenia.

Introdução: Considerando o prejuízo causado pela esquizofrenia e a tendência mundial de inserir e tratar seus portadores na comunidade, torna-se imprescindível rever a literatura científica referente aos fatores influentes associados à qualidade de vida dessa população. Método: Uma revisão bibliográfica foi realizada com o objetivo de descrever quais papéis sociais influenciam na qualidade de vida e quais variáveis foram investigadas. Resultados: Foram selecionados 17 estudos, a maior parte de países europeus. A maioria foi realizada após o ano 2000. Quase todos os estudos eram seccionais e a maior parte avaliou amostras ambulatoriais. De um modo geral, a maioria dos estudos relatou uma melhor qualidade de vida associada com maior número de papéis sociais. Os papéis sociais apareceram atrelados aos domínios da qualidade de vida e nenhum dos estudos utilizou um instrumento específico para papéis sociais. Conclusões: A necessidade de maior número de estudos com aprofundamento sobre os aspectos centrais do tema se fez notar, devido à importância percebida sobre a influência dos papéis sociais na qualidade de vida.

Human experimental anxiety: actual public speaking induces more intense physiological responses than simulated public speaking

Objectives: a) To perform a systematic and meta-analytic review to verify whether the Simulated Public Speaking Task (SPST) leads to a greater increase in self-rated anxiety than in physiological correlates of anxiety; and b) to compare the results obtained with the SPST with an actual public speaking task involving healthy volunteers. Methods: a) The PubMed and ISI Web of Knowledge databases were searched for studies involving the SPST prior to 2012. Eleven publications were eligible and provided data from 143 healthy volunteers for meta-analysis; b) 48 university students without somatic or psychiatric disorders were divided into three experimental groups of 16 subjects to undergo one of the following: SPST, real-world public speaking task (real-world), and control situation (control). Results: The meta-analysis showed that the SPST induced a significant increase in the Visual Analogue Mood Scale (VAMS) anxiety factor, but no significant increases in systolic blood pressure or heart rate. The empirical study showed that the real-world public speaking task increased heart rate, systolic blood pressure and diastolic blood pressure significantly more than the control and SPST conditions. Conclusions: These results suggest that real public speaking might be better than SPST in inducing experimental anxiety. .

Adesão à medicação em pacientes com doença de Parkinson atendidos em ambulatório especializado / Adherence to medication among patients with Parkinson's disease treated at a specialized outpatient unit

A doença de Parkinson é universal, sendo a segunda doença neurodegenerativa mais comum em idosos e tem alta prevalência, afetando entre 0,5 e 1% da população com idade entre 65 e 69 anos. A adesão à terapia medicamentosa é considerada o principal determinante para a efetividade do tratamento, porém apenas recentemente vem sendo estudado em pacientes com doença de Parkinson. Trata-se de estudo transversal e descritivo que avaliou a adesão à terapia com levodopa em 112 pacientes com doença de Parkinson que frequentavam regularmente o ambulatório de distúrbios do movimento do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo utilizando o teste Morisky e Green e o instrumento que avalia atitudes frente à tomada dos remédios (IAAFTR). Dos pacientes entrevistados, 53% não apresentaram adesão ao tratamento e 52% não tomam a medicação no horário correto. Os pacientes devem ser orientados sobre a importância de ingerir sua medicação no horário correto, entendendo os benefícios que a adesão pode proporcionar estando cientes de que doses não tomadas, tomadas em excesso, ou em horários diferentes dos prescritos podem diminuir sua resposta ao tratamento, afetando negativamente sua evolução clínica e qualidade de vida, gerando maiores custos à saúde pública do país.

