Diferentes ensaios clínicos randomizados demonstram que a Terapia Cognitivo-Comportamental (TCC) é muito efetiva no tratamento do Transtorno de Ansiedade Social (TAS). Entretanto, uma quantidade significativa de pacientes não apresentam melhora após a finalização da intervenção com TCC. Tal dado indica a necessidade de desenvolver novas estratégias de tratamento para o TAS. A Terapia Cognitiva Processual (TCP) é uma nova abordagem dentro do campo da TCC que tem como principal objetivo auxiliar os pacientes a identificar e modificar suas crenças centrais disfuncionais, sendo o Processo uma das principais técnicas utilizadas. Algumas pesquisas têm demonstrado a efetividade do Processo no tratamento do TAS e de outros transtornos psiquiátricos. Entretanto, novas pesquisas são necessárias para avaliação não somente de tal técnica, mas de todo o protocolo de intervenção da TCP. Esta pesquisa objetivou avaliar se participantes que receberam uma intervenção individual em TCP apresentam diferenças em relação a sintomas de ansiedade social, medo da avaliação negativa, esquiva e desconforto social, ansiedade, depressão, sofrimento psíquico, distorções cognitivas e viés atencional. Este é um ensaio clínico randomizado que comparou um grupo que recebeu intervenção em TCP e um grupo lista de espera no tratamento do TAS. O estudo apresenta três grupos de pesquisa: o TCP (n =18), o lista de espera (n =21) e o saudável (n =19). Um pesquisador independente ao estudo realizou a distribuição aleatória dos participantes com TAS entre os grupos TCP e lista de espera. Foram realizadas avaliações no pré e pós-teste através de diferentes escalas de auto-relato e do teste de Stroop emocional. Adicionalmente, o grupo TCP respondeu tais escalas a cada quatro sessões. O tratamento foi realizado em 16 sessões com duração de 1h30min cada utilizando a TCP no formato individual. Houve uma redução significativa nos sintomas de ansiedade social, ansiedade, depressão, esquiva e desconforto social, e sofrimento psíquico no grupo TCP ao longo do tratamento (p < 0,05). Tais reduções foram associadas a tamanhos de efeito grandes. Não foram observadas mudanças em nenhum dos instrumentos utilizados no grupo lista de espera (p > 0,05). Houve ainda uma significativa redução no medo da avaliação negativa após a utilização do Processo no grupo tratado, além de uma redução em distorções cognitivas (p < 0,05). Não foram observadas diferenças no pré e pós-teste em relação ao viés atencional nos três grupos da pesquisa (p > 0,05). Este estudo sugere que a TCP pode ser uma nova abordagem clínica efetiva no tratamento do TAS associado à diferentes comorbidades, haja vista que houve uma redução em sintomas de ansiedade social e sintomas comórbidos / Different randomized clinical trials show that Cognitive Behavioral Therapy (CBT) is highly effective in the treatment of Social Anxiety Disorder (SAD). However, a large number of patients do not show improvement after receiving CBT. This indicates that it is important to develop new treatments for SAD. Trial-Based Cognitive Therapy (TBCT) is a new approach within the field of CBT area. It aims to help patients to identify and to modify their dysfunctional core beliefs. One of the main TBCT techniques proposed by TBCT is the Trial. Some research studies have demonstrated the effectiveness of Trial in the treatment of SAD, and other disorders. However, further investigation is needed to firmly establish the efficacy not just for the Trial technique, but also the TBCT approach as a treatment for SAD and other disorders. This research aims to evaluate wheter SAD participants receiving TBCT individual-sessions differ from a SAD waiting list group condition regarding symptoms of social anxiety, fear of negative evaluation, social avoidance and distress, anxiety, depression, mental suffering, and attentional bias. This is a randomized clinical trial comparing TBCT and a Waitlist control condition for the treatment of SAD. The study has three groups: TBCT (n =18), Wailist (n =21), and healthy group (n =19). An independent researcher to study distributed randomly the participants with SAD between TBCT or Waitlist condition. Assessments were made at pre and post-test using several self-report scales, and the emotional Stroop test in the three groups. Additionaly, the TBCT group answered these scales each four sessions. The treatment was delivered in sixteen 1.5 hour sessions using the individual TBCT format. There were reductions in social anxiety, anxiety, depression, social avoidance and distress, and mental suffering symptoms at TBCT group (p < 0.05), but not in the Waitlist group (p > 0.05). Those reductions were associated with a large effect size. There was a significant reduction at fear of negative evaluation after Trial use, and reductions at cognitive distortions throughout the treatment as well (p < 0.05). There were no differences among the three groups regarding attentional bias at pre-test nor at post-test (p > 0.05). This study suggests that TBCT may be a new effective clinical approach to treat SAD associated with high rates of comorbidity, as there were significant reductions in the comorbid symptoms

