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Biomedical subjects

J J Mari

Publications and source records attributed to J J Mari.

At least 19 recordsLinked to original sources
PubMed2000

Family intervention for schizophrenia.

BACKGROUND: It has been showed that people with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of their emotions. Psychosocial interventions designed to reduce these levels of expressed emotions within families now exist for mental health workers. These interventions are proposed as adjuncts rather than alternatives to drug treatments, and their main purpose is to decrease the stress within the family and also the rate of relapse. OBJECTIVES: To estimate the effects of family psychosocial interventions in community settings for the care of those with schizophrenia or schizophrenia-like conditions compared to standard care. SEARCH STRATEGY: Electronic searches of the Cochrane Library (Issue 2, 1998), the Cochrane Schizophrenia Group's Register (June 1998), EMBASE (1981-1995) and MEDLINE (1966-1995) were undertaken and supplemented with reference searching of the identified literature. SELECTION CRITERIA: Randomised or quasi-randomised studies were selected if they focused on families of people with schizophrenia or schizoaffective disorder and compared community-orientated family-based psychosocial intervention of more than five sessions to standard care. DATA COLLECTION AND ANALYSIS: Data were reliably extracted, and, where appropriate and possible, summated. Peto odds ratios (OR), their 95% confidence intervals (CI) and number needed to treat (NNT) were estimated. The reviewers assume that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS: Family intervention may decrease the frequency of relapse (one year OR 0.57 CI 0.4-0.8, NNT 6.5 CI 4-14). The trend over time of this main finding is towards the null and some small but negative studies may not have been identified by the search. Family intervention may decrease hospitalisation and encourage compliance with medication but data are few and equivocal. Family intervention does not obviously effect the tendency of individuals/families to drop out of care. It may improve general social impairment and the levels of expressed emotion within the family. This review provides no data to suggest that family intervention either prevents or promotes suicide. REVIEWER'S CONCLUSIONS: Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are generalisable to routine care.

Family Therapy↗
PubMed2000

Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review.

OBJECTIVE: The objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa. METHOD: A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed. RESULTS: Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk=0.88, 95% CI=0.83-0.94, p<0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6% and 31.4% for drug and placebo; RR=1.03, 95% CI=0.80-1.32, p=0.8). No difference in efficacy could be demonstrated among different classes of antidepressants. CONCLUSIONS: The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.

Antidepressive Agents↗
PubMed2000

Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review.

UNLABELLED: This review assessed the effect of a combination of antidepressants plus psychological approaches compared to each single treatment for bulimia nervosa. METHOD: Trials were included in two meta-analyses: single antidepressants versus combination and single psychological approaches versus combination. Methodological quality and homogeneity of results were assessed. Dichotomous outcomes were analysed by calculating relative risks (RR). RESULT: Five trials were included in meta-analysis 1 and 7 in meta-analysis 2. Remission rates were 42% for combination versus 23% for antidepressants (RR = 1.38; 95% CI=0.98-1.93; P=0.06) and 36% for psychological approaches compared to 49% for combination (RR= 1.21; P=0.03). Drop-out rates were 16% for psychological approaches and 30% for combination (RR =0.57; 95% CI = 0.38-0.088; P=0.11). CONCLUSION: Efficacy of combined treatments was superior to single approaches. When antidepressants were combined to treatment, acceptability of psychological approaches was significantly reduced.

Adult↗
PubMed1999

Psychiatric disorder and the use of benzodiazepines: an example of the inverse care law from Brazil.

BACKGROUND: A cross-sectional survey was conducted in Pelotas, southern Brazil, to assess the relationship between the use of benzodiazepines (BZD), minor psychiatric disorders (MPD) and social factors. METHODS: A representative sample (n = 1277) was interviewed using the Self-Reporting Questionnaire (SRQ-20) for MPD. Subjects were asked about the use of BZD in the preceding 2 weeks and were also asked for socioeconomic details. RESULTS: A total of 152 (11.9%; 95% CI 10.1-13.7) subjects had taken psychotropic drugs, with BZD being the most commonly reported (8%). The prevalence of MPD was 22.7% (95% CI 20.4-25.0): males 17.9% and females 26.5%. An inverse relationship was seen between level of income, schooling and prevalence of MPD (P < 0.001), but a positive relationship was found between income and BZD consumption (P < 0.05). CONCLUSIONS: These data suggest that the inverse care law operates in prescribing psychotropic medications for MPD.