Parkinson's disease is universal and the second most prevalent neurodegenerative disease among the elderly affecting between 0.5 and 1% of the population between 65 and 69 years of age. Adherence to medication is considered the main determinant for the effectiveness of treatment, but only recently has it been studied in patients with Parkinson's disease. This cross-sectional and descriptive study assessed adherence to medication in 112 patients with Parkinson's disease who regularly attended the movement disorder outpatient unit at the Hospital das Clinicas of the School of Medicine of Ribeirao Preto, University of São Paulo, using the Morisky and Green test and an instrument that assesses attitudes of medicine intake (IAAFTR). Of the patients interviewed, 53% failed to adhere to treatment and 52% did not take the medication at the correct time. Patients should receive guidance about the importance of taking their medication at the correct time, understanding the benefits that adherence to medication can provide. They should also be aware that doses not taken, taken in excess or not taken at the prescribed times can reduce their response to treatment, having a negative effect on the clinical outcome and quality of life, thereby generating higher costs to public health in the country.

Aspectos cognitivos do falar em público: validação de uma escala de autoavaliação para universitários brasileiros / Cognitive aspects of public speaking: validation of a self-assessment scale for Brazilian university students

CONTEXTO: O falar em público é o medo mais prevalente na população geral e no Transtorno de Ansiedade Social (TAS). Assim sendo, estudos que dimensionem essa situação específica são necessários. OBJETIVOS: Validar a Self Statements during Public Speaking (SSPS) em amostra da população geral de estudantes universitários (PG - n = 2.314), casos (C - n = 88) e não casos de TAS (NC - n = 90) do Brasil. MÉTODOS: Conduziu-se o estudo em duas fases: a) preenchimento dos questionários autoaplicados em sala de aula; b) participação em entrevista telefônica e ao vivo. RESULTADOS: Evidenciaram-se correlações baixas/moderadas entre SSPS e Inventário de Fobia Social (PG = 0,22-0,65; C = 0,28-0,32; NC = 0,21-0,30), Inventário de Ansiedade de Beck (PG = 0,18-0,53; C = 0,25-0,33; NC = 0,22-0,25) e Escala Breve de Fobia Social (C = não significativa, NC = 0,23-0,31) nas diferentes amostras, especialmente para a PG. A análise fatorial apontou a presença de dois fatores, associados à autoavaliação positiva e negativa. O estudo da validade discriminativa evidenciou a capacidade da SSPS de discriminar os casos dos não casos de TAS. CONCLUSÃO: A SSPS é adequada para uso no contexto brasileiro, sendo que a subescala autoavaliação positiva parece ser mais efetiva para a avaliação de amostras identificadas ou suspeitas de TAS e a subescala autoavaliação negativa ter uma característica mais rastreadora quando aplicada em amostras da população geral.

BACKGROUND: Fear of public speaking is the most prevalent fear in the general population and among persons with a social anxiety disorder (SAD). Nevertheless, studies about the assessment of this specific phenomenon are still needed. OBJECTIVES: To examine the validity of the Self Statements during Public Speaking (SSPS) scale in a general population of Brazilian university students (GP, n = 2314), in an SAD sample (n = 88), and in a non-SAD sample (n = 90). METHODS: The study was conducted in two phases: a) completing a self-administered questionnaire in the classroom, b) participating in a telephone and face-to-face interview. RESULTS: The SSPS showed low/median correlations with the Social Phobia Inventory (GP = 0.22-0.65; SAD = 0.28-0.32; non-SAD = 0.21-0.30), the Beck Anxiety Inventory (GP = 0.18-0.53; SAD = 0.25-0.33; non-SAD = 0.22-0.25), and the Brief Social Phobia Scale (SAD = not significant, non-SAD = 0.23-0.31) in all the samples, especially in the GP sample. Factorial analysis indicated the presence of two factors associated with positive and negative self-assessment. The study of discriminative validity demonstrated that the SSPS has the ability to differentiate between cases and non-cases of SAD. DISCUSSION: The SSPS is an adequate instrument to be used within the Brazilian context. The positive self-assessment subscale seems to be more effective for the evaluation of SAD samples. The negative self-assessment subscale appears to have a better screening characteristic in the general population of university students.

Tratamentos farmacológicos para o transtorno de ansiedade social: existem novos parâmetros na atualidade? / Pharmacological treatments for social anxiety disorder: are there new parameters today?

