Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).

Objective: The field of food addiction has attracted growing research attention. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a screening tool based on DSM-5 criteria for substance use disorders. However, there is no validated instrument to assess food addiction. Methods: The mYFAS 2.0 has been transculturally adapted to Brazilian Portuguese. The data for this study was obtained through an anonymous web-based research platform: participants provided sociodemographic data and answered Brazilian versions of the the mYFAS 2.0 and the Barratt Impulsivity Scale (BIS-11). Analysis included an assessment of the Brazilian mYFAS 2.0’s internal consistency reliability, factor structure, and convergent validity in relation to BIS-11 scores. Results: Overall, 7,639 participants were included (71.3% females; age: 27.2±7.9 years). The Brazilian mYFAS 2.0 had adequate internal consistency reliability (Cronbach’s alpha = 0.89). A single factor solution yielded the best goodness-of-fit parameters for both the continuous and categorical version of the mYFAS 2.0 in confirmatory factor analysis. In addition, mYFAS 2.0 correlated with BIS-11 total scores (Spearman’s rho = 0.26, p < 0.001) and subscores. Conclusion: The Brazilian mYFAS 2.0 demonstrated adequate psychometric properties in our sample; however, future studies should further evaluate its discriminant validity.

Objective: To develop and validate a Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST), a questionnaire used for the screening of premenstrual syndrome (PMS) and of the most severe form of PMS, premenstrual dysphoric disorder (PMDD). The PSST also rates the impact of premenstrual symptoms on daily activities. Methods: A consecutive sample of 801 women aged ≥ 18 years completed the study protocol. The internal consistency, test-retest reliability, and content validity of the Brazilian PSST were determined. The independent association of a positive screen for PMS or PMDD and quality of life determined by the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-Bref) was also assessed. Results: Of 801 participants, 132 (16.5%) had a positive screening for PMDD. The Brazilian PSST had adequate internal consistency (Cronbach’s alpha = 0.91) and test-retest reliability. The PSST also had adequate convergent/discriminant validity, without redundancy. Content validity ratio and content validity index were 0.61 and 0.94 respectively. Finally, a positive screen for PMS/PMDD was associated with worse WHOQOL-Bref scores. Conclusions: These findings suggest that PSST is a reliable and valid instrument to screen for PMS/PMDD in Brazilian women.

Objective: Inflammatory bowel disease (IBD) is associated with elevated levels of anxiety and depression and a reduction in health-related quality of life (HRQoL). Nonadherence to treatment is also frequent in IBD and compromises outcomes. Religious coping plays a role in the adaptation to several chronic diseases. However, the influence of religious coping on IBD-related psychological distress, HRQoL, and treatment adherence remains unknown. Method: This cross-sectional study recruited 147 consecutive patients with either Crohn’s disease or ulcerative colitis. Sociodemographic data, disease-related variables, psychological distress (Hospital Anxiety and Depression Scale), religious coping (Brief RCOPE Scale), HRQoL (WHOQOL-Bref), and adherence (8-item Morisky Medication Adherence Scale) were assessed. Hierarchical multiple regression models were used to evaluate the effects of religious coping on IBD-related psychological distress, treatment adherence, and HRQoL. Results: Positive RCOPE was negatively associated with anxiety (b = 0.256; p = 0.007) as well as with overall, physical, and mental health HRQoL. Religious struggle was significantly associated with depression (b = 0.307; p < 0.001) and self-reported adherence (b = 0.258; p = 0.009). Finally, anxiety symptoms fully mediated the effect of positive religious coping on overall HRQoL. Conclusion: Religious coping is significantly associated with psychological distress, HRQoL, and adherence in IBD.

