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Cabo MCD, Freire RCDR, Gomes MDM, Nardi AE. Fifty years after “good enough” Donald Woods Winnicott (1896-1971). J bras psiquiatr 2022. [DOI: 10.1590/0047-2085000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Ferreira-Garcia R, Gitahy Falcão Faria C, Nardi AE, da Rocha Freire RC. Negative Affect Mediates Impulsivity in Generalized Anxiety Disorder. Psychopathology 2019; 52:327-333. [PMID: 31968352 DOI: 10.1159/000503395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although anxiety and impulsivity are intuitively thought to be inversely correlated, increased impulsivity has been associated both with generalized anxiety disorder (GAD) diagnosis and GAD symptoms in non-clinical samples. The emotional dysregulation model of GAD posits that patients experience more frequent and intense negative emotions while having poor regulatory control over emotional states and greater negative reactivity to their emotions. We hypothesized that poor regulatory control in the presence of negative emotions might explain the increased impulsivity found in GAD patients. In this study, we examined if negative affect mediates the relationship between GAD and impulsivity. METHODS Thirty-four GAD patients and 35 healthy controls were included, and evaluated with measurements of impulsivity, negative and positive emotions, the severity of worrying and GAD symptoms, depression, and 5-factor personality traits. RESULTS Global impulsivity scores and the attentional facet of impulsivity were higher in the patient group when compared to the controls. Negative affect was correlated with global impulsivity in the patient group only and explained impulsivity in our regression model while worrying and depressive symptoms did not. An indirect relationship was found between diagnosis and impulsivity through negative affect. CONCLUSION Our study showed that the cardinal symptom of GAD - worrying - was not independently related to impulsivity in our sample. Increased impulsivity in GAD seems to be mediated by the increased presence of negative emotions, as it is common in mood and impulse-control disorders, indicating an unspecific shared vulnerability factor to psychopathology.
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Affiliation(s)
- Rafael Ferreira-Garcia
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,
| | | | - Antonio Egídio Nardi
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Christophe da Rocha Freire
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, School of Medicine, Queen's University, Kingston, Ontario, Canada
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Ferreira-Garcia R, da Rocha Freire RC, Appolinário JC, Levitan MN, Halkjær-Lassen RD, Bueno JR, Nardi AE. Tranylcypromine Plus Amitriptyline for Electroconvulsive Therapy-Resistant Depression: A Long-Term Study. J Clin Psychopharmacol 2018; 38:502-504. [PMID: 30106881 DOI: 10.1097/jcp.0000000000000945] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few therapeutic options are available for patients with electroconvulsive therapy-resistant major depressive disorder (ECT-r MDD), leaving a substantial proportion of this population beyond treatment possibilities. The combination of monoamine oxidase inhibitors and tricyclic antidepressants could be a potential strategy for managing ECT-r MDD, and the specific association of amitriptyline and tranylcypromine may offer additional tolerability advantages. Although promising, in our knowledge, no studies have examined until now the effectiveness of this combination in ECT-r MDD. METHODS We report a retrospective cohort of 31 patients with ECT-r MDD treated in an open-label fashion with the combination of amitriptyline and tranylcypromine. RESULTS Overall, 80.6% of the sample met response criteria at the end of the first 12 weeks of treatment. Seventy-six percent (19 of 25) of the responders were followed for a mean of 9.37 ± 3.86 years. During this follow-up period, none of the patients had a recurring depressive episode. The combination was well tolerated, whereas minor adverse effects were common, and no severe or life-threatening events were reported throughout the study. CONCLUSIONS These findings indicate that the combination tranylcypromine and amitriptyline is a potentially safe and effective candidate for future investigation in the treatment and long-term maintenance of ECT-r MDD.