CONTEXTO: O transtorno de ansiedade social (TAS), apesar da baixa taxa de detecção e do alto índice de comorbidades associadas, é considerado uma condição tratável. Apesar da resposta estabelecida a diversas classes de medicamentos, os algoritmos para o tratamento do TAS necessitam de atualização constante. OBJETIVO: Realizar revisão sistemática da literatura no que diz respeito à eficácia dos tratamentos farmacológicos relativos ao TAS, a partir de estudos controlados, conduzidos no período de 2005 a 2010. MÉTODO: Foram utilizados os indexadores eletrônicos PsycoInfo, Lilacs e Medline, utilizando-se as palavras-chave: "social phobia or social anxiety and treatment". RESULTADOS: De acordo com critérios de inclusão adotados, 29 artigos foram incluídos e analisados. Mostram-se eficazes para o tratamento do TAS as seguintes drogas, de acordo com a classe: a) ISRSs: escitalopram, fluvoxamina, citalopram, GR205171 e sertralina; b) ISRSN: venlafaxina; c) IMAOs: fenelzina, moclobemina; d) aminoácidos: d-cicloserina; f) anticonvulsivantes: tiagabina. CONCLUSÃO: Os ISRSs e os ISRSNs têm seu uso estabelecido e ainda continuam sendo considerados primeira opção de tratamento. Porém, destaca-se o potencial futuro da d-cicloserina e dos anticonvulsivantes, com necessidade de um número maior de estudos controlados que confirmem os achado iniciais. A ação das diferentes drogas em nível neurobiológico, bem como dos tratamentos associados, necessita ainda ser mais explorada.

BACKGROUND: Social anxiety disorder (SAD), despite its low detection rates and high level of associated comorbidities, is considered a treatable condition. Although the condition's response to several drug classes is well established, the algorithms for the treatment of SAD require regular updating. OBJECTIVE: To perform a systematic literature review on the efficacy of pharmacological treatments for SAD based on controlled trials published between 2005 and 2010. METHOD: Searches were performed in the electronic databases PsycInfo, Lilacs, and Medline using the search terms "social phobia or social anxiety and treatment". RESULTS: In accordance with the inclusion criteria adopted, 29 articles were included and analyzed. The following drugs, grouped according to class, proved efficient to treat SAD: a) SSRIs: escitalopram, fluvoxamine, citalopram, GR205171, and sertraline; b) SNRI: venlafaxine; c) MAOIs: phenelzine, moclobemide; d) amino acids: f-cycloserine; and (e) anticonvulsants: tiagabine. DISCUSSION: The use of SSRIs and SNRIs to treat SAD is well established and these are still considered the first-line treatment for the condition; however, evidence suggests the future potential of D-cycloserine and anticonvulsants, whose efficacy must be confirmed by further controlled trials. The action profiles of the different medications used to treat SAD at the neurobiological level, as well as that of associated treatments, need to be explored in greater depth.

Escala Razões para Fumar da Universidade de São Paulo: um novo instrumento para avaliar a motivação para fumar / University of São Paulo Reasons for Smoking Scale: a new tool for the evaluation of smoking motivation