O Transtorno de Ansiedade Social (TAS) consiste em um medo acentuado e persistente de situações sociais ou de desempenho nas quais o indivíduo poderia sentir vergonha. Dentre os transtornos de ansiedade, o TAS é um dos mais prevalecentes, sendo considerado o quinto transtorno mais incapacitante, contudo, a busca por tratamento é muito baixa. Diferentes estudos clínicos randomizados evidenciam que a TCCG apresenta resultados satisfatórios e duradouros, sendo considerada padrão ouro de intervenção para TAS, porém, ainda assim, uma parcela de pacientes com TAS não respondem ao tratamento. Assim sendo, o objetivo deste trabalho foi investigar o efeito de uma intervenção em grupo de exposição com alto custo social em pacientes com TAS sobre variáveis psicológicas e também sobre a qualidade de memória. A intervenção utilizada nesse estudo foi a proposta por Hofmann e Otto (2008). Dentre as variáveis psicológicas estudadas foram avaliadas mudanças em sintomas de ansiedade social, ansiedade, medo da avaliação negativa, esquiva e desconforto social, depressão e sintomas de transtornos psiquiátricos comuns. Participaram desse estudo 58 adultos, compondo três grupos experimentais diferentes: o grupo de comparação sem TAS, que consiste em participantes sem sintomas clínicos, o grupo de comparação com TAS, que são participantes portadores de TAS os quais não realizaram a intervenção durante a pesquisa (grupo lista de espera) e o grupo de portadores de TAS participaram da intervenção (grupo TCCG). Um pesquisador independente ao estudo realizou a distribuição aleatória dos participantes com TAS entre os grupos TCCG e lista de espera. Foram realizadas avaliações no pré e pós-teste através do Inventário de Fobia Social (SPIN), Inventários de Ansiedade e Depressão de Beck (BAI e BDI-II), Escala de Medo da Avaliação Negativa (FNE), Escala de Esquiva e Desconforto Social (SADS), Questionário sobre a saúde do paciente (PHQ-9), Questionário de Autorrelato (SRQ) e teste de falsas memórias. Assim, os resultados encontrados evidenciam que a intervenção alcançou redução significativa nos sintomas de ansiedade social, ansiedade geral, depressão e sintomas de transtornos mentais comuns, mostrando que foi uma intervenção efetiva. Além disso, os escores relacionados à ansiedade geral, depressão e sintomas de transtornos mentais comuns, após a intervenção foram equiparados com o escore obtidos pelo grupo de participantes saudáveis, evidenciando a excelente eficácia do processo de intervenção. A eficácia também pode ser constatada a partir da mensuração do tamanho de efeito grande encontrado no estudo relacionado ao principal instrumento de avaliação de TAS utilizado (SPIN), ou seja, esse estudo evidenciou que a forma psicoterápica utilizada atingiu o objetivo esperado da intervenção considerada padrão ouro. No que concerne às medidas relacionadas à qualidade de memória, a hipótese inicial relacionava-se à teoria de que os indivíduos ansiosos sociais apresentariam um número maior de falsas memórias e/ou uma redução de memórias verdadeiras, porém essa hipótese não foi confirmada. / Social Anxiety Disorder (SAD) consists of a marked and persistent fear of social or performance situations in which the individual could feel shame. Among the anxiety disorders, SAD is one of the most prevalent, considered the fifth most disabling disorder, however, the search for treatment is very low. Different randomized clinical trials show that Cognitive-Behavioral Group Therapy (CBGT) presents satisfactory and long-lasting results, which is considered the gold standard of intervention for SAD, however, a portion of patients with SAD do not respond to treatment. Thus, the objective of this study was to investigate the effect of a group intervention related to high social cost exposure in patients with SAD about psychological variables and memory quality. The intervention used in this study was proposed by Hofmann and Otto (2008). Among the psychological variables studied changes in symptoms of social anxiety, anxiety, fear of negative evaluation, avoidance and social discomfort, depression and symptoms of common psychiatric disorders were evaluated. Fifty-five adults participated in this study, composing three different experimental groups: the comparison group without SAD, which consists of participants without clinical symptoms, the comparison group with SAD, participants with SAD who did not receive intervention during the research (Waitlist control condition), and the group of SAD patients who participated in the intervention. An independent researcher to study distributed randomly the participants with SAD between CBGT or Waitlist condition. Assessments were made at pre and post-test using Social Phobia Inventory (SPIN), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Fear of Negative Evaluation (FNE), Social Avoidance and Distress Scale (SADS), Patient Health-Questionnaire (PHQ-9), Self-Report Questionnaire (SRQ), and false memories test in the three groups. The results showed that the intervention achieved a significant reduction in the symptoms of social anxiety, general anxiety, depression and symptoms of common mental disorders, showing that it was an effective intervention. In addition, the scores related to general anxiety, depression and common mental disorder symptoms after the intervention were similar to the scores obtained by the group of healthy participants, evidencing the excellent efficacy of the intervention process. Efficacy can also be seen from the measurement of the large effect size found in the study evaluated by the main evaluation instrument of SAD used (SPIN), this study achieved the expected goal of the gold standard considered intervention. Concerning measures related to memory quality, the initial hypothesis was that social anxious individuals would present a greater number of false memories and / or a reduction of true memories, but this hypothesis was not confirmed.

