Fernando Kratz Gazalle

Universidade Federal de Pelotas, São Francisco de Paula, Rio Grande do Sul, Brazil

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Publications (25)38.73 Total impact

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    ABSTRACT: To identify the prevalence of depressive symptoms and examine associated factors in a Southern Brazilian adult population, a cross-sectional population-based study was carried out, including 972 subjects, men and women, aged 20 to 69 years, living in the urban area of Pelotas, Rio Grande do Sul. The sampling strategy relied on the census tracts of the city as primary sampling units and households as the secondary units. The questionnaire included socio-demographic, behavioral and nutritional variables. The prevalence of sadness, anxiety, loss of energy, lack of will to do things, thinking about the past, and wishing to stay at home were 29.4%, 57.6%, 37.4%, 40.4%, 33.8%, and 54.3%, respectively. Female gender, older ages, smokers and obese individuals showed association with depressive symptoms. Population-based studies using longitudinal designs may help to clarify the relationship between biopsychosocial variables and depressive symptoms.
    Revista Brasileira de Epidemiologia 12/2010; 13(4):620-629.
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    ABSTRACT: To identify the prevalence of depressive symptoms and examine associated factors in a Southern Brazilian adult population, a cross-sectional population-based study was carried out, including 972 subjects, men and women, aged 20 to 69 years, living in the urban area of Pelotas, Rio Grande do Sul. The sampling strategy relied on the census tracts of the city as primary sampling units and households as the secondary units. The questionnaire included socio-demographic, behavioral and nutritional variables. The prevalence of sadness, anxiety, loss of energy, lack of will to do things, thinking about the past, and wishing to stay at home were 29.4%, 57.6%, 37.4%, 40.4%, 33.8%, and 54.3%, respectively. Female gender, older ages, smokers and obese individuals showed association with depressive symptoms. Population-based studies using longitudinal designs may help to clarify the relationship between biopsychosocial variables and depressive symptoms.
    Revista Brasileira de Epidemiologia 12/2010; 13(4):620-9.
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    ABSTRACT: Cognitive impairment has been well documented in bipolar disorder. However, specific aspects of cognition such as emotional memory have not been examined. To investigate episodic emotional memory in bipolar disorder, as indicated by performance on an amygdala-related cognitive task. Twenty euthymic patients with bipolar disorder and 20 matched controls were recruited. Participants were shown a slide show of an emotionally neutral story, or a closely matched emotionally arousing story. One week later, participants were assessed on a memory-recall test. In contrast with the pattern observed in controls, patients with bipolar disorder had no enhancement of memory for the emotional content of the story (F=14.7, d.f.=1,36, P<0.001). The subjective perception of the emotional impact of the emotional condition was significantly different from that of the neutral condition in controls but not in people with bipolar disorder. Our data suggest that the physiological pattern of enhanced memory retrieval for emotionally bound information is blunted in bipolar disorder.
    The British Journal of Psychiatry 06/2008; 192(6):458-63. · 6.61 Impact Factor
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    ABSTRACT: Studies addressing self-reported quality of life (QoL) in acute mania are scarce and inconsistent. While it has been suggested that there is some disagreement between objective measures and subjective QoL as reported by acutely manic patients, this issue has not been systematically studied. This study aims to investigate the self-reported QoL in manic, depressed, and euthymic BD subjects, as compared to matched healthy controls. One-hundred and twenty type-I bipolar patients (40 manic, 40 depressed, and 40 euthymic) and 40 matched controls were studied. Self-reported QoL was assessed using the World Health Organization's Quality of Life Instrument-Short Version (WHOQOL-BREF). Objective functioning was assessed using the Global Assessment of Functioning (GAF), and depressive and manic symptoms were assessed using the Hamilton Depression Rating Scale-17 items (HDRS) and the Young Mania Rating Scale (YMRS), respectively. Manic patients presented the lowest GAF measures but reported same overall QoL as euthymic patients and controls, and better QoL than depressed patients. Within the manic subgroup, there was a significant inverse correlation between psychological QoL and GAF scores (r=-0.54; p=0.001). The cross-sectional design and the lack of control for potential comorbid conditions are the major limitations of the present study. Our findings suggest that this mismatch between objective and subjective measures during acute mania may be associated with a lack of insight or awareness of their own illness.