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Affiliation(s)
- Rafael Ferreira-Garcia
- From the Laboratory of Panic and Respiration, Resistant Depression Outpatient Clinic, Instituto de Psiquiatria-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Mochcovitch MD, da Rocha Freire RC, Garcia RF, Nardi AE. Can Long-Term Pharmacotherapy Prevent Relapses in Generalized Anxiety Disorder? A Systematic Review. Clin Drug Investig 2017; 37:737-743. [DOI: 10.1007/s40261-017-0528-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Perna G, Schruers KRJ, da Rocha Freire RC, Nardi AE, Caldirola D. Comments on "Heart rate and respiratory response to doxapram in patients with panic disorder". Psychiatry Res 2016; 239:362-3. [PMID: 26952828 DOI: 10.1016/j.psychres.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias - Villa San Benedetto Menni Hospital, FoRiPsi, 22032, Albese con Cassano, Como, Italy; Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, 33136 Miami, FL, USA.
| | - Koen R J Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Hermanas Hospitalarias - Villa San Benedetto Menni Hospital, FoRiPsi, 22032, Albese con Cassano, Como, Italy
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Mochcovitch MD, da Rocha Freire RC, Garcia RF, Nardi AE. A systematic review of fMRI studies in generalized anxiety disorder: evaluating its neural and cognitive basis. J Affect Disord 2015; 167:336-42. [PMID: 25020268 DOI: 10.1016/j.jad.2014.06.041] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a prevalent anxiety disorder, but its neurobiological basis has been poorly studied. A few cognitive models have been proposed for understanding GAD development and maintenance. The aim of this study is to review functional Magnetic Resonance Image (fMRI) studies conducted with GAD patients and evaluate if they support and underpin the theoretical cognitive models proposed for this anxiety disorder. METHODS A literature systematic review was undertaken in PubMed and ISI databases with no time limits. RESULTS From the studies included in this review, 10 explored the "emotional dysregulation model", showing, prefrontal cortex (PFC) and anterior cingulate cortex (ACC) hypofunction and deficient top-down control system during emotion regulation tasks, despite conflicting techniques and results. Only one study explored the "conditioned fear overgeneralization theory", other the "intolerance of uncertainty model" and two studies were unspecific (worry induction tasks). Between those, there were 4 studies evaluating pre- and post-treatment with antidepressants or "mindfulness". LIMITATIONS The studies׳ methodologies differ between one another making it difficult to identify a common finding. CONCLUSION Emotion dysregulation seems to be an important cognitive dysfunction in GAD patients and fMRI studies suggest that it is related to PFC and ACC hypofunction as well as a deficient cortex-amygdala functional connectivity.
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Affiliation(s)
| | | | | | - Antonio E Nardi
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Costa RTD, Carvalho MRD, Cantini J, Freire RCDR, Nardi AE. Demographics, clinical characteristics and quality of life of Brazilian women with driving phobia. Compr Psychiatry 2014; 55:374-9. [PMID: 24238932 DOI: 10.1016/j.comppsych.2013.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 07/30/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022] Open
Abstract
Driving phobia is associated with serious consequences such as restriction of freedom, career impairments and social embarrassment. The main objective of this paper is to compare clinical characteristics and quality of life between women with driving phobia and women without this phobia. These factors were assessed using structured interviews, semi-structured questionnaires, scales and inventories. We accessed diagnoses, depressive symptoms, anxiety symptoms, anxiety traits, driving cognitions and quality of life. There was no difference between groups with regard to demographic data and driving history. Both groups were also equivalent in the number of traumatic events and accidents experienced while driving or riding. The fear of driving group showed higher state and trait anxiety scores. A high frequency of cognitive distortions can explain why people with driving phobia often engage in maladaptive safety behaviors in an attempt to protect themselves from unpredicted dangers when driving. Regarding quality of life, the control group had slightly higher scores on all subscales, but significant differences were observed for only three scales: "functional capacity", "social aspects", and "mental health". More studies with larger samples more instruments and other contexts are needed to further investigate the clinical characteristics and personality traits of people who have a fear of driving.
