Doing neuroscience in Brazil. The best Brazilian theses in Neuroscience 2007 – a contest sponsored by the IV Brazilian Congress on Brain, Behavior and Emotions

1 Differentiating attention-Deficit/ hyperactivity DisorDer inattentive anD combineD types: a 1h-magnetic resonance spectroscopy stuDy of fronto-striatothalamic regions Pedro Eugênio Mazzucchi Santana Ferreira, André Palmini, João Rubião Hoefel, Maurício Annès, Paulo Belmonte de Abreu Pontifícia Universidade Católica do Rio Grande do Sul. Departamento de Psiquiatria da Faculdade de Medicina da PUCRS e do Programa de Residência do Hospital São Lucas da PUCRS. Background