    Journal of Affective Disorders 12/2007; 103(1-3):247-52. · 3.30 Impact Factor
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    ABSTRACT: This study evaluates the influence of manic symptoms on quality of life in a sample of adult bipolar disorder (BD) patients. This was a cross-sectional study including 125 BD outpatients from a university-based program. All patients were diagnosed using the Structured Clinical Interview for DSM-IV for BD. Manic symptoms and quality of life were assessed using the Young Mania Rating Scale (YMRS) and the World Health Organization Quality of Life Instrument-Short Version (WHOQOL-BREF), respectively. In the unadjusted analysis using linear regression, the score of manic symptoms was inversely associated with scores of quality of life within the social domain of the WHOQOL. In the adjusted analysis, the score of manic symptoms was inversely associated with the social, physical, and psychological domains of the WHOQOL. In a separate analysis at the YMRS items, items 4 (irritability) and 5 (sleep) were associated with lower quality of life.
    Psychiatry Research 10/2007; 153(1):33-8. · 2.68 Impact Factor
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    ABSTRACT: To assess the impact of anxiety comorbidity on the quality of life of patients with bipolar disorder (BD). We undertook a cross-Sectional survey of 162 BD outpatients interviewed with the Structured Clinical Interview for DSM-IV. The primary outcome measure was quality of life, assessed with the 26-item WHO Quality of Life Instrument (WHOQOL-BREF). Anxiety comorbidity in BD patients was associated with lower scores in all domains of quality of life. The impact of anxiety comorbidity on the psychological domain of the WHOQOL-BREF was kept, even when the current level of depression was added to the model as a confounding factor. Current anxiety comorbidity was also associated with lifetime alcohol abuse and dependence, rapid cycling, lifetime psychosis, number of suicide attempts, and a lower score in the Global Assessment of Functioning measure. Our findings suggest that anxiety comorbidity in BD patients is related to lower quality of life, particularly on the psychological domain. BD-anxiety comorbidity may be associated with such markers of illness severity as number of suicide attempts, rapid cycling, lifetime alcohol abuse, and psychosis. The recognition and treatment of anxiety comorbidity may help patients with BD to relieve their psychological pain and improve their overall quality of life.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 04/2007; 52(3):175-81. · 2.48 Impact Factor
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    ABSTRACT: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.
    Revista Brasileira de Psiquiatria 04/2007; 29(1):35-8. · 1.86 Impact Factor
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    ABSTRACT: OBJECTIVE: This research studied the efficacy and tolerability of fluvoxamine in the treatment of major depressive disorder (MDD), during 6 weeks, in an open trial, without placebo or active comparator. A secondary objective was the evaluation of the effects of fluvoxamine on the sleep of the pacients. METHODS: 104 patients were inicially included, with the diagnosis of MDD in accordance to the criteria of the Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV). Patients should have scores > 17 in the Hamilton Depression Scale for Depression 17 itens (HAM-D 17). The efficacy of fluvoxamine was studied through the HAM-D 17 and CGI (Clinical Global Impression). The analysis of the HAM-D 17 itens 4, 5, and 6 was used for the evaluation of the quality of sleep of the patients. Security and tolerability of fluvoxamine was assessed throughout the six weeks, being registered any adverse event. Fluvoxamine was inicially administered at the doses of 50 or 100 mg/day; the doses could be progressively increased until 300 mg/day. RESULTS: From the 104 included patients, 81 (78%) concluded the study. Sixty nine percent (69%) of the patients obtained favorable response (defined as 50% improvement in the HAM-D 17) and the remission rate (HAM-D 17 < 7) was 52%. The specific analysis of CGI showed significant improvement (p < 0.001) comparing to the baseline scores. The speficic analysis of the sleep itens of the HAM-D 17 showed significant improvement from the 2nd week; the improvement was sustained until the end of the 6 weeks study. The adverse events were those expected for the serotonin selective reuptake inhibitors (SSRI), predominantly gastrointestinal complaints, transitory and of low intensity in most of the cases. CONCLUSION: This study confirms the efficacy and tolerability of fluvoxamine in the treatment of MDD, and also its efficacy in the treatment of sleep disturbs among depressed patients. The profile of adverse events were those expected for SSRI. It should be emphasized that few patients reported sexual disfunction (2.5% of the patients).
