Publications by authors named "Luciano Dias de Mattos Souza"

88 Publications

Brief cognitive behavioral therapy in pregnant women at risk of postpartum depression: Pre-post therapy study in a city in southern Brazil.

J Affect Disord 2021 Jul 30;290:15-22. Epub 2021 Apr 30.

Catholic University of Pelotas, Brazil; PQ CNPq, Brazil.

Background: Postpartum depression (PPD) affects a high number of women, often the first manifestation of a mood disorder that will occur later in life, bringing serious consequences for the patient and her offspring. Depression today is the leading cause of disability worldwide. The aim of this study was to evaluate the effectiveness of a preventive cognitive behavioral therapy (CBT) for PPD.

Methods: Pre-post therapy study, as part of a population-based cohort study. Pregnant women without a diagnosis of depression participated, who were divided into two groups: risk of depression (CBT) and a control group (without therapy). The preventive therapy consisted of six sessions of CBT, administered weekly. The Outcome Questionnaire (OQ-45) was used in all sessions. The Mini International Neuropsychiatric Interview and Beck Depression Inventory-II were used on three occasions. The final statistical analyses were performed by Poisson regression.

Results: The prevalence of PPD in the risk group was 5.5% and in the control group 2.2%, with no difference between the groups (PR 1.66 95% CI 0.44-6.18). The OQ-45 averages gradually reduced during the therapy sessions, indicating therapeutic progress. Schooling was an associated factor, both with the manifestation of PPD and with the greater effectiveness of the therapy.

Limitations: Rate of 40.5% refusal to preventive treatment and absence of a group with similar characteristics in another therapy model.

Conclusions: Brief cognitive behavioral therapy applied by mental health professionals with basic training was effective in preventing the manifestation of PPD.
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http://dx.doi.org/10.1016/j.jad.2021.04.031DOI Listing
July 2021

Cognitive complaints in individuals recently diagnosed with bipolar disorder: A cross-sectional study.

Psychiatry Res 2021 Jun 21;300:113894. Epub 2021 Mar 21.

Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Aim: To assess the differences in subjective cognitive dysfunction between major depressive disorder (MDD) and recently diagnosed Bipolar Disorder (BD) across euthymia and mood episodes.

Methods: This is a cross-sectional study corresponding to the second wave of a longitudinal study. The first wave consisted of subjects aged between 18 and 60 diagnosed with MDD. In the follow up after three years (second wave), conversion from MDD to BD diagnosis was assessed by qualified psychologists using the Mini International Neuropsychiatric Interview (MINI-Plus). Subjects were categorized in four diagnostic groups: euthymic MDD, MDD in a current mood episode, euthymic BD, and BD in a current mood episode. All subjects completed the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), an instrument specifically designed for detecting subjective cognitive deficits in BD.

Results: The total sample (n = 468) included 410 subjects with MDD and 58 individuals recently diagnosed with BD. We subdivided the 2 groups based on their current mood state, and found a significant difference in COBRA total scores between euthymic BD individuals (median 17.00 [IQR: 8.75 - 20.75]) and euthymic MDD subjects (median 8.00 [IRQ: 5.00 - 14.00], p = 0.002), showing higher subjective cognitive dysfunction in individuals recently diagnosed with BD. The differences remained significant after adjusting for the presence of lifetime psychotic symptoms. We found no differences between MDD and BD during an acute mood episode.

Limitation: The small sample size of individuals with BD.

Conclusion: The findings suggest a higher presence of subjective cognitive complaints among individuals recently diagnosed with BD in comparison to individuals with MDD during euthymia.
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http://dx.doi.org/10.1016/j.psychres.2021.113894DOI Listing
June 2021

Sleep alterations in individuals recently diagnosed with bipolar disorder across different mood stages.

Psychiatry Res 2021 May 25;299:113824. Epub 2021 Feb 25.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brasil. Electronic address:

Objectives: To assess the differences in sleep impairments in major depressive disorder (MDD) and individuals recently diagnosed with bipolar disorder (BD) across different mood stages.

Methods: This is a cross-sectional study corresponding to the second wave of a prospective clinical cohort of a sample of outpatients. The first wave included subjects diagnosed with MDD aged 18 to 60 years. Averaging 3 years after the first phase (second wave), conversion from MDD to BD diagnosis was assessed using the Mini International Neuropsychiatric Interview. The total sample was divided into four groups: euthymic MDD, MDD in a current episode, euthymic BD, and BD in a current mood episode. The sleep alterations were assessed using the Pittsburgh Sleep Quality Index.

Results: The sample included 468 subjects (261 euthymic MDD, 149 MDD currently depressed, 16 euthymic BD, and 42 BDs currently in a (hypo)manic or depressive episode). Euthymic BD differed from euthymic MDD only in the domains of sleep efficiency and sleep disturbances, showing lower sleep efficiency (PR 4.91 [95%CI 1.94 - 12.42]) and higher sleep disturbances (PR 3.38 [95%CI 1.32 - 8.67]) in subjects recently diagnosed with BD during euthymia. These differences remained significant after adjusting for the potential confounding factors.