Adolescent↗
PubMed1999

Antidepressants versus psychotherapy for bulimia nervosa: a systematic review.

OBJECTIVE: To assess the efficacy and acceptability of antidepressants compared to psychotherapy as single approaches for the treatment of bulimia nervosa. METHOD: Dichotomous outcomes were analysed by calculating relative risks and continuous outcomes by calculating effect sizes. The number needed to treat (or harm) was calculated. Methodological quality of trials and heterogeneity in the results were evaluated. RESULTS: A meta-analysis including five randomized controlled trials showed a non-significant difference in short-term remission of bulimic symptoms favouring psychotherapy. Remission rates were 20% for antidepressants and 39% for psychotherapy (P = 0.07). Dropout rates were higher (P = 0.027) for antidepressants (40%) than for psychotherapy (18%). The number needed to harm (NNH) was 4. DISCUSSION: Psychotherapy was superior to antidepressants, but using a more conservative statistical approach this difference, although clinically relevant, was not significant. The number of trials might be insufficient to show the significance of a 20% absolute risk reduction in efficacy. Psychotherapy was a better accepted treatment.

Adult↗
PubMed1998

Use of amphetamine-like appetite suppressants: a cross-sectional survey in Southern Brazil.

In 1994 a cross-sectional survey was undertaken in Pelotas, Southern Brazil, to assess the prevalence of amphetamine-like appetite suppressant use. 1,277 adults were interviewed, and the prevalence of anorectic drug use was 1.3% (95% CI = 0.7-1.9): 15 women and one man, mainly from higher socioeconomic groups. Most of the users (81%) had a medical prescription. Forty-one different drugs had been prescribed. Mean length of use was 8.7 months. These findings are discussed in terms of the overreliance on anorectics as aids to dieting, the dangers of polypharmacy, and the risks of long-term use.

Adolescent↗
PubMed1997

Neurovegetative dystonia--psychiatric evaluation of 40 patients diagnosed by general physicians in Brazil.

The diagnosis of neurovegetative dystonia (NVD) is commonly made by general physicians in Brazil, but its precise meaning is unclear. Anecdotal evidence suggests that it is used to describe patients with a wide range of psychological and physical symptoms and is often used pejoratively, in a similar way to "crocks" in the USA. Forty patients who had been diagnosed as having NVD by general physicians working in a triage department of a general public hospital were compared with 40 non-NVD patients, matched for age and gender, from the same department. Patients were evaluated by a psychiatrist who was blind to the diagnosis that had been made. The assessment included a structured sociodemographic questionnaire, the Clinical Interview Schedule (CIS), and a routine psychiatric interview using DSM-III-R criteria. Using the CIS, the "reported symptoms" that most distinguished NVD patients from controls were somatic and anxiety, whereas for "manifest abnormality" NVD patients displayed more anxiety, histrionic behavior, hypochondriasis, and depressive thoughts. A total of 92.5% of NVD patients received diagnoses using DSM-III-R criteria compared to 37.5% of controls. The relative risk of NVD patients subsequently receiving a psychiatric disorder was 8.3 (95% CI = 2.5-43.1, p < 0.001). Although general physicians correctly identify most patients with psychiatric disorder they miss many others. Furthermore, they use an obsolete diagnostic category which has no psychiatric currency. Medical students and residents need better psychiatric training so that they can correctly identify patients in general medical settings who are suffering from mental disorders and make a diagnosis using accepted psychiatric terminology.

Adult↗
PubMed1996

A systematic evaluation of linkage studies in bipolar disorder.