OBJETIVO: O papel da religiosidade em saúde mental vem sendo objeto de intensa investigação. Estudos devem ser executados em diferentes locais e culturas. O presente estudo objetiva desenvolver e validar um instrumento breve para mensurar religiosidade intrínseca (Inventário de Religiosidade Intrínseca - IRI) em duas amostras brasileiras. MÉTODO: A versão inicial foi baseada na revisão de literatura e em sugestões de especialistas. Estudantes universitários (amostra 1; n = 323) e pacientes psiquiátricos (amostra 2; n = 102) preencheram o Índice de Religiosidade de Duke (DUREL), o IRI, uma medida de espiritualidade (WHOQOL-SRPB), bem como medidas de sintomas ansiosos e depressivos. RESULTADOS: O IRI apresentou consistência interna adequada nas amostras 1 (α de Cronbach = 0,96; IC 95%; 0,95-0,97) e 2 (α = 0,96; IC 95%; 0,95-0,97). Análises de componentes principais indicaram um único fator que explicou 73,7% e 74,9% da variância nas amostras 1 e 2, respectivamente. Foram observadas fortes correlações entre o IRI e a subescala de religiosidade intrínseca da DUREL (r de Spearman de 0,87 a 0,73 nas amostras 1 e 2, respectivamente, p < 0,001). O IRI apresentou boa validade teste-reteste (coeficientes de correlação intraclasse > 0,70). CONCLUSÃO: Os dados indicam que o IRI é um instrumento válido e pode contribuir para estudar religiosidade intrínseca em amostras brasileiras.

OBJECTIVE: The role of religious involvement in mental health has been increasingly investigated in psychiatric research; however, there is a shortage of scales on religiousness in Portuguese. The present study aimed to develop and validate a brief instrument to assess intrinsic religiosity (Intrinsic Religiousness Inventory - IRI) in two Brazilian samples. METHOD: The initial version was based on literature review and experts' suggestions. University students (sample 1; n = 323) and psychiatric patients (sample 2; n = 102) completed the Duke Religiosity Index (DUREL), the IRI, an instrument of spirituality measurement (WHOQOL-SRPB), as well as measurements of anxiety and depressive symptoms. RESULTS: The IRI showed adequate internal consistence reliability in sample 1 (Cronbach's α = 0.96; 95% CI; 0.95-0.97) and sample 2 (α = 0.96; 95% CI; 0.95-0.97). The IRI main component analyses indicated a single factor, which explained 73.7% and 74.9% of variance in samples 1 and 2, respectively. Strong correlations between IRI and intrinsic subscale of the DUREL were observed (Spearman's r ranging from 0.87 to 0.73 in samples 1 and 2, respectively, p < 0.001). The IRI showed good test-retest reliability (intraclass correlation coefficients > 0.70). CONCLUSION: These data indicate that the IRI is a valid instrument and may contribute to study intrinsic religiosity in Brazilian samples.

Dorstenia cayapia Vellozo, Moraceae (carapiá) é uma erva medicinal e nativa do Brasil. Pertence à categoria "vulnerável", devido à drástica redução dos seus habitats e ao declínio populacional. Esta pesquisa foi realizada em casa de vegetação pertencente ao Centro de Ciências Agrárias da Universidade Federal de Uberlândia. Teve como objetivo obter informações agronômicas que permitam cultivar e explorar racionalmente o carapiá, visando a obtenção de material cultivado para produtos fitoterápicos e indústria química. O material vegetal foi coletado em Raul Soares-MG, em um resquício de Floresta da Encosta Atlântica. Nesse experimento de estaquia de rizomas avaliaram-se três substratos: Substrato comercial, S1 (40% terra + 40% esterco bovino + 20% húmus) e S2 (20% terra + 20% esterco bovino + 40% húmus + 20% vermiculita); três partes de rizoma: apical, basal e mediano e dois tipos de bandeja de poliestireno expandido com 128 e 200 células. Adotaram-se estacas com o tamanho médio de 2 cm, que foram plantadas de acordo com o geotropismo positivo. Conduziu-se o experimento de abril a junho de 2007. O delineamento foi inteiramente casualisado em esquema fatorial (3x3x2). Determinou-se a brotação (%) aos 30 e 68 dias após o plantio (DAP) e as massas fresca e seca da parte aérea (folhas e inflorescências) e da parte subterrânea (rizomas e raiz) aos 68 DAP. Os substratos não tiveram efeito na brotação dos rizomas em bandejas aos 30 DAP. A brotação da parte apical do rizoma foi superior às brotações das posições basal e mediana do rizoma aos 68 DAP. Comparando o uso das bandejas de 128 e de 200 células, a brotação dos rizomas foi superior com o uso da bandeja de 128 células. Pode-se recomendar, para o plantio de Dorstenia cayapia, o corte da parte apical do rizoma, evitando-se assim, o arranquio da planta inteira, auxiliando na preservação dos indivíduos em seu ambiente natural e possibilitando sua propagação assexuada.

Dorstenia cayapia Vellozo, Moraceae (carapiá) is a Brazilian native medicinal herb that is classified as "vulnerable" because of the drastic reduction of its habitat and its declining population. This study was carried out in a greenhouse at the Center for Agricultural Sciences, Federal University of Uberlândia, Minas Gerais State, Brazil. The objective of the study was to obtain informations about cultivation and exploration of carapiá to obtain plant material for phytotherapy and chemical industry products. Plant material was collected in Raul Soares, Minas Gerais State, in a fragment of the Atlantic Coastal Forest. Three substrates were evaluated in the rhizome cutting experiment: Commercial substrate, S1 (40% soil + 40% cattle manure + 20% humus); S2 (20% soil + 20% cattle manure + 40% humus + 20% vermiculite); three sections of the rhizome: apical, basal and intermediate and two types of trays: 128 and 200 cells. Medium sized cuttings (2 cm) were prepared and planting was done according to positive geotropism. The experiment was carried out from April to June 2007 and the experimental design was completely randomized as a 3x3x2 factorial. Dry mass was determined for the above ground (leaves and inflorescences) and for the under ground (roots and rhizomes) parts of the plant. The rhizome tip sprouting was greater than those of the median and basal sections. Rhizome sprouting was better in the 128-cells tray than in the 200-cell tray. Collecting cuttings from the top of the rhizomes could be recommended for planting because it avoids removing the entire plant, thus preserving the plants in their environment and providing for the possibility of asexual propagation.

OBJETIVO: Transtornos do espectro bipolar são prevalentes e comumente subdiagnosticados e subtratados. O presente trabalho descreve o desenvolvimento e a validação da versão brasileira do questionário de transtornos do humor, um instrumento de rastreio para transtornos bipolares, em uma população psiquiátrica adulta. MÉTODO: 114 pacientes consecutivos de um ambulatório psiquiátrico completaram a versão brasileira do questionário de transtornos do humor. Um psiquiatra pesquisador, cego para os escores da versão brasileira do questionário de transtornos do humor, entrevistou os participantes por meio do módulo de transtornos do humor da entrevista clínica estruturada para o DSM-IV ("padrão-ouro"). RESULTADOS: A consistência interna da versão brasileira do questionário de transtornos do humor, avaliada por meio do coeficiente alfa de Cronbach, foi de 0,76 (IC 95%; 0,69-0,92). Uma análise de componentes principais com rotação ortogonal indicou fator de "irritabilidade-pensamentos acelerados" e outro de "energia-atividade", que explicaram 39,1% da variação dos escores. De acordo com o padrão-ouro, 69 (60,5%) dos participantes tiveram um diagnóstico de transtornos bipolares. Um escore do questionário de transtornos do humor de 8 ou mais itens apresentou uma sensibilidade de 0,91 (IC 95%; 0,85-0,98), especificidade de 0,70 (IC 95%; 0,62-0,75), valor preditivo positivo de 0,82 (IC 95%; 0,75-0,88) e valor preditivo negativo de 0,84 (IC 95%; 0,77-0,90). CONCLUSÃO: Os resultados do presente estudo demonstram que a versão brasileira do questionário de transtornos do humor é um instrumento válido para o rastreio de transtornos bipolares. O instrumento necessita de validação em outros contextos (p.ex., serviços primários).

OBJECTIVE: Bipolar spectrum disorders are prevalent and frequently underdiagnosed and undertreated. This report describes the development and validation of the Brazilian version of the Mood Disorder Questionnaire, a screening instrument for bipolar spectrum disorders, in an adult psychiatric population. METHOD: A total of 114 consecutive patients attending an outpatient psychiatric clinic completed the Brazilian version of the Mood Disorder Questionnaire. A research psychiatrist, blind to the Mood Disorder Questionnaire results, interviewed patients by means of the mood module of the Structured Clinical Interview for DSM-IV ('gold standard'). RESULTS: The internal consistency of the Brazilian Mood Disorder Questionnaire, evaluated with Cronbach's alpha coefficient was 0.76 (95% CI; 0.69-0.92). Principal component analysis with varimax rotation indicated an 'irritability-racing thoughts' factor and 'energized-activity' factor, which explained 39.1% of variance. On the basis of the SCID, 69 (60.5%) individuals received a diagnosis of bipolar disorders. A Brazilian Mood Disorder Questionnaire screening score of 8 or more items yielded sensitivity of 0.91 (95% CI; 0.85-0.98), specificity of 0.70 (95% CI; 0.62-0.75), a positive predictive value of 0.82 (95% CI; 0.75-0.88) and a negative predictive value of 0.84 (95% CI; 0.77-0.90). CONCLUSION: The present data demonstrate that the Brazilian Mood Disorder Questionnaire is a valid instrument for the screening of bipolar disorders. The instrument needs to be validated in other settings (e.g., in general practice).

Dorstenia cayapia Vellozo (Moraceae), popularmente conhecida por carapiá, é uma espécie primitiva do ponto de vista geológico e ao mesmo tempo evoluída do ponto de vista de estruturas morfológicas; com amplo uso medicinal é pouco estudada quanto à sua capacidade reprodutiva. Diante disso, e pelo fato de Dorstenia cayapia ser uma espécie ameaçada de extinção, o objetivo deste trabalho foi determinar o potencial da espécie para propagação por sementes por meio de seus atributos biológicos e tecnológicos. O experimento foi instalado em delineamento inteiramente casualizado em esquema fatorial 2 x 3 sendo o primeiro fator correspondente à temperatura (constante em 25ºC e alternada 20-30ºC) e o segundo fator ao substrato (vermiculita, papel mata-borrão e papel de filtro), com quatro repetições de 20 sementes por parcela. O uso dos substratos vermiculita e papel mata-borão à temperatura de 25ºC aumentaram o percentual de plântulas normais e de sementes germinadas. A germinação das sementes tornou-se mais lenta quando as sementes foram dispostas em papel de filtro, assim como se tornaram mais assíncronas nesse substrato. A temperatura alternada 20-30ºC atrasou o início do processo de germinação das sementes de carapiá.

Dorstenia cayapia Vellozo (Moraceae), popularly known as carapiá, is a primitive species from the geological point of view but well evolved from the point of view of morphological structures; of large medicinal use, this plant reproductive capacity was not well studied . Since this species is threatened with extinction, the objective of this study was to evaluate the physiological quality of its seeds by their biological and technological attributes. The experiment was set up in a completely randomized design with a factorial 2x3 scheme, in which the first factor was the temperature (constant of 25ºC and alternated 20-30ºC) and the second factor was the substrate (vermiculite, rolled paper and filter paper), with four replications of 20 seeds per plot. The use of the substrates vermiculite and rolled paper at 25ºC increased the percentage of normal seedlings and germinated seeds. The seeds germination was slower when they were placed on filter paper, and it was more asynchronous in this substrate. Additionally, the alternating temperature 20-30ºC delayed the beginning of the germination of Dorstenia cayapia seeds.

OBJETIVO: Transtornos do espectro bipolar (TEB) são prevalentes e comumente subdiagnosticados e subtratados. O presente trabalho descreve o desenvolvimento e a validação da versão brasileira da escala diagnóstica do espectro bipolar (B-EDEB), um instrumento de rastreio para transtornos bipolares, em uma população psiquiátrica adulta. MÉTODO: 114 pacientes consecutivos de um ambulatório psiquiátrico completaram a versão brasileira da B-EDEB. Um psiquiatra pesquisador, cego para os escores do B-EDEB, entrevistou os participantes por meio de uma versão modificada do módulo de transtornos do humor da entrevista clínica estruturada para o DSM-IV ("padrão-ouro"). RESULTADOS: A consistência interna da B-EDEB, avaliada mediante o coeficiente alfa de Cronbach, foi de 0,89 (IC 95%; 0,86-0,91). De acordo com o padrão-ouro, 70 (61,4%) participantes tiveram diagnóstico de TEB. Um escore da B-EDEB de 16 ou mais itens apresentou sensibilidade de 0,79 (IC 95%; 0,72-0,85), especificidade de 0,77 (IC 95%; 0,70-0,83), valor preditivo positivo de 0,85 (IC 95%; 0,78-0,91) e valor preditivo negativo de 0,70 (IC 95%; 0,63-0,75). CONCLUSÃO: Os resultados do presente estudo demonstram que a B-EDEB é um instrumento válido para o rastreio de TEB.

OBJECTIVE: Bipolar spectrum disorders (BSDs) are prevalent and frequently unrecognized and undertreated. This report describes the development and validation of the Brazilian version of the bipolar spectrum diagnostic scale (B-BSDS), a screening instrument for bipolar disorders, in an adult psychiatric population. METHOD: 114 consecutive patients attending an outpatient psychiatric clinic completed the B-BSDS. A research psychiatrist, blind to the B-BSDS scores, interviewed patients by means of a modified version of the mood module of the Structured Clinical Interview for DSM-IV ("gold standard"). Subthreshold bipolar disorders were defined as recurrent hypomania without a major depressive episode or with fewer symptoms than those required for threshold hypomania. RESULTS: The internal consistency of the B-BSDS evaluated with Cronbach's alpha coefficient was 0.89 (95% CI; 0.86-0.91). On the basis of the modified SCID, 70 patients (61.4%) of the sample received a diagnosis of BSDs. A B-BSDS screening score of 16 or more items yielded: sensitivity of 0.79 (95% CI; 0.72-0.85), specificity of 0.77 (95% CI; 0.70-0.83), a positive predictive value of 0.85 (95% CI; 0.78-0.91) and a negative predictive value of 0.70 (95% CI; 0.63-0.75). CONCLUSION: The present data demonstrate that the B-BSDS is a valid instrument for the screening of BSDs.

INTRODUÇÃO: O transtorno de personalidade limítrofe (TPL) é uma síndrome psiquiátrica que causa significativa morbidade e mortalidade para pacientes internados e ambulatoriais tratados por profissionais de saúde mental. Dada a sua alta prevalência na população de pacientes psiquiátricos, esforços são necessários para tratar esse grupo apropriadamente. OBJETIVO: O objetivo do presente artigo é revisar evidências atuais acerca da efetividade das diversas abordagens farmacológicas empregadas como parte do plano de tratamento produzido para indivíduos que enfrentam essa doença. MÉTODOS: Para esse propósito, os autores revisaram o banco de dados MEDLINE em busca de ensaios clínicos publicados entre 1986 e 2003. Borderline personality disorder e clinical trials foram usados com descritores. RESULTADOS: Numerosos trabalhos foram encontrados, mas poucos estudos controlados estavam disponíveis. Notável é o fato de que virtualmente todas as classes de psicofármacos foram testadas nesse grupo de pacientes, comumente com desfechos modestos ou variáveis. Devido a limitações metodológicas na vasta maioria dos ensaios clínicos envolvendo drogas específicas nesse grupo de pacientes, foi difícil estimar o benefício real dos vários agentes testados. A evidência mais forte existe para os inibidores seletivos de serotonina, antipsicóticos e divalproato. DISCUSSÃO: Claramente, mais ensaios clínicos bem delineados são necessários, mas os dados revisados sugerem que psicofármacos são efetivos para tratar sintomas-alvo nesses pacientes. Conclui-se que psicotrópicos são adjuntos úteis às abordagens psicoterapêuticas usualmente empregadas para tratar pacientes limítrofes.

INTRODUCTION: Borderline personality disorder (BPD) is a psychiatric syndrome that causes significant morbidity and mortality to both inpatients and outpatients treated by mental health care providers. Due to its relatively high prevalence in the psychiatric population, efforts are necessary to treat this problematic group of patients properly. OBJECTIVE: The aim of this paper is to review current evidence of the effectiveness of the various pharmacological approaches employed as part of the treatment plan designed for individuals coping with this illness. METHODS: For this purpose, the MEDLINE database was searched for clinical trials from 1986 to 2003. "Borderline personality disorder" and "clinical trials" were used as descriptors. RESULTS: Numerous works were retrieved, but very few controlled trials were available. Noteworthy is the fact that virtually all classes of psychopharmacological agents were tested in this set of patients, often with modest and variable outcomes. Due to methodological limitations observed in the vast majority of trials involving specific drugs in this group of patients, it was difficult to estimate the real benefit of the several agents tested. The most robust evidence exists for selective serotonin reuptake inhibitors, antipsychotics and divalproex. DISCUSSION: Clearly, more well-designed clinical trials are needed, but the data reviewed suggest that drugs are effective in the treatment of target symptoms in these patients. Psychotropics are useful when used in association with the psychotherapeutic approaches usually employed with borderline patients.

INTRODUCCÍON: El trastorno de personalidad limítrofe (TPL) es un síndrome psiquiátrico que causa significativa morbididad y mortalidad a pacientes internados y ambulatoriales tratados por profesionales de salud mental. Vista su alta prevalencia en la población de pacientes psiquiátricos, son necesarios esfuerzos para tratar apropiadamente a ese grupo. OBJETIVO: El objetivo del presente artículo es revisar evidencias actuales sobre la efectividad de los diversos aportes farmacológicos empleados como parte del plan de tratamiento producido para individuos que enfrentan esa enfermedad. MÉTODOS: Para ese propósito, los autores revisaron la base de datos MEDLINE buscando ensayos clínicos publicados entre 1986 y 2003. Se usaron como descriptores borderline personality disorder y clinical trials. RESULTADOS: Se encontraron numerosos trabajos, pero pocos estudios controlados estaban disponibles. Es notable el hecho de que, en ese grupo de pacientes, virtualmente han sido probadas todas las clases de psicofármacos, comúnmente con resultados modestos o variables. Debido a limitaciones metodológicas en la vasta mayoría de los ensayos clínicos abarcando drogas específicas en ese grupo de pacientes, fue difícil estimar el beneficio real de los varios agentes probados. La evidencia más fuerte existe para los inhibidores selectivos de serotonina, antipsicóticos y divalproato. DISCUSIÓN: Claramente, son necesarios más ensayos clínicos bien enmarcados, pero los datos revisados sugieren que psicofármacos son efectivos para tratar síntomas blanco en estos pacientes. Se concluye que los psicotrópicos son adjuntos útiles a los abordajes psicoterapéuticos usualmente empleados para tratar a pacientes limítrofes.