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

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

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

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

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

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

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

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

Bipolar disorder: an association between body mass index and cingulate gyrus fractional anisotropy not mediated by systemic inflammation

Abstract Objective To investigate associations between body mass index (BMI), white matter fractional anisotropy (FA), and C-reactive protein (CRP) in a group of individuals with bipolar disorder (BD) during euthymia and compare them with a control group of healthy subjects (CTR). Methods The sample consisted of 101 individuals (BD n = 35 and CTR n = 66). Regions of interest (ROI) were defined using a machine learning approach. For each ROI, a regression model tested the association between FA and BMI, controlling for covariates. Peripheral CRP levels were assayed, correlated with BMI, and included in a mediation analysis. Results BMI predicted the FA of the right cingulate gyrus in BD (AdjR2 = 0.312 F(3) = 5.537 p = 0.004; β = -0.340 p = 0.034), while there was no association in CTR. There was an interaction effect between BMI and BD diagnosis (F(5) = 3.5857 p = 0.012; Fchange = 0.227 AdjR2 = 0.093; β = -1.093, p = 0.048). Furthermore, there was a positive correlation between BMI and CRP in both groups (AdjR2 = 0.170 F(3) = 7.337 p < 0.001; β = 0.364 p = 0.001), but it did not act as a mediator of the effect on FA. Conclusion Higher BMI is associated with right cingulate microstructure in BD, but not in CTR, and this effect could not be explained by inflammatory mediation alone.

Clozapine use decreases the number of hospitalizations per year in patients with treatment-resistant schizophrenia

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS. (AU)

Translation and cross-cultural adaptation of the Brazilian Portuguese version of the Emotional Memory Scale / Tradução e adaptação transcultural da versão brasileira da Escala de Memória Emocional

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

Resumo Introdução Memória emocional é um tipo importante de memória que é acionado por emoções positivas e negativas. Ela é caracterizada por um aumento de memória para estímulos emocionais que normalmente está associado a um prejuízo de memória para eventos neutros que os precedem. Memória emocional é fortemente relacionada à função da amígdala e, portanto, pode estar alterada em transtornos neuropsiquiátricos. Pelo nosso conhecimento, não existe instrumento traduzido e adaptado culturalmente para a população falante de português brasileiro para avaliar memória emocional. Objetivo Descrever a tradução e adaptação transcultural para o português brasileiro da Escala de Memória Emocional, originalmente publicada por Strange et al. em 2003. Métodos O autor da escala original forneceu 36 listas com 16 palavras cada. A tradução foi feita por três tradutores bilíngues e independentes. Sujeitos saudáveis foram selecionados para avaliar o quanto cada palavra era semanticamente relacionada dentro da lista (0 a 10) e qual era a valência emocional de cada palavra (-6 a +6). Listas sem palavras negativas foram excluídas (seleção negativa), palavras mais positivas e menos relacionadas de cada lista foram excluídas (seleções positiva e semântica, respectivamente) e listas com relação semântica fraca foram excluídas (avaliação semântica). Resultados Cinco listas foram excluídas durante a seleção negativa, quatro palavras de cada lista foram excluídas nas seleções positiva e semântica, e 11 listas foram excluídas na avaliação semântica. Por fim, chegamos em 20 listas de palavras semanticamente relacionadas; cada lista com uma palavra negativa e 11 palavras neutras. Conclusão Uma escala está disponível para avaliar memória emocional na população brasileira e requer posterior validação de suas propriedades psicométricas.

Functioning in early and late stages of schizophrenia / Funcionalidade nos estágios inicial e final da esquizofrenia

INTRODUCTION: Schizophrenia is frequently associated with a debilitating course and prominent impairment in social and occupational functioning. Although the criteria for classification into stages have not been defined in the literature, illness duration and functioning seem to be good candidates. OBJECTIVE: To compare functioning of patients with schizophrenia at different stages of the disease (early vs. late) and healthy sex- and age-matched controls. METHODS: This double-blinded, case-controlled study included 79 individuals: 23 patients with schizophrenia diagnosed up to 5 years earlier; 19 patients with schizophrenia diagnosed at least 20 years earlier; and healthy matched controls. Diagnoses were established using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I Disorder. Functioning was assessed using the Functioning Assessment Short Test (FAST). RESULTS: Patients in the early stage had significantly higher scores than healthy controls in total FAST and in autonomy, occupational functioning, cognitive functioning and interpersonal relationships. Individuals in the late stage had significantly poorer functioning than controls in all domains. The comparison of functioning between the two groups of patients revealed no significant differences, except in occupational functioning, in which late stage patients had a poorer performance. CONCLUSION: Functioning impairment in schizophrenia tends to remain stable despite illness duration. Therefore, functioning should be effectively assessed at an early stage, as illness duration alone may not be the most reliable criterion to stage patients with schizophrenia (AU)

