PEDRO GOMES DE ALVARENGA

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LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina

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  • article 39 Citação(ões) na Scopus
    Obsessive-compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children
    (2016) ALVARENGA, Pedro G.; ROSARIO, Maria C. do; CESAR, Raony C.; MANFRO, Gisele G.; MORIYAMA, Tais S.; BLOCH, Michael H.; SHAVITT, Roseli G.; HOEXTER, Marcelo Q.; COUGHLIN, Catherine G.; LECKMAN, James F.; MIGUEL, Euripedes C.
    Pediatric-onset obsessive-compulsive disorder (OCD) is underdiagnosed, and many affected children are untreated. The present study seeks to evaluate the presence and the clinical impact of OCD and obsessive-compulsive symptoms (OCS) in a large sample of school-age children. In Phase I, we performed an initial screening using the Family History Screen (FHS). In Phase II, we identified an ""at-risk"" sample, as well as a randomly selected group of children. A total of 2,512 children (6-12 years old) were assessed using the FHS, the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), and the Child Behavior Checklist (CBCL). Data analyses included descriptive and multivariate analytical techniques. 2,512 children (mean age: 8.86 +/- A 1.84 years; 55.0 % male) were categorized into one of the three diagnostic groups: OCD (n = 77), OCS (n = 488), and unaffected controls (n = 1,947). There were no significant socio-demographic differences (age, gender, socioeconomic status) across groups. The OCS group resembled the OCD on overall impairment, including school problems and delinquent behaviors. However, the OCD group did have significantly higher rates of several comorbid psychiatric disorders, including separation anxiety, generalized anxiety, and major depressive disorder, than OCS or unaffected controls. Moreover, the OCD group also scored higher than the SDQ, as well as on each of CBCL items rated by the parent. Our findings suggest that there is a psychopathological continuum between OCS and OCD in school-aged children. The presence of OCS is associated with functional impairment, which needs further investigation in longitudinal studies.
  • article 48 Citação(ões) na Scopus
    Obsessive-compulsive symptom dimensions in a population-based, cross-sectional sample of school-aged children
    (2015) ALVARENGA, Pedro G.; CESAR, Raony C.; LECKMAN, James F.; MORIYAMA, Tais S.; TORRES, Albina R.; BLOCH, Michael H.; COUGHLIN, Catherine G.; HOEXTER, Marcelo Q.; MANFRO, Gisele G.; POLANCZYK, Guilherme V.; MIGUEL, Euripedes C.; ROSARIO, Maria C. do
    Background: Obsessive-compulsive disorder can be expressed as four potentially overlapping obsessive-compulsive symptom (OCS) dimensions (OCSD) (""symmetry/ordering"", ""contamination/cleaning"", ""aggressive/sexual/religious"" and ""collecting/hoarding""). In clinical samples, some dimensions are more familial and associated with increased psychiatric comorbidity and malfunctioning. However, data concerning OCS and OCSD are scarce in non-clinical samples, particularly among children. The present study aims to estimate: (1) the prevalence and sex/age distribution of OCS/OCSD in a community-based sample of schoolchildren; (2) the association between OCS and additional clinical factors; and (3) the degree of familial aggregation of OCS/OCSD. Methods: OCS and OCSD were evaluated in 9937 Brazilian school-children (6-12 years-old) and their biological relatives using the Family History Screen. Data analyses included gradient estimated equations and post-hoc tests. Results: We included data on 9937 index-children, 3305 siblings (13-18 years-old), and 16,218 parents. Biological mothers were the informants in 87.6% of the interviews. OCS were present in 14.7% of the index-children; 15.6% of their siblings; 34.6% of their mothers and 12.1% of their fathers. The prevalence of OCS and each of the OCSD gradually increased from ages 6 to 12 years. Overall, OCS in children were associated with the presence of other psychiatric symptoms, as well as behavioral/school impairment. OCS and each of the four OCSD aggregated significantly within families. Conclusions: OCS are prevalent and associated with psychiatric symptoms and clinical impairment among school-aged children. OCSD aggregate within families in a dimension-specific fashion. These findings suggest a natural continuum between OCS and OCD with regard to their dimensional character.