Conclusions: The findings point out the relevance of regular sleep assessments in individuals recently diagnosed with BD, since the differences in sleep quality observed could provide insights regarding prognosis, treatment, and the extent to which these individuals display significant subsyndromal symptomatology, even in the absence of a mood episode.
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http://dx.doi.org/10.1016/j.psychres.2021.113824DOI Listing
May 2021

Predictors of conversion from major depressive disorder to bipolar disorder.

Psychiatry Res 2021 Mar 18;297:113740. Epub 2021 Jan 18.

Graduate Program in Health and Behavior, Universidade Católica de Pelotas (UCPEL), Pelotas, RS, Brazil. Electronic address:

The present study has two main aims: (1) To assess whether childhood trauma helps to differentiate Major Depressive Disorder (MDD) from Bipolar Disorder (BD) in a cross-sectional design; and (2) Describe the rate of conversion from MDD to BD, as well as the clinical and demographic predictors of conversion from MDD to BD in a prospective cohort design. We conducted a prospective cohort study in two phases, in the city of Pelotas, RS, Brazil. In the first phase, 565 subjects diagnosed with MDD, and 127 with BD according to the Mini International Neuropsychiatric Interview were included. In the second phase, only individuals with MDD were reevaluated for potential conversion to BD. The rate of conversion from MDD to BD in 3 years was 12.4%. Predictors of conversion from MDD to BD included lower educational level, use of illicit substances, younger age of the first depressive episode, and family history of BD. Childhood trauma was not a significant risk factor for conversion to BD in our prospective study. Our findings can contribute to the prevention and identification of conversion from MDD to BD, as well as to the establishment of more targeted therapeutic interventions, improving the prognosis of these individuals.
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http://dx.doi.org/10.1016/j.psychres.2021.113740DOI Listing
March 2021

Effects of depression and excess body weight on cognition and functioning in young adults: A population-based study.

J Affect Disord 2021 03 27;282:401-406. Epub 2020 Dec 27.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Objectives: The purpose of this study is to assess the independent effects of depression and excess body weight (EBW) on cognition and functioning in a community sample of young adults.

Methods: This was a cross-sectional of 943 young adults. The diagnosis of a current depressive episode was performed using the Mini International Neuropsychiatric Interview (MINI). Cognition and functioning were assessed using the Montreal Cognitive Assessment (MoCA) and the Functional Assessment Short Test (FAST), respectively. The EBW was defined as BMI ≥ 25.0 kg/m. The independent main effects of depression and EBW, as well as the analysis interaction were performed using two-way analysis of covariance (ANCOVA).

Results: The total sample comprised 943 adults, with 75 (8.0%) individuals diagnosed with a current depressive episode and 493 (52,6%) with EBW. Of the 75 subjects with depression, 40 were identified with EBW comorbidity. Subjects with depression and EBW comorbidity reported greater cognitive and functional impairment, as compared to individuals with depression without EBW. There was a significant interaction between depression and EBW on MoCA total (p<0.001) as well as FAST total (p=0.010), work (p=0.002), cognition (p=0.023), finances (p=0.032) and relationships domains (p=0.008).

Conclusions: The adverse effects of depression and EBW are independent and cumulative with respect to cognition and functioning of individuals. The understanding of the complex interactions between cognition, functioning, EBW and depression are important for development of preventive and therapeutic strategies.
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http://dx.doi.org/10.1016/j.jad.2020.12.083DOI Listing
March 2021

Effects of depression and excess body weight on cognition and functioning in young adults: A population-based study.

J Affect Disord 2021 03 27;282:401-406. Epub 2020 Dec 27.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Objectives: The purpose of this study is to assess the independent effects of depression and excess body weight (EBW) on cognition and functioning in a community sample of young adults.

Methods: This was a cross-sectional of 943 young adults. The diagnosis of a current depressive episode was performed using the Mini International Neuropsychiatric Interview (MINI). Cognition and functioning were assessed using the Montreal Cognitive Assessment (MoCA) and the Functional Assessment Short Test (FAST), respectively. The EBW was defined as BMI ≥ 25.0 kg/m. The independent main effects of depression and EBW, as well as the analysis interaction were performed using two-way analysis of covariance (ANCOVA).

Results: The total sample comprised 943 adults, with 75 (8.0%) individuals diagnosed with a current depressive episode and 493 (52,6%) with EBW. Of the 75 subjects with depression, 40 were identified with EBW comorbidity. Subjects with depression and EBW comorbidity reported greater cognitive and functional impairment, as compared to individuals with depression without EBW. There was a significant interaction between depression and EBW on MoCA total (p<0.001) as well as FAST total (p=0.010), work (p=0.002), cognition (p=0.023), finances (p=0.032) and relationships domains (p=0.008).