INTRODUÇÃO: A esquizofrenia está frequentemente associada a um curso debilitante e a um importante comprometimento no funcionamento social e ocupacional. Embora os critérios para classificação em diferentes estágios ainda não tenham sido definidos, a duração da doença e a funcionalidade têm sido apontadas como bons candidatos. OBJETIVO: Comparar a funcionalidade de indivíduos com esquizofrenia no estágio inicial e final com controles saudáveis correspondentes em idade e sexo. MÉTODOS: Neste estudo caso-controle, duplo-cego, foram incluídos 79 pacientes: 23 com diagnóstico de esquizofrenia feito até 5 anos atrás (estágio inicial); 19 diagnosticados há pelo menos 20 anos (estágio final); e controles saudáveis pareados. O diagnóstico foi estabelecido pela Entrevista Clínica Estruturada para Transtornos do Eixo I do Manual Diagnóstico e Estatístico de Transtornos Mentais, 4ª edição (DSM-IV). A funcionalidade foi avaliada através da escala Teste Breve de Avaliação Funcional (FAST). RESULTADOS: Os pacientes em estágio inicial tiveram escores significativamente maiores do que controles saudáveis na escala FAST (escore total e domínios autonomia, funcionamento ocupacional, funcionamento cognitivo e relações interpessoais). Os indivíduos em estágio final apresentaram funcionalidade pior que os controles em todos os domínios. A comparação entre os dois grupos não mostrou diferenças, exceto no funcionamento ocupacional, em que os pacientes em estágio final apresentaram um desempenho pior. CONCLUSÃO: O prejuízo da funcionalidade na esquizofrenia tende a permanecer estável ao longo da doença. Portanto, a funcionalidade deve ser avaliada nos estágios iniciais da doença, já que a duração da doença por si só pode não ser o critério mais confiável para definir o estágio de pacientes com esquizofrenia (AU)

Adaptação da escala brian para uso emcrianças e adolescentes: um estudopreliminar / Brian scale adaptation for use in childrenand adolescents: a preliminary study

Introdução: Alterações nos ritmos circadianos tem sido frequentemente observadas entre pacientes com Transtorno do Humor Bipolar (THB). No entanto, existem poucos instrumentos para medi-las e a maioria deles mede exclusivamente distúrbios do sono. A escala BRIAN, validada para adultos com THB, avalia a regularidade dos ritmos biológicos em quatro diferentes aspectos: sono, atividades, social e padrão de alimentação. O objetivo deste estudo-piloto foi adaptar a escala BRIAN para uma população de crianças e adolescentes (BRIAN-K) e avaliar se o novo instrumento é capaz de detectar diferenças entre pacientes e controles saudáveis. Métodos: Foram avaliados 20 pacientes com THB entre 8-16 anos e 32 controles pareados por sexo e idade. Os sujeitos foram avaliados por meio de entrevista clínica, K-SADS-PL e testagem cognitiva. A BRIAN-K foi aplicada em ambos os grupos. Resultados: O grupo de pacientes com THB apresentou escores mais altos de alterações em seus ritmos circadianos pelo escore total da BRIAN-K, quando comparados com o grupo controle (p=0,022). Particularmente, maior irregularidade foi observada no domínio “atividades” no grupo de pacientes (p=0,001). Nossos resultados também mostraram uma correlação positiva entre a idade de diagnóstico e o domínio “sono” da BRIAN-K (r=0,485; p=0,03). Conclusões: Estes dados preliminares sugerem que a versão BRIAN-K, recentemente adaptada para crianças e adolescentes, é capaz de discriminar pacientes com THB e controles. Futuros estudos com maior tamanho amostral são necessários para determinar a confiabilidade, a validade interna e externa do presente instrumento.

Background: Alterations in the circadian rhythms have been frequently observed in patients with Bipolar Disorder (BD). However, there are few instruments to measure these changes, and most of them only assess sleep disorders. The BRIAN scale validated for adults with BD, evaluates the regularity of the biological rhythms in four different aspects: sleep, activities, social rhythm, and eating pattern. The objective of this pilot study was to adapt the BRIAN scale to a sample of children and adolescents (BRIAN-K) and to evaluate if the new instrument is capable of detecting differences among patients and healthy controls. Methods: Twenty patients with BD, aged between 8 and 16 years, and 32 controls matched for gender and age were included. Participants were assessed using the clinical interview Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS-PL) and cognitive testing. The BRIAN-K was administered to both groups. Results: The group of patients with BD had higher scores of alterations in the circadian rhythms according to the BRIAN-K total score when compared to the control group (p=0.022). Particularly, more irregularity was found in the “activities”domain in the group of patients (p=0.001). Our results have also showed a positive correlation between the age at diagnosis and the “sleep” domain of the BRIAN-K(r=0.485; p=0.03). Conclusions: These preliminary data suggest that the BRIAN-K version, recently adapted for children and adolescents, can differentiate patients and controls. Future studies with a larger sample size are necessary to determine the reliability, as well as the internal and external validity of the present instrument.