    Jornal brasileiro de psiquiatria 12/2006; 56(1):17-22.
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    ABSTRACT: The aim of the present study is to compare quality of life among currently depressed, subsyndromal and remitted patients with bipolar disorder (BD) and to assess whether the level of depression correlates with the scores of quality of life in BD patients. Sixty bipolar outpatients diagnosed using the Structured Clinical Interview for DSM-IV who met criteria for diagnosis of BD type I, II or not otherwise specified (BD-NOS), and who were not currently on a manic or mixed episode were included. The main variables of interest were quality of life (QOL) assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF) and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS). A linear trend test showed a dose response association between patients' current mood state and all domains of quality of life. Higher quality of life scores were found among remitted patients, followed by subsyndromal patients; depressed patients presented lower scores of quality of life, except for the social domain. The four domains of the WHOQOL scale correlated negatively with the HDRS. Our findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with QOL in BD patients.
    Revista Brasileira de Psiquiatria 07/2006; 28(2):93-6. · 1.86 Impact Factor
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    Fernando Kratz Gazalle, Flávio Kapczinski
    Revista Brasileira de Psiquiatria 04/2006; 28(1):82-3. · 1.86 Impact Factor
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    Fernando Kratz Gazalle, Flávio Kapczinski
    Revista Brasileira de Psiquiatria 04/2006; 28(1):82. · 1.86 Impact Factor
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    ABSTRACT: Poor adherence to lithium is very common in bipolar patients and it is a frequent cause of recurrence during prophylactic treatment. Several reports suggest that attitudes of bipolar patients interfere with adherence to lithium. The Lithium Attitudes Questionnaire (LAQ) is a brief questionnaire developed as a means of identifying and grouping the problems patients commonly have with taking lithium regularly. The original version is validated in patients, but a validated version in Portuguese is not yet available. One-hundred six patients with bipolar disorder (DSM-IV criteria) criteria under lithium treatment for at least one month were assessed using LAQ. LAQ is a brief questionnaire administered under interview conditions, which includes 19 items rating attitudes towards prophylactic lithium treatment. We analysed the internal consistency, concurrent validity, sensitivity and specificity of the Portuguese version of LAQ. The internal consistency, evaluated by Cronbach's alpha was 0.78. The mean total LAQ score was 4.1. Concurrent validity was confirmed by a negative correlation between plasma lithium concentration and total LAQ score (r = -0,198; p = 0.048). We analysed the scale's discriminative capacity revealing a sensitivity of 69% and a specificity of 71% in the identification of negative attitudes of bipolar patients. The psychometric assessment of the Portuguese version of LAQ showed good internal consistency, sensitivity and specificity. The results were similar to the original version in relation to attitudes of bipolar patients towards lithium therapy.
    Clinical Practice and Epidemiology in Mental Health 02/2006; 2:32.
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    ABSTRACT: Adherence problems are a common feature among bipolar patients. A recent study showed that lithium knowledge was the main difference between adherent and non adherents bipolar patients. The Lithium Knowledge Test (LKT), a brief questionnaire, was developed as a means of identifying aspects of patients' practical and pharmacological knowledge which are important if therapy is to be safe and effective. The original English version is validated in psychiatric population, but a validated Portuguese one is not yet available. One hundred six patients selected were diagnosed with bipolar disorder (I or II) according to DSM-IV criteria and had to be on lithium treatment for at least one month. The LKT was administered on only one occasion. We analysed the internal consistency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients. The internal consistency, evaluated by Cronbach's alpha was 0.596. The mean of total score LKT by bipolar patients was 9.0 (SD: 0.75) for men and 8.74 (SD: 0.44) for women. Concurrent validity based on plasma lithium concentration showed a significant correlation between the total LKT score and plasma lithium (r = 0.232; p = 0.020). The sensitivity was 84% and specificity was 81%. LKT is a rapid, reliable instrument which appears to be as effective as a lengthier standard interview with a lithium clinic doctor, and which has a high level of acceptability to lithium patients. We found that the psychometric assessment of the Portuguese version of LKT showed good internal consistency, sensitivity and specificity.
