Treatment effects and adherence of sexually compulsive men in a randomized controlled trial of psychotherapy and medication.

Background: Little attention has been given to efficacious treatment and adherence to treatment of compulsive sexual behavior (CSB). Aims: Randomized controlled trial investigated short-term psychodynamic group therapy followed by relapse prevention group (STPGP-RPGT) and pharmacological treatment (PT) for CSB men on sexual compulsivity and adherence. Method: 135 men, 38 (SD = 9) years old on average, were randomly assigned to 1) STPGP-RPGT; 2) PT; 3) Both. Participants completed measures at baseline, 25th, and 34th week. 57 (42.2%) participants dropped out between baseline and 25th week, and 68 (50.4%) between baseline and 34th week. 94 (69.6%) did not adhere (80% pills taken or attended 75% therapy sessions). Results: A significant interaction effect was found between time and group (F (4, 128) = 2.62, P = 0.038, ES = 0.08), showing who received PT improved less in sexual compulsivity than those who received STPGP-RPGT (t = 2.41; P = 0.038; ES = 0.60) and PT + STPGP-RPGT (t = 3.15; P = 0.007, ES = 0.74). Adherent participants improved more in sexual compulsivity than non-adherent at the 25th week (t = 2.82; P = 0.006, ES = 0.65) and 34th week (t = 2.26; P = 0.027, ES = 0.55), but there was no interaction effect, F (2, 130) = 2.88; P = 0.06; ES = 0.04). The most reported behavior (masturbation) showed greater risk of non-adherence (72.6%). Discussion and conclusions: Adherent participants improved better than non-adherent. Participants who received psychotherapy improved better than those who received PT. Methodological limitations preclude conclusions on efficacy.

Mortalidade em transtornos mentais no estudo UK Biobank / Mortality in mental disorders in the UK Biobank study

Introdução - Vasta literatura tem associado transtornos mentais a uma mortalidade aumentada. Porém, poucos estudos sobre o tema identificaram transtornos mentais através de questionários validados. Além disso, pouco se sabe sobre a contribuição de fatores de risco modificáveis para explicar o excesso de mortalidade associado a transtornos mentais. Objetivo - Utilizar dados do UK Biobank, um grande estudo prospectivo que recrutou meio milhão de participantes de meia idade e idosos entre 2006 e 2010, para investigar: (I) a mortalidade relativa e as causas de morte associadas a uma ampla gama de transtornos mentais; (II) padrões de combinações de transtornos mentais e a mortalidade relativa associada a essas combinações; e (III) a contribuição de fatores de risco modificáveis para explicar o excesso de mortalidade associado à depressão. Transtornos mentais foram identificados por variados métodos, incluindo um Questionário de Saúde Mental completado por cerca de 160.000 participantes, diagnósticos registrados durante internações hospitalares obtidos via linkage e diagnósticos autorrelatados. Métodos - Foram obtidas estimativas de mortalidade relativa por todas as causas associadas a diferentes transtornos mentais e suas combinações com modelos de regressão de Cox ajustados por idade (ou idade e sexo). Padrões de combinações de transtornos mentais foram explorados através de mineração de regras de associação. Um método baseado em modelos de regressão de Cox foi utilizado para estimar a porcentagem do excesso de mortalidade associada à depressão explicada por fatores de risco modificáveis. Resultados - A maioria dos transtornos mentais e combinações de transtornos mentais se associaram com maior mortalidade, independentemente do método de identificação. Cerca de 70% da mortalidade em excesso associada à depressão pôde ser explicada por fatores de risco modificáveis. Conclusões - Em uma grande amostra de indivíduos de meia idade e idosos no Reino Unido, transtornos mentais e suas combinações estiveram consistentemente associados a uma maior mortalidade. Em depressão, essa associação parece ser explicada em grande parte pela presença de fatores de risco modificáveis.

