Luciano Dias de Mattos Souza

Universidade Católica de Pelotas (UCPel), São Francisco de Paula, Rio Grande do Sul, Brazil

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Publications (50)62.47 Total impact

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    ABSTRACT: Generalized anxiety disorder (GAD) is a common psychiatric disorder characterized by long-term worry, tension, nervousness, fidgeting, and symptoms of autonomic system hyperactivity. The neurobiology of this disorder is still unclear, although it has been shown consistently that the environment and the genetic profile could increase its risk. We examined whether a polymorphism in the brain-derived neurotrophic factor (BDNF) gene, which plays a role in neuroplasticity and memory, could increase the vulnerability to this disorder. In our study, 816 participants from a population-based study were genotyped by qPCR for the BDNF functional variant rs6265 (Val66Met) and the BDNF serum levels were measured by ELISA. Our results showed a significant association between the Met allele and risk for GAD (P=0.014), but no differences were observed in the serum levels of BDNF according to diagnosis (P=0.531) or genotype distribution (P=0.197). However, after stratification according to the GAD diagnosis, the Met allele was associated significantly with an increase in serum BDNF levels compared with the Val/Val genotype in GAD participants (F=3.93; P=0.048). The logistic regression analysis confirmed the independent association of Met allele as a risk factor for development of GAD after adjusting for confounder variables (β=0.528; 95% confidence interval: 0.320-0.871; P=0.012). These results suggest that BDNF could be involved in the neurobiology of GAD and might represent a useful marker associated with the disease.
    Psychiatric genetics 06/2015; DOI:10.1097/YPG.0000000000000097 · 2.27 Impact Factor
  • Susane Müller Klug Passos, Luciano Dias de Mattos Souza
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    ABSTRACT: This cross-sectional study evaluated the quality of life and its associated factors among people living with HIV/AIDS at a regional reference center for the treatment of HIV/AIDS in southern Brazil. WHOQOL-HIV Bref, ASSIST 2.0, HAD Scale, and a questionnaire were used to assess 625 participants on quality of life, clinical and sociodemographic characteristics, drug use, depression and anxiety. Multivariate analysis was performed through linear regression. The lowest results for quality of life were associated with being female, age (< 47 years), low education levels, low socioeconomic class, unemployment, not having a stable relationship, signs of anxiety and depression, abuse or addiction of psychoactive substances, lack of perceived social support, never taking antiretroviral medication, lipodystrophy, comorbidities, HIV related hospitalizations and a CD4+ cell count less than 350. Psychosocial factors should be included in the physical and clinical evaluation given their strong association with quality of life domains.
    Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 04/2015; 31(4):800-14. · 0.89 Impact Factor
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    ABSTRACT: Depression during pregnancy in adolescents is increasing significantly. However, instruments for early depression screening during prenatal care are scarce. Faced this fact, the objective of this research is to identify the best cutoff points for the Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) in a sample of pregnant adolescents. 807 pregnant adolescents, with a mean age of 17 years, met in public antenatal services were evaluated. Two screening scales for depression were analyzed, EPDS and the BDI. These scales had their accuracy measured by AUC of their ROC curve, as well as their respective sensitivity and specificity. In the analysis, the best cutoff for the EPDS was≥10, in which the sensitivity was 81.1% and specificity 82.7%. For the BDI, it was with recognized the cutoff ≥11, sensitivity 86.7% and specificity 73.8%. In the analysis of the ROC AUC, values of 0.89 (CI 0.87-0.92) for the EPDS and BDI for 0.87 (CI 0.84-0.89) were identified compared to the MINI. The sample was composed majority by middle and low income adolescent and the study was performed only with pregnant women in the second trimester. The results indicate that both scales have good accuracy in screening of depression in adolescent mothers. However, the EPDS scale shows higher AUC ROC and also better sensitivity and specificity values, the latter being more precise and effective for screening for depression in this population. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 02/2015; 177C. DOI:10.1016/j.jad.2015.01.051 · 3.71 Impact Factor
  • Susane Müller Klug Passos, Luciano Dias de Mattos Souza
    Cadernos de Saúde Pública 01/2015; 31(4):800-814. DOI:10.1590/0102-311X00000514 · 0.89 Impact Factor
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    ABSTRACT: This research aims to evaluate factors associated with the presence of comorbidities between mood and anxiety disorders in young adults aged 18 to 24 years, from Pelotas, Rio Grande do Sul State, Brazil. This was a cross-sectional, population-based study with a probabilistic sample by conglomerates. The Mini International Neuropsychiatric Interview (MINI) was used to assess mood and anxiety disorders. The prevalence of mental disorders in the sample (n = 1,561) was of 26.8% of which 9.7% had comorbidities between mood and anxiety disorders. The prevalence of comorbidities on mood and anxiety disorders is almost three times higher among women than men (p < 0.001). Lower education levels, socioeconomic status (p < 0.001) and a history of divorced parents (p < 0.050) was associated with comorbidities between mood and anxiety disorders. The main conclusion is that social factors are highly associated with comorbidities between mood and anxiety disorders. Prevention strategies on mental health should focus particularly on women in vulnerable social conditions.