Conclusions: The adverse effects of depression and EBW are independent and cumulative with respect to cognition and functioning of individuals. The understanding of the complex interactions between cognition, functioning, EBW and depression are important for development of preventive and therapeutic strategies.
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http://dx.doi.org/10.1016/j.jad.2020.12.083DOI Listing
March 2021

Resilience as a mediator factor in the relationship between childhood trauma and mood disorder: A community sample of young adults.

J Affect Disord 2020 09 1;274:48-53. Epub 2020 May 1.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brasil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Background: Studies on the field of mood disorders has mainly focusing on the risk factors associated to develop the illness or the clinical factors associated with the clinical progression. Less attention was given to factors such as resilience that may be associated with better outcomes in the course of mood disorders. In this study, we assessed the mediation effect of resilience on the relationship between childhood trauma and mood disorders, as well as the severity of depressive symptoms in a population-based sample.

Methods: This is a cross-sectional study with a community sample of young adults with bipolar disorder (BD), major depressive disorder (MDD), and community controls without any mood disorder. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and to assess the resilience was used the Resilience Scale (RS-25).

Results: All subtypes of trauma were associated with both MDD and BD, however, only physical and emotional abuse differentiated BD from MDD subjects. Bootstrapping-enhanced mediation analyses indicated that resilience partly mediated the association of childhood trauma to both mood disorder and severity of depression.

Limitation: The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality.

Conclusions: The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of childhood trauma. This study provides important information regarding the relationships among childhood trauma, resilience, and mood disorder.
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http://dx.doi.org/10.1016/j.jad.2020.04.011DOI Listing
September 2020

The role of CACNA1C gene and childhood trauma interaction on bipolar disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2020 07 10;101:109915. Epub 2020 Mar 10.

Laboratory of Clinical Neuroscience, Post-graduation Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Studies on gene x environment interaction (GxE) have provided vital information for uncovering the origins of complex diseases. When considering the etiology of bipolar disorder (BD), the role of such interactions is unknown. Here, we tested whether trauma during childhood could modify the effect of two polymorphisms in the CACNA1C gene (rs1006737 and rs4765913) in terms of susceptibility to BD. The study enrolled 878 Caucasian young adults in a cross-sectional population-based survey. BD diagnosis was performed using a clinical interview MINI 5.0, and trauma was assessed with the childhood trauma questionnaire (CTQ). Binary logistic regression models were employed to test the main effects of polymorphisms, haplotypes, and GxE interactions using sex as a confounder. We did not observe an association between the polymorphisms and diagnosis of BD. However, we noted that childhood trauma modified the effect of the rs4765913 polymorphism (p = .018) and the AA haplotype (rs1006737 - rs4765913) (p = .018) on BD susceptibility. A allele carriers of the rs4765913 polymorphism or the AA haplotype exposed to childhood trauma are more likely to develop BD compared to the individuals without a genetic risk. Thus, this study showed that the risk of developing BD in individuals exposed to childhood trauma was influenced by the individual's genetic background, varying according to the CACNA1C genotypes.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109915DOI Listing
July 2020

The role of CACNA1C gene and childhood trauma interaction on bipolar disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2020 07 10;101:109915. Epub 2020 Mar 10.

Laboratory of Clinical Neuroscience, Post-graduation Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Studies on gene x environment interaction (GxE) have provided vital information for uncovering the origins of complex diseases. When considering the etiology of bipolar disorder (BD), the role of such interactions is unknown. Here, we tested whether trauma during childhood could modify the effect of two polymorphisms in the CACNA1C gene (rs1006737 and rs4765913) in terms of susceptibility to BD. The study enrolled 878 Caucasian young adults in a cross-sectional population-based survey. BD diagnosis was performed using a clinical interview MINI 5.0, and trauma was assessed with the childhood trauma questionnaire (CTQ). Binary logistic regression models were employed to test the main effects of polymorphisms, haplotypes, and GxE interactions using sex as a confounder. We did not observe an association between the polymorphisms and diagnosis of BD. However, we noted that childhood trauma modified the effect of the rs4765913 polymorphism (p = .018) and the AA haplotype (rs1006737 - rs4765913) (p = .018) on BD susceptibility. A allele carriers of the rs4765913 polymorphism or the AA haplotype exposed to childhood trauma are more likely to develop BD compared to the individuals without a genetic risk. Thus, this study showed that the risk of developing BD in individuals exposed to childhood trauma was influenced by the individual's genetic background, varying according to the CACNA1C genotypes.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109915DOI Listing
July 2020

Incidence of Common Mental Disorders in Teachers: Is There a Relationship with Voice Disorders?

J Voice 2021 May 2;35(3):432-437. Epub 2019 Dec 2.

