Attention in schizophrenia and in epileptic psychosis

The adaptive behavior of human beings is usually supported by rapid monitoring of outstanding events in the environment. Some investigators have suggested that a primary attention deficit might trigger symptoms of schizophrenia. In addition, researchers have long discussed the relationship between schizophrenia and the schizophrenia-like psychosis of epilepsy (SLPE). On the basis of these considerations, the objective of the present study was to investigate attention performance of patients with both disorders. Patient age was 18 to 60 years, and all patients had received formal schooling for at least four years. Patients were excluded if they had any systemic disease with neurologic or psychiatric comorbidity, or a history of brain surgery. The computer-assisted TAVIS-2R test was applied to all patients and to a control group to evaluate and discriminate between selective, alternating and sustained attention. The TAVIS-2R test is divided into three parts: one for selective attention (5 min), the second for alternating attention (5 min), and the third for the evaluation of vigilance or sustained attention (10 min). The same computer software was used for statistical analysis of reaction time, omission errors, and commission errors. The sample consisted of 36 patients with schizophrenia, 28 with interictal SLPE, and 47 healthy controls. The results of the selective attention tests for both patient groups were significantly lower than that for controls. The patients with schizophrenia and SLPE performed differently in the alternating and sustained attention tests: patients with SLPE had alternating attention deficits, whereas patients with schizophrenia showed deficits in sustained attention. These quantitative results confirmed the qualitative clinical observations for both patient groups, that is, that patients with schizophrenia had difficulties in focusing attention, whereas those with epilepsy showed perseveration in attention focus.

The scientific production in health and biological sciences of the top 20 Brazilian universities

Brazilian scientific output exhibited a 4-fold increase in the last two decades because of the stability of the investment in research and development activities and of changes in the policies of the main funding agencies. Most of this production is concentrated in public universities and research institutes located in the richest part of the country. Among all areas of knowledge, the most productive are Health and Biological Sciences. During the 1998-2002 period these areas presented heterogeneous growth ranging from 4.5 percent (Pharmacology) to 191 percent (Psychiatry), with a median growth rate of 47.2 percent. In order to identify and rank the 20 most prolific institutions in these areas, searches were made in three databases (DataCAPES, ISI and MEDLINE) which permitted the identification of 109,507 original articles produced by the 592 Graduate Programs in Health and Biological Sciences offered by 118 public universities and research institutes. The 20 most productive centers, ranked according to the total number of ISI-indexed articles published during the 1998-2003 period, produced 78.7 percent of the papers in these areas and are strongly concentrated in the Southern part of the country, mainly in São Paulo State.

Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis

The aim of the present study was to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer in a systematic review and meta-analysis of randomized clinical trials that included a comparison of chemotherapy and support care treatment in patients diagnosed with gastric adenocarcinoma, regardless of their age, gender or place of treatment. The search strategy was based on the criteria of the Cochrane Base, using the following key words: 1) randomized clinical trials and antineoplastic combined therapy or gastrointestinal neoplasm, 2) stomach neoplasm and drug therapy, 3) clinical trial and multi-modality therapy, 4) stomach neoplasm and drug therapy or quality of life, 5) double-blind method or clinical trial. The search was carried out using the Cochrane, Medline and Lilacs databases. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53 percent) receiving chemotherapy, 182 (47 percent) receiving support care treatment and 6 losses (1.6 percent). The 1-year survival rate was 8 percent for support care and 20 percent for chemotherapy (RR = 2.14, 95 percent CI = 1.00-4.57, P = 0.05); 30 percent of the patients in the chemotherapy group and 12 percent in the support care group attained a 6-month symptom-free period (RR = 2.33, 95 percent CI = 1.41-3.87, P < 0.01). Quality of life evaluated after 4 months was significantly better for the chemotherapy patients (34 percent; RR = 2.07, 95 percent CI = 1.31-3.28, P < 0.01) with tumor mass reduction (RR = 3.32, 95 percent CI = 0.77-14.24, P = 0.1). Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life.

Decision support system for the diagnosis of schizophrenia disorders

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2 percent, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6 percent exhibited anorexia nervosa and 5.6 percent, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40 percent sensitivity, 84 percent specificity, and 14 percent positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit

The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50 percent, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9 percent) female patients and 87 (29.1 percent) male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo) completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20) was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8 percent) scored > or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50 percent of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64 percent of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.

The modest but growing Brazilian presence in psychiatric, psychobiological and mental health research: assessment of the 1998-2002 period

The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (ISI). There are nine Master's and Doctoral graduate programs dedicated to research in psychiatry, neuropsychiatry, psychobiology, and mental health in the country, seven being located in southern states. During the 5-year period, from 1998 to 2002, 186 students received their doctorate degree (37/year). The programs published 637 articles in journals indexed by ISI, the majority of them in journals with an impact factor higher than 2. The research advisors' productivity varied among graduate programs, ranging from 0.6 to 2.0 articles per year in ISI-indexed journals. Despite the substantial barriers faced by the Brazilian scientific community (mainly financial and writing difficulties), Brazil's scientific mental health production is on the rise. The number of articles published in ISI-indexed journals has doubled without a significant increase in the number of graduate theses, suggesting that there was an improvement in both the quality of the scientific production and the productivity of the graduate programs. Based on these data, it is reasonable to predict a tendency to an increase in production over the next few years.