OBJETIVO: Desenvolver uma nova escala voltada para a avaliação da motivação para fumar, incorporando questões do 68-item Wisconsin Inventory of Smoking Dependence Motives (WISDM-68, Inventário Wisconsin dos Motivos de Dependência ao Fumo, de 68 itens) na Modified Reasons for Smoking Scale (MRSS. Escala Razões para Fumar Modificada). MÉTODOS: Nove questões do WISDM-68 relativas à associação estreita, exposição a gatilhos/processos associativos e controle de peso foram incorporadas às 21 questões da MRSS. Um total de 311 fumantes (214 homens; idade média = 37,6 ± 10,8 anos; média de cigarros consumidos ao dia = 15,0 ± 9,2) responderam a nova escala, o Fagerström Test for Nicotine Dependence (FTND, Teste de Fagerström para Dependência de Nicotina) e outras questões. Empregamos a análise fatorial exploratória para determinar a estrutura fatorial da escala. A influência de algumas características clínicas nos escores da solução fatorial final foi também avaliada. RESULTADOS: A análise fatorial revelou uma solução com 21 questões agrupadas em nove fatores: dependência, prazer de fumar, redução da tensão, estimulação, automatismo, manuseio, tabagismo social, controle de peso e associação estreita. Para a escala como um todo, o coeficiente alfa de Cronbach foi de 0,83. As mulheres exibiram maiores escores para dependência, redução da tensão, manuseio, controle de peso e associação estreita do que os homens. Os escores do FTND correlacionaram-se positivamente com dependência, redução da tensão, estimulação, automatismo, tabagismo social e associação estreita. O número de cigarros fumados ao dia se associou com dependência, redução da tensão, estimulação, automatismo, associação estreita e manuseio. Os níveis de CO exalado mostraram associações positivas com dependência, automatismo e associação estreita. CONCLUSÕES: A nova escala fornece um quadro aceitável dos fatores motivacionais associados ao tabagismo, com confiabilidade e propriedades psicométricas satisfatórias.

OBJECTIVE: To develop a new scale aimed at evaluating smoking motivation by incorporating questions and domains from the 68-item Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) into the Modified Reasons for Smoking Scale (MRSS). METHODS: Nine WISDM-68 questions regarding affiliative attachment, cue exposure/associative processes, and weight control were added to the 21 questions of the MRSS. The new scale, together with the Fagerström Test for Nicotine Dependence (FTND), was administered to 311 smokers (214 males; mean age = 37.6 ± 10.8 years; mean number of cigarettes smoked per day = 15.0 ± 9.2), who also provided additional information. We used exploratory factor analysis in order to determine the factor structure of the scale. The influence that certain clinical features had on the scores of the final factor solution was also analyzed. RESULTS: The factor analysis revealed a 21-question solution grouped into nine factors: addiction, pleasure from smoking, tension reduction, stimulation, automatism, handling, social smoking, weight control, and affiliative attachment. For the overall scale, the Cronbach's alpha coefficient was 0.83. Females scored significantly higher for addiction, tension reduction, handling, weight control, and affiliative attachment than did males. The FTND score correlated positively with addiction, tension reduction, stimulation, automatism, social smoking, and affiliative attachment. The number of cigarettes smoked per day was associated with addiction, tension reduction, stimulation, automatism, affiliative attachment, and handling. The level of exhaled CO correlated positively with addiction, automatism, and affiliative attachment. CONCLUSIONS: The new scale provides an acceptable framework of motivational factors for smoking, with satisfactory psychometric properties and reliability.

Transtornos de ansiedade / Anxiety disorders

Os transtornos de ansiedade apresentam alta prevalência na população e provocam grande prejuízo a pacientes e familiares. Existem diversos subtipos de transtornos de ansiedade e seu diagnóstico correto se baseia na avaliação clínica cuidadosa. Neste artigo descrevemos como diagnosticar e tratar o transtorno de ansiedade generalizada, o transtorno do pânico e o transtorno de ansiedade social, três dos mais frequentes transtornos de ansiedade.

Comparação entre solicitações psiquiátricas de dois hospitais gerais universitários brasileiros: uso do protocolo de registro de interconsulta em saúde mental / A comparison of consultative psychiatric services in two Brazilian university hospitals using a standardized protocol for recording liaison consultations