Objetivos: Estudar a confiabilidade e validade de uma versão brasileira dos módulos Episódio Depressivo Maior (EDM) e Transtorno de Ansiedade Generalizado (TAG) do Mini International Neuropsychiatric Interview TRACKING (MINI-TRACKING); comparar a evolução de pacientes com diagnóstico de EDM e TAG seguidos por equipes de Estratégia de Saúde da Família (ESF) com acesso ao modelo de Cuidado Colaborativo (CC) em Saúde Mental versus um grupo de pacientes seguidos por equipes sem acesso ao CC. Metodologia: O estudo envolveu quatro equipes de ESF vinculadas à Faculdade de Medicina de Ribeirão Preto (FMRP), sendo duas com acesso ao CC e duas sem CC. Um total de 147 pacientes foram entrevistados com o objetivo de rastrear transtornos mentais com a aplicação do WHO-5 e do COOP-WONCA Quadro Sentimentos. Após a confirmação diagnóstica de EDM e/ou TAG, com a entrevista MINI, 42 pacientes foram selecionados e concordaram em participar da pesquisa. Estes pacientes foram acompanhados por doze meses por um médico de família (MF), que aplicou periodicamente a cada oito a doze semanas os módulos EDM e/ou TAG do MINI-TRACKING. Para avaliação da fidedignidade e da validade concorrente, um psiquiatra (cego quanto ao diagnóstico do MF e quanto a qual equipe seguia o paciente) aplicou, com intervalo máximo de 72h do MF, os mesmos módulos do MINI-TRACKING, o PHQ-9 e/ou o GAD-7. Resultados: Não foi encontrada diferença estatisticamente significativa entre os pacientes das equipes com e sem CC no que se refere as características clínicodemográficas. Os itens individuais dos dois módulos do MINI-TRACKING mostraram boa fidedignidade inter-avaliadores (Kappa entre 0,78 e 0,98), bem como seus escores totais (Coeficiente Intra-classe de 0,996 e 0,993 para EDM e TAG, respectivamente). Os módulos EDM e TAG mostraram também boa validade concorrente com as escalas PHQ-9 e GAD-7 (coeficiente de Pearson 0,994 e 0,976, respectivamente). Trinta pacientes (quinze de equipes com CC e 15 de equipes sem CC) completaram as cinco avaliações no decorrer de um ano de seguimento. A ANOVAmr destes pacientes mostrou diferenças significativas no fator tempo e na interação tempo x intervenção, com diminuição significativamente maior dos escores do MINI-TRACKING nos pacientes seguidos pelas equipes com CC. Conclusão: Os módulos EDM e TAG do MINI-TRACKING são uma opção confiável para o seguimento de pacientes com estes diagnósticos. Este estudo também mostrou, de forma preliminar, que o CC em saúde mental é uma estratégia eficaz na redução de sintomas dos pacientes com EDM e TAG na Atenção Primária. / Objectives: To study the reliability and validity of a Brazilian version of the Mini International Neuropsychiatric Interview - TRACKING (MINI-TRACKING) modules for Major Depressive Episode (MDE) and Generalized Anxiety Disorder (GAD); To compare the outcomes of patients diagnosed with MDE and GAD followed by teams of the Family Health Strategy (FHS) with access to the Mental Health Collaborative Care model (CC) versus a group of patients followed by teams without access to CC. Methodology: The study involved four FHS teams of the Faculty of Medicine of Ribeirão Preto (FMRP), two of them with access to CC and two without it. A total of 147 patients were tracked for mental disorders with the application of the WHO-5 and the COOP-WONCA Chart Feelings. After confirming the diagnosis of MDE and/or GAD using the MINI interview, 42 patients were selected and agreed to participate. These patients were followed for twelve months by a family physician (FP), who applied regularly every eight to twelve weeks the MDE and/or the GAD MINI-TRACKING modules. To assess the reliability and concurrent validity, a psychiatrist (blind to the diagnosis and to which team the patient was followed) also applied the same modules of the MINI-TRACKING, the PHQ-9 and/or the GAD-7, with a maximum interval of 72 hours of the FP. Results: There was no statistically significant difference between the patients with and without CC teams regarding demographic and clinical characteristics. The individual items of the two MINI-TRACKING modules showed good inter-rater reliability (kappa between 0.78 and 0.98), as well as their total scores (Intra-class coefficient of 0.996 and 0.993 for MDE and GAD, respectively). The MDE and GAD modules also showed good concurrent validity with PHQ-9 and GAD-7 scales (Pearson coefficient 0.994 and 0.976, respectively). Thirty patients (fifteen with CC and 15 without CC) completed the five assessments during one year of follow up. The repeated-measures analysis of variance (rmANOVA) showed significant differences in the time factor and the interaction time x intervention, decrease significantly higher of the MINI-TRACKING scores in the patients followed by teams with CC. Conclusion: MINI-TRACKING MDE and GAD modules are a reliable option for following patients with these diagnoses. This study also showed, preliminarily, that CC in Mental Health is an effective strategy in reducing symptoms in Primary Care patients with MDE and GAD.

