Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study.

OBJECTIVE:: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. METHODS:: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. RESULTS:: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). CONCLUSIONS:: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study / Desempenho em tarefas de atenção, memória, habilidades visuoconstrutivas e funções executivas em adolescentes com transtornos de ansiedade: um estudo comunitário caso-controle

Abstract Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Resumo Objetivo: Este estudo objetivou avaliar crianças e adolescentes com transtornos de ansiedade leve e moderada nas funções neuropsicológicas de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global, comparando o seu desempenho ao de crianças com desenvolvimento típico. Métodos: Participaram do estudo 68 crianças e adolescentes com idade de 10 a 17 anos (41 com diagnósticos clínicos atuais de transtornos de ansiedade e 27 controles), selecionados de uma amostra transversal mais ampla de adolescentes da comunidade. Os adolescentes com diagnóstico foram divididos ainda em dois grupos com base na gravidade dos transtornos (leve ou moderado). Todos os participantes realizaram uma avaliação neuropsicológica individual das funções de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global. Resultados: Nenhum dos testes neuropsicológicas demonstrou diferenças significativas, sendo a única exceção a tarefa de span de dígitos ordem inversa, na qual o grupo com ansiedade leve apresentou desempenho superior ao do grupo com ansiedade moderada e também ao dos controles (p = 0.041; η2 = 0.11). Conclusão: Os resultados sugerem que não só os transtornos de ansiedade podem preservar as principais funções cognitivas durante a adolescência, mas que podem até melhorar certos processos de memória de trabalho.

Phonemic verbal fluency and severity of anxiety disorders in young children.

INTRODUCTION: Previous studies have implicated impaired verbal fluency as being associated with anxiety disorders in adolescents. OBJECTIVES: To replicate and extend previously reported evidence by investigating whether performance in phonemic verbal fluency tasks is related to severity of anxiety symptoms in young children with anxiety disorders. We also aim to investigate whether putative associations are independent from co-occurring attention deficit hyperactivity disorder (ADHD) symptoms. METHODS: Sixty children (6-12 years old) with primary diagnoses of anxiety disorders participated in this study. Severity of symptoms was measured using clinician-based, parent-rated and self-rated validated scales. Verbal fluency was assessed using a simple task that measures the number of words evoked in 1-minute with the letter F, from which we quantified the number of isolated words, number of clusters (groups of similar words) and number of switches (transitions between clusters and/or between isolated words). RESULTS: There was a significant association between the number of clusters and anxiety scores. Further analysis revealed associations were independent from co-occurring ADHD symptoms. CONCLUSION: We replicate and extend previous findings showing that verbal fluency is consistently associated with severity in anxiety disorders in children. Further studies should explore the potential effect of cognitive training on symptoms of anxiety disorders.

Phonemic verbal fluency is associated with pediatric anxiety disorders: evidence from a community study.

BACKGROUND: Anxiety disorders typically begin in childhood and adolescence and predict risk for many problems throughout life. Although some neuropsychological correlates have been described, more research is needed, particularly in adolescents. This study compares neurocognitive characteristics of anxious adolescents with and without comorbidity to externalizing disorders to those of typically developing comparison (TDC) adolescents and adolescents with externalizing disorders alone. METHODS: The study included 57 adolescents 12-18 years of age (TDC, n=23; anxiety, n=16; externalizing, n=11; comorbid, n=7). We used a neuropsychological battery to assess eight domains: Orientation, attention, visual perception, memory, arithmetic, language, praxis, and executive function. RESULTS: Multivariate analysis of variance revealed a main effect of group in the neurocognitive domains evaluated (F8,48=2.32, p=0.034, ηp(2)=0.279). Post-hoc analysis revealed that executive functions score differed among groups, specifically in the task of verbal fluency (F[df=3]=5.01, p=0.004, ηp(2)=0.221), with both the anxious groups (anxiety and comorbid) presenting a lower score than the TDC and externalizing groups. This effect was independent of age, intelligence, and levels of education. CONCLUSIONS: Verbal fluency is specifically impaired in adolescents with anxiety disorders. This extends results from neuroimaging research implicating prefrontal areas in pediatric anxiety disorder neurobiology, and has potential implications to new therapeutics.