Introduction - Extensive literature has associated mental disorders with increased mortality. However, few studies on this topic have identified mental disorders through validated questionnaires. In addition, little is known about the contribution of modifiable risk factors to explain the excess mortality associated with mental disorders. Objective - To use data from the UK Biobank, a large prospective study which recruited half a million middle-aged and elderly participants between 2006 and 2010, to investigate: (I) the relative mortality and causes of death associated with a wide range of mental disorders; (II) patterns of combinations of mental disorders and the relative mortality associated with these combinations; and (III) the contribution of modifiable risk factors to explain the excess mortality associated with depression. Mental disorders were identified by various methods, including a Mental Health Questionnaire completed by approximately 160,000 participants, diagnoses from hospital inpatient records obtained via linkage, and self-reported diagnoses. Methods - The relative all-cause mortality associated with different mental disorders and their combinations was estimated using Cox regression models adjusted for age (or age and sex). Association rule mining was used to explore patterns of combinations of mental disorders. A method based on Cox regression models was used to estimate the percentage of excess mortality associated with depression explained by modifiable risk factors. Results The majority of mental disorders and combinations of mental disorders were associated with higher mortality, regardless of the identification method. Approximately 70% of the excess mortality associated with depression could be explained by modifiable risk factors. Conclusions - In a large sample of middle-aged and elderly individuals in the UK, mental disorders and their combinations were consistently associated with higher mortality. In depression, this association seems to be largely explained by the presence of modifiable risk factors.

A randomized controlled trial comparing lithium plus valproic acid versus lithium plus carbamazepine in young patients with type 1 bipolar disorder: the LICAVAL study.

BACKGROUND: Treatment of bipolar disorder (BD) usually requires drug combinations. Combinations of lithium plus valproic acid (Li/VPA) and lithium plus carbamazepine (Li/CBZ) are used in clinical practice but were not previously compared in a head-to-head trial. OBJECTIVE: The objective of this trial was to compare the efficacy and tolerability of Li/VPA versus Li/CBZ in treating type 1 BD in any phase of illness in young individuals. METHODS: LICAVAL was a randomized, unicenter, open-label, parallel-group trial that was conducted from January 2009 to December 2012 in a tertiary hospital in São Paulo, Brazil. Participants were between 18 and 35 years old and were followed up for 2 years. Our primary outcome was the number of participants achieving/maintaining response and remission during the acute and maintenance phases of BD treatment, respectively. Other outcomes assessed were symptom severity and adverse events throughout the study. In the analysis of the primary outcome, we compared groups by using a two-way repeated measures analysis of variance and estimated effect sizes by using Cohen's d. RESULTS: Of our 64 participants, 36 were allocated to Li/VPA and 28 to Li/CBZ. Our sample was composed predominantly of females (66.6%) and the average age was 27.8 years. A total of 27 (45.0%) participants had depression, 17 (28.3%) had mania/hypomania, and 16 (26.7%) had a mixed state. We found no between-group differences in CGI-BP (Clinical Global Impression Scale modified for use in bipolar disorder) scores (P = 0.326) or in any other outcome. Side effects differed significantly between groups only in the first week of treatment (P = 0.021), and there were more side effects in the Li/VPA group. Also, the Li/VPA group gained weight (+2.1 kg) whereas the Li/CBZ group presented slight weight loss (-0.2 kg). CONCLUSION: Our study suggests that Li/VPA and Li/CBZ have similar efficacy and tolerability in BD but that Li/CBZ might have metabolic advantages in the long term. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00976794 . Registered on September 9, 2009.

What is the nonverbal communication of depression? Assessing expressive differences between depressive patients and healthy volunteers during clinical interviews.

BACKGROUND: It is unclear if individuals with Major Depressive Disorder (MDD) present different nonverbal behavior (NVB) compared with healthy individuals, and also if depression treatments affect NVB. In this study, we compared the NVB of MDD subjects and healthy controls. We also verified how MDD subjects' NVB is affected by depression severity and acute treatments. METHODS: We evaluated 100 MDD outpatients and 83 controls. We used a 21-category ethogram to assess the frequency of positive and negative NVB at baseline. MDD subjects were also assessed after eight weeks of treatment (pharmacotherapy or neuromodulation). We used the Wilcoxon signed-rank test to compare the NVB of MDD subjects and controls; beta regression models to verify associations between MDD severity and NVB; the Shapiro-Wilk test to verify changes in NVB after treatment; and logistic regression models to verify NVB associated with treatment response according to the Hamilton depression rating scale. RESULTS: Compared with controls, MDD subjects presented higher levels of six negative NVB (shrug, head and lips down, adaptive hand gestures, frown and cry) and lower levels of two positive NVB (eye contact and smile). MDD subjects' NVB was not associated with depression severity, and did not significantly change after depression treatment. Treatment responders showed more interpersonal proximity at baseline than non-responders. LIMITATIONS: Our ethogram had no measure of behavior duration, and we had a short follow-up period. CONCLUSIONS: MDD subjects have more negative and less positive social NVB than controls. Their nonverbal behavior remained stable after clinical response to acute depression treatments.