This dissertation is divided into three parts. The first part aimed to investigate the cannabidiol anxiolytic effect in treatment-naïve individuals with social anxiety disorder through simulation of public speaking. Twenty-four never-treated social anxiety disorder subjects were allocated to receive 0 or 600 mg cannabidiol (CBD; n=12) in a double-blind randomized design. The same number of controls performed the simulation of a public speaking test without receiving any medication. Pretreatment with CBD significantly reduced anxiety, cognitive impairment, and discomfort in speech performance and significantly decreased alertness in their anticipatory speech. The placebo group displayed higher anxiety, cognitive impairment, discomfort, and alertness when compared with controls as assessed with the Visual Analogue Mood Scale (VAMS). The SSPS-N scores showed significant increases during testing of the placebo group that was almost abolished in the cannabidiol group. No significant differences were observed between the cannabidiol and control groups in SSPS-N scores or in cognitive impairment, discomfort, and alertness factors of the VAMS. The second part evaluated healthy subjects\' x y during a public speaking test following a high rimonabant oral dose, to understand better the possible pharmacological approaches for anxiety disorder treatment. Twenty four participants were randomly allocated to receive 0 or 90 mg rimonabant (n=12) in a double-blind design. No significant adverse effects were reported in either group. Participants who received rimonabant showed increased anxiety levels compared to placebo during anticipatory speech and performance measurements. Rimonabant treatment did not affect sedation, cognitive impairment, discomfort, blood pressure, heart rate, self-statements during public speaking, or bodily symptoms scales. Increased anxiety may reflect lower endocannabinoid activity in CB1 receptors and CB1 p \' possible role in modulation of anxiety and anxiety disorders. The third part aimed to monitor cannabinoid blood concentrations during sustained abstinence from chronic daily cannabis smoking. Thirty male chronic daily cannabis smokers resided on a secure clinical research unit for up to 33 days, with blood collected once daily. ?9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) whole blood concentrations were quantified by two-dimensional gas chromatography-mass spectrometry. Twenty-seven of 30 participants were THC-positive on admission, with a median (range) concentration 1.4 ng/mL (0.3-6.3). THC decreased gradually with only 1 of 11 participants negative at 26 days; 2 of 5 participants remained THC-positive (0.3 ng/mL) for 30 days. 5.0% f p p h TH >=1 0 g/ L f 12 y M 11-OH-THC w 1 1 g/ L w h >=1 0 g/ L 24h THCCOOH detection rates were 96.7 on admission, decreasing slowly to 95.7 and 85.7% on days 8 and 22, respectively; four of 5 participants remained THCCOOH positive (0.6-2.7 ng/mL) after 30 days and one remained positive on discharge at 33 days. THC was quantified in some participants for 30 days, albeit in low concentrations, due to the large cannabinoid body burden from extended exposure / Esta tese é dividida em três partes. A primeira parte consiste em investigar o efeito ansiolítico do canabidiol na ansiedade social através do teste de simulação de falar em público. Vinte e quatro sujeitos com ansiedade social, nunca tratados, receberam placebo ou canabidiol (CBD) 600 mg (n=12) em um estudo randomizado e duplo-cego. O mesmo número de indivíduos saudáveis realizaram o teste de simulação de falar em público sem receber medicação. A administração do CBD reduziu significativamente a ansiedade, sedação física e outros sentimentos e atitudes durante a fase de estresse, e diminui o nível de alerta na fase pré-estresse. O grupo placebo apresentou níveis elevado de ansiedade, sedação física, outros sentimentos e atitudes, e alerta comparado com o grupo controle. A pontuação do SSPS-N evidenciou aumento significativo durante o teste no grupo placebo, enquanto que o CBD reduziu estes níveis. Não houve diferenças