Cognitive-behavioral group therapy for youths with anxiety disorders in the community: effectiveness in low and middle income countries.

BACKGROUND: Although cognitive-behavioral therapy (CBT) is established as a first line treatment for anxiety disorders in children and adolescents, there is little evidence about the effectiveness of CBT protocols in cases identified in the community in low and middle income countries (LaMICs). AIMS: To evaluate the effectiveness of group CBT protocol for youths with anxiety disorders identified in a community sample in LaMICs. METHOD: A total of 14 sessions of group CBT for youths and 2 concurrent sessions for parents based on Kendall's Coping Cat program were offered. Participants were selected from a cross-sectional community study; 45 subjects fulfilled inclusion criteria and 28 agreed to participate in the open clinical trial. Treatment effectiveness was evaluated with standard clinical, self- and parent-rated measures of anxiety, depression, externalizing symptoms and quality of life (QoL). RESULTS: Twenty youths completed the protocol. All scales showed an improvement of anxiety and reduction in externalizing symptoms over time, with a moderate to large effect size (d = 0.59 to 2.06; p < .05), but not in depressive symptoms or QoL. CONCLUSIONS: Consistent with previous evidence, group CBT is effective in treating anxiety disorders in youths. Results encourage further randomized clinical trials using CBT protocols adapted and developed to be used in LaMICs.

Association between anxiety symptoms and problematic alcohol use in adolescents.

BACKGROUND: Anxiety disorders are highly prevalent, affecting approximately 10% of individuals throughout life; its onset can be detected since early childhood or adolescence. Studies in adults have shown that anxiety disorders are associated with alcohol abuse, but few studies have investigated the association between anxiety symptoms and problematic alcohol use in early ages. OBJECTIVE: To evaluate if anxiety symptoms are associated with problematic alcohol use in young subjects. METHODS: A total of 239 individuals aged 10-17 years were randomly selected from schools located in the catchment area of Hospital de Clínicas de Porto Alegre. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was used to evaluate the presence of anxiety symptoms, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), to evaluate alcohol use. RESULTS: One hundred twenty-seven individuals (53.1% ) reported having already used alcohol. Of these, 14 individuals showed problematic alcohol use (5.8% ). There was no association between lifetime use of alcohol and anxiety symptoms, but mean SCARED scores in individuals with problematic alcohol use was higher if compared to those without problematic use, even after adjustment for age and gender (29.9±8.5 vs. 23.7±11.8, p < 0.001). CONCLUSIONS: Despite the limitation of a cross-sectional design, our study suggests that anxiety symptoms are associated with problematic alcohol use early in life.

Association between anxiety symptoms and problematic alcohol use in adolescents / Associação entre sintomas ansiosos e uso problemático de álcool em adolescentes

BACKGROUND: Anxiety disorders are highly prevalent, affecting approximately 10% of individuals throughout life; its onset can be detected since early childhood or adolescence. Studies in adults have shown that anxiety disorders are associated with alcohol abuse, but few studies have investigated the association between anxiety symptoms and problematic alcohol use in early ages. OBJECTIVE: To evaluate if anxiety symptoms are associated with problematic alcohol use in young subjects. METHODS: A total of 239 individuals aged 10-17 years were randomly selected from schools located in the catchment area of Hospital de Clínicas de Porto Alegre. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was used to evaluate the presence of anxiety symptoms, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), to evaluate alcohol use. RESULTS: One hundred twenty-seven individuals (53.1% ) reported having already used alcohol. Of these, 14 individuals showed problematic alcohol use (5.8% ). There was no association between lifetime use of alcohol and anxiety symptoms, but mean SCARED scores in individuals with problematic alcohol use was higher if compared to those without problematic use, even after adjustment for age and gender (29.9±8.5 vs. 23.7±11.8, p < 0.001). CONCLUSIONS: Despite the limitation of a cross-sectional design, our study suggests that anxiety symptoms are associated with problematic alcohol use early in life