Genetic factors have long been implicated in the aetiology of bipolar disorder (BD). During the past two decades several linkage studies have been carried out with the aim of identifying major genes. However, remarkable discrepancies in results both between and within studies have constituted a major problem. In order to elucidate some of these conflicts, we assessed the published literature on linkage studies of bipolar disorder, focusing on methodological issues. Studies published between January 1980 and December 1994 were identified by computerized literature searches and subsequent scanning of review articles, and the reference lists of the articles primarily identified. A set of defined inclusion and exclusion criteria was used to select studies for assessment. A total of 31 variables were determined, and pre-defined codes were assigned in a structured manner. More than 200 citations were reviewed, and 60 articles were included in this study. Descriptive statistical analyses of the variables, as well as associations between variables, are presented. The findings are discussed with regard to the possibility that, beyond the genetic complexity of the disorder itself, there are several other similarly complicated study design issues which should be more carefully observed. Moreover, the need for standardization of basic criteria to use and report clinical and analytical parameters employed in linkage studies is strongly suggested.

Bipolar Disorder↗
PubMed1996

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients.

A case series to study factors related to family expectation regarding schizophrenic patients was conducted in an out-patient setting in the city of S. Paulo, Brazil. Patients diagnosed as presenting schizophrenia by the ICD 9th Edition and having had the disease for more than four years were included in the study. Family Expectation was measured by the difference between the Katz Adjustment Scale (R2 and R3) scores based on the relative's expectation and the socially expected activities of the patient (Discrepancy Score), and social adjustment was given by the DSM-III-R Global Assessment Scale (GAS). Outcome assessments were made independently, and 44 patients comprised the sample (25 males and 19 females). The Discrepancy mean score was twice as high for males as for females (p < 0.02), and there was an inverse relationship between the discrepancy score and social adjustment (r = -0.46, p < 0.001). Moreover, sex and social adjustment exerted independent effects on the discrepancy score when age, age at onset and number of psychiatric admissions were controlled by means of a multiple regression technique. There was an interaction between sex and social adjustment, the inverse relationship between social adjustment and discrepancy score being more pronounced for males. These findings are discussed in the light of the potential association between the family environment, gender and social adjustment of schizophrenic patients, and the need for further research, i.e. ethnographic accounts of interactions between patient and relatives sharing households particularly in less developed countries.

Adult↗
PubMed1996

Stressful life events and minor psychiatric disorders: an estimate of the population attributable fraction in a Brazilian community-based study.

OBJECTIVE: A population-based survey was conducted in Pelotas, southern Brazil, to assess the specific and the combined contribution of life events and socioeconomic factors on the overall prevalence of minor psychiatric disorders (MPD). METHODS: The study covered a representative sample of the population aged fifteen years or older living in the urban area of the city. Using multi-stage sampling, a total of thirty census tracts and 600 households were selected. A standardized questionnaire assessed the presence of MPD (using the Self-Reporting Questionnaire-SRQ-20), the occurrence of life events (death of a relative, a relative with a chronic disease, loss of employment, divorce, migration, accident, and robbery/assault), and socioeconomic factors. RESULTS: The prevalence of MPD was 22.7 percent (17.9% males and 26.5% females) and increased with age. Significant linear relationships with education and income were observed: the less education and income, the higher the prevalence of MPD. All life events, except migration and accident, were positively associated with MPD. People who experienced divorce in the last year had a prevalence of MPD three times higher than those who had not. The likelihood of MPD increased linearly with the number of life events. The highest proportion of Population Attributable Fraction for any life events was 24 percent. CONCLUSIONS: These data suggest that life events can explain a substantial proportion of MPD and with socioeconomic factors may be related to the onset of MPD.

Adolescent↗
PubMed1995

Type I bipolar disorder associated with a fragile site on chromosome 1.