O objetivo do presente estudo foi comparar pedidos de interconsulta psiquiátrica realizados para dois hospitais gerais universitários brasileiros e avaliar a aplicabilidade de um protocolo de registro de interconsulta psiquiátrica (PRISMe). Foi realizada análise dos pedidos de interconsulta, do PRISMe anexado a eles e o número total de pedidos de interconsulta incluídos na amostra foi 541 (438 pedidos de interconsulta do HCFMRP-USP e 103 pedidos de interconsulta do HU-UFSC). Observou-se maior freqüência de solicitação para pacientes do sexo feminino, caucasianos, entre 31 a 60 anos e casados. Os diagnósticos psiquiátricos mais freqüentes foram depressão, transtornos de adaptação e de personalidade. Os resultados estão de acordo com a literatura nacional e internacional e as diferenças encontradas podem ser atribuídas às diferenças na infra-estrutura das instituições e nos contextos sócio-econômicos nos quais estão inseridas. Achados do presente estudo demonstram a aplicabilidade do PRISMe e sugerem que podem facilitar a sistematização da obtenção de achados clínico-demográficos e a comparabilidade entre as diferenças.

The objective of the present report was to compare consultative psychiatric services in two Brazilian university hospitals and to evaluate the applicability of a standardized protocol (PRISMe) for recording psychiatric liaison consultations. Analyses of psychiatric consultations and the attached protocol were performed. 541 consecutive liaison consultations were included in the final sample (438 consecutive consultations from the Federal university hospital in São Paulo and 103 from the Federal university hospital in Santa Catarina). In both hospitals, the majority of patients were female, married, white, and 31 to 60 years of age. Depression and adjustment and personality disorders were the most common psychiatric diagnoses, which could explain the higher referral of female patients. The results are consistent with the Brazilian and international literature, and the differences between the two hospitals could be related to both logistical differences between the consultative psychiatric services and the socioeconomic contexts. The findings confirm the applicability of the PRISMe and suggest that systematization of clinical and demographic information is important for future comparative studies.

Transtorno de ansiedade social e comportamentos de evitação e de segurança: uma revisão sistemática / Social anxiety disorder, avoidance and safety behavior: a systematic review

O Transtorno de Ansiedade Social (TAS) caracteriza-se por um medo persistente de situações sociais. Objetiva-se identificar na literatura indexada, estudos relativos à qualidade técnica de instrumentos psicométricos e experimentais sobre a avaliação dos pensamentos negativos e comportamentos de segurança associados ao TAS. Foram identificados 22 artigos, agrupados em dois conjuntos, considerando os procedimentos utilizados. No primeiro conjunto os estudos investigaram as qualidades psicométricas de instrumentos que avaliam cognições e TAS, sendo que destes, quatro abordaram versões já aferidas previamente e dois avaliaram instrumentos propostos especificamente para mensurar comportamento de segurança e pensamentos negativos. Os estudos do segundo conjunto investigaram, por meio de simulações de situações de desempenho verbal, aspectos cognitivos associados à ansiedade, destacando as variáveis auto-imagem negativa, pensamentos negativos e comportamentos de segurança associados ao aumento da ansiedade social. A análise dos estudos aponta que a identificação de comportamentos evitativos pode ser útil para a implementação de intervenções.

Social anxiety disorder (SAD) is characterized by and intense and constant fear of social situations. The goal of this work is to identify, in indexed publications, psychometric and empirical studies on the evaluation of negative thoughts and safety behaviors associated with SAD. Twenty-two articles were located and grouped into two sets considering the type of procedure used. In the first set, studies investigated the psychometric properties of instruments that evaluate cognition and SAD, out of which four studies addressed instruments that had been previously evaluated, and two others evaluated instruments specifically proposed for measuring safety behavior and negative thoughts. The studies in the second set used simulations of verbal performance situations to investigate the cognitive aspects associated with anxiety. These studies confirmed the association of negative self-image, negative thoughts, and safety behaviors with social anxiety. The analysis of the studies reveals that identifying avoidance behaviors can be useful for implementing intervention procedures.

