Dadas a elevada prevalência e os grandes prejuízos sociais, familiares e pessoais que caracterizam o envolvimento patológico com jogos de azar, torna-se necessária a investigação sistemática de fatores de vulnerabilidade e de resistência que possam influir no desenvolvimento de tais condições. Uma das principais estratégias utilizadas para a profilaxia e tratamento dessas formas de envolvimento patológico tem sido a investigação dos componentes biológico-genéticos do Jogo Patológico (JP). O presente estudo objetivou investigar a associação de polimorfismos de genes candidatos do sistema serotonérgico e JP em pares de irmãos discordantes para este diagnóstico. Participaram do estudo 140 pares de irmãos discordantes para o diagnóstico de JP pelos critérios do Manual Diagnóstico e Estatístico da Associação Psiquiátrica Americana, DSM-IV. Foram genotipados os seguintes polimorfismos de genes que codificam: o transportador da serotonina (polimorfismo 5HTTLPR-l/s), o receptor serotoninérgico subtipo 1B (5HT1B G861C), e o receptor serotoninérgico subtipo 2A (polimorfismos 5HT2A T102C e C516T). Na análise estatística observou-se uma maior distribuição do alelo C do polimorfismo T102C do gene 5HT2A no grupo de irmãos com o diagnóstico de JP (p<0,01), sugerindo uma possível contribuição desse alelo na predisposição ao JP. Entretanto, faz-se necessária a investigação desses polimorfismos em amostras independentes envolvendo o fenótipo JP para a confirmação dos achados apresentados nesse trabalho. Uma análise preliminar dos haplótipos (102 e 516) apresentou resultados inconclusivos. É interessante notar que há associação entre esse polimorfismo e manifestações psiquiátricas outras que não o JP. / The high prevalence and the great social, familial and personal hazards that appear along with the occurrence of pathological involvement in gambling makes it necessary to systematically investigate vulnerability and resilience factors that may influence the development of such a condition. One of the main strategies in prevention and treatment of these pathological behaviors has been the investigation of the biological-genetic basis of pathological gambling (PG). The present study aimed to determine any association between candidate gene polymorphisms of the serotoninergic system and the occurrence of PG in sib-pairs discordant for this diagnosis. One hundred and forty (140) PG-discordant sib-pairs were evaluated by the Diagnostic and Statistical Manual from the American Psychiatric Association (DSM-IV), who had already been previously genotyped in other studies. We genotyped the polymorphisms which codified: the serotonin transporter (5HTTLPRl/ s polymorphism), the serotonergic receptor subtype 1B (5HT1B G861C polymorphism), and the serotonergic receptor subtype 2A (T102C and C516T polymorphisms). Statistical analysis revealed a greater distribution of the C allele of the T102C polymorphism of the 5HT2A gene in the gambling sib group (p<0,01), suggesting a possible contribution of this allele in the predisposition for PG. Nevertheless, it is necessary to further investigate these polymorphisms in independent samples involving PG phenotype for the adequate confirmation of such findings. A preliminary analysis of the haplotypes (102 and 516) show inconclusive results. It is noteworthy that there are previous associations between this polymorphism and psychiatric manifestations other than PG.

Introdução: A automutilação é definida como qualquer comportamento intencional envolvendo agressão direta ao próprio corpo sem intenção consciente de suicídio. As formas mais frequentes de automutilação são cortar a própria pele, queimar-se, bater em si mesmo, morder-se e arranharse. Alguns pacientes apresentam rituais de automutilação e passam muito tempo pensando em como executá-la, lembrando sintomas compulsivos, porém com intenso componente de impulsividade. O DSM-IV classifica a automutilação como um dos critérios de diagnósticos para transtornos do controle dos impulsos não classificados em outro local ou Transtorno de Personalidade Borderline. O DSM-V propõe que a automutilação seja uma entidade diagnóstica à parte. A falta de homogeneidade na descrição da automutilação dificulta as pesquisas, tanto epidemiológicas como clínicas. A melhor caracterização clínica e psicopatológica da automutilação é fundamental para que intervenções terapêuticas mais efetivas possam ser desenvolvidas, incluindo novas abordagens psicofarmacológicas. Os objetivos deste estudo foram: fazer uma descrição clínica dos pacientes que procuram tratamento, tendo como principal queixa a automutilação e comparar estes com pacientes com Transtorno Obsessivo-Compulsivo (TOC) quanto a características compulsivas e impulsivas. Métodos: 70 pacientes foram avaliados, sendo 40 pacientes com automutilação e 30 pacientes com TOC. Todos estes pacientes foram avaliados de forma direta com os instrumentos: Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica (SCID-I); Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica, adaptada para Transtornos de Controle de Impulsos; Entrevista Clínica Estruturada para Transtornos de Eixo II, versão clínica (SCID-II); Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS); Escala Dimensional para Avaliação de Presença e Gravidade de Sintomas Obsessivo-Compulsivos (DY-BOCS); Escala para Avaliação da Presença e Gravidade de Fenômenos Sensoriais da Universidade de São Paulo (USP-SPS); Questionários de História de Traumas; Escala de Comportamento de Automutilação (FASM); e Barrat Impulsivity Scale (BIS-11). Para comparação das variáveis categóricas, foi utilizado o teste qui-quadrado e para variáveis contínuas, o test-t. Para análise multivariada, foram utilizados os testes ANCOVA ou Regressão Logística Linear. Foi considerado, para todos os testes, o nível de significância 5%. Resultados: A média de idade dos pacientes avaliados foi de 29 anos. Quanto às características clínicas dos pacientes com automutilação, estes iniciaram o comportamento em média aos 17 anos de idade, e apresentavam cinco tipos diferentes de automutilação em média. Os comportamentos mais frequentes foram: cortar a pele (90%), cutucar ferimentos (75%), bater em si mesmo (67,5%). Os motivos mais frequentemente relacionados à automutilação foram para: parar sentimentos ruins (75%), aliviar sensação de vazio (70%), se castigar (70%), sentir algo, mesmo que fosse dor (47,5%) e sentir-se relaxado (40%). Na comparação entre os grupos com automutilação e TOC, quanto às comorbidades do Eixo I, o grupo com automutilação apresentou mais comorbidades com depressão (92,5%, p=0,03) e bulimia (25%, p<0,001). O grupo com TOC apresentou mais fobia social (40%, p<0,001). Os pacientes do grupo com TOC tiveram maior gravidade em todas as medidas do Y-BOCS (média: 26, p<0,001) e DY-BOCS (média 23,1, p=0,01). No grupo com automutilação, 60% dos pacientes referiram a automutilação associada a fenômenos sensoriais. Este grupo teve mais relato de fenômenos sensoriais referente à \"sensação de incompletude\" (45%, p=0,007) e \"sensação de energia interna\" (57,5%, p=0,001). O transtorno de personalidade mais prevalente em ambos os grupos foi Transtorno de Personalidade Obsessivo-Compulsiva. O grupo com automutilação apresentou maior prevalência de Transtorno de Personalidade Histriônica (22,5 %, p=0,02) e Transtorno de Personalidade Borderline (15%, p=0,04). A gravidade da impulsividade foi maior no grupo com automutilação segundo as medidas da BIS-11 para características motoras (média 26,6, p=0,002) e dificuldade para planejamento (média 31, p=0,014). Conclusão: A automutilação e o TOC são transtornos heterogêneos que compartilham características compulsivas e impulsivas. Na automutilação, o componente impulsivo é maior e no TOC, a compulsividade é maior quando comparamos estes dois grupos. Entretanto, a automutilação esteve associada à ocorrência de fenômenos sensoriais, apontando também para a presença de aspectos compulsivos nestes quadros. O Transtorno de Personalidade Borderline não é regra entre os pacientes com automutilação. Outros transtornos de personalidade, inclusive cluster C como o Transtorno de Personalidade Obsessivo-Compulsiva, também podem estar presentes entre pacientes com automutilação, assim como com TOC. Os pacientes adultos com automutilação apresentam este comportamento desde a adolescência e os tipos de automutilação apresentados por estes são de moderada a grave intensidade, além de associarem diferentes tipos de automutilação. Isto evidencia a necessidade de desenvolvimento de instrumentos diagnósticos mais precisos para identificação e tratamento precoce específico para estes quadros, evitando a cronicidade dos mesmos / Introduction: Non-suicidal self-injury (NSSI) is defined as a deliberate and voluntary physical self-injury without any conscious suicidal intent. Common forms of NSSI include cutting, burning, scratching, hitting, biting and interfering with wound healing. Some patients spend a lot of time thinking about how to perform their act doing it always the same way. They remember compulsive symptoms with intense component of impulsivity. The DSM-IV classifies NSSI as one diagnostic criteria for impulsive control disorders not elsewhere classified or as borderline personality disorder. The DSM-V proposes that the NSSI should be classified as a different disorder. The lack of a singular meaning for NSSI makes difficult the clinical and epidemiological researches about the subject. A better clinical and psychopathological definition for NSSI is crucial for the development of more effective therapeutic interventions, including new psychopharmacological treatment. The objective of this study is to describe the clinical features of patients seeking treatment for NSSI and compare their compulsive and impulsive features with patients with Obsessive Compulsive Disorder (OCD). Methods: 70 patients were interviewed, 40 patients who specifically sought treatment for NSSI and 30 patients who sought treatment for OCD. Standardized instruments were used: Structured Clinical Interview for Diagnosis of Axis I, according to DSM-IV and for impulse-control disorders, Structured Clinical Interview for Axis II Disorders (Clinical Version (SCID-II)), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS); Dimensional Yale- Brown Obsessive-Compulsive Scale (DY-BOCS), University of São Paulo Sensory Phenomena Scale (USP-SPS); Trauma History Questionnaire; Functional Assessment of Self-Mutilation (FASM) and Barratt Impulsivity Scale, version-11 (BIS -11). To compare categorical variables the chi-square test was applied. For continuous variables, t-test was applied. For multivariate analysis, the ANCOVA test or Logistic Regression were applied when required. A significance level of 5% was applied for all statistical tests. Results: The mean age of patients was 29 years. The NSSI began at 17 years old, and had 5 different types of NSSI on average. The more common behaviors were: cutting the skin (90%), pick at a wound (75%), beat himself (67.5%). The most often reasons for NSSI were to: stop bad feelings (75%), relieve feeling numb or empty (70%), punish himself (70%), feel something, even if it was pain (47.5%) and feel relaxed (40%). In the comparison between NSSI and OCD groups, the NSSI group presented more axis I comorbidities with depression (92.5%, p = 0.03) and bulimia (25%, p <0.001). The OCD group showed more social phobia (40%, p <0.001). The OCD group had higher severity in all measures of the Y-BOCS (mean: 26, p <0.001) and DY-BOCS (mean 23.1, p = 0.01). In the NSSI group, 60% of the patients reported NSSI associated with sensory phenomena. This group had more reports of sensory phenomena related to the \"incompleteness\" (45%, p = 0.007) and \"internal energy\" (57.5%, p = 0.001). The most prevalent personality disorder in both groups was Obsessive-Compulsive Personality Disorder. The NSSI group had higher prevalence of Histrionic Personality Disorder (22.5%, p = 0.02) and Borderline Personality Disorder (15%, p = 0.04). The severity of impulsivity was higher in the NSSI group according to the measures of the BIS-11 for motor impulsivity (mean 26.6, p = 0.002) and non-planning impulsivity (mean 31, p= 0.014). Conclusion: NSSI and OCD are heterogeneous disorders that share compulsive and impulsive features. In NSSI, the impulsive component is stronger and in OCD the compulsive is stronger when comparing both groups. However, NSSI was associated with the occurrence of sensory phenomena which evidence the presence of compulsive aspects. The borderline personality disorder is not a rule among patients with NSSI. Other personality disorders, including cluster C personality disorders, may also be present among patients with NSSI and OCD, as well. Adult patients with NSSI started this behavior during adolescence. The NSSI symptoms presented were moderate to severe, different types of NSSI were also involved. These results highlights the needs for development of more accurate diagnostic tools for early identification and specific treatment of the NSSI, avoiding chronicity

Adolescence is characterized as a time of impulsivity, emotional decision-making, and peer influence; thus, interventions targeting the development of effective psychosocial skills are imperative. Improved psychosocial functioning can equip adolescents for successfully overcoming future life challenges. There are few studies that have examined how adolescents' psychosocial skills could be improved in the context of substance abuse prevention program participation. The purpose of this study was to examine changes in psychosocial skills in a group of adolescents who participated in 2 of 10 Lions Quest Skills for Adolescence (Lions Quest SFA) programs being used in central Virginia middle schools. This study examined whether Lions Quest SFA was useful in observing changes in the total score of lagging psychosocial skills, which incorporated measures of impulse control, emotion regulation, and social skills. The adolescent population of interest had already demonstrated weaknesses in these areas as they had been referred to this program from school-based mental health services. This archival study used an ANCOVA to analyze 1-year pre- and posttest score differences on the Assessment of Lagging Skills and Unsolved Problems and examine possible gender differences following participation in the program for 1 school year. The secondary dataset consisted of pre- and posttest scores of 36 male students and 30 female students. The results of this study demonstrated implications for social change as they extended the knowledge in this area by suggesting that participation in the Lions Quest SFA program may contribute to the improvement of psychosocial skills, and these findings could contribute to the improvement of treatment interventions used at Horizon Behavioral Health.

One of the most difficult and serious challenges facing the mental health professional is the prevention of suicide. Efficient prevention, however, depends on early detection of patients at risk for suicidal behaviour, which in turn depends on a better understanding of the predisposing factors. Over the last years, based on a large volume of data, it has become increasingly clear that subjects who commit suicide present high levels of impulsive and impulsive-aggressive behaviours. / In the first approach, we investigate whether levels of the impulsive aggressive diathesis were more important in suicide occurring at different life stages. In the second, we investigate whether levels of the diathesis predicted when during the course of major depressive disorder suicide occurs. / Family studies have consistently indicated that suicidal behaviour tends to cluster in families. However, relatives also present increased risk for psychiatric morbidity, and therefore, the critical question is whether or not the liability to suicidal behavior is given by the same predisposition to the coexistent psychiatric disorders. / Therefore, in the third study, we examined the independence of familial liability using a three group design. The relatives of deceased suicide probands who died in the context of a major depressive episode are compared to the relatives of living depressed subjects without a history of suicide and to the relatives of healthy controls screened for the absence of major depression and suicide.

Problem gambling is best understood from a biopsychosocial perspective, whereby multifaceted biological, psychological, and socio-environmental factors interact in ways that may lead to individual risk. Reinforcement contingencies and operant conditioning appear to play particularly important etiological roles. Theoretically, operant conditioning approaches should therefore comprise particularly effective treatment strategies. While operant conditioning in the form of contingency management is known to be an effective treatment for alcohol and substance abuse, it has never been applied by clinical practitioners in community-based treatment for problem gambling. The present pilot study explored the utility of adding concrete reward contingencies to community outpatient treatment, from the perspectives of clinical effectiveness and client/counsellor experiences. At 3-month follow-up, clinical outcomes compared well to typical treatment outcomes, and treatment retention appeared to be superior. Participating clients perceived concrete rewards to be moderately effective in the change process, while active therapist acceptance of this technique appeared to be limited. / xi, 186 leaves ; 29 cm. --

Impulse control, an executive process that restrains inappropriate actions, is impaired in numerous psychiatric conditions. This thesis reports three experiments that utilized a novel animal model of impulse control, the response inhibition (RI) task, to examine the substrates that underlie learning this task. In the first experiment, rats were trained to withhold responding on the RI task, and then euthanized for electrophysiological testing. Training in the RI task increased the AMPA/NMDA ratio at the synapses of pyramidal neurons in the prelimbic, but not infralimbic, region of the medial prefrontal cortex. This enhancement paralleled performance as subjects underwent acquisition and extinction of the inhibitory response. AMPA/NMDA was elevated only in neurons that project to the ventral striatum. Thus, this experiment identified a synaptic correlate of impulse control. In the second experiment, a separate group of rats were trained in the RI task prior to electrophysiological testing. Training in the RI task produced a decrease in membrane excitability in prelimbic, but not infralimbic, neurons as measured by maximal spiking evoked in response to increasing current injection. Importantly, this decrease was strongly correlated with successful inhibition in the task. Fortuitously, subjects trained in an operant control condition showed elevated infralimbic, but not prelimbic, excitability, which was produced by learning an anticipatory signal that predicted imminent reward availability. These experiments revealed two cellular correlates of performance, corresponding to learning two different associations under distinct task conditions. In the final experiment, rats were trained on the RI task under three conditions: Short (4-s), long (60-s), or unpredictable (1-s to 60-s) premature phases. These conditions produced distinct errors on the RI task. Interestingly, amphetamine increased premature responding in the short and long conditions, but decreased premature responding in the unpredictable condition. This dissociation may arise from interactions between amphetamine and underlying cognitive processes, such as attention, timing, and conditioned avoidance. In summary, this thesis showed that learning to inhibit a response produces distinct synaptic, cellular, and pharmacological changes. It is hoped that these advances will provide a starting point for future therapeutic interventions of disorders of impulse control. / Thesis (Ph.D, Neuroscience Studies) -- Queen's University, 2011-07-11 09:44:54.815

Thesis (M.S.)--State University of New York at Binghamton, Department of Psychology, 2007. / Includes bibliographical references.

Thesis (M.S.)--State University of New York at Binghamton, Department of Psychology, 2008. / Includes bibliographical references.

Thesis (M.A.)--Carleton University, 2001. / Includes bibliographical references. Also available in electronic format on the Internet.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-12T15:45:35Z No. of bitstreams: 2 Dissertação - Murilo Ferreira Caetano - 2016.pdf: 2316268 bytes, checksum: 0cd8b2f8a5a17444a8932e0ccf022f8f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-12T15:46:52Z (GMT) No. of bitstreams: 2 Dissertação - Murilo Ferreira Caetano - 2016.pdf: 2316268 bytes, checksum: 0cd8b2f8a5a17444a8932e0ccf022f8f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-12T15:46:52Z (GMT). No. of bitstreams: 2 Dissertação - Murilo Ferreira Caetano - 2016.pdf: 2316268 bytes, checksum: 0cd8b2f8a5a17444a8932e0ccf022f8f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-08-19 / Introduction: Bipolar disorder (BD) is a chronic and potentially harmful psychiatric condition that usually begins in adolescence or in early adulthood. It is associated with suicidal behavior, social and occupational impairment, distress, substance abuse, low quality of life and high prevalence of comorbid psychiatric disorders. Impulsivity is a marked feature of the acute phases but has been showed to be also a longitudinal feature of the the disorder, a trait. Impulse control disorders (ICD) form a heterogeneous group with several syndromes characterized by impulsive and compulsive behavior leading to marked distress and social or occupational impairment. ICD have been associated with both depressive and anxiety disorders and substance abuse, its relation with BD is yet to be understood. Methods: We evaluated 42 patients with BP I and BP II disorders according to DSM-IVTR criteria. The diagnosis was confirmed using the Structured Clinical Interview for Axis I disorders of the DSM-IV (SCID-I-P). Sociodemographic data were assessed using the Brazilian Bipolar Disorder Association standard interview. ICD were assessed with a specific SCID module for ICD. Impulsivity was measured using the Barrat Impulsiveness Scale (BIS-11). Patients with severe depression (MADRS > 34) or with manic symptoms (Young >6) were excluded to avoid difficulties in data collection. Patients with active or a sequel of neurological disorders (such as Epilepsy, Parkinson Disease and Stroke) were excluded because it has been associated with impulsive behavior. We compared the group with at least one ICD with the group without ICD in terms of impulsivity, sociodemographic data, comorbities and course of the disease. Results: The prevalence of ICD was 35.7 % (n=15). Compulsive buying and intermittent explosive disorder were the most commons followed by skin picking disorder, trichotilomania, kleptomania and internet addiction. There were no cases of gambling disorder or pyromania. The ICD+ group was found to have more men, co-morbidity with alcohol abuse, early onset of the first depressive episode, less hospital admissions due to mania and the subjects were more likely to be using antidepressants. There was no difference regarding the age, type of BD, comorbidity with anxiety or eating disorders, psychotic features, age of first manic episode, educational level, marital status or income. Impulsivity measured by BIS-11 was higher in the ICD+ group, as well as the inhibitory control scale of the BIS-11. No difference was found in ‘lack of planning’ domain of the BIS-11. Conclusion: ICD are very common in BD and should always be assessed in clinical setting. Alcohol abuse, masculine sex, early onset of the first depressive episode and fewer hospital admissions to treat mania were associated with comorbid ICD. / O Transtorno Bipolar (TB) é uma condição psiquiátrica crônica, potencialmente incapacitante, que se inicia geralmente na adolescência ou no início da na vida adulta, está marcado por risco aumentado de suicídio, incapacitação para o trabalho, uso de drogas e outros problemas. A impulsividade é uma característica marcante como um estado das fases agudas, sobretudo da mania e da hipomania, mas tem sido demonstrada como um traço, uma característica longitudinal do TB. Já os Transtornos do Controle dos Impulsos (TCI) formam um grupo heterogêneo de síndromes psiquiátricas cujo aspecto nuclear é a falência recorrente em resistir a impulso levando a comportamentos repetitivos que trazem sofrimento para si e terceiros. Apesar de relativamente pouco estudados, a relação dos TCI com transtornos de humor, transtornos de ansiedade e transtornos por uso de substâncias é algo já demonstrado. Faltam dados na literatura sobre a prevalência de TCI em populações com TB. O objetivo desse trabalho é determinar a prevalência de TCI em uma população de pacientes com TB tipos I e II e comparar os grupos com e sem TCI com relação aos aspectos sociodemográficos, clínicos e nível de impulsividade. Métodos: Em um serviço especializado, usando critérios do DSM-IV-TR, avaliamos 42 pacientes com TB tipos I e II relacionando comorbidades psiquiátricas, curso da doença, características demográficas e nível de impulsividade. Após a aplicação da Entrevista Estruturada para diagnósticos de Eixo 1 do DSM-IV, versão para pacientes (SCID-I-P), utilizamos um módulo específico para diagnóstico de TCI. Aplicamos a escala de impulsividade de Barrat na versão brasileira (BIS-11) para mensurar o nível de impulsividade e as escalas de Montgomery e Asberg para depressão e Young para mania para excluir pacientes com sintomas maníacos ou com depressão grave que pudessem gerar equívocos na avaliação. Fizemos, em seguida, a comparação do grupo com algum tipo de TCI (TCI(+) com o grupo sem diagnóstico de TCI (TCI(-)) com relação à pontuação na BIS-11, condições sócio-demográficas e evolução da doença. Resultados: a prevalência de TCI foi de 35,7% (n=15), sendo a compulsão por compras e o transtorno explosivo intermitente os mais comuns. Foram seguidos por compulsão sexual e, posteriormente, por transtorno de escoriações, tricotilomania e cleptomania. A compulsão por internet e celular foi o menos prevalente. Não houve casos de jogo patológico nem de piromania. O grupo TCI(+) diferiu-se por ter mais homens, maior prevalência de transtorno por uso de álcool, menor idade do primeiro episódio depressivo, ter tido menos internações por mania e ter maior probabilidade de estar medicado com antidepressivos no presente. Não houve diferença estatística na idade, subtipo de TB, presença de transtornos de ansiedade ou alimentares, sintomas psicóticos, doenças não psiquiátricas, idade do primeiro episódio maníaco/hipomaníaco, nível educacional, estado civil ou renda. A impulsividade global pela BIS-11 foi maior no grupo TCI(+), assim como a subescala de ‘controle inibitório’, mas não houve diferença na subescala de falta de planejamento. Conclusões: os TCI são condições muito prevalentes nos pacientes com TB e devem ser sempre avaliados no contexto clínico. Houve relação entre TCI e abuso de álcool, sexo masculino, episódio depressivo mais precoce e menos internações por mania.