behavioral interventions will be helpful in primary or secondary prevention, perhaps years before full-blown anxiety or depressivedisorders would be expected to develop. It would be good to see more prevention research. In the meantime, cross-sectional and longitudinal observational research will continue to inform the field regarding which personality traits might be relevant.
improve health outcomes associated with cardiometabolic risk [12, 14]. To date, several studies have examined the effectiveness of different lifestyle interventionsin patients with psychotic disorders; numerous randomized controlled trials (RCTs) as well as a number of meta-analyses [15–17] and systematic reviews have been published [14, 18, 19]. The available reviews to date however show several limitations. First, the only meta-analysis that reported long-term post-interven- tion results  did not include all available studies [20–26]. Second, the quality of RCTs included in the available meta-analyses has not been assessed. Including low quality trials may yield biased results. Third, only two of the available meta- analyses included the effects of lifestyle interventions on cardiometabolic risk [16, 17]. The authors of these studies however did not report results on all relevant metabolic outcomes that were available, even though these are important factors with regard to comorbidities and mortality in this patient group. Fourth, two of the reviews had a limited patient sample: one only included studies in patients with diabetes  and one could not include any study because their inclusion criteria stated patients should be in primary care . Last, none of the available meta-analyses reported on the effects of lifestyle interventions on depressive symptoms, although it has been widely recognized that patients with psychotic disorders often suffer from comorbid depressive symptoms [27–29], and that increased physical activity in these patients has been associated with lower levels of depression .
MDD is associated with one or more episodes of depressed mood or loss of interest in plea- sure in nearly all activities over a period of at least two weeks . MDD requires treatment be- cause otherwise substantial psychosocial problems may occur . Patients with sub-threshold depressive symptoms or mild depression are advised by clinical practice guidelines to be treated with low-intensity psychological interventions and group cognitive behavioral therapy. Pa- tients with moderate to severe depression are advised to be treated either with an antidepres- sant medication or high-intensity psychological interventions alone, or with a combination of both [10, 11]. The clinical practice guideline of the English National Institute for Health and Clinical Excellence (NICE)  also advises to use the framework of a stepped-care model to organize the provision of services, and support patients, carers and physicians in identifying and accessing the most effective interventions. The steps of such a model should consist of psy- choeducation, active monitoring, medication and psychosocialinterventions.
BACKGROUND: Substance use-related disorders are characterized by social problems, thought to be the result of social cognition impairments. In particular, the ability to interpret the thoughts of other people - Theory of Mind (ToM) - seems to be impaired. In view of this, this study aimed to investigate ToM functioning in a cocaine dependent (COD) sample. METHOD: This dissertation comprised four studies. The first is a systematic review of ToM in substance users. The second and the third deal with the development of instruments for the ToM assessment. The second is the translation and adaption of the Reading the Mind in the Eyes Test (RMET) into the Brazilian Portuguese, and the third describes the validation of the Hinting task and the ToM Stories task. The fourth work represents the main study of this dissertation – the investigation of the ToM of COD women. 30 COD women and 30 healthy controls (HC) matched for sex, age, education, individual income and IQ took part in this study. All participants were assessed with the RMET, the Hinting Task and the ToM stories. Cognitive and clinical factors were also assessed in order to control for possible differences. RESULTS: The systematic review revealed that ToM deficits were present in substance use-related disorders. Besides that, the review indicated that these impairments were related to daily life and clinical features of substance use-related disorders. In addition, this dissertation advanced with regard the technological development, since it guaranteed a translated and adapted Brazilian version of the RMET. By the same token, in the third study the Hinting Task and the ToM Stories were shown to have convergent, predictive, concurrent, discriminative and diagnostic validity. Finally, in the fourth study, COD women were found to have impaired ToM in comparison with HC. Additionally, correlations indicated ToM was negatively associated with dependence chronicity. CONCLUSION: Results were consistent with the published literature, suggesting that COD like other drug dependence disorders, is associated with ToM deficits. In view of the results that suggested an association between ToM and social and clinical outcomes, we have proposed a framework in which there is a bidirectional, facilitative relationship between drug use and ToM impairments. The implications of the results for future research and potential interventions based on targeting the psychosocial problems found to be impaired in substance use disorders are discussed.
Abstract | Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene–environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.
In conclusion, these preliminary results for the study population showed a high prevalence (37.1%) of depressive symptoms, and an association with female gender, low educational level and socioeconomic status. As this is a single-phase study, patients with depressive symptoms were not reevaluated to conirm a diagnosis of depression or otherwise. All patients with memory complaints shall be followed, and participants with de- pressive symptoms could also be followed to allow di- agnostic clariication, evaluation of the accuracy of the Cornell scale and PHD, as well as determine the correla- tion between depression and cognitive decline.