INTRODUÇÃO: Os transtornos de ansiedade possuem alta prevalência, afetando aproximadamente 10% dos indivíduos ao longo da vida; seu início pode ser detectado já na infância e na adolescência. Estudos em adultos demonstram que a ansiedade está associada ao abuso de álcool. No entanto, poucos estudos investigaram a associação entre sintomas ansiosos e o uso problemático de álcool em indivíduos jovens. OBJETIVO: Avaliar se os sintomas de ansiedade estão relacionados com uso problemático de álcool em jovens. Métodos: Um total de 239 indivíduos com idade de 10-17 anos foram aleatoriamente selecionados em escolas pertencentes à área de abrangência do Hospital de Clinicas de Porto Alegre. A escala Screen for Child Anxiety-Related Emotional Disorders (SCARED) foi utilizada para avaliar a presença de sintomas ansiosos, e a escala Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), para avaliar o uso de álcool. RESULTADOS: Cento e vinte e sete indivíduos (53,1% ) já haviam utilizado bebida alcoólica. Desses, 14 indivíduos mostraram uso problemático de álcool (5,8% ). Não foi observada associação entre ter usado álcool na vida e sintomas ansiosos. Porém, o escore médio da SCARED em indivíduos com uso problemático de álcool foi maior quando comparado com o escore daqueles sem uso de álcool problemático, mesmo após ajuste para idade e gênero (29,9±8,5 vs. 23,7±11,8, p < 0,001). CONCLUSÕES: Apesar das limitações impostas pelo desenho transversal, nosso estudo sugere que sintomas de ansiedade estão associados com o uso problemático de álcool em indivíduos jovens

Anxiety disorders in adolescence are associated with impaired facial expression recognition to negative valence.

OBJECTIVE: The aim of the present study was to test the ability of adolescents with a current anxiety diagnosis to recognize facial affective expressions, compared to those without an anxiety disorder. METHODS: Forty cases and 27 controls were selected from a larger cross sectional community sample of adolescents, aged from 10 to 17 years old. Adolescent's facial recognition of six human emotions (sadness, anger, disgust, happy, surprise and fear) and neutral faces was assessed through a facial labeling test using Ekman's Pictures of Facial Affect (POFA). RESULTS: Adolescents with anxiety disorders had a higher mean number of errors in angry faces as compared to controls: 3.1 (SD=1.13) vs. 2.5 (SD=2.5), OR=1.72 (CI95% 1.02 to 2.89; p=0.040). However, they named neutral faces more accurately than adolescents without anxiety diagnosis: 15% of cases vs. 37.1% of controls presented at least one error in neutral faces, OR=3.46 (CI95% 1.02 to 11.7; p=0.047). No differences were found considering other human emotions or on the distribution of errors in each emotional face between the groups. CONCLUSION: Our findings support an anxiety-mediated influence on the recognition of facial expressions in adolescence. These difficulty in recognizing angry faces and more accuracy in naming neutral faces may lead to misinterpretation of social clues and can explain some aspects of the impairment in social interactions in adolescents with anxiety disorders.

The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings.

OBJECTIVE: This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project. METHOD: Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. RESULTS: A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8%), social anxiety disorder (n = 57; 41.3%) and separation anxiety disorder (n = 49; 35.5%) were the most frequent disorders. CONCLUSION: The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.

Perfil psiquiátrico e sociodemográfico dos idosos avaliados no pronto-atendimento de um hospital universitário de Porto Alegre / Sociodemographic and psychiatric profile of the elderly assisted at an emergency room of a teaching hospital in Porto Alegre