Universidade Católica de Pelotas, Department of Health and Behavior. Pelotas, Rio Grande do Sul, Brazil; Universidade Federal de São Paulo, Department of Speech-language Pathology and Audiology, São Paulo, Brazil.

Objective: This study aims to evaluate the risk factors associated with the incidence of common mental disorders (CMD) in teachers, particularly the possible relationship with voice disorders.

Material And Methods: A longitudinal quantitative study of 469 teachers of the municipal schools of Pelotas in Brazil was conducted over three years after a baseline interview. The symptoms of CMD were assessed with the Self-Reporting Questionnaire 20 items (SRQ-20 scale) and the voice disorder was assessed with the Voice Handicap Index Protocol with cutoff of 19 points. A bivariate analysis was performed using Poisson regression to verify the difference in proportion of the incidence of CMD in the different categories of independent variables.

Results: The incidence of CMD was 18% (N = 265). In the bivariate analysis, the risk for CMD was 77% higher for teachers who presented with a voice disorder (RR 1.77 95% CI 1.04 to 3.03).

Conclusions: Teachers who reported a voice disorder had an increased risk of developing a CMD.
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http://dx.doi.org/10.1016/j.jvoice.2019.10.009DOI Listing
May 2021

Risk Factors for Recurrent Perceived Voice Disorders in Elementary School Teachers-A Longitudinal Study.

J Voice 2021 Mar 6;35(2):325.e23-325.e27. Epub 2019 Nov 6.

Programa de Pós Graduação em Saúde e Comportamento da Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Objective: To identify the progression of voice disorders and their risk factors in teachers.

Design: Longitudinal quantitative study conducted in municipal schools.

Method: Of the 575 teachers who participated in the baseline study, 469 were re-evaluated after 3 years of the initial study. Out of these, 152 reported having a voice disorder at baseline and participated in the re-evaluation. Voice disorders were diagnosed with the Voice Handicap Index (VHI) and teachers were considered positive for voice disorders when the total score was above 19. Symptoms of common mental disorder were measured with the SRQ-20 scale (Self-Reporting Questionnaire, 20 items), with a cut-off value of 8 points. A bivariate analysis was performed using Poisson regression to verify the differences in the proportion of teachers who continued presenting a voice disorder among the different categories of the independent variables in the study.

Results: A total of 69.1% of the teachers reported having a voice disorder after 3 years. High prevalence of acute common mental disorder symptoms was a predictor for a recurring perceived voice disorder. The risk of having a voice disorder was 30% higher for teachers who presented a common mental disorder 3 years after.

Conclusions: Teachers who had both a voice disorder and symptoms of common mental disorder were more likely to maintain the voice disorder.
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http://dx.doi.org/10.1016/j.jvoice.2019.08.030DOI Listing
March 2021

Leptin polymorphism rs3828942: risk for anxiety disorders?

Eur Arch Psychiatry Clin Neurosci 2019 Aug 16. Epub 2019 Aug 16.

Institute of Health Sciences, Department of Health and Behavior, Catholic University of Pelotas - UCPel, Rua Gonçalves Chaves 373, Sala 324, Pelotas, RS, 96010-280, Brazil.

Leptin is an anorexigenic hormone well recognized by its role in mediating energy homeostasis. Recently, leptin has been associated with psychiatric disorders and interestingly, leptin treatment has shown antidepressant and anxiolytic effects. We examined the association of leptin levels and leptin (LEP) gene rs3828942 polymorphism with anxiety disorders considering sex differences. A cross-sectional population-based study, including 1067 young adults, of whom 291 presented anxiety disorders diagnosed by the Mini International Neuropsychiatric Interview (MINI 5.0). The rs3828942 polymorphism was genotyped by real-time PCR and ELISA measured leptin levels. Leptin levels were not associated with anxiety disorders after adjusting for sex and body mass index (BMI) [ß = - 0.009 (- 0.090-0.072); p = 0.832]. The distribution of rs3828942 genotypes was not associated with anxiety disorders. However, in a sex-stratified sample, the A-allele of rs3828942 polymorphism was associated with risk for GAD in women even when adjusting for confounding variables [OR = 1.87 (1.17-2.98); p = 0.008]. In a subsample of 202 individuals with GAD and control matched by sex and BMI, results suggest an interaction between genotypes and GAD diagnosis based on leptin levels only in the male group [F (1, 54) = 6.464; p = 0.0139]. Leptin is suggested to be related with the neurobiology of anxiety disorders in a sex-dependent manner since women carrying the A-allele of LEP rs3828942 present a higher risk for GAD, while leptin levels seem to be lower in men with GAD carrying A-allele. Studies on the relationship between leptin polymorphisms and levels are scarce and, therefore, further research is necessary.
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http://dx.doi.org/10.1007/s00406-019-01051-8DOI Listing
August 2019

Cognitive performance and salivary cortisol levels in school children.