Although the concept of coping can be applied to numerous physical, psychological, and psychosocial conditions, a large body of evidence indicates that psychosocial stress might play a major role in the onset and course of BD (Post & Leverich, 2006). Stressful experiences likely occur in a substantial number of people and have been considered dificult to control, and the choice of coping strategy could be a potential target for psychosocialinterventions. In fact, controlled studies that evaluated psychosocialinterventionsin BD have reported moderate functional improvement, improved social functioning/adaptation, and increased life satisfaction (Miklowitz & Otto, 2007). Psychosocialinterventions for BD patients often include self- monitoring, the identiication of early warning signs of relapse, and techniques for managing adverse conditions and stressful life events (Reinares et al., 2008; Scott, Colom, & Vieta, 2007; Zaretsky, Lancee, Miller, Harris, & Parikh, 2008). Although coping may be considered a mechanism of action of these interventions, its role has not yet been rigorously evaluated (Parikh et al., 2007).
Many studies had a small number of participants [29,30,33,35,36]. For example, the study aiming to reduce sexual risk behaviour calculated that it needed 5.4 times more participants to show significance . For adherence studies it has been suggested that for a study comparing one intervention group and one control group, at least 60 participants per group should be included to achieve a power of 80% and detect an absolute difference of 25% in the proportion of participants having acceptable adherence . Studies assessing ART adherence used subjective questionnaires [29,34,35]. Self-reported outcomes are related to low sensitivity, resulting in PLHIV with low adherence not being identified. Objective measures, such as direct observation and pill counts, are more precise . Some studies used objective measures: one study compared positive urine screening results and self-reported substance use . The smoking cessation trial used expired Carbon Monoxide levels to biochemically verify smoking status . While interventions aiming to improve long-term effects require a minimum follow-up of six months , only two studies fulfilled this criterion [31,36].
patients may tend to get only the negative aspects of psychoeducational information and may have serious cognitive difficulties that may hinder the learning processes needed in psychoeducation. Manic patients can be disruptive and do not absorb the information at all because of their distractibility and other cognitive disturbances. Hence, psychoeducation should be always performed during euthymia: in our study patients were required to have maintained a euthymic state (Young Mania Rating Scale [YMRS] <6, Hamilton Rating Scale for Depression [HAM- D] < 8) for at least 6 months prior to entering the study. The psychoeducational group was composed by from 8 to 12 patients, which met for 20 90-minute sessions under the direction of two trained psychologists with expertise in bipolar disorder. The content, which followed a medical model with a directive style, encouraged participation and focused on the illness rather than on psychodynamic issues. At the end of the 2-year follow-up, the number of hospitalizations per patient was lower for the psychoeducation group, although the number of patients who required hospitalization did not change significantly, which can be interpreted as psychoeducation having a good profile for avoiding the impact of the “revolving door” phenomena in the bipolar population. This study had a reasonably large sample size (N=120) and a random allocation of subjects to either a treatment condition (psychoeducation plus standard pharmacological treatment) or non-intervention (non-structured meetings plus standard pharmacological treatment).
However, these studies were designed to evaluate HRQOL, not designed to address the risk of depressivedisorders, which are clinical conditions with depressed mood, experiencing a loss of energy and interest, feelings of guilt, difficulty in concentrating, loss of appetite, and thoughts of death or suicide . Moreover, these studies are based on screening instruments rather than clinical diagnosis by physicians . Therefore, the risk of depressivedisorders fol- lowing HCC remains unknown. In summary, according to the current published cancer- related papers, lots of published papers focused on the cancer-induced fatigue, quality of life or some mental disorders measured by questionnaires, and relatively less studies focused on the physician-confirmed depressivedisordersin HCC patients. This study was aimed to investigate the subsequent risk of depressivedisordersin HCC patients, using the population-based retro- spective cohort derived from the National Health Insurance Research Database (NHIRD) in Taiwan.