Escala Razões para Fumar Modificada: tradução e adaptação cultural para o português para uso no Brasil e avaliação da confiabilidade teste-reteste / Modified Reasons for Smoking Scale: translation to Portuguese, cross-cultural adaptation for use in Brazil and evaluation of test-retest reliability

OBJETIVO: Traduzir, fazer a adaptação cultural e testar a confiabilidade teste-reteste de uma versão em língua portuguesa da Escala Razões Para Fumar Modificada (ERPFM) para uso no Brasil. MÉTODOS: Uma versão em língua inglesa da ERPFM foi traduzida por médicos brasileiros com profundo conhecimento sobre a língua inglesa. Uma versão de consenso foi obtida por grupo multidisciplinar composto por dois pneumologistas, um psiquiatra e um psicólogo. Essa versão foi traduzida de volta ao inglês por um tradutor americano. A avaliação da adaptação cultural da versão final foi efetuada em uma amostra de 20 fumantes saudáveis. A avaliação da confiabilidade teste-reteste foi feita pela aplicação da versão traduzida da escala em 54 fumantes saudáveis em duas ocasiões separadas por 15 dias. RESULTADOS: Essa versão traduzida da ERPFM exibiu excelente identidade cultural, sendo bem compreendida por 95% dos fumantes. Os graus de concordância das respostas em duas ocasiões distintas foram quase perfeito para duas questões, substancial para dez questões, moderado para oito questões e discreto para uma questão. Os valores dos coeficientes de correlação intraclasse dos fatores motivacionais em duas ocasiões, empregando-se modelos teóricos previamente publicados, foram superiores a 0,7 em seis dos sete domínios. CONCLUSÕES: A presente versão da ERPFM exibe identidade cultural e confiabilidade teste-reteste satisfatórias, podendo ser de utilidade no tratamento e na avaliação de tabagistas em nosso meio.

OBJECTIVE: To translate the Modified Reasons for Smoking Scale (MRSS) to Portuguese, to submit it to cross-cultural adaptation for use in Brazil and to evaluate the test-retest reliability of the translated version. METHODS: An English-language version of the MRSS was translated to Portuguese by Brazilian doctors who have thorough knowledge of the English language. A consensus version was produced by a multidisciplinary group including two pulmonologists, a psychiatrist and a psychologist. This version was back-translated to English by an American translator. Cross-cultural adaptation of the final version was evaluated in a sample of 20 healthy smokers. Test-retest reliability was evaluated by applying the translated version of the scale in 54 healthy smokers on two distinct occasions, 15 days apart. RESULTS: This translated version of the MRSS was well understood by 95% of the smokers, indicating excellent cross-cultural equivalence. The degree of reliability of the answers in two different occasions was almost perfect for two questions, substantial for ten questions, moderate for eight questions, and low for one question. The intraclass correlation coefficients of the motivational factors obtained on the two different occasions, calculated according to previously published theoretical models, were higher than 0.7 for six of the seven subscales. CONCLUSIONS: The Portuguese-language version of the MRSS shows satisfactory cross-cultural equivalence and test-retest reliability. It can be a useful tool in the evaluation and treatment of smokers in Brazil.

As propriedades psicométricas do Teste de Fagerström para Dependência de Nicotina / Psychometric properties of the Fagerström Test for Nicotine Dependence

OBJETIVO: O Fagerström Test for Nicotine Dependence (FTND, Teste de Fagerström para Dependência de Nicotina) é um instrumento de rastreamento para dependência física de tabaco, amplamente utilizado em diversos países. Objetivou-se realizar uma revisão de artigos relacionados às propriedades psicométricas do FTND. MÉTODOS: Uma busca sistemática foi realizada usando-se vários indexadores eletrônicos até dezembro de 2007, com os seguintes descritores: "Fagerström Test for Nicotine Dependence"; "FTND"; "psychometric"; "validity"; "reliability"; "feasibility"; e "factors". Foram incluídos os artigos relacionados à avaliação das propriedades psicométricas do FTND publicados em inglês, espanhol e português. RESULTADOS: Vinte e seis estudos relativos às propriedades psicométricas do FTND foram identificados na literatura indexada. A análise dos estudos confirmou a confiabilidade do FTND na avaliação da dependência de tabaco em diferentes contextos e populações. CONCLUSÕES: Futuros estudos de validação, utilizando como medida comparativa instrumentos aferidos, de modo a referendar o seu extenso uso pelas suas qualidades psicométricas ainda são necessários.