  • article 16 Citação(ões) na Scopus
    An integrative approach to investigate the respective roles of single-nucleotide variants and copy-number variants in Attention-Deficit/Hyperactivity Disorder
    (2016) LIMA, Leandro de Araujo; FEIO-DOS-SANTOS, Ana Cecilia; BELANGERO, Sintia Iole; GADELHA, Ary; BRESSAN, Rodrigo Affonseca; SALUM, Giovanni Abrahao; PAN, Pedro Mario; MORIYAMA, Tais Silveira; GRAEFF-MARTINS, Ana Soledade; TAMANAHA, Ana Carina; ALVARENGA, Pedro; KRIEGER, Fernanda Valle; FLEITLICH-BILYK, Bacy; JACKOWSKI, Andrea Parolin; BRIETZKE, Elisa; SATO, Joao Ricardo; POLANCZYK, Guilherme Vanoni; MARI, Jair de Jesus; MANFRO, Gisele Gus; ROSARIO, Maria Conceicao do; MIGUEL, Euripedes Constantino; PUGA, Renato David; TAHIRA, Ana Carolina; SOUZA, Viviane Neri; CHILE, Thais; GOUVEIA, Gisele Rodrigues; SIMOES, Sergio Nery; CHANG, Xiao; PELLEGRINO, Renata; TIAN, Lifeng; GLESSNER, Joseph T.; HASHIMOTO, Ronaldo Fumio; ROHDE, Luis Augusto; SLEIMAN, Patrick M. A.; HAKONARSON, Hakon; BRENTANI, Helena
    Many studies have attempted to investigate the genetic susceptibility of Attention-Deficit/Hyperactivity Disorder (ADHD), but without much success. The present study aimed to analyze both single-nucleotide and copy-number variants contributing to the genetic architecture of ADHD. We generated exome data from 30 Brazilian trios with sporadic ADHD. We also analyzed a Brazilian sample of 503 children/adolescent controls from a High Risk Cohort Study for the Development of Childhood Psychiatric Disorders, and also previously published results of five CNV studies and one GWAS meta-analysis of ADHD involving children/adolescents. The results from the Brazilian trios showed that cases with de novo SNVs tend not to have de novo CNVs and vice-versa. Although the sample size is small, we could also see that various comorbidities are more frequent in cases with only inherited variants. Moreover, using only genes expressed in brain, we constructed two ""in silico"" protein-protein interaction networks, one with genes from any analysis, and other with genes with hits in two analyses. Topological and functional analyses of genes in this network uncovered genes related to synapse, cell adhesion, glutamatergic and serotoninergic pathways, both confirming findings of previous studies and capturing new genes and genetic variants in these pathways.
  • article 16 Citação(ões) na Scopus
    Lateral hypothalamic activity indicates hunger and satiety states in humans
    (2017) TALAKOUB, Omid; PAIVA, Raquel R.; MILOSEVIC, Matija; HOEXTER, Marcelo Q.; FRANCO, Ruth; ALHO, Eduardo; NAVARRO, Jessie; PEREIRA JR., Jose F.; POPOVIC, Milos R.; SAVAGE, Cary; LOPES, Antonio C.; ALVARENGA, Pedro; DAMIANI, Durval; TEIXEIRA, Manoel J.; MIGUEL, Euripides C.; FONOFF, Erich T.; BATISTUZZO, Marcelo C.; HAMANI, Clement
    Lateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader-Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food-related cues induced an increase in beta/low-gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alpha-frequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.
  • article 1 Citação(ões) na Scopus
    Educação em psiquiatria do desenvolvimento: resultados preliminares em estudantes de graduação no Brasil
    (2011) MORAES, Erika Neves de Souza; SCIVOLETTO, Sandra; FOSSALUZA, Vitor; VIEIRA, Joaquim Edson; MIGUEL, Euripedes Constantino; ALVARENGA, Pedro Gomes de
    Background: Although knowledge on developmental psychiatry is fundamental for the early recognition, treatment, and prevention of mental disorders, this subject has not been incorporated into the medical curriculum or psychiatric practice in Brazil. Objective: To evaluate the effect of a short course on developmental psychiatry for undergraduate students and to expand education policies concerning developmental psychiatry in Brazil. Methods: Before and after attending an extracurricular 12-hour, 4-day course on the fundamentals of developmental psychiatry, undergraduate health sciences students were tested regarding their knowledge of the subject. The pre-test/post-test included 12 randomly selected multiple-choice questions designed to evaluate knowledge related to developmental psychiatry and was administered together with a questionnaire designed to evaluate students' attitudes. To compare performances between groups, nonparametric analyses of ordinal categorical data were employed. Results: The final sample comprised 43 students. The mean post-test score was significantly higher than the mean pre-test score (65.0% vs 39.9%; p < 0.0001). We found that strongly positive attitudes correlated with better performance. The 3rd and 4th year medical students performed better than the 1st and 2nd year medical students and the non-medical students. Sex differences favoring males were also observed. Conclusion: Our findings encourage additional educational policies related to developmental psychiatry which may result in direct clinical implications.