Psychiatry Clin Neurosci 2019 Sep 20;73(9):596-597. Epub 2019 Jul 20.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.

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http://dx.doi.org/10.1111/pcn.12904DOI Listing
September 2019

Cognitive performance and salivary cortisol levels in school children.

Psychiatry Clin Neurosci 2019 Sep 20;73(9):596-597. Epub 2019 Jul 20.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.

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http://dx.doi.org/10.1111/pcn.12904DOI Listing
September 2019

Clinical outcomes and childhood trauma in bipolar disorder: A community sample of young adults.

Psychiatry Res 2019 05 21;275:228-232. Epub 2018 Dec 21.

Department of Health and Behavior, Catholic University of Pelotas, 373 Goncalves Chaves, 416C room, Zip code 96015-560, Pelotas, RS, Brazil. Electronic address:

Childhood trauma is a complex experience, much reported by subjects with bipolar disorder. There are still few studies that assess its consequences in a community sample of bipolar in early stage. The aim of the present study is to assess the association between childhood trauma and clinical outcomes, including the global functioning, in a community sample of young adults with bipolar disorder. This is a cross-sectional study with a community sample of subjects with bipolar disorder, from 23 to 30 years old, with and without childhood trauma. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The functioning was assessed by Functioning Assessment Short Test (FAST). Ninety subjects with bipolar disorder were included in the study (30 with childhood trauma and 60 without childhood trauma). Young adults with bipolar disorder and childhood trauma showed higher prevalence of current suicide risk, higher severity of depressive symptoms, and higher functioning impairment as compared to subjects with bipolar disorder without childhood trauma. The childhood trauma experiences appear to be an environmental risk factor for worse clinical outcomes and higher functional impairment.
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http://dx.doi.org/10.1016/j.psychres.2018.12.114DOI Listing
May 2019

Persistence of symptoms after cognitive therapies is associated with childhood trauma: A six months follow-up study.

Psychiatry Res 2019 05 20;275:177-180. Epub 2019 Feb 20.

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, 373 Goncalves Chaves, 416C room, Zip code 96015-560. Pelotas-RS, Brazil. Electronic address:

This study aims to assess the effect of childhood trauma on the outcomes of brief cognitive therapies for major depressive disorder. This is a follow-up clinical study nested in a randomized clinical trial of cognitive therapies. Sixty-one patients were assessed at baseline, post-intervention and six-month follow-up. The study showed that brief cognitive therapies improved depressive and anxious symptoms at post-intervention and six-month follow-up. Higher childhood trauma scores at baseline were significantly associated with higher severity of depressive and anxious symptoms at six-month follow-up. Longer courses of psychotherapy may be needed to improve the long-lasting effects of traumatic experiences.
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http://dx.doi.org/10.1016/j.psychres.2019.02.044DOI Listing
May 2019

Metabolic syndrome, depression and anhedonia among young adults.

Psychiatry Res 2019 01 7;271:306-310. Epub 2018 Aug 7.

Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil; Department of Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.

The aim of this study was to assess the association between anhedonia and metabolic syndrome (MetS) in a well-characterized community sample of individuals with a current depressive episode. This is a cross-sectional study with young adults aged 24-30 years old. Depressive episode and the presence of anhedonia was assessed using the Mini International Neuropsychiatric Interview - Plus version (MINI Plus). The MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). The sample included 931 subjects, being 22 had depression without anhedonia, whereas 55 had depression with anhedonia. MetS was more prevalent among subjects with depression and anhedonia (43.6%) when compared to individuals without anhedonia and population control group. Moreover, subjects with depression and anhedonia have a significant increase of levels of glucose, triglycerides, total-cholesterol and LDL-cholesterol, as well as significant decreased in the HDL-cholesterol level. The present study showed that individuals with depression and anhedonia present higher prevalence of MetS. Our study suggests that the use of the concept of anhedonia may contribute to a better understanding of the complex relationship between depression and metabolic syndrome.
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http://dx.doi.org/10.1016/j.psychres.2018.08.009DOI Listing
January 2019

Differences between unipolar mania and bipolar-I disorder: Evidence from nine epidemiological studies.

Bipolar Disord 2019 08 14;21(5):437-448. Epub 2018 Dec 14.

Department of Psychiatry, University Hospital of Lausanne, Prilly, Switzerland.

Objectives: Although clinical evidence suggests important differences between unipolar mania and bipolar-I disorder (BP-I), epidemiological data are limited. Combining data from nine population-based studies, we compared subjects with mania (M) or mania with mild depression (Md) to those with BP-I with both manic and depressive episodes with respect to demographic and clinical characteristics in order to highlight differences.

Methods: Participants were compared for gender, age, age at onset of mania, psychiatric comorbidity, temperament, and family history of mental disorders. Generalized linear mixed models with adjustment for sex and age as well as for each study source were applied. Analyses were performed for the pooled adult and adolescent samples, separately.