The mental health of graduate students at the Federal University of São Paulo: a preliminary report

We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5 percent), with a mean (± SD) age of 28.6 ± 4.42 years, not married (71.9 percent). Most of the subjects were professionals who had not graduated from the Federal University (78.1 percent). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44 percent) causing 4.5 percent of the subjects to be temporarily suspended from their graduate studies; 19.2 percent reported that they had used psychotropic drugs within the previous month, and 47.9 percent referred to sleep disturbances. Suicidal tendencies were mentioned by 18 percent of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

Estudo de confiabilidade da Escala Calgary de Depressäo para Esquizofrenia / Reliability study of the Portuguese version of the Calgary Depression Rating Scale to Schizophrenia

Os sintomas depressivos têm um impacto importante no curso e na qualidade de vida dos pacientes com esquizofrenia, podendo aparecer a qualquer momento ao longo da evoluçäo da doença. Como a identificaçäo e a mensuraçÝo dos sintomas depressivos säo consideradas difíceis nessa populaçäo, foi desenvolvida uma escala especialmente para esta, a Escala Calgary de Depressäo para Esquizofrenia (ECDE). O objetivo deste estudo foi avaliar a confiabilidade entre examinadores da versäo em português da ECDE. Quinze pacientes com esquizofrenia pelos critérios do DSM-IV foram avaliados por dois examinadores. Na análise dos itens a confiabilidae variou entre 0,63 e 1,00, mostrando bom desempenho da escala em nosso meio

Validaçao da versao brasileira do "Child Behavior Checklist" (CBCL) (Invent rio de Comportamentos da Infância e Adolescência): dados preliminares / Validation of the Brazilian version of the Child Behavior Checklist (CBCL)

O Child Behavior Checklist (CBCL) é um question rio que avalia competência social e problemas de comportamento em indivíduos de quatro a 18 anos, a partir de informaçöes fornecidas pelos pais. A presente pesquisa utilizou a avaliaçäo psiqui trica como padräo para determinar a validade da versäo brasileira do CBCL. Com o consentimento dos pais, pediatras da Escola Paulista de Medicina encaminharam aleatoriamente pacientes ambulatoriais para participar do estudo. Um total de 49 crianças de ambos os sexos, com idade entre quatro e 12 anos completaram todas as etapas da pesquisa. O CBCL foi aplicado a pais por pessoa leiga previamente treinada na administraçäo do question rio e as crianças foram avaliadas por psiquiatra infantil, sem conhecimento prévio dos resultados do CBCL. Crianças com um ou mais diagnósticos psiqui tricos segundo os critérios da 10§ ediçäo da Classificaçäo Internacional de Doenças (CID-10) foram consideradas "casos", sendo registrados os níveis de gravidade dos distúrbios. Crianças com pelo menos um dos perfís do CBCL (social e/ou comportamental) em nível clínico foram classificadas como "casos". Os pontos de corte em escores T utilizados para classificaçäo da amostra em categorias clínica e näo clínica correspondem ao percentil 90 para Total de Problemas de Comportamento e ao percentil 10 para Competência Social Total, ambos percentis obtidos em amostras de crianças da populaçäo geral americana. A versäo brasileira do CBCL alcançou boa sensibilidade (87 por cento), identificando corretamente 75 por cento dos casos leves, 95 por cento dos moderados e 100 por cento dos casos graves. O estudo examina variaçöes nos índices de validade do CBCL em funçäo de alteraçöes no critério de teste-positividade do instrumento e de modificaçöes no critério de morbidade utilizado pela avaliaçäo psiqui trica. O trabalho também descreve o processo de adaptaçäo cultural do CBCL em nosso meio, visando sua aplicabilidade em populaçöes de nível socioecon"mico baixo

Estudo da fragilidade cromossomica e cariotípico em pacientes com distúrbio bipolar do tipo I / Chromosomal fragility and karyotypic study in patients with type I bipolar disorder

Estudar a associaçäo de alteraçöes estruturais cromoss"micas particularmente de sítios fr geis, com distúrbio bipolar do tipo I. Planejamento: a) Investigaçäo de sítios fr geis: estudo caso-controle comparando pacientes bipolares com controles normais; b) investigaçäo cariotípica: estudo descritivo. Pacientes/participantes: Vinte e cinco casos com distúrbio bipolar do tipo I diagnosticados de acordo com os critérios do DSM-III-R através do Composite International Diagnostic Interview (CIDI), foram selecionados do programa ambulatorial de distúrbios afetivos da Escola Paulista de Medicina. Para o estudo de sítios fr geis, dez deles foram emparelhados por sexo e idade com dez controles sadios (CIDI negativos para distúrbios psiqui tricos) provenientes do ambulatório geral de otorrinolaringologia da mesma instituiçäo. Intervençäo: An lise citogenètica foi realizada em linfócitos sanguíneos cultivados em: a) meio pobre em folatos para a investigaçäo de sítios fr geis; b) meio padräo para o estudo cariotípico. Aferiçäo: a) Estudo de sítios fr geis: cem mitoses por indivíduo foram analisadas em teste cego ao diagnóstico psiqui trico. Os sítios fr geis foram identificados de acordo com uma frequência mínima de eventos esperada por banda de acordo com uma distribuiçäo de Poisson; b) Estudo cariotípico: 16 mitoses por indivíduo foram analisadas tentando-se identificar possíveis alteraçöes estruturais cromoss"micas cujos pontos de quebra possam sugerir locais de genes associados ao distúrbio bipolar. Resultados: a) Estudos de sítios fr geis: foi encontrada entre os casos maior frequência de lesöes nas seguintes bandas: 1q32, 5q31 e 11q23, sendo 1q32 o único sítio considerado fr gil; b) estudo cariotípico: näo foram evidenciadas alteraçöes estruturais cromoss"micas nem numéricas. Conclusöes: Apesar de que até o momento nenhum componente etiológico aparentemente envolvido em distúrbios neuro-psiqui tricos tenha sido mapeado na regiäo 1q32, estes achados podem levar a futuras investigaçöes de possível ligaçäo entre marcadores genéticos desta regiäo e o distúrbio bipolar