  • article 2 Citação(ões) na Scopus
    Acquisition and retention of basic pathophysiological knowledge in psychiatry
    (2014) GUARNIERO, Francisco; DIAS, Alvaro; TRONCON, Luiz; ALVARENGA, Pedro; ROSA, Pedro; BUSATTO, Geraldo
    An important and yet underexplored issue in medical education concerns the extent to which students retain early taught theoretical knowledge during subsequent stages of their academic schooling. This study aimed to assess the degree to which medical students retain basic pathophysiological knowledge on biological psychiatry across different stages of medical education. A cross-sectional investigation was conducted using a multiple choice questionnaire (MCQ) of objective pathophysiological knowledge taught in a course given to second-year students, supplemented by questions measuring subjective interest and attributed importance to the content taught. Comparisons (ANOVA with post hoc Tukey tests) were carried out among five groups (n = 417): baseline (freshmen), pre-intervention group (second-year students attending the first day of the course), immediate tested group (second-year students on the final day of the course), 1-year delayed tested group (third-year students), and 3-years delayed tested group (interns). In comparison to the baseline and pre-intervention groups, the other three groups that received teaching displayed significantly better levels of knowledge (p < 0.0001). Differently, scores of interest and attributed importance were higher in the pre-intervention group relative to all other groups that were tested after having been given the course (p < 0.005). There were no significant associations between knowledge retention, attributed importance, and interest within pre-intervention or post-intervention groups. The only modest loss of knowledge over time indicates that a large proportion of early taught content is retained throughout the later years of medical education. Nevertheless, retained knowledge does not seem to be associated with subjective interest and attributed importance to such early taught content.
  • article 20 Citação(ões) na Scopus
    The Child Behavior Checklist-Obsessive-Compulsive Subscale Detects Severe Psychopathology and Behavioral Problems Among School-Aged Children
    (2017) SAAD, Laura O.; ROSARIO, Maria C. do; CESAR, Raony C.; BATISTUZZO, Marcelo C.; HOEXTER, Marcelo Q.; MANFRO, Gisele G.; SHAVITT, Roseli G.; LECKMAN, James F.; MIGUEL, Euripedes C.; ALVARENGA, Pedro G.
    Objective: The aims of this study were (1) to assess obsessive-compulsive symptoms (OCS) dimensionally in a school-aged community sample and to correlate them with clinical and demographical variables; (2) to determine a subgroup with significant OCS ""at-risk for OCD'') using the Child Behavior Checklist (CBCL-OCS) and (3) to compare it with the rest of the sample; (4) To review the CBCL-OCS subscale properties as a screening tool for pediatric OCD. Methods: Data from the Brazilian High Risk Cohort were analyzed. The presence and severity of OCS were assessed through the CBCL-OCS subscale. DSM-IV psychiatric diagnoses were obtained by the Developmental and Well-Being Assessment. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire, the Youth Strengths Inventory, and the CBCL internalizing and externalizing behavior subscales. Results: A total of 2512 (mean age: 8.86 +/- 1.84 years; 55.0% male) children were included. Moderate correlations were found between OCS severity and functional impairment (r = 0.36, p < 0.001). Children with higher levels of OCS had higher rates of psychiatric comorbidity and behavioral problems (p < 0.001). A score of 5 or higher in the CBCL-OCS scale determined an ""at-risk for OCD'' subgroup, comprising 9.7% of the sample (n = 244), with behavioral patterns and psychiatric comorbidities (e.g., tics [odds ratios, OR = 6.41, p < 0.001]), anxiety disorders grouped [OR = 3.68, p < 0.001] and depressive disorders [OR = 3.0, p < 0.001] very similar to those described in OCD. Sensitivity, specificity, positive predictive value, and negative predictive value of the CBCL-OCS for OCD diagnosis were, respectively, 48%, 91.5%; 15.1%, and 98.2%. Conclusions: The dimensional approach suggests that the presence of OCS in children is associated with higher rates of comorbidity, behavioral problems, and impairment. The ""at-risk for OCD'' group defined by the CBCL revealed a group of patients phenotypically similar to full blown OCD.
  • conferenceObject
    The Relationship Between Childhood Behavior and Cortical Thickness in Scholars From 7-14 Years Old
    (2014) ZUGMAN, Andre; SATO, Joao; AQUILLA, Marco Dell; PAN, Pedro M.; GADELHA, Ary; KEMPTON, Matthew; MORIYAMA, Tais; HOEXTER, Marcelo; SALLUM, Giovanni A.; ROSARIO, Maria C.; POLANCZYK, Guilherme; ALVARENGA, Pedro; PICON, Felipe A.; AMARO, Edson; MIGUEL, Euripedes C.; ROHDE, Luis A.; MCGUIRE, Philip; MARI, Jair J.; BRESSAN, Rodrigo A.; JACKOWSKI, Andrea P.
  • article 138 Citação(ões) na Scopus
    High risk cohort study for psychiatric disorders in childhood: rationale, design, methods and preliminary results
    (2015) SALUM, Giovanni Abrahao; GADELHA, Ary; PAN, Pedro Mario; MORIYAMA, Tais Silveira; GRAEFF-MARTINS, Ana Soledade; TAMANAHA, Ana Carina; ALVARENGA, Pedro; KRIEGER, Fernanda Valle; FLEITLICH-BILYK, Bacy; JACKOWSKI, Andrea; SATO, Joao Ricardo; BRIETZKE, Elisa; POLANCZYK, Guilherme Vanoni; BRENTANI, Helena; MARI, Jair de Jesus; ROSARIO, Maria Conceicao Do; MANFRO, Gisele Gus; BRESSAN, Rodrigo Affonseca; MERCADANTE, Marcos Tomanik; MIGUEL, Euripedes Constantino; ROHDE, Luis Augusto
    The objective of this study is to present the rationale, methods, design and preliminary results from the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders. We describe the sample selection and the components of each phases of the study, its instruments, tasks and procedures. Preliminary results are limited to the baseline phase and encompass: (i) the efficacy of the oversampling procedure used to increase the frequency of both child and family psychopathology; (ii) interrater reliability and (iii) the role of differential participation rate. A total of 9937 children from 57 schools participated in the screening procedures. From those 2512 (random =958; high risk =1554) were further evaluated with diagnostic instruments. The prevalence of any child mental disorder in the random strata and high-risk strata was 19.9% and 29.7%. The oversampling procedure was successful in selecting a sample with higher family rates of any mental disorders according to diagnostic instruments. Interrater reliability (kappa) for the main diagnostic instrument range from 0.72 (hyperkinetic disorders) to 0.84 (emotional disorders). The screening instrument was successful in selecting a sub-sample with high risk for developing mental disorders. This study may help advance the field of child psychiatry and ultimately provide useful clinical information.
  • article 58 Citação(ões) na Scopus
    Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study
    (2012) ALVARENGA, Pedro Gomes de; MATHIS, Maria Alice de; ALVES, Anna Claudia Dominguez; ROSARIO, Maria Conceicao do; FOSSALUZA, Victor; HOUNIE, Ana Gabriela; MIGUEL, Euripedes Constantino; TORRES, Albina Rodrigues
    Objective. To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample. Method. A cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Results. The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n=236), with 8.9% (n=72) presenting Tourette syndrome, 17.3% (n=5141) chronic motor tic disorder, and 2.8% (n=523) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD1TD group. Compared to OCD patients without comorbid TD, those with TD (OCD1TD group, n=236) were more likely to be males (49.2% vs. 38.5%, p<005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the ""aggressive,"" ""sexual/religious,"" and ""hoarding"" symptom dimensions were more severe in the OCD+TD group. Conclusion. Tic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.