    Cadernos de Saúde Pública 11/2014; 30(11):2413-2422. DOI:10.1590/0102-311X00012614 · 0.89 Impact Factor
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    ABSTRACT: There are scarce follow-up studies evaluating the role of psychoeducation in the treatment of bipolar disorder, especially in a young sample, with a recent diagnosis and that probably received a few previous interventions. This was a randomized clinical trial with young adults aged 18-29 years, who had been diagnosed with bipolar disorder through the Structured Clinical Interview for DSM (SCID). The evaluation of quality of life was carried out using the Medical Outcomes Survey 36-Item Short-Form Health Survey (MOS SF-36). All participants were randomized into two groups: combined intervention (psychoeducation plus medication) and treatment-as-usual (medication). The sample consisted of 61 patients divided in two groups (29 usual treatment; 32 combined intervention). The quality of life domains did not reveal statistically significant differences when comparing baseline, post-intervention and 6-month follow-up evaluations, which indicates that there is no difference between combined intervention and usual intervention regarding quality of life improvement. Both groups presented improvements in quality of life domains, except General Health and Bodily Pain, at post-intervention. Moreover, this improvement persisted at 6-month follow-up, except for the Role Physical Health domain, which remained reduced. Combined Psychoeducation plus pharmacological intervention is so effective in improving quality of life perception as it is pharmacological only intervention.
    Psychiatry Research 09/2014; 220(3). DOI:10.1016/j.psychres.2014.09.013 · 2.68 Impact Factor
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    ABSTRACT: Mood disorders are a consequence of the interaction between environmental and biological factors. The objective of this study was to identify associations between stressful life events (LEs) and mood disorders in a community sample of young people in southern Brazil. It is a cross-sectional population-based study on young people between 18 and 24 years of age. The selection of the sample was conducted via conglomerates. Mini International Neuropsychiatric Interviews were used to evaluate mood disorders, and the Social Readjustment Rating Scale to assess stressful life events. The sample included 1172 young people. Of the total sample, the proportion of stressful life events in the last year in each category was: 53.8% work, 42.4% loss of social support, 63.8% family, 50.9% environmental changes, 61.1% personal difficulties, and 38.7% finances. A significant relationship was found between categories of stressful life events and mood disorder episodes. A higher incidence of stressful life events was found among young people in a mixed episode compared to young people in a depressive, (hypo)maniac episode with controls. This finding suggests a psychosocial interaction between stressful life events and the occurrence of mood disorders.
    Ciência & Saúde Coletiva 09/2014; 19(9):3941-6. DOI:10.1590/1413-81232014199.12932013 · 0.40 Impact Factor
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    ABSTRACT: Objective: To evaluate the prevalence of leisure time physical activity and episodes of mood alteration in a population based sample of adults, and its relation with gender. Method: This is a cross-sectional population based study with young adults aged between 18 and 35 years old. Sample selection was performed by clusters. The practice of physical activity was evaluated through the International Physical Activity Questionnaire (IPAQ), whereas mood disorders were evaluated using a short structured diagnostic interview the Mini International Neuropsychiatric Interview (MINI) for DSM-IV and ICD-10 psychiatric disorders. Limitation: Causal inferences are limited due the study's design. Results: Sample consisted of 1953 young adults. The prevalence of leisure time physical activity and of depressive episodes in the total sample was 25.3% and 17.2%, respectively. The prevalence of activity amongst men was 1.18 (CI 95% 1.18-1.32) Limes higher than in the women's group, whereas depression was 1.87 (CI 95% 1.41-2.47) Limes more prevalent amongst women than men. The prevalence of physical activity was not different between women (p=0.287), nor between men (p=0.895) regarding the presence of mania/hypomania episode. Conclusion: The prevalence of physical activity and depression was different concerning gender. The prevalence of physical activity is lower amongst women, whereas the prevalence of depression is higher amongst women when compared to men. (C) 2014 Elsevier B.V. All tights reserved
    Journal of Affective Disorders 08/2014; 169C:165-169. DOI:10.1016/j.jad.2014.08.020 · 3.71 Impact Factor
  • Susane Müller Klug Passos, Luciano Dias de Mattos Souza, Bárbara Coiro Spessato
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    ABSTRACT: A cross-sectional study was developed to evaluate suicide risk and associated factors in HIV/AIDS patients at a regional reference center for the treatment of HIV/AIDS in southern Brazil. We assessed 211 patients in regard to suicide risk, clinical and sociodemographic characteristics, drug use, depression, and anxiety. Suicide risk was assessed with Mini International Neuropsychiatric Interview, Module C. Multivariate analysis was performed using Poisson regression. Of the total sample, 34.1% were at risk of suicide. In the multivariate analysis, the following variables were independently associated with suicide risk: female gender; age up to 47 years; unemployment; indicative of anxiety; indicative of depression; and abuse or addiction on psychoactive substances. Suicide risk is high in this population. Psychosocial factors should be included in the physical and clinical evaluation, given their strong association with suicide risk.
    AIDS Care 05/2014; 26(11):1-4. DOI:10.1080/09540121.2014.913767 · 1.60 Impact Factor
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    ABSTRACT: Background: Studies show high comorbidity between anxiety disorder and depression. Little is known regarding how anxiety symptoms affect prognosis in depression treatment, suggesting the importance of studying the impact of anxiety symptoms in the treatment of depression. We evaluated the impact of anxiety symptoms in the remission of depressive symptoms after brief psychotherapies for depression. Methods: This randomized clinical trial of 18-29-year-old adults included individuals who met the diagnostic criteria for depression as assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD); anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale (HARS). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP). Both treatments included seven sessions. At the end of the treatment and six-month follow-up, an evaluation was made with the HRSD and HARS. The sample included 97 patients divided between the protocols of psychotherapy. Results: There was a significant, positive, moderate correlation between the severity of anxiety symptoms at baseline and the remission of depressive symptoms at post-intervention (r =0.38 p <0.001) as well as a significant, positive, low correlation at follow up (r= 20 p=0.049). We found remission of anxiety symptoms and depressive symptoms after brief psychotherapies, and the remission persisted at follow up. Limitation: We did not evaluate the diagnosis of anxiety disorders. Conclusion: The severity of anxiety symptoms did not compromise the treatment focused primarily on depressive symptoms. (C) 2014 Published by Elsevier B.V.
    Journal of Affective Disorders 04/2014; 168C:331-336. DOI:10.1016/j.jad.2014.03.034 · 3.71 Impact Factor
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    ABSTRACT: To assess the associations of the perceived quality of parental bonding with suicidality in a sample of pregnant adolescents. A cross-sectional study with a sample size of 828 pregnant teenagers receiving prenatal medical assistance in the national public health system in the urban area of Pelotas, southern Brazil. Suicidality and psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview (MINI), and the Parental Bonding Instrument (PBI) was employed to measure the perceived quality of parental bonding. A self-report questionnaire was used to collect sociodemographic, obstetric and other psychosocial data. Forty-three (4.94 %) teenagers from a consecutive sample of 871 refused to participate, resulting in 828 participants. Prevalence of suicidality was 13.3 %, lifetime suicide attempts were 7.4 % with 1.3 % reporting attempting suicide within the last month. Significant associations of suicidality with the 18-19-year-old subgroup, low education, prior abortion, physical abuse within the last 12 months were present, and most psychiatric disorders were associated with a higher suicidality prevalence. Additionally, after adjustment in the multivariate analysis, the style of parental bonding was independently associated with suicidality in the pregnant adolescent, with a PR of 2.53 (95 % CI 1.14-5.59) for the maternal 'affectionless control' and a PR of 2.91 (95 % CI 1.10-7.70) for the paternal 'neglectful parenting.' CONCLUSIONS: We found that maternal 'affectionless control' and paternal 'neglectful parenting' were independent predictors of suicidality in this sample of pregnant teenagers.
    Social Psychiatry 02/2014; 49(8). DOI:10.1007/s00127-014-0832-1 · 2.58 Impact Factor
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    ABSTRACT: Changes in biological rhythm are among the various characteristics of bipolar disorder, and have long been associated with the functional impairment of the disease. There are only a few viable options of psychosocial interventions that deal with this specific topic; one of them is psychoeducation, a model that, although it has been used by practitioners for some time, only recently have studies shown its efficacy in clinical practice.
    Psychology Research and Behavior Management 01/2014; 7:167-74. DOI:10.2147/PRBM.S52352
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    ABSTRACT: Background Studies show high comorbidity between anxiety disorder and depression. Little is known regarding how anxiety symptoms affect prognosis in depression treatment, suggesting the importance of studying the impact of anxiety symptoms in the treatment of depression. We evaluated the impact of anxiety symptoms in the remission of depressive symptoms after brief psychotherapies for depression. Methods This randomized clinical trial of 18–29-year-old adults included individuals who met the diagnostic criteria for depression as assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD); anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale (HARS). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP). Both treatments included seven sessions. At the end of the treatment and six-month follow-up, an evaluation was made with the HRSD and HARS. The sample included 97 patients divided between the protocols of psychotherapy. Results There was a significant, positive, moderate correlation between the severity of anxiety symptoms at baseline and the remission of depressive symptoms at post-intervention (r=0.38 p<0.001) as well as a significant, positive, low correlation at follow up (r=0.20 p=0.049). We found remission of anxiety symptoms and depressive symptoms after brief psychotherapies, and the remission persisted at follow up. Limitation We did not evaluate the diagnosis of anxiety disorders. Conclusion The severity of anxiety symptoms did not compromise the treatment focused primarily on depressive symptoms.
    Journal of Affective Disorders 01/2014; 168:331–336. · 3.71 Impact Factor
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    ABSTRACT: Stability between internal and external biological regulators are essential to stable mood states. However, the literature needs studies investigating the effect of brief psychotherapies in the biological rhythm regularization. To verify the capacity regulation of biological rhythms in two models of brief psychotherapy for the remission of depressive symptoms. We conducted a randomized clinical trial with young adults aged 18-29 years old who met diagnostic criteria for depression according to the Structured Clinical Interview for DSM (SCID). In order to evaluate the biological rhythm the Biological Rhythm of assessment in Neuropsychiatry (BRIAN) interview was used; whereas the severity of depression was assessed by the Hamilton Depression Rating Scale (HDRS). The psychotherapy models consisted of two cognitive psychotherapies: Cognitive Narrative Therapy (CNT) and Cognitive-Behavioral Therapy (CBT). The sample consisted of 97 randomized into two models of brief psychotherapy. The patients regulated the biological rhythm from baseline to post-intervention (p=.001) and follow up (p=.003). We also found a positive moderate correlation between biological rhythm regularization and remission of the depressive symptoms (r=.594; p<.001). The two models of brief psychotherapies were effective in the remission of depressive symptoms as well as the regulation of biological rhythms in the follow-up of 6 months. We did not assess genetic, hormonal and neurochemical factors. Also, we did not include patients in pharmaceutical treatment, and with severe symptomatology.
    Journal of Affective Disorders 11/2013; 155. DOI:10.1016/j.jad.2013.10.039 · 3.71 Impact Factor
  • Luise Marques da Rocha, Luciano Dias de Mattos Souza
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    ABSTRACT: OBJECTIVE/HYPOTHESIS: To verify the relationship between common mental disorders (CMDs) and the Voice Handicap Index (VHI) in elementary school teachers from municipal schools. The VHI mean scores in the group of teachers with symptoms of mental disorder were significantly higher than those in the group of teachers with no symptoms in the total scores of three subscales: disability (functional domain), handicap (emotional domain), and impairment (organic domain). DESIGN: An observational cross-sectional, quantitative study was conducted in the public schools of urban and rural areas of the city of Pelotas. METHOD: A total of 575 teachers participated. Vocal handicap was measured using VHI, producing a total score and three subscales, including emotional, functional, and organic domains. The Self-Reporting Questionnaire, 20 items scale was used to measure mental disorder symptoms. A log transformation was used, followed by linear regression, to evaluate the relationship between the independent variables and the outcomes. RESULTS: Teachers with CMD symptoms and who took a sick leave from teaching because of voice problems obtained the lowest scores in VHI (P<0.050). Emotional, functional, and organic voice handicap scores were significantly higher in teachers with CMD symptoms (P<0.001). CONCLUSIONS: A close association between voice problems and mental disorders was identified based on the statistically significant association between high levels of voice handicap and the mental disorders.
    05/2013; 27(5). DOI:10.1016/j.jvoice.2012.10.001
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    ABSTRACT: Several biological factors have been recently related with major depression and bipolar disorder. The aim of our paper was to investigate the peripheral levels of the protein neuronal specific enolase (NSE), a putative marker of neuronal damage, comparing patients with major depressive disorder and bipolar disorder to control subjects. This is a case-control study nested in a cross-sectional population-based survey. Psychopathology screen was performed using the Mini-International Neuropsychiatric Interview 5.0 and blood samples were collected from 108 young adults. Three groups were selected, 36 healthy controls, 36 subjects with major depression disorder and 36 subjects with bipolar disorder. Serum levels of NSE significantly decreased (p = 0.002) in major depression disorder (2.19 ± 1.78 ng/mL) and bipolar disorder subjects (2.53 ± 2.61 ng/mL) compared to the control group (3.55 ± 2.19 ng/mL). In conclusion, peripheral neuronal specific enolase may be a useful marker drug-naïve major depression disorder and bipolar disorder, but its pathophysiological significance and response to treatment should be further investigated.
    Neurochemical Research 04/2013; DOI:10.1007/s11064-013-1036-x · 2.55 Impact Factor
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    ABSTRACT: Abstract We conducted a cross-sectional study nested within a cohort study with 276 postpartum women to evaluate the role of a serotonin transporter gene polymorphism (5-HTTLPR) and the stressful life events (SLE) on the risk of postpartum depression (PPD) symptoms in a community sample. Participants were assessed between 45 and 90 days after delivery with the Edinburgh Postnatal Depression Scale (EPDS) and the Mini International Neuropsychiatric Interview (MINI). Data regarding socio-demographic variables, alcohol consumption, tobacco smoking and SLE occurring during pregnancy, were also collected. In the adjusted analysis, the women carrying the long (L) allele (LL) who experienced SLE showed higher prevalence ratios (PR) for PPD symptoms (EPDS ≥13) than those with two copies of the short (S) allele (SL) (PR = 9.91; 95% confidence interval: 1.70-57.87). In contrast, a trend of association was found between prior history of major depressive disorder (MDD) and the S allele carrier status (p = 0.07). No association was found between the formal diagnosis of current MDD and the 5-HTTLPR genotypes. In line with previous reports, we find in this sample that the L allele carrier status was associated with a heighten risk of depressive symptoms in postpartum when SLE were experienced during pregnancy.
    Journal of Psychosomatic Obstetrics & Gynecology 03/2013; 34(1):29-33. DOI:10.3109/0167482X.2012.759555 · 1.23 Impact Factor
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    ABSTRACT: To describe the prevalence of Major Depressive Disorder (MDD) during pregnancy in teenage mothers and to assess its association with socio-demographic characteristics, obstetric history and psychosocial variables. A cross-sectional study was conducted with a sample of pregnant teenagers enrolled in the national public health system in the urban area of Pelotas, southern Brazil. MDD was assessed with the Mini International Neuropsychiatric Interview, the Abuse Assessment Screen was used to identify physical abuse within the last 12 months and during pregnancy, and social support was assessed with the Medical Outcomes Survey Social Support Scale. Forty-three (4.94%) potential subjects refused to participate, resulting in 828 total participants. The prevalence of MDD was 17.8%, 9.2% reported they had been subjected to violence within the last 12 months, while 5.8% had suffered violence during pregnancy, and the mean (SD) overall social support score was 87.40 (11.75). After adjustment, we found the highest incidence of MDD in adolescents with less than 8 years of education, followed by those with previous episodes of MDD and those with lower overall social support. MDD is a relatively common condition in pregnant teenagers and appears to be more prevalent in young mothers who are both socioeconomically and psychosocially underprivileged.
    Revista Brasileira de Psiquiatria 03/2013; 35(1):51-6. DOI:10.1016/j.rbp.2012.03.006 · 1.64 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess quality of life among Brazilian young adults who are 18-24 years old and who experience depressive, manic/hypomanic, and mixed episodes. METHOD: This is a cross-sectional population-based study. The sample was selected in clusters. Mood disorders were assessed using a short, structured diagnostic interview-the Mini International Neuropsychiatric Interview (MINI) for DSM-IV and ICD-10 psychiatric disorders. Quality of life was assessed by the MOS 36-item Short-form General Health Survey (SF-36). RESULTS: The sample comprised 1560 young adults. The prevalence ratio of mood disorder episodes were as follows: 10.0% depressive episode, 2.3% manic/hypomanic episode, and 2.4% mixed episode. Lower scores were found in all domains of quality of life among young adults who experience mood disorder episodes when compared to the general population (p<0.001 in the eight domains of the SF-36). Moreover, the impact on quality of life was higher among young adults with mixed episodes, followed by depressive episodes. CONCLUSION: Young adults with mood disorders, even without a previous diagnosis of bipolar disorder, have an impaired quality of life in comparison to the general population.
    Journal of Affective Disorders 12/2012; 147(1-3). DOI:10.1016/j.jad.2012.10.021 · 3.71 Impact Factor
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    ABSTRACT: To evaluate the prevalence of common mental disorders in women diagnosed with polycystic ovary syndrome as compared with paired controls without this syndrome. Cross-sectional study with a Control Group examining women between the ages of 18 and 30 who did not use antidepressants and who sought the Gynecology Service of the researched sites. For every woman diagnosed with the polycystic ovary syndrome, another with the same age, educational status and presence or absence of sexual partners was sought without this diagnosis. In total, 166 patients agreed to participate, consisting of 95 diagnosed with polycystic ovary syndrome and 71 in the Control Group. The diagnosis of polycystic ovary syndrome was made by the presence of two from three criteria: oligomenorrhea or amenorrhea, clinical or biochemical hyperandrogenism and polycystic ovaries on transvaginal ultrasound, following exclusion of patients with Cushing's syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors. Weight and height were measured to calculate the body mass index. The Self-Reporting Questionnaire, which evaluated 20 items, was used as an indicator of common mental disorders. A χ² analysis stratified by the category of body mass index was used to compare the prevalence of common mental disorders, between the groups of women with and without the polycystic ovary syndrome. There were no significant differences in age, education, presence of sexual partners, ethnicity, socioeconomic status, use of psychiatric medication, and search for consultation in mental health between the studied groups. The prevalence of obese women with indications of common mental disorders was significantly higher in women with polycystic ovary syndrome than in the Control Group. In the group with healthy body mass index, the incidence of common mental disorders was statistically significant different between women with polycystic ovary syndrome and normal controls (p=0.008). Women with diagnosis of this disease have an almost three-fold increased likelihood of common mental disorders as compared with those without polycystic ovary syndrome. Although obesity is often observed in polycystic ovary syndrome, even women with a healthy body mass index have an increased risk of psychiatric comorbidity.
    Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 10/2012; 34(10):442-6. DOI:10.1590/S0100-72032012001000002