The objective of this paper is to study the association between chromosomal fragile sites and type I bipolar disorder. This case-control study compares bipolar patients with normal controls. Ten cases of type I bipolar disorder diagnosed according to DSM-III-R criteria and the Composite International Diagnostic Interview (CIDI) were selected from the Escola Paulista affective disorders outpatient clinic and 10 healthy controls (CIDI negative for psychiatric diagnoses) matched for sex and age were drawn from the otorhinolaryngologic outpatient clinic of the same hospital. The cytogenetic analysis was carried out with blood lymphocytes, which were cultured in a folic acid-free medium. A total of 100 mitoses per subject were blindly analyzed to the psychiatric diagnostic assignment, and fragile sites were identified according to a minimum expected frequency of events per band in conformity with a Poisson distribution. A higher frequency of chromosomal lesions for cases than controls was found for the following bands: 1q32, 5q31, and 11q23, the 1q32 being considered a fragile site. Although no evident neuropsychiatric etiological component has been mapped to the 1q32 region so far, this finding may lead to further investigation of a possible linkage between genetic markers of this region and bipolar disorder.

Bipolar Disorder↗
PubMed1994

An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings.

The purpose of this overview is to appraise the studies on the efficacy and effectiveness of family interventions in decreasing relapse in schizophrenic patients. The studies were identified by means of a computerized MEDLINE search, and the scanning of review articles and the reference lists of the primary articles identified. More than 300 citations were reviewed, and the potentially relevant articles revealed six randomized controlled trials that were included in this meta-analysis. The criteria for selecting potential studies as well as for the meta-analysis were tested by means of an inter-rater reliability check that showed a good agreement between two independent raters (kappa = 0.83, and kappa = 0.82, respectively). There were independent assessments of the quality of the studies selected, and data extraction comprised a descriptive information of the study population, the types of interventions, and the relevant outcome measurements. The total number of patients included in the six trials was 350 (181 in the control group and 169 in the experimental group). Regarding the decrease of relapse in the experimental group, the pooled odds ratios and their 95% confidence intervals were: 0.30 (0.06, 0.71) for six months; 0.22 (0.09, 0.37) for nine months; and 0.17 (0.10, 0.35) for the 2-year follow-up. Two to five patients needed to be treated to avert one episode of relapse in a nine-month follow-up. The changes in Expressed Emotion status between experimental and control group combining nine months and one year follow-ups were shown to be marginally significant (P < 0.06), in favour of the experimental group. Emotional over-involvement was also marginally significant (P < 0.07), and there was no statistical difference in the distribution of criticism and hostility. In addition, the experimental group showed a significant increase with drug compliance and a reduction in hospitalization over time. These findings are discussed in light of the potential ingredients in the efficacy of family interventions by focusing on the limitations of using relapse as primary outcome in the assessment of efficacy trials with schizophrenic patients.

Family↗
PubMed1994

[The factor structure of the adult psychiatry morbidity questionnaire in a community sample of Brazilian cities].

Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptoms and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasília, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue = 3.81, 10.9%); Irritability/Depression (eigenvalue = 2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue = 1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

Adolescent↗
PubMed1993

Schizophrenia: impact of positive symptoms on gender social role.

A cross-sectional survey was conducted at one public and one private schizophrenia outpatient setting in the city of São Paulo, Brazil, in order to study gender differences in social disabilities. Sixty-nine patients who fulfilled DSM-III-R diagnostic criteria for schizophrenia were assessed by means of Brazilian versions of PANSS (Positive and Negative Syndrome Scale) and DAS (Disability Assessment Scale). Males presented an earlier onset of the disease and were less likely to have ever married. With respect to social disabilities, males fared worse than females on three items of DAS: self-care, under-activity and work performance. The adjusted scores of Section 1 (Overall Behavior) and Section 2 (Social Role Performance) were submitted to multiple regression analysis using the variables of sex, age of onset, age at examination, educational level, number of psychiatric admissions and the total scores of the positive and negative syndromes. Three variables explained a substantial part (45%) of the variance of overall behavior. These three were sex, age at examination, and negative syndrome total score. The higher the negative syndrome total score, the greater the disabilities for both sexes. Three variables explained 38% of the variance of social role performance. These were sex, negative symptoms and an interaction between sex and positive symptoms. The higher the negative syndrome total score, the greater the role impairment, regardless of sex. In women, but not in men, we found that the higher the positive syndrome total score, the greater the impairment in social role performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

The epidemiology of psychotropic use in the city of São Paulo.

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.

Adult↗