OBJECTIVE: The Fagerström Test for Nicotine Dependence (FTND) is a screening instrument for physical nicotine dependence and is extensively used in various countries. The objective of the present report was to review articles related to the psychometric properties of the FTND. METHODS: A systematic search for articles published up through December of 2007 was carried out in various electronic databases. The following search terms were used: "Fagerström Test for Nicotine Dependence"; "FTND"; "psychometric"; "validity"; "reliability"; "feasibility"; and "factors". We included articles published in English, Spanish or Portuguese and in which the psychometric properties of the FTND were evaluated. RESULTS: Twenty-six studies related to the psychometric properties of the FTND were identified in the indexed literature. Analysis of the studies confirmed the reliability of the FTND for the assessment of nicotine dependence in different settings and populations. CONCLUSIONS: Further validation studies using previously validated instruments as a comparative measure are needed before the extensive use of the FTND can be justified on the basis of its psychometric qualities.

Validade e fidedignidade da escala de comportamento de segurança na ansiedade social / Validity and reliability of the social phobia safety behaviour scale in social anxiety

CONTEXTO: A utilização dos comportamentos de segurança acentua a falha no processamento cognitivo e tende a distorcer a avaliação de experiências interpessoais. OBJETIVO: Avaliar a fidedignidade e a validade da escala autoaplicável Social Phobia Safety Behaviours Scale (ECSAS), visando a verificar a associação do transtorno de ansiedade social (TAS) a processos cognitivos e a comportamentos de segurança. MÉTODO: Participou deste estudo uma amostra de 155 universitários, de ambos os sexos, sem história prévia de tratamento psiquiátrico, distribuídos em dois grupos (80 casos de TAS e 75 não casos), avaliados sistematicamente pelo Inventário de Fobia Social (SPIN) e pela Entrevista Clínica Estruturada para o DSM-IV (SCID-IV), como recurso de confirmação diagnóstica e exclusão de outros transtornos psiquiátricos. RESULTADOS: A ECSAS apresentou consistência interna, medida pelo alfa de Cronbach, de 0,92, e, com base no método de teste e reteste, com um intervalo de duas semanas, atingiu níveis satisfatórios de estabilidade temporal, com Kappa ponderado de 0,73. Quanto à validade discriminante, apresentou valores de sensibilidade de 0,963 e de especificidade de 1. Na validade convergente apresentou correlação (r) de 0,60. CONCLUSÃO: A ECSAS apresentou boas características psicométricas, contribuindo para a avaliação sistemática dos padrões de comportamentos de segurança e evitação associados ao TAS.

CONTEXT: The use of safety behaviours stresses the cognitive failure and tends to distort the evaluation of interpersonal experiences. OBJECTIVE: To assess the reliability of the self-administered Social Phobia Safety Behaviors Scale (ECSAS in the Portuguese acronym) in order to determine the association of social anxiety disorder (SAD) with processes related to safety behaviors. METHOD: A total of 155 university students of both genders with no previous history of psychiatric treatment, divided into two groups (80 cases and 75 non-cases of SAD), were systematically assessed using the Social Phobia Inventory (SPIN) and the Structured Clinical Interview for the DSM-IV (SCID-IV) for diagnostic confirmation and for the exclusion of other psychiatric disorders. RESULTS: The internal consistency of the ECSAS measured by the Cronbach alpha was 0.92, and, based on the test-retest method separated by a two-week interval, it reached satisfactory levels of temporal stability, with a weighted Kappa of 0.73. Regarding discriminant validity, the ECSAS had 0.963 sensitivity and 1 specificity. Regarding convergent validity, it presented a correlation (r) of 0.60. CONCLUSION: The ECSAS presented good psychometric indicators, contributing to a systematic assessment of the safety and avoidance behaviors associated with SAD.