significativas entre os grupos CBD e controle na SSPS-N e nos fatores sedação física, outros sentimentos e atitudes e alerta, da Visual Analogue Mood Scale (VAMS). A segunda parte do estudo avaliou a ansiedade em indivíduos saudáveis que receberam alta dose oral de rimonabanto e submetidos ao teste de simulação de falar em público, para melhor entendimento do possível mecanismo farmacológico para tratamento de transtornos de ansiedade. Vinte e quatro sujeitos saudáveis receberam placebo ou rimonabanto 90 mg (n=12) em um randomizado e duplo-cego. Não foi observado efeitos adversos significativo em ambos grupos. O grupo rimonabanto apresentou maiores níveis de ansiedade na fase pré-estresse e durante o estresse. Não houve diferença significativa quanto aos demais fatores avaliados entre os grupos. O aumento na ansiedade após administração do rimonabanto pode-se ao fato de haver diminuição no sistema endocanabinóide nos receptores CB1 e a possível modulação na ansiedade clínica e patológica. A terceira parte objetivou quantificar canabinóides no sangue total em usuários crônicos de cannabis durante abstinência supervisionada. Trinta usuários crônicos de cannabis, do sexo masculino, permaneceram no centro de pesquisa por até 33 dias, com coleta de sangue uma vez ao dia. ?9-tetrahidrocanabinol (THC), 11-hidróxi-THC (11-OH-THC) e 11-nor-9-carbóxi-THC (THCCOOH) foram quantificados no sangue por meio da cromatografia gasosa-espectrometria de massa bidimensional. Vinte e sete de 30 usuários foram positivos para THC no ingresso do estudo, com concentração mediana (variação) de 1.4 ng/mL (0.3-6.3). Níveis de THC diminuíram gradativamente com somente 1 de 11 participantes negativo no dia 26; 2 de 5 indivíduos permaneceram positivos para THC (0.3 g/ L p 30 5 0% j TH >=1 0 g/ L p 12 ç mediana de 11-OH-TH f 1 1 g/ L g >=1 0 g/ L pó 24h. A taxa de detecção de THCCOOH foi 96.7% no ingresso, diminuindo gradativamente para 95.7 e 85.7% nos dias 8 e 22, respectivamente; 4 de 5 sujeitos permaneceram positivo para THCCOOH (0.6-2.7 ng/mL) após 30 dias e um permaneceu positivo no 33º dia. Foi detectado THC em alguns indivíduos por 30 dias, porém em baixas concentrações, devido a extensa eliminação do canabinóide em decorrência da exposição crônica

O Transtorno de Ansiedade Social (TAS) consiste em um medo acentuado e persistente de situações sociais ou de desempenho nas quais o indivíduo poderia sentir vergonha. Dentre os transtornos de ansiedade, o TAS é um dos mais prevalecentes, sendo considerado o quinto transtorno mais incapacitante, contudo, a busca por tratamento é muito baixa. Diferentes estudos clínicos randomizados evidenciam que a TCCG apresenta resultados satisfatórios e duradouros, sendo considerada padrão ouro de intervenção para TAS, porém, ainda assim, uma parcela de pacientes com TAS não respondem ao tratamento. Assim sendo, o objetivo deste trabalho foi investigar o efeito de uma intervenção em grupo de exposição com alto custo social em pacientes com TAS sobre variáveis psicológicas e também sobre a qualidade de memória. A intervenção utilizada nesse estudo foi a proposta por Hofmann e Otto (2008). Dentre as variáveis psicológicas estudadas foram avaliadas mudanças em sintomas de ansiedade social, ansiedade, medo da avaliação negativa, esquiva e desconforto social, depressão e sintomas de transtornos psiquiátricos comuns. Participaram desse estudo 58 adultos, compondo três grupos experimentais diferentes: o grupo de comparação sem TAS, que consiste em participantes sem sintomas clínicos, o grupo de comparação com TAS, que são participantes portadores de TAS os quais não realizaram a intervenção durante a pesquisa (grupo lista de espera) e o grupo de portadores de TAS participaram da intervenção (grupo TCCG). Um pesquisador independente ao estudo realizou a distribuição aleatória dos participantes com TAS entre os grupos TCCG e lista de espera. Foram realizadas avaliações no pré e pós-teste através do Inventário de Fobia Social (SPIN), Inventários de Ansiedade e Depressão de Beck (BAI e BDI-II), Escala de Medo da Avaliação Negativa (FNE), Escala de