Introdução: A assistência à população de idosos tem sido assunto importante no mundo atual. Visto que os idosos são responsáveis pela maior parte da demanda nos serviços de saúde, conhecer as suas características é essencial para a sua assistência no hospital geral. O presente trabalho tem como objetivo traçar o perfil dos idosos atendidos na Consultoria Psiquiátrica de Urgência do Pronto-Atendimento do Hospital São Lucas da PUCRS. Métodos: Foi realizado um estudo transversal com análise descritiva dos dados dos pacientes geriátricos (≥; 60 anos), comparando-os com os dados dos pacientes não idosos. Resultados: Setecentos e quatro pacientes foram incluídos no estudo, sendo que, desses, 12,4% eram idosos. A maioria da população de idosos era composta de pessoas do sexo feminino (75,3%), casadas (42,4%) e aposentadas (76,8%). Cerca de quarenta e cinco por cento (45,2%) foram encaminhados por profissionais da saúde. Dentre os transtornos psiquiátricos, o mais frequente entre os idosos foi o de transtornos de humor, observado em 65,9% dos pacientes, seguidos pelos transtornos mentais orgânicos (13,4%), transtornos de ansiedade e relacionados ao estresse (9,8%). Conclusão: Os achados são, em parte, consistentes com aqueles encontrados em estudo realizado em cenário clínico semelhante e ainda acrescentam novos dados ainda pouco explorados, como as diferentes prevalências no uso de psicotrópicos e a comparação entre a população de idosos e não-idosos. Tais achados são de grande importância para embasar novas políticas de saúde na população geriátrica.

Introduction: The care of the elderly population has been an important issue in today’s world. Since the elderly are responsible for most of the demand in health services, knowledge of their characteristics is essential for their assistance in the general hospital. This study aims to trace the profile of the elderly in the Consulting Psychiatric Emergency Department of the Hospital São Lucas of PUCRS. Methods: We conducted a cross-sectional study with descriptive data analysis of geriatric patients (≥ 60 years), comparing them with data from nonelderly patients. Results: Seven hundred and four patients were included in the study, and among these, 12.4% were elderly. Most of the elderly population were females (75.3%), married (42.4%) and retired (76.8%). About forty-five percent (45.2%) were referred by health professionals. The most common psychiatric disorders among the elderly were mood disorders, observed in 65.9% of patients, followed by organic mental disorders (13.4%), anxiety disorders and stress-related (9.8%). Conclusion: The findings are partly consistent with those found in studies conducted in similar clinical setting and add new data still largely unexplored, such as the different prevalence in the use of psychotropic drugs and a comparison of the elderly and nonelderly populations. These findings are highly important as a foundation for new health policies in the geriatric population.

The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings / Avaliação multidimensional e tratamento da ansiedade em crianças e adolescentes: marco teórico, desenho, métodos e resultados preliminares

OBJECTIVE: This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project. METHOD: Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. RESULTS: A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8 percent), social anxiety disorder (n = 57; 41.3 percent) and separation anxiety disorder (n = 49; 35.5 percent) were the most frequent disorders. CONCLUSION: The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.

OBJETIVO: o objetivo deste estudo é descrever o desenho, os métodos e as características amostrais da Avaliação Multidimensional e Tratamento da Ansiedade em Crianças e Adolescentes - Projeto PROTAIA. MÉTODO: Escolares entre 10 e 17 anos de todas as escolas pertencentes à área de abrangência da unidade de atenção primária do Hospital de Clínicas de Porto Alegre foram incluídos no projeto. O projeto compreende cinco fases: 1) triagem comunitária; 2) diagnóstico psiquiátrico; 3) avaliação multidimensional, incluindo fatores ambientais, neuropsicológicos, nutricionais e marcadores biológicos; 4) tratamento; e 5) fase translacional. RESULTADOS: Um total de 2.457 sujeitos foram triados para transtornos de ansiedade na comunidade. Dos indivíduos que compareceram à avaliação diagnóstica, 138 foram detectados com ao menos um transtorno de ansiedade (excluindo fobia específica) e 102 indivíduos sem nenhum transtorno de ansiedade. Dentre os casos de ansiedade, o transtorno de ansiedade generalizada (n = 95; 68,8 por cento), transtorno de ansiedade social (n = 57; 41,3 por cento) e o transtorno de ansiedade de separação (n = 49; 35,5 por cento) foram os mais frequentes. CONCLUSÃO: O projeto PROTAIA é um projeto de pesquisa promissor que pode contribuir para o entendimento da relação entre transtornos de ansiedade e fenótipos relacionados à ansiedade com vários fatores de risco, tanto genéticos quanto ambientais.

Estudo bibliométrico da produção brasileira na interface da psicologia com espiritualidade-religiosidade / Bibliometric study about de Brazilian production in the interface between psychology and spirituality-religiosity

O presente trabalho apresenta uma revisão bibliométrica da produção brasileira na interface psicologia espiritualidade-religiosidade, no período de 1998 a 2006. Para isso definimos temas (psicologia e espiritualidade/religiosidade) e termos de buscas ('religiosidade' e 'psicologia', 'espiritualidade' e 'psicologia', e 'espiritualidade' e 'religiosidade') realizadas em bases de dados de artigos e periódicos científicos on-line, de acesso gratuito e privado, além da busca manual, realizada nas bibliotecas da Pontifícia Universidade Católica do Rio Grande do Sul, PUC-RS e da Universidade Católica de Pelotas, UCPel. Foram priorizados periódicos classificados como QUALIS Nacional A, B e C, e os Locais. Os resultados apontam que até 2006 os dados da produção brasileira na interface psicologia espiritualidade/religiosidade menores em relação ao total da produção. No entanto, esse número cresce a partir do referido período. Assim, consideramos o panorama da produção como crescente, uma informação bastante relevante, em função do importante papel da dimensão espiritual-religiosa no desenvolvimento pessoal(AU)

A bibliometric revision of the Brazilian production about the interface between spirituality and psychology were analyzed, from 1998 to 2006. To achieve that were defined the themes (psychology and spirituality-religiosity) and search terms ('religiosity and psychology', 'spirituality and psychology', and 'spirituality' and 'religiosity ') and searches were done in article and scientifical periodic online databases, of free and private access. Beyond that, manual searches were made at the libraries of the Pontifícia Universidade Católica of Rio Grande do Sul and Universidade Católica de Pelotas,. Were prioritized the periodic classified as National QUALIS A, B and C, and the Local ones. The results point out in the direction that until 2006, data on Brazilian production about the interface between spirituality and psychology are very few related to production totals. However, this number grows larger after the referred period. Thus, the production scenario were consider as growing, a very relevant information, in face of the important role of the spiritual-religious dimension in the personal development(AU)

Estudo bibliométrico da produção brasileira na interface da psicologia com espiritualidade-religiosidade / Bibliometric study about de Brazilian production in the interface between psychology and spirituality-religiosity

O presente trabalho apresenta uma revisão bibliométrica da produção brasileira na interface psicologia espiritualidade-religiosidade, no período de 1998 a 2006. Para isso definimos temas (psicologia e espiritualidade/religiosidade) e termos de buscas ("religiosidade" e "psicologia", "espiritualidade" e "psicologia", e "espiritualidade" e "religiosidade") realizadas em bases de dados de artigos e periódicos científicos on-line, de acesso gratuito e privado, além da busca manual, realizada nas bibliotecas da Pontifícia Universidade Católica do Rio Grande do Sul, PUC-RS e da Universidade Católica de Pelotas, UCPel. Foram priorizados periódicos classificados como QUALIS Nacional A, B e C, e os Locais. Os resultados apontam que até 2006 os dados da produção brasileira na interface psicologia espiritualidade/religiosidade menores em relação ao total da produção. No entanto, esse número cresce a partir do referido período. Assim, consideramos o panorama da produção como crescente, uma informação bastante relevante, em função do importante papel da dimensão espiritual-religiosa no desenvolvimento pessoal.

A bibliometric revision of the Brazilian production about the interface between spirituality and psychology were analyzed, from 1998 to 2006. To achieve that were defined the themes (psychology and spirituality-religiosity) and search terms ("religiosity and psychology", "spirituality and psychology", and "spirituality" and "religiosity ") and searches were done in article and scientifical periodic online databases, of free and private access. Beyond that, manual searches were made at the libraries of the Pontifícia Universidade Católica of Rio Grande do Sul and Universidade Católica de Pelotas,. Were prioritized the periodic classified as National QUALIS A, B and C, and the Local ones. The results point out in the direction that until 2006, data on Brazilian production about the interface between spirituality and psychology are very few related to production totals. However, this number grows larger after the referred period. Thus, the production scenario were consider as growing, a very relevant information, in face of the important role of the spiritual-religious dimension in the personal development.