Results: Within the included cohorts, 109 adults and 195 adolescents were diagnosed with M/Md and 323 adults and 182 adolescents with BP-I. In both adult and adolescent samples, there was a male preponderance in M/Md, whereas lifetime generalized anxiety and/panic disorders and suicide attempts were less common in M/Md than in BP-I. Furthermore, adults with mania revealed bulimia/binge eating and drug use disorders less frequently than those with BP-I.

Conclusions: The significant differences found in gender and comorbidity between mania and BP-I suggest that unipolar mania, despite its low prevalence, should be established as a separate diagnosis both for clinical and research purposes. In clinical settings, the rarer occurrence of suicide attempts, anxiety, and drug use disorders among individuals with unipolar mania may facilitate successful treatment of the disorder and lead to a more favorable course than that of BP-I disorder.
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http://dx.doi.org/10.1111/bdi.12732DOI Listing
August 2019

Psychometric Validation of the Short Form of the Smoking Consequences Questionnaire (S-SCQ) for Brazil.

Cien Saude Colet 2018 Nov;23(11):3947-3955

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas. R. Gonçalves Chaves 373, Centro. 96015-560 Pelotas RS Brasil.

Smoking accounts for 24% of deaths in the general population and is also the factor that explains the biggest amount of years of life lost. It is important to understand the expectations regarding smoking behavior. The present study aimed to validate the Short Form of the Smoking Consequences Questionnaire (S-SCQ) for a Brazilian version. The Researchers did the process of semantic adaptation to language and national context. The S-SCQ was applied in a sample of 129 people. The next step was to perform psychometric analyses for the set of 21 items. Exploratory Factor Analysis, with pairwise treatment for missing cases, was used to achieve construct validity. To carry out Factor Analysis, the method of Principal Component Analysis (PCA) was used initially. Afterwards, Principal Axis Factoring (PAF) using Varimax rotation with Kaiser normalization was applied. The reliability of the total scale (21 items) showed a Cronbach alpha index of 0.851 and a 0.870 Lambda2 of Gutmann. Quite satisfactory rates were also observed in the subscales. Similarly, the item-overall correlation values also confirmed the scale's good reliability indices.
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http://dx.doi.org/10.1590/1413-812320182311.09612016DOI Listing
November 2018

Impact of resilience on the improvement of depressive symptoms after cognitive therapies for depression in a sample of young adults.

Trends Psychiatry Psychother 2018 Jul-Sep;40(3):226-231

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil.

Introduction: Few studies have evaluated positive measures for therapeutic response. Thus, the objective of this study was to assess the effects of resilience on severity of depressive and anxious symptoms after brief cognitive psychotherapy for depression.

Methods: This was a clinical follow-up study nested in a randomized clinical trial of cognitive therapies. The Resilience Scale was applied at baseline. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used at baseline, post-intervention, and at six-month follow-up.

Results: Sixty-one patients were assessed at baseline, post-intervention and at six-month follow-up. Resilience scores were significantly different between baseline and post-intervention assessments (p<0.001), as well as at baseline and at six-month follow-up (p<0.001). We observed a weak negative correlation between baseline resilience scores and HDRS scores at post-intervention (r=-0.295, p=0.015) and at six-month follow-up (r=-0.354, p=0.005). Furthermore, we observed a weak negative correlation between resilience scores and HARS scores at post-intervention (r=-0.292, p=0.016).

Conclusion: Subjects with higher resilience scores at baseline showed a lower severity of symptoms at post-intervention and at six-month follow-up.
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http://dx.doi.org/10.1590/2237-6089-2017-0047DOI Listing
November 2018

Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults.

J Affect Disord 2019 01 11;243:103-107. Epub 2018 Sep 11.

Federal University of Pelotas, RS, Brazil.

Introduction: Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.

Objective: To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.

Methods: This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.

Results: The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028).

Limitations: The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.

Conclusion: Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.
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http://dx.doi.org/10.1016/j.jad.2018.09.007DOI Listing
January 2019

Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults.

J Affect Disord 2019 01 11;243:103-107. Epub 2018 Sep 11.

Federal University of Pelotas, RS, Brazil.

Introduction: Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.

Objective: To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.

Methods: This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.

Results: The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028).

Limitations: The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.

Conclusion: Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.
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http://dx.doi.org/10.1016/j.jad.2018.09.007DOI Listing
January 2019

Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults.

J Affect Disord 2019 01 11;243:103-107. Epub 2018 Sep 11.

Federal University of Pelotas, RS, Brazil.

Introduction: Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.

Objective: To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.

Methods: This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.

Results: The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028).

Limitations: The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.

Conclusion: Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.
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http://dx.doi.org/10.1016/j.jad.2018.09.007DOI Listing
January 2019

Comparison of Clinical Significance of Cognitive-Behavioral Therapy and Psychodynamic Therapy for Major Depressive Disorder: A Randomized Clinical Trial.