Otitis media with effusion in children younger than 1 year / Otite média com efusão em crianças menores de um ano

Objective: To determine the prevalence of otitis media with effusion in children younger than 1 year and its association with the season of the year, artificial feeding, environmental and perinatal factors. Methods: Retrospective study of 184 randomly included medical records from a total of 982 healthy infants evaluated for hearing screening tests. Diagnosis of otitis media with effusion was based on otoscopy (amber-gold color, fluid level, handle of malleus position), type B tympanometric curves and absence of otoacoustic emissions. Incomplete medical records or those describing acute otitis media, upper respiratory tract infections on the assessment day or in the last 3 months, neuropathies and craniofacial anomalies were excluded. Data such as gestational age, birth weight, Apgar score, type of feeding and day care attendance were compared between children with and without otitis media with effusion through likelihood tests and multivariate analysis. Results: 25.3% of 184 infants had otitis media with bilateral effusion; 9.2% had unilateral. In infants with otitis media, the following were observed: chronological age of 9.6±1.7 months; gestational age >38 weeks in 43.4% and birth weight >2500g in 48.4%. Otitis media with effusion was associated with winter/fall, artificial feeding, Apgar score <7 and day care attendance. The multivariate analysis showed that artificial feeding is the factor most often associated to otitis media with effusion. Conclusions: Otitis media with effusion was found in about one third of children younger than 1 year and was mainly associated with artificial feeding.

Objetivo: Determinar prevalência de otite média com efusão em menores de um ano e sua associação com estação do ano, aleitamento artificial, fatores ambientais e perinatais. Métodos: Estudo retrospectivo com 184 prontuários incluídos de forma randomizada dentre 982 lactentes saudáveis avaliados para testes de triagem auditiva. Diagnóstico de otite média com efusão baseou-se em otoscopia (coloração âmbar-ouro, nível líquido, posição do cabo do martelo), curva timpanométrica tipo B e otoemissões acústicas ausentes. Excluíram-se prontuários incompletos ou que descreviam otite média aguda, infecções de vias aéreas superiores no dia da avaliação ou nos últimos três meses, neuropatias e anomalias craniofaciais. Dados como idade gestacional, peso ao nascimento, Apgar, tipo de aleitamento, frequência à creche foram comparados entre crianças com e sem otites com efusão por meio de testes de verossimilhança e análise multivariada. Resultados: 25,3% dos 184 lactentes apresentavam otite média com efusão bilateral; 9,2% unilateral. Nos lactentes com otite média, observou-se idade cronológica 9,6±1,7 meses; idade gestacional >38 semanas em 43,4% e peso ao nascer >2.500g em 48,4%. Otite média com efusão foi associada ao inverno/outono, aleitamento artificial, Índice de Apgar <7 e atendimento à creche. Já a análise multivariada demonstrou que o aleitamento artificial é o fator mais associado à otite média com efusão. Conclusões: A otite média com efusão foi encontrada em cerca de 1/3 dos menores de um ano e principalmente associada ao aleitamento artificial.

[Otitis media with effusion in children younger than 1 year]. / Otite média com efusão em crianças menores de um ano.

OBJECTIVE: To determine the prevalence of otitis media with effusion in children younger than 1 year and its association with the season of the year, artificial feeding, environmental and perinatal factors. METHODS: Retrospective study of 184 randomly included medical records from a total of 982 healthy infants evaluated for hearing screening tests. Diagnosis of otitis media with effusion was based on otoscopy (amber-gold color, fluid level, handle of malleus position), type B tympanometric curves and absence of otoacoustic emissions. Incomplete medical records or those describing acute otitis media, upper respiratory tract infections on the assessment day or in the last 3 months, neuropathies and craniofacial anomalies were excluded. Data such as gestational age, birth weight, Apgar score, type of feeding and day care attendance were compared between children with and without otitis media with effusion through likelihood tests and multivariate analysis. RESULTS: 25.3% of 184 infants had otitis media with bilateral effusion; 9.2% had unilateral. In infants with otitis media, the following were observed: chronological age of 9.6±1.7 months; gestational age >38 weeks in 43.4% and birth weight >2,500g in 48.4%. Otitis media with effusion was associated with winter/fall, artificial feeding, Apgar score <7 and day care attendance. The multivariate analysis showed that artificial feeding is the factor most often associated to otitis media with effusion. CONCLUSIONS: Otitis media with effusion was found in about one third of children younger than 1 year and was mainly associated with artificial feeding.