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Affiliation(s)
- Rafael T da Costa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro National Institute for Translational Medicine (INCT - CNPq), Rua José Higino, 164, 30220520202 Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Marcele Regine de Carvalho
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro National Institute for Translational Medicine (INCT - CNPq), Rua José Higino, 164, 30220520202 Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jessye Cantini
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro National Institute for Translational Medicine (INCT - CNPq), Rua José Higino, 164, 30220520202 Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Christophe da Rocha Freire
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro National Institute for Translational Medicine (INCT - CNPq), Rua José Higino, 164, 30220520202 Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro National Institute for Translational Medicine (INCT - CNPq), Rua José Higino, 164, 30220520202 Rio de Janeiro, Rio de Janeiro, Brazil
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Costa RTD, Cheniaux E, Rosaes PAL, Carvalho MRD, Freire RCDR, Versiani M, Rangé BP, Nardi AE. The effectiveness of cognitive behavioral group therapy in treating bipolar disorder: a randomized controlled study. Rev Bras Psiquiatr 2011; 33:144-9. [DOI: 10.1590/s1516-44462011000200009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/13/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Recent studies suggest that, when combined with pharmacotherapy, structured psychotherapy may modify the course of bipolar disorder. However, there are few studies that have examined the effects of cognitive behavioral group therapy on the course of this disorder. The aim of the present study was to evaluate the effectiveness of 14 sessions of cognitive behavioral group therapy, combined with pharmacotherapy, on the treatment of patients with bipolar disorder, and to compare our results against those from the use of pharmacotherapy alone. METHOD: Forty-one patients with bipolar I and II disorder participated in the study and were randomly allocated to one of two treatment groups; thirty-seven patients remained in the study until its completion. Mood and anxiety symptoms were measured in all subjects. Statistical analysis was used to investigate if the groups differed with respect to demographic characteristics and the scores recorded in the pre- and post-treatment stages, as well as during treatment (intra/inter groups). RESULTS: Patients showed statistically similar population characteristics. The association of cognitive behavioral group therapy and pharmacological treatment proved to be effective. Patients who had undergone cognitive behavioral group therapy presented fewer symptoms of mania, depression and anxiety, as well as fewer and shorter mood change episodes. CONCLUSION: Cognitive behavioral group therapy sessions substantially contributed to the improvement of depression symptoms.
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Affiliation(s)
| | - Elie Cheniaux
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil
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Sardinha A, Freire RCDR, Zin WA, Nardi AE. Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications. J Bras Pneumol 2010; 35:698-708. [PMID: 19669009 DOI: 10.1590/s1806-37132009000700012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/17/2009] [Indexed: 11/22/2022] Open
Abstract
Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.
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Affiliation(s)
- Aline Sardinha
- Laboratory of Panic and Respiration, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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de-Melo-Neto VL, King ALS, Valença AM, da Rocha Freire RC, Nardi AE. Subtipos respiratório e não respiratório do transtorno de pânico: Comparações clínicas e de qualidade de vida. Revista Portuguesa de Pneumologia 2009. [DOI: 10.1016/s0873-2159(15)30182-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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de-Melo-Neto VL, King ALS, Valença AM, da Rocha Freire RC, Nardi AE. Respiratory and non-respiratory panic disorder subtypes: clinical and quality of life comparisons. Rev Port Pneumol 2009; 15:859-874. [PMID: 19649544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
AIM to compare the scores of the WHOQOL quality of life domains with the clinical features of patients with respiratory and non-respiratory panic disorders (PD) treated at the UFRJ Panic and Respiration Laboratory. METHOD cross sectional study. Thirty-two PD outpatients under treatment were consecutively selected and evaluated by the MINI v.4.4. They were divided into two different groups according to Briggs et al. classification of respiratory and non-respiratory PD subtypes. Twelve (37.5%) patients had the respiratory subtype (SR) and 20 (62.5%) the non-respiratory subtype (SN). RESULTS the SN patients presented worse scores in the psychological domain of the WHOQOL. There were no differences between groups in gender, age, level of schooling, occupational status, marital status, smoking and comorbidities. There were no differences in the anxiety questionnaires and PD questionnaire (BAI, STAI-T, STAI-S, PAS) scores and in the age at the beginning of the disorder and the disorder's duration. CONCLUSION non-respiratory subtype patients presented worse scores in the psychological domain of WHOQOL than the respiratory subtype group, when they had similar anxiety and PD scores.
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Nascimento I, Melo-Neto VLD, Valença AM, Lopes FL, Freire RCDR, Cassabian LA, Garcia CSNB, Zin WA, Nardi AE. Medicação antipânico e função pulmonar em pacientes com transtorno de pânico. ARCH CLIN PSYCHIAT 2009. [DOI: 10.1590/s0101-60832009000400001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nascimento I, Melo-Neto VLD, Valença AM, Lopes FL, Freire RCDR, Cassabian LA, Garcia CSNB, Zin WA, Nardi AE. Antipanic drugs and pulmonary function in panic disorder patients. ARCH CLIN PSYCHIAT 2009. [DOI: 10.1590/s0101-60832009000400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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