J Nerv Ment Dis 2018 09;206(9):686-693

Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

The aim of this study was to evaluate the effect of two brief psychotherapy models for major depressive disorder (MDD). This is a randomized clinical trial with 247 individuals diagnosed with MDD. Supportive-expressive dynamic psychotherapy (SEDP) (18 sessions) and cognitive-behavioral therapy (CBT) (16 sessions) were the two models used in this study. Participants were evaluated at baseline, during treatment, and postintervention (last session). Clinically significant changes were found in both psychotherapy models, and CBT showed higher response rates. Regarding the Beck Depression Inventory-II [F(1,120) = 4.07, p = 0.046] and Outcome Questionnaire 45.2 [F(1.114) = 7.99, p = 0.006], CBT had a better effect than SEDP. Hence, the results obtained have contributed to literature, served to corroborate the importance and effectiveness of psychodynamic psychotherapy, as well as explored the mechanisms of change, remission, and response in the treatment of MDD, which have been ignored to a large extent.
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http://dx.doi.org/10.1097/NMD.0000000000000872DOI Listing
September 2018

Prevalence and factors associated with Premenstrual Dysphoric Disorder: A community sample of young adult women.

Psychiatry Res 2018 10 26;268:42-45. Epub 2018 Jun 26.

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, 373, Gonçalves Chaves, Centro, Pelotas, Rio Grande do Sul, Brazil.

Premenstrual Dysphoric Disorder (PMDD) was recently included in DSM-5 as a full diagnostic category. Few studies have investigated PMDD in a community sample of young adults, especially in Brazil. Thus, the objective of this study was to evaluate the prevalence and the factors associated with PMDD in a community sample of 727 young adult women between the 18 and 24 years of age in southern Brazil. This was a cross-sectional population-based study. The data were collected from 2012 to 2014. PMDD was assessed using the Mini International Neuropsychiatry Interview (M.I.N.I. - Plus). The prevalence of PMDD was 17.6%. PMDD was significantly higher among older women, and in women from lower socio-economic status. A trend towards significance was found for women without a current occupation (study or work). The comorbidities significantly associated with PMDD were current major depression disorder, agoraphobia, bipolar disorder, current suicide risk, generalized anxiety disorder, social phobia, and specific phobia. The high prevalence found in the present study should be interpreted considering a retrospective report. However, our data showed that clinicians should be alert for PMDD symptoms, especially among young adult women.
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http://dx.doi.org/10.1016/j.psychres.2018.06.005DOI Listing
October 2018

Serum GDNF levels and anxiety disorders in a population-based study of young adults.

Clin Chim Acta 2018 Oct 12;485:21-25. Epub 2018 Jun 12.

Translational Science on Brain Disorders, Clinical Neuroscience Laboratory, Department of Health and Behavior, Catholic University of Pelotas, RS, Brazil; Technology Application in Neurosciences, Department of Electronic Engineering and Computer, Catholic University of Pelotas.

Objective: The aim of this study was to verify the serum GDNF levels in individuals with anxiety disorder (AD) in a population-based study.

Methods: This was a cross-sectional study population-based, with people aged 18 to 35. AD's assessment was performed using the Mini International Neuropsychiatric Interview (M.I.N.I). Serum GDNF was measured by ELISA using a commercial kit.

Results: The prevalence was 3.3% for post-traumatic stress disorder, 6.7% for panic disorders, 17% generalized anxiety disorder, 5.1% for obsessive- compulsive disorder and 7.5% for social phobia. Serum GDNF levels was higher in individuals with panic disorders (p = 0.013), generalized anxiety (p = 0.035), obsessive- compulsive disorder (p = 0.005) and social phobia (p = 0.004), when compared to individuals without ADs. Only post traumatic stress disorder is not associated with serum GDNF levels (p = 0.119).

Conclusion: In this paper, we observed increased serum levels of GDNF in individuals with anxiety disorders, suggesting that this biomarker can be used as a putative marker for AD's. The knowledge of the physiological changes related to anxiety disorders can provide a better understanding of AD's pathogenesis, as well as, mechanisms involved in the progression of this condition.
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http://dx.doi.org/10.1016/j.cca.2018.06.017DOI Listing
October 2018

Construction of a biological rhythm assessment scale for children.

Trends Psychiatry Psychother 2018 Mar;40(1):53-60

Universidade Católica de Pelotas, Pelotas, RS, Brazil.