Esquiva e Desconforto Social (SADS), Questionário sobre a saúde do paciente (PHQ-9), Questionário de Autorrelato (SRQ) e teste de falsas memórias. Assim, os resultados encontrados evidenciam que a intervenção alcançou redução significativa nos sintomas de ansiedade social, ansiedade geral, depressão e sintomas de transtornos mentais comuns, mostrando que foi uma intervenção efetiva. Além disso, os escores relacionados à ansiedade geral, depressão e sintomas de transtornos mentais comuns, após a intervenção foram equiparados com o escore obtidos pelo grupo de participantes saudáveis, evidenciando a excelente eficácia do processo de intervenção. A eficácia também pode ser constatada a partir da mensuração do tamanho de efeito grande encontrado no estudo relacionado ao principal instrumento de avaliação de TAS utilizado (SPIN), ou seja, esse estudo evidenciou que a forma psicoterápica utilizada atingiu o objetivo esperado da intervenção considerada padrão ouro. No que concerne às medidas relacionadas à qualidade de memória, a hipótese inicial relacionava-se à teoria de que os indivíduos ansiosos sociais apresentariam um número maior de falsas memórias e/ou uma redução de memórias verdadeiras, porém essa hipótese não foi confirmada. / Social Anxiety Disorder (SAD) consists of a marked and persistent fear of social or performance situations in which the individual could feel shame. Among the anxiety disorders, SAD is one of the most prevalent, considered the fifth most disabling disorder, however, the search for treatment is very low. Different randomized clinical trials show that Cognitive-Behavioral Group Therapy (CBGT) presents satisfactory and long-lasting results, which is considered the gold standard of intervention for SAD, however, a portion of patients with SAD do not respond to treatment. Thus, the objective of this study was to investigate the effect of a group intervention related to high social cost exposure in patients with SAD about psychological variables and memory quality. The intervention used in this study was proposed by Hofmann and Otto (2008). Among the psychological variables studied changes in symptoms of social anxiety, anxiety, fear of negative evaluation, avoidance and social discomfort, depression and symptoms of common psychiatric disorders were evaluated. Fifty-five adults participated in this study, composing three different experimental groups: the comparison group without SAD, which consists of participants without clinical symptoms, the comparison group with SAD, participants with SAD who did not receive intervention during the research (Waitlist control condition), and the group of SAD patients who participated in the intervention. An independent researcher to study distributed randomly the participants with SAD between CBGT or Waitlist condition. Assessments were made at pre and post-test using Social Phobia Inventory (SPIN), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Fear of Negative Evaluation (FNE), Social Avoidance and Distress Scale (SADS), Patient Health-Questionnaire (PHQ-9), Self-Report Questionnaire (SRQ), and false memories test in the three groups. The results showed that the intervention achieved a significant reduction in the symptoms of social anxiety, general anxiety, depression and symptoms of common mental disorders, showing that it was an effective intervention. In addition, the scores related to general anxiety, depression and common mental disorder symptoms after the intervention were similar to the scores obtained by the group of healthy participants, evidencing the excellent efficacy of the intervention process. Efficacy can also be seen from the measurement of the large effect size found in the study evaluated by the main evaluation instrument of SAD used (SPIN), this study achieved the expected goal of the gold standard considered intervention. Concerning measures related to memory quality, the initial hypothesis was that social anxious individuals would present a greater number of false memories and / or a reduction of true memories, but this hypothesis was not confirmed.