    Clinical Practice and Epidemiology in Mental Health 02/2006; 2:34.
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    ABSTRACT: To study the prevalence and current predictors of low body mass index (BMI) in a population undergoing a rapid nutritional transition. Population-based cross-sectional study. Individuals living in the urban area of Pelotas, a medium-sized southern Brazilian city, were interviewed at home. A multiple-stage sampling strategy was used. Out of 3372 eligible subjects, 3047 were interviewed. The study was restricted to adults (> or = 20 y). Low BMI was defined as <18.5 kg/m2. The prevalence of low BMI was 2.7% (95% confidence interval: 2.1; 3.3), higher in women than men (3.8 vs 1.3%; P < 0.001). In the whole sample (men and women combined), living without a partner and current smoking were positively associated with low BMI. Among women, low BMI presented a U-shaped relationship with age and was positively associated with educational level. The prevalence of low BMI in young women was 6.3%, and in highly educated young women was 8.9%. Consistently with previous Brazilian studies, a decline in the overall prevalence of low BMI is clear. However, differently from these studies, the predictors of low BMI in women are similar to those observed within developed countries (including low age and high education), possibly indicating an increase in eating disorders.
    European Journal of Clinical Nutrition 10/2005; 59(9):1002-6. · 2.76 Impact Factor
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    ABSTRACT: This study assessed the impact of number of years undiagnosed (NYU) on current morbidity in patients with bipolar disorder. The sample size used was rather small, which may make difficult the generalization of our findings to larger datasets. The data about age of onset and age when patients received their diagnosis may present a certain degree of recall error. Sixty-five bipolar outpatients diagnosed using the Structured Clinical Interview for DSM were included. The main outcome measurements were quality of life (QOL) assessed using the 26-item World Health Organization QOL instrument (WHOQOL-Bref) and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS). Age of onset and years of disorder were not correlated with the outcomes assessed. The NYU were associated with higher scores of HDRS (P<0.01), lower scores of QOL within the physical (p<0.01) and psychological (p<0.05) domains of QOL. Our findings suggest that the NYU may be an important predictor of the current clinical status of bipolar patients.
    Journal of Affective Disorders 06/2005; 86(2-3):313-6. · 3.30 Impact Factor
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    ABSTRACT: To investigate the efficacy and acceptability of antidepressants in the treatment of generalized anxiety disorder. All randomized controlled trials assessing the use of antidepressants in generalized anxiety disorder up to may 2002 were included. Non randomized trials and those that included patients with both generalized anxiety disorder and another Axis I co-morbidity were excluded. Relative risks, weighted mean difference and number needed to treat were estimated. People who died or dropped out were regarded as having had no improvement. Antidepressants (imipramine, venlafaxine and paroxetine) were found to be superior to placebo in treating generalized anxiety disorder. The calculated number needed to treat for antidepressants in generalized anxiety disorder was 5.15. Dropout rates did not differ between antidepressants and placebo. The available evidence suggests that antidepressants would probably be a reasonable treatment for generalized anxiety disorder patients in the clinical context.
    Revista Brasileira de Psiquiatria 04/2005; 27(1):18-24. · 1.86 Impact Factor
  • Revista Brasileira de Psiquiatria 04/2005; 27(1):83-4. · 1.86 Impact Factor
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    Revista De Psiquiatria Clinica - REV PSIQUIATR CLIN. 01/2005; 32.
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    Revista Brasileira de Psiquiatria 01/2005; 27(1). · 1.86 Impact Factor
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    ABSTRACT: The present article is a synthesis of the published clinical trials about the treatment of Bipolar disorder (BD). The methodology used to search the literature is described and results are presented. Using the best available evidence (systematic reviews of clinical trials or at lest one randomized clinical trial) the following is recommended: 1) acute mania can be treated with lithium, carbamazepine, valrpoate and antipsychotics; 2) acute depression can be treated with lamotrigine, olanzapine/fluoxetine combination and with antidepressants (with an increased risk of switch into mania); 3) maintenance can be performed using lithium, valproate, olanzapine and lamotrigine (when the aim is prophylaxis of bipolar depression). The absence of published results about certain interventions does not mean that such interventions are not useful.
    Revista de Psiquiatria Clínica 12/2004; 32:34-38. · 0.63 Impact Factor