Introduction Biological rhythm is associated with the level of alertness, cognitive performance and mood of the individuals. Its regularity is essential to preserve good health and quality of life. Objective To present the steps for the construction of the scale entitled Biological Rhythm Interview of Assessment in Neuropsychiatry - Kids (BRIAN-K), designed to measure biological rhythm disruptions in Brazilian children and adolescents. Methods Items were developed following the adult version of the scale. Analysis of the psychometric characteristics of the scale was based on the responses of 373 parents/caregivers of school age children (7 and 8 years old). Results A theoretical model of 17 items with the purpose of evaluating four domains (sleep, activities, social rhythm and eating pattern) was determined using exploratory factor analysis (EFA) and via identification of a general factor. The psychometric properties of the BRIAN-K showed favorable properties. Conclusion Only two items needed to be rewritten. Further studies are needed to investigate the instrument's adequacy to different age groups and additional evidence of validity and reliability.
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http://dx.doi.org/10.1590/2237-6089-2017-0081DOI Listing
March 2018

Childhood trauma and increased peripheral cytokines in young adults with major depressive: Population-based study.

J Neuroimmunol 2018 06 6;319:112-116. Epub 2018 Mar 6.

Translational Science on Brain Disorders, Clinical Neuroscience Laboratory, Department of Health and Behavior, Catholic University of Pelotas, RS, Brazil; Technology Application in Neurosciences, Department of Electronic Engineering and Computer, Catholic University of Pelotas, Brazil.

Objective: The aim of this study was to evaluate the effect of childhood trauma in cytokine serum levels of individuals with MDD.

Methods: This was a cross-sectional study population-based, with people aged 18 to 35. The Mini International Neuropsychiatric Interview (M.I.N.I) measured to current major depressive disorder (MDD). To evaluate traumatic experiences during childhood, the Childhood Trauma Questionnaire (CTQ) was applied. Serum TNF- α, IL-6 and IL-10 levels were measured by ELISA using a commercial kit.

Results: The total sample comprised 166 young adults, of these: 40.4% were subjects with MDD and childhood trauma and 59.6% were diagnosed with MDD without childhood trauma. In relation to serum interleukin levels, subjects with childhood trauma showed a significantly higher serum IL-6 (p = 0.013) and IL-10 levels (p = 0.022) to compare no childhood trauma. Subjects with childhood trauma was observed positive correlation between serum IL-6 and physical abuse (r = 0.232, p = 0.035) and emotional abuse (r = 0.460, p ≤ 0.001). Moreover, IL-10 were positive correlation with physical abuse (r = 0.258, p = 0.013). TNF- α was not associated with childhood trauma.

Conclusion: Childhood maltreatment may result higher inflammation dysregulation in individuals with depression than individuals that no has childhood maltreatment.
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http://dx.doi.org/10.1016/j.jneuroim.2018.02.018DOI Listing
June 2018

Serum levels of interleukins IL-6 and IL-10 in individuals with posttraumatic stress disorder in a population-based sample.

Psychiatry Res 2018 02 21;260:111-115. Epub 2017 Nov 21.

Translational Science on Brain Disorders, Clinical Neuroscience Laboratory, Department of Health and Behavior, Catholic University of Pelotas, RS, Brazil; Technology Application in Neurosciences, Department of Electronic Engineering and Computer, Catholic University of Pelotas, Brazil.

To evaluate the serum levels of IL-6 and IL-10 anti-inflammatory interleukins in individuals with post-traumatic stress disorder (PTSD) in a population-based study. This is a paired study nested in a cross-sectional population-based study. All individuals who presented PTSD and did not present major depressive disorder, diagnostic by interview--Mini International Neuropsychiatric Interview were selected. From these, 41 healthy controls were matched by sex and age. Serum levels of IL-6 and IL-10 were measured by the ELISA, using commercial kits. The group of individuals with PTSD showed a significant increase in the serum levels of IL-6 and IL-10. Our results suggest that individuals with PTSD may present an activation of the immune system, which may lead to neuroinflammation.
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http://dx.doi.org/10.1016/j.psychres.2017.11.061DOI Listing
February 2018

Is Narrative Cognitive Therapy as Effective as Cognitive Behavior Therapy in the Treatment for Depression in Young Adults?

J Nerv Ment Dis 2017 12;205(12):918-924

Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

This study aimed to compare the effectiveness of narrative cognitive therapy (NCT) and cognitive behavior therapy (CBT) in the improvement of perception of quality of life in young adults with depression at 12-month follow-up. This was a randomized clinical trial conducted using seven sessions of NCT or CBT. Quality of life was measured using the Medical Outcomes Survey Short-Form General Health Survey. The sample included 97 patients. Considering only completers to be samples, CBT was more effective than NCT for improvement of physical functioning (p = 0.031), vitality (p = 0.013), and mental health (p = 0.002) at 12-month follow-up. However, in the intention-to-treat analysis, we found no difference between groups. Regardless of model, we found a significant improvement in all domains from baseline to postintervention and 6- and 12-month follow-ups, except for the bodily pain domain. In conclusion, both models were effective in the improvement of perception of quality of life.
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http://dx.doi.org/10.1097/NMD.0000000000000758DOI Listing
December 2017