increased risk of IBS in asthma patients compared with the general population and that the risk of IBS was reduced by the use of oral steroids in asthma patients. In our study, the patients had not used oral steroids in the last 6 months. Yazar et al. 8 studied 133 patients with IBS and showed that 15.8% of them had bronchial asthma according to history, clinical, and pulmoner function test findings. There were 45 (33.8%) and 8 (5.8%) subjects with respiratory symptoms in the IBS and control groups, respectively (p,0.0001). 8 In another study conducted in patients 60 years of age (aged 45.1¡14.9 years), Roussos et al. 6 reported that the pre- valence of IBS was significantly higher in asthmatics (62/ 150, 41.3%) than in subjects with other pulmonary disorders (29/130, 22.3%) and in age-matched healthy controls (25/ 120, 20.8%, p,0.001). Similarly, the frequency of IBS in asthma patients and healthy controls was 36.6% and 17.9%, respectively, in our study. Ekici et al. 22 showed that the
We hope that the possible classification bias associated with diagnoses recorded in medical charts has been minimized, as this is a clinical trial unit that adopts standardized protocols for diagnosis and clinical staging as recommended by the Brazilian Society of Infectious Diseases. Although not random, patient inclusion was consecutive among the patients referred to the outpatient psychiatry clinic, without selection biases related to the day of the visit or to the therapist, and with no demographic and clinical differences between those included and those who did not meet the inclusion criteria. The predominant profile of the psychiatric patients evaluated in this study – – female, in the fifth decade of life, with low educational attainment and a low family income – – resembled that of the patients with mental disorders covered by the Family Health Program in a previous study 38 and that of patients observed in a home survey of minor mental disordersin an urban area. 39
In the current study, families of depressive adolescents had difficulties not only in demonstrating affection but also in communicating with each other, defining their roles, solving conflicts, expressing aggressiveness, and showing integration and cohesion when acting as a group. Problems in communication are rooted in the complex area of family behavior, and the adults provide the patterns that rule the child’s development from childhood to maturity (Chiariello & Orvaschel, 1995). Depressive parents and parents of depressive children tend to establish a negative, critical, and hostile communication pattern with a deleterious effect on the child’s self-esteem and on the way the child learns to communicate with others. Depressive children and children of depressive parents usually establish interplay with parents involving a negative response to their communication style and reinforcing the depressive behavior (Chiariello & Orvaschel, 1995; Dadds, Sanders, Morrison, & Rebgetz, 1992). Regarding difficulties in expressing aggressiveness in families of depressive adolescents, a previous study found that parental exposure to their children’s depressive behavior reduced their own aggressiveness (Sheeber & Sorensen, 1998). Parental responses to the adolescent depressive behavior are relatively stable features of family interaction, which are not modifiable by changes in the adolescent depressive condition. Parents do not modify their response to the adolescent depressive behavior, and by doing that, they maintain the interactive pattern and reinforce the adolescent depressive behavior. Therefore, an important point to consider in the family functioning of depressed adolescents is that parents may inadvertently teach their children to behave in a depressive way through a reinforcement process.
The following analyses were performed: Student’s t-test to compare means; Pearson’s Chi-square with Yates’ correction to compare the proportions of the categorical variables, when necessary; Multiple Linear Regression to adjust for the differences found between patients and healthy individuals in regard to the dependent (WHOQOL-100 domains) and independent (age, SES, BDI score, and presence of a chronic health condition) variables. 37
months, with a negative impact on several features of the sufferer’s life. MDD is characterized by depressive moods that cause a loss of interest in play as well as social and academic activities. In preschool children the most common symptoms are as follows: somatic complaints such as headaches and abdominal pains, facial hypomimia, hair-trigger crying, irritability, aggression outbreaks, reduced or increased motor activity, and inappropriate behavior intended to attract the attention of parents or teachers. In elementary school-aged children, the most common symptoms are inattention or lack of concentration, lack of interest in activities previously considered enjoyable, spontaneous manifestations of worry or despair about life, worsening academic performance and provocative or challenging behavior including auto- or hetero-aggression. In adolescents, the symptoms just described can be accompanied by apathy, withdrawal, anger, despair, lack of interest, anxiety, low self-esteem, fear of the future and, in the most severe cases, suicidal behavior. 10 In
Thus, knowing the pattern of use of these psychotropic drugs at the Mental Health Clinic in the city of Sorocaba (São Paulo, Brazil) may contribute to decision making process of pre- scribers and health professionals when choosing those drugs. The benzodiazepines prescribed during the period of study were alprazolam, bromazepam, clonazepam, diazepam, estazol- am, lorazepam, midazolam and nitrazepam. The present study aims to compare the benzodiaze- pines’ appropriate use indicators among adults and older adults.
revealed similar outcomes across most results, with several exceptions. The CBT group focused on treating anxiety disorder symptoms, and the MBSR group more broadly emphasized redirecting participants’ attention to the current moment and shifting their primary relationship with thoughts, feelings, and the present internal experience, which led to larger symptom effects (external anxiety). The CBT intervention resulted in more improvement in anxious arousal effects at follow up, while the adapted MBSR intervention resulted in superior improvements in co-occurring mood disorders and reduced worry, but also showed greater severity of these measures at the pretreatment stage, confounding the interpretation of these results. The severity of the primary anxiety disorders was rated by clinicians who were blind to the treatment groups, and a comparison of clinician diagnoses indicated large effect sizes across both treatment groups. In contrast, the effect sizes on the self-report results showed more modest advances. The CBT and adapted MBSR interventions were mutually effective at reducing the primary diagnoses and fairly effective at reducing self-reported anxiety symptoms within the trial. The overall indings suggested that the CBT and adapted MBSR interventions resulted in similar rates of therapeutic change. 16