Objetivos: Estudar a confiabilidade e validade de uma versão brasileira dos módulos Episódio Depressivo Maior (EDM) e Transtorno de Ansiedade Generalizado (TAG) do Mini International Neuropsychiatric Interview TRACKING (MINI-TRACKING); comparar a evolução de pacientes com diagnóstico de EDM e TAG seguidos por equipes de Estratégia de Saúde da Família (ESF) com acesso ao modelo de Cuidado Colaborativo (CC) em Saúde Mental versus um grupo de pacientes seguidos por equipes sem acesso ao CC. Metodologia: O estudo envolveu quatro equipes de ESF vinculadas à Faculdade de Medicina de Ribeirão Preto (FMRP), sendo duas com acesso ao CC e duas sem CC. Um total de 147 pacientes foram entrevistados com o objetivo de rastrear transtornos mentais com a aplicação do WHO-5 e do COOP-WONCA Quadro Sentimentos. Após a confirmação diagnóstica de EDM e/ou TAG, com a entrevista MINI, 42 pacientes foram selecionados e concordaram em participar da pesquisa. Estes pacientes foram acompanhados por doze meses por um médico de família (MF), que aplicou periodicamente a cada oito a doze semanas os módulos EDM e/ou TAG do MINI-TRACKING. Para avaliação da fidedignidade e da validade concorrente, um psiquiatra (cego quanto ao diagnóstico do MF e quanto a qual equipe seguia o paciente) aplicou, com intervalo máximo de 72h do MF, os mesmos módulos do MINI-TRACKING, o PHQ-9 e/ou o GAD-7. Resultados: Não foi encontrada diferença estatisticamente significativa entre os pacientes das equipes com e sem CC no que se refere as características clínicodemográficas. Os itens individuais dos dois módulos do MINI-TRACKING mostraram boa fidedignidade inter-avaliadores (Kappa entre 0,78 e 0,98), bem como seus escores totais (Coeficiente Intra-classe de 0,996 e 0,993 para EDM e TAG, respectivamente). Os módulos EDM e TAG mostraram também boa validade concorrente com as escalas PHQ-9 e GAD-7 (coeficiente de Pearson 0,994 e 0,976, respectivamente). Trinta pacientes (quinze de equipes com CC e 15 de equipes sem CC) completaram as cinco avaliações no decorrer de um ano de seguimento. A ANOVAmr destes pacientes mostrou diferenças significativas no fator tempo e na interação tempo x intervenção, com diminuição significativamente maior dos escores do MINI-TRACKING nos pacientes seguidos pelas equipes com CC. Conclusão: Os módulos EDM e TAG do MINI-TRACKING são uma opção confiável para o seguimento de pacientes com estes diagnósticos. Este estudo também mostrou, de forma preliminar, que o CC em saúde mental é uma estratégia eficaz na redução de sintomas dos pacientes com EDM e TAG na Atenção Primária. / Objectives: To study the reliability and validity of a Brazilian version of the Mini International Neuropsychiatric Interview - TRACKING (MINI-TRACKING) modules for Major Depressive Episode (MDE) and Generalized Anxiety Disorder (GAD); To compare the outcomes of patients diagnosed with MDE and GAD followed by teams of the Family Health Strategy (FHS) with access to the Mental Health Collaborative Care model (CC) versus a group of patients followed by teams without access to CC. Methodology: The study involved four FHS teams of the Faculty of Medicine of Ribeirão Preto (FMRP), two of them with access to CC and two without it. A total of 147 patients were tracked for mental disorders with the application of the WHO-5 and the COOP-WONCA Chart Feelings. After confirming the diagnosis of MDE and/or GAD using the MINI interview, 42 patients were selected and agreed to participate. These patients were followed for twelve months by a family physician (FP), who applied regularly every eight to twelve weeks the MDE and/or the GAD MINI-TRACKING modules. To assess the reliability and concurrent validity, a psychiatrist (blind to the diagnosis and to which team the patient was followed) also applied the same modules of the MINI-TRACKING, the PHQ-9 and/or the GAD-7, with a maximum interval of 72 hours of the FP. Results: There was no statistically significant difference between the patients with and without CC teams regarding demographic and clinical characteristics. The individual items of the two MINI-TRACKING modules showed good inter-rater reliability (kappa between 0.78 and 0.98), as well as their total scores (Intra-class coefficient of 0.996 and 0.993 for MDE and GAD, respectively). The MDE and GAD modules also showed good concurrent validity with PHQ-9 and GAD-7 scales (Pearson coefficient 0.994 and 0.976, respectively). Thirty patients (fifteen with CC and 15 without CC) completed the five assessments during one year of follow up. The repeated-measures analysis of variance (rmANOVA) showed significant differences in the time factor and the interaction time x intervention, decrease significantly higher of the MINI-TRACKING scores in the patients followed by teams with CC. Conclusion: MINI-TRACKING MDE and GAD modules are a reliable option for following patients with these diagnoses. This study also showed, preliminarily, that CC in Mental Health is an effective strategy in reducing symptoms in Primary Care patients with MDE and GAD.

This study investigated the utility of the Personality Assessment Inventory (PAI) for diagnosing and discriminating between Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) with university counseling center clients. Participants were 1541 male and female students who received services at a student counseling center at a large university. Participants were classified as MDD, GAD, or Other Diagnosis (OD) based on the diagnosis determined by the treating clinician, and PAI profiles were compared between the three groups. The PAI Structural Summary-Revised contains Diagnostic Consider Clusters (DCC) that were designed to identify PAI scales/subscales that are typically elevated or suppressed when a particular disorder is present. The DCC’s for MDD and GAD were examined and the results demonstrated that the criteria for the DCC for MDD were met by 2.2% of the MDD group, and the criteria for the DCC for GAD were met by 3.8% of the GAD group. A discussion of these findings is offered, and the appropriateness of using the DCC’s for the purpose of diagnosis with any population is questioned. Additionally, DCC’s for MDD and GAD for use with university counseling center clients are proposed. Finally, discriminant analysis (DA) was employed to develop various discriminant functions that can be used to classify individual PAI profile data into specific diagnostic groups. In particular, one discriminant function was created that is capable of examining any PAI profile, and classifying it as either MDD or OD. A second discriminant function was produced that can analyze any PAI profile and categorize it as either GAD or OD. The final discriminant function was developed to evaluate a PAI profile that represents either MDD or GAD and determine which diagnosis is appropriate. Each discriminant function was shown to accurately predict the associated diagnoses. A discussion of the various predictor variables is offered. Taken together, these results support the use of the PAI for diagnosing and discriminating between MDD and GAD with university counseling center clients.

Generalized anxiety disorder (GAD) is associated with painful physical symptoms (PPS). These post hoc analyses of previous trial data assessed PPS and their response to duloxetine treatment in GAD patients. Studies 1 and 2 (n = 840) were 9- to 10-week efficacy trials; study 3 (n = 887) was a relapse prevention trial comprising a 26-week open-label treatment phase and a 26-week double-blind, placebo-controlled treatment continuation phase. Mean baseline visual analog scale scores (VAS, 0–100; n = 1727) ranged from 26 to 37 for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time in pain while awake. In studies 1 and 2, improvement on all VAS scores was greater in duloxetine-treated than in placebo-treated patients (p ≤ 0.01). In study 3, pain symptoms worsened in responders switched to placebo compared with those maintained on duloxetine (p ≤ 0.02). In conclusion, duloxetine was efficacious in the short- and long-term treatment of PPS, which are common in GAD patients.

Background: Subtle and inconsistent differences in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported for patients with panic disorder. While these patients show little or no alterations in basal ACTH and cortisol levels, it has been hypothesized that HPA hyperresponsivity was a trait in panic patients when exposed to novel and uncontrollable stimulation. Methods: Thirty-four patients (23 females, mean age 35 yrs) diagnosed with panic disorder were compared to 34 healthy controls matched for age, gender, smoking status, and use of oral contraceptives. Both groups were exposed twice to a potent laboratory stress protocol, the Trier Social Stress Test (TSST) on consecutive days. Free salivary cortisol levels and heart rate responses were repeatedly measured before and following the TSST. In addition, the cortisol awakening response (CAR) was assessed to further investigate HPA reactivity in PD patients. Results: While the TSST induced similar heart rate stress responses in both groups, cortisol responses were clearly absent in the panic patients with normal responses in the controls (F(1.96, 66) = 20.16; p < 0.001). No differences in basal cortisol levels were observed in the extended baseline period. The same cortisol stress non-response patterns were observed when patients with/without comorbid depression, or with/without psychotropic medication were compared. In contrast to their non-response to the psychosocial stressor, panic patients showed a significant CAR. Conclusion: These findings provide strong evidence to suggest that PD patients present with a striking lack of cortisol responsivity to acute uncontrollable psychosocial stress under laboratory conditions. This unresponsiveness of the HPA axis appears to be rather specific, since a normal CAR in the morning could be documented in these patients. Thus, the present results do not support the hypothesis that PD patients show a trait HPA hyperresponsiveness to novel and uncontrollable stimulation. In contrast, the data provide support for a hyporesponsive HPA axis under emotional stress in PD patients.

Objective: To examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia. Method: The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14–24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview. Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders. Results: Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6–58.7), specific phobia (HR = 2.7, 95% CI = 1.001–7.6), generalized anxiety disorder (HR = 9.4, 95% CI = 1.8–48.7), obsessive-compulsive disorder (HR = 10.7, 95% CI = 1.7–66.1), bipolar disorder (HR = 7.7, 95% CI = 2.8–20.8), pain disorder (HR = 3.5, 95% CI = 1.3–9.1), and alcohol dependence (HR = 4.7, 95% CI = 1.7–12.4). Increased hazard rates for PDAG (HR = 4.2, 95% CI = 1.4–12.1), bipolar disorder type II (HR = 8.1, 95% CI = 2.3–27.4), pain disorder (HR = 1.9, 95% CI = 1.01–3.5), and alcohol dependence (HR = 2.1, 95% CI = 1.1–4.) were also found for subjects fulfilling subthreshold SAD. Conclusions: Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD.