HERMANO TAVARES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
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- Trichotillomania and its clinical relationship to depression and anxiety(2017) GRANT, Jon E.; REDDEN, Sarah A.; MEDEIROS, Gustavo C.; ODLAUG, Brian L.; CURLEY, Erin E.; TAVARES, Hermano; KEUTHEN, Nancy J.Objective: Trichotillomania (TTM) is associated with high rates of co-occurring depression and anxiety disorders. What the co-occurrence of TTM, depression or anxiety disorders means clinically and cognitively, however, has garnered little research attention.Methods: About 530 adults with TTM were examined on a variety of clinical measures including symptom severity, psychosocial measures of functioning, psychiatric comorbidity and neurocognitive testing assessing motor inhibition and cognitive flexibility. Clinical features and cognitive functioning were compared between TTM patients with current comorbid major depressive disorder (MDD), a current anxiety disorder, both MDD and an anxiety disorder, or neither.Results: Of 530 participants, 58 (10.3%) had MDD only, 97 (18.3%) had an anxiety disorder only, 58 (10.3%) had both MDD and an anxiety disorder, and 317 (59.8%) had neither. For almost all clinical measures, those with MDD only reported worse symptoms than those with an anxiety disorder only, and the combination of MDD and an anxiety disorder reported the worst level of symptom severity.Conclusions: These results suggest that adults with TTM and co-occurring MDD and anxiety disorders exhibit unique clinical differences. The clinical differences may also have treatment implications.
- Compulsive sexual behavior and psychopathology among treatment-seeking men in Sao Paulo, Brazil(2013) SCANAVINO, Marco de Tubino; VENTUNEAC, Ana; ABDO, Carmita Helena Najjar; TAVARES, Hermano; AMARAL, Maria Luiza Sant'Ana do; MESSINA, Bruna; REIS, Sirlene Caramello dos; MATTINS, Joao Paulo Lian Branco; PARSONS, Jeffrey T.This study examined compulsive sexual behavior (CSB) and psychopathology in a treatment-seeking sample of men in Sao Paulo, Brazil. Eighty-six men (26% gay, 17% bisexual, 57% heterosexual) who met diagnostic criteria for excessive sexual drive and sexual addiction completed assessments consisting of the Mini International Neuropsychiatric Interview, a structured clinical interview for DSM-IV Axis I Disorders Clinical Version (segment for Impulse Control Disorder), Sexual Compulsivity Scale (SCS), and questions about problematic CSB. The average SCS score for our sample was above the cut-off score reported in other studies, and 72% of the sample presented at least one Axis I psychiatric diagnosis. There were no differences among gay, bisexual, and heterosexual men on SCS scores and psychiatric conditions, but gay and bisexual men were more likely than heterosexual men to report casual sex and sex with multiple casual partners as problematic behaviors. SCS scores were associated with psychiatric co-morbidities, mood disorder, and suicide risk, but diagnosis of a mood disorder predicted higher SCS scores in a regression analysis. The study provides important data on the mental health needs of men with CSB in Sao Paulo, Brazil.
- The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating(2018) MATTOS, Cristiana Nicoli de; KIM, Hyoun S.; LACROIX, Emilie; REQUIAO, Marinalva; FILOMENSKY, Tatiana Zambrano; HODGINS, David C.; TAVARES, HermanoIntroduction: Compulsive buying and binge eating are two frequently co-occurring psychiatric conditions. Hoarding, which is the psychological need to excessively gather and store items, is frequently associated with both compulsive buying severity and binge eating severity. In the present study, we explored whether different dimensions of hoarding are a shared feature of compulsive buying and binge eating. Method: Participants consisted of 434 people seeking treatment for compulsive buying disorder. Registered psychiatrists confirmed the diagnosis of compulsive buying through semi-structured clinical interviews. Participants also completed measures to assess compulsive buying severity, binge eating severity, and dimensions of hoarding (acquisition, difficulty discarding, and clutter). Two-hundred and seven participants completed all three measures. Results: Significant correlations were found between compulsive buying severity and the acquisition dimension of hoarding. Binge eating severity was significantly correlated with all three dimensions of hoarding. Hierarchical regression analysis found that compulsive buying severity was a significant predictor of binge eating severity. However, compulsive buying severity no longer predicted binge eating severity when the dimensions of hoarding were included simultaneously in the model. Clutter was the only subscale of hoarding to predict binge eating severity in step two of the regression analysis. Conclusion: Our results suggest that the psychological need to excessively gather and store items may constitute a shared process that is important in understanding behaviors characterized by excessive consumption such as compulsive buying and binge eating.
- Family-Based Association Analysis of Serotonin Genes in Pathological Gambling Disorder: Evidence of Vulnerability Risk in the 5HT-2A Receptor Gene(2013) WILSON, David; LOBO, Daniela Sabbatini da Silva; TAVARES, Hermano; GENTIL, Valentim; VALLADA, HomeroPathological gambling (PG) has become a growing public health problem in many countries around the world. PG is an impulse control disorder and its behavior and psychopathology present similarities with substance abuse disorders. Evidence from twin studies supports a significant genetic predisposition to PG, but the precise genetic loci still remain unclear. The present study investigates the allele and genotype distribution of polymorphisms of the serotonin transporter, serotonin receptor 1B and 2A genes in 140 sib-pairs discordant for the diagnosis of PG. A significant association of the C/C genotype of the serotonin receptor 2A T102C (rs 6313) polymorphism and the PG phenotype was observed [OR = 1.7 (1.1-3.4)]. This preliminary result is consistent with the hypothesis that the serotonin system is associated with addiction behavior and similar results have been reported for nicotine and alcohol dependence.
- Dual diagnosis of obsessive compulsive and compulsive buying disorders: Demographic, clinical, and psychiatric correlates(2018) KIM, Hyoun S.; HODGINS, David C.; TORRES, Albina R.; FONTENELLE, Leonardo F.; ROSARIO, Maria Conceicao do; MATHIS, Maria Alice de; FERRAO, Ygor A.; MIGUEL, Euripedes C.; TAVARES, HermanoAim: The present research assessed the rates as well as the demographic, clinical, and psychiatric correlates associated with comorbid obsessive-compulsive disorder (OCD) and compulsive buying disorder (CBD). Method: Participants were drawn from a large (N = 993) multi-center study of people seeking treatment for their OCD. The diagnoses of psychiatric disorders were made using the Structured Clinical Interview for DSM by registered psychologists and psychiatrists. The clinical correlates, including the severity and presence of OCD symptoms and dimensions were assessed using psychometrically sound measures. Results: 75 (7.5%) participants met criteria for comorbid CBD. The results of binary logistic regression found that women were more likely to present with comorbid CBD, whereas being a student was a protective factor. The presence of hoarding dimension, poorer insight, social phobia, binge eating disorder, internet use disorder and kleptomania were significantly associated with comorbid CBD. Conclusion: The results suggest that individuals with a dual diagnosis of OCD and CBD may represent a unique clinical population that warrants tailored interventions. Specifically, they were more likely to present with other psychiatric disorders characterized by high levels of impulsivity and compulsivity. Targeting psychological mechanisms common to impulsivity-compulsivity disorders may enhance treatment utility in this dual diagnosis population.
- The Clinical Utility of Food Addiction: Characteristics and Psychosocial Impairments in a Treatment-Seeking Sample(2020) OLIVEIRA, Edgar; KIM, Hyoun S.; LACROIX, Emilie; VASQUES, Maria de Fatima; DURANTE, Cristiane Ruiz; PEREIRA, Daniela; CABRAL, Janice Rico; BERNSTEIN, Paula Sanches; GARCIA, Ximena; RITCHIE, Emma V.; TAVARES, HermanoLittle is known about the characteristics of individuals seeking treatment for food addiction (FA), and the clinical utility of FA has yet to be established. To address these gaps, we examined (i) the demographic, eating pathology, and psychiatric conditions associated with FA and (ii) whether FA is associated with psychosocial impairments when accounting for eating-related and other psychopathology. Forty-six patients seeking treatment for FA completed self-report questionnaires and semi-structured clinical interviews. The majority of the sample were women and self-identified as White, with a mean age of 43 years. Most participants (83.3%) presented with a comorbid psychiatric condition, most commonly anxiety and mood disorders, with a mean of 2.31 comorbid conditions. FA was associated with binge eating severity and anxiety symptoms, as well as psychological, physical, and social impairment. In regression analyses controlling for binge eating severity, food cravings, depression, and anxiety, FA remained a significant predictor only of social impairment. Taken together, the results suggest that individuals seeking treatment for FA are likely to present with significant comorbid conditions, in particular anxiety disorders. The results of the present research provide evidence for the clinical utility of FA, particularly in explaining social impairment.
- A cross-cultural study of gambling disorder: a comparison between women from Brazil and the United States(2016) MEDEIROS, Gustavo C.; LEPPINK, Eric W.; REDDEN, Sarah A.; YAEMI, Ana; MARIANI, Mirella; TAVARES, Hermano; GRANT, Jon E.Objective: To perform a cross-cultural comparison of gambling disorder (GD) in women from Brazil and the United States, two countries with pronounced social and cultural differences. We hoped to produce insight into the impact of cultural influences on the presentation of GD in women, which may be useful for the development of culturally-sensitive interventions. Method: We assessed 681 women with GD: 406 from a Brazilian sample and 275 from a U.S. sample. We assessed demographic and gambling behavior variables in addition to co-occurring psychiatric disorders. Results: Fewer Brazilian participants were Caucasian (73.3 vs. 91.3%; p = 0.022). Also, Brazilian women had lower levels of education (59.9% with high school or less vs. 44.4%; p < 0.001), and were more likely to have a current partner (54.9 vs. 43.4%; p = 0.003). Brazilian gamblers also reported lower urge scores (6.6 +/- 4.3 vs. 11.6 +/- 2.4; p < 0.001) and higher chasing rates (89.1 vs. 80.0%; p = 0.002). Brazilian gamblers reported higher rates of bingo gambling (19.2 vs. 5.7%; p < 0.001), but lower rates of card game gambling (5.8 vs. 23.1%; p < 0.001). Finally, Brazilian gamblers were more likely to endorse a history of major depressive disorder (36.9 vs. 24.4%; p = 0.001). Conclusions: This study reinforces the need for further general cross-cultural research on GD and particularly for studies investigating how gender mediates these differences. Finally, the differences noted in this analysis suggest that the findings of predominantly Anglo-Saxon cultures may not be generalizable to other world populations.
- Neither bipolar nor obsessive-compulsive disorder: compulsive buyers are impulsive acquirers(2012) FILOMENSKY, Tatiana Zambrano; ALMEIDA, Karla Mathias; NOGUEIRA, Marcelo Campos Castro; DINIZ, Juliana Belo; LAFER, Beny; BORCATO, Sonia; TAVARES, HermanIntroduction: Compulsive buying (CB) is currently classified as an impulse control disorder (ICD) not otherwise classified. Compulsive buying prevalence is estimated at around 5% of the general population. There is controversy about whether CB should be classified as an ICD, a subsyndromal bipolar disorder (BD), or an obsessive-compulsive disorder (OCD) akin to a hoarding syndrome. To further investigate the appropriate classification of CB, we compared patients with CB, BD, and OCD for impulsivity, affective instability, hoarding, and other OCD symptoms. Method: Eighty outpatients (24 CB, 21 BD, and 35 OCD) who were neither manic nor hypomanic were asked to fill out self-report questionnaires. Results: Compulsive buying patients scored significantly higher on all impulsivity measures and on acquisition but not on the hoarding subdimensions of clutter and ""difficulty discarding."" Patients with BD scored higher on the mania dimension from the Structured Clinical Interview for Mood Spectrum scale. Patients with OCD scored higher on obsessive-compulsive symptoms and, particularly, higher on the contamination/washing and checking dimensions from the Padua Inventory; however, they did not score higher on any hoarding dimension. A discriminant model built with these variables correctly classified patients with CB (79%), BD (71%), and OCD (77%). Conclusion: Patients with CB came out as impulsive acquirers, resembling ICD- rather than BD- or OCD-related disorders. Manic symptoms were distinctive of patients with BD. Hoarding symptoms other than acquisition were not particularly associated with any diagnostic group.
- Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial(2017) BRITO, Antonio Marcelo Cabrita de; PINTO, Moema Galindo de Almeida; BRONSTEIN, Gabriel; CARNEIRO, Elizabeth; FAERTES, Daniela; FUKUGAWA, Viviane; DUQUE, Angela; VASCONCELLOS, Fatima; TAVARES, HermanoGambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.
- Demographic, psychiatric, and personality correlates of adults seeking treatment for disordered gambling with a comorbid binge/purge type eating disorder(2018) KIM, Hyoun S.; RANSON, Kristin M. von; HODGINS, David C.; MCGRATH, Daniel S.; TAVARES, HermanoPreliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co-occur. However, this dual-diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge-eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N=349). In total, 11.5% of the sample (n=40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n=33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling-related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual-diagnosed population that may require clinical attention.