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Biomedical subjects

J J Mari

Publications and source records attributed to J J Mari.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1991

The use of the Clinical Interview Schedule for the evaluation of mental health in the aged community.

As a part of a survey to study the health and living conditions of the elderly population, a random sample of residents aged 65 and over are examined using the Clinical Interview Schedule (CIS) in order to evaluate their psychiatric status. The aim of this study is to evaluate this standard method of assessment as a case-identification instrument in our country. The schedule was completed by 91 subjects. It is easily administered, easily scored, and economical on time. Its completion rate is high. The weighted total scores (WTS) range from 0 to 48. Using the case criteria defined by Cooper & Schwarz (1982), 27 subjects (30%) are considered cases and 64 (70%) are regarded as non-cases. The sensitivity coefficients for the WTS are examined against the overall severity rating at different cut-off points. The optimum cut-off can be anywhere between 16 and 20 points. The WTS has higher validity coefficients to detect the following diagnostic categories (sensitivity, specificity): normals (100%,-); personality (100%, 92%) and affective disorders (100%, 75%). In general the CIS items are given low ratings. Psychotic symptoms are rarely found in this sample. One main problem arose: the item depersonalization is misunderstood by some patients probably because of interpreting it as an upsetting memory disturbance.

Aged↗
PubMed1989

Reliability and factor structure of the Portuguese version of Self-Reporting Questionnaire.

The Self-Reporting Questionnaire is a screening instrument devised by the WHO to identify minor psychiatric morbidity in primary care settings and the community in developing countries. It has already been widely used although its psychometric properties are not yet completely explained. The present article describes the following properties of the Portuguese version of the SRQ-20: a) coefficients of internal consistency; b) inter-rater reliability coefficients, and c) a factor analysis. Internal consistency, measured by the KD20 method, was 0.81. The intra-class correlation coefficient obtained from simultaneous scoring of four interviewers was 0.96, considerably high, as expected from a structured instrument. In the factor analysis four main factors accounted for 41% of the total item variance, and they could be reasonably identified as Decreased Energy, Somatic symptoms, Depressive mood and Depressive thoughts.

Adolescent↗
PubMed1987

Psychiatric morbidity in primary health care. A two-stage screening procedure in developing countries: choice of instruments and cost-effectiveness.

The use in two developing countries of a two-stage psychiatric screening procedure with an emphasis on minor morbidity is described. This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction. Health auxiliaries with limited training administered the first-stage screening instrument. In comparison with other psychiatric screening techniques used in developing countries, the procedure described may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.

Brazil↗
PubMed1986

Misclassification by psychiatric screening questionnaires.

Two psychiatric screening instruments were applied to a sample of attenders (n = 875) in three primary medical care clinics in the city of Sao Paulo. The two questionnaires were validated in a subsample (n = 260) against the Clinical Interview Schedule [8]. The effect of sociodemographic variables on misclassification (by both questionnaires) was investigated using Relative Operating Characteristic (ROC) analysis and linear logistic modelling. Both these techniques proved to be useful in this regard, and it is recommended that they be more widely used in screening studies. Sex and educational level exerted important influences on misclassification. In general, men were more likely than women to be classified as false negative, while poorly educated respondents were more likely to be classified as false positive. These results are interpreted in an illness-behavior context.

Ambulatory Care Facilities↗
PubMed1986

Psychiatric research instruments in the transcultural setting: experiences in India and Brazil.

Some of the issues concerned with the application of standardized psychiatric research instruments in settings other than the one in which they are developed are discussed in the light of the authors' experiences in India and Brazil. The authors contend that in spite of the divergent manifestations of mental disorders across cultures, there is an inner core of human suffering which can be reliably detected by suitably modified instruments developed in the West. It is contended that the research worker should be as familiar with the cultural setting where the instrument is to be applied as the language in which the instrument has been developed.

Brazil↗
PubMed1986

A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo.

A validity study of the Self-Report Questionnaire (20 item version, Harding et al, 1980) against the criterion of a standardised psychiatric interview (Goldberg et al, 1970) was carried out at three primary care clinics in Sao Paulo; 875 patients filled in the SRQ-20 questionnaires and a subsample of 260 was interviewed by the psychiatrist. The SRQ-20 was shown to be a feasible screening instrument for psycho-emotional disturbance in these settings. Sensitivity was 83% and specificity 80%, and the questionnaire was a good indicator of morbidity. A correlation was found between questionnaire total scores and independent clinical judgment (r = +0.70). A sex difference in the validity coefficients is described.

Adolescent↗
PubMed1985

A comparison of the validity of two psychiatric screening questionnaires (GHQ-12 and SRQ-20) in Brazil, using Relative Operating Characteristic (ROC) analysis.

The General Health Questionnaire (GHQ-12) (Goldberg, 1972) and the Self Report Questionnaire (SRQ-20) (Harding et al. 1980) were simultaneously validated against the criterion of the Clinical Interview Schedule (CIS) (Goldberg et al. 1970) in three primary care clinics in the city of Sao Paulo, Brazil. A comparison between the two screening instruments was carried out. The product-moment correlation between the two sets of scores was +0.72, and the validation coefficients for the GHQ-12 and the SRQ-20 were respectively: sensitivity 85% and 83%; specificity 79% and 80%; overall misclassification rate 18% and 19%. The two screening instruments were further compared by the application of Relative Operating Characteristic (ROC) analysis and, again, were found to be very similar in performance. The area under the ROC curve was 0.87 for the GHQ and 0.90 for the SRQ-20 (Z = 0.92, NS). Both psychiatric screening instruments were therefore found to be acceptably valid when assessed against the CIS in three primary care settings in Brazil. The application of ROC analysis to studies of this kind was feasible and straightforward. It was found to be superior to the conventional method of presentation of validity data. It is recommended that the application of ROC analysis to psychiatric screening studies be further utilized and explored.

Brazil↗
PubMed1984

Minor psychiatric disorder in primary care in Brazil: a pilot study.

The General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS) were translated into Portuguese and were used in a pilot study of psychiatric morbidity in primary care at 'The Health Centre Barra Funda/Bom Retiro' of the Faculty of Medicine of Santa Casa Hospital at Sao Paulo, Brazil. The Portuguese translation of the CIS was found to be a feasible instrument for community studies in Brazil, but the Portuguese translation of the GHQ-30 was shown to be of limited use in this particular setting. The extent of minor psychiatric morbidity was very high (46%); 33% was regarded as conspicuous (CPM) and 13% as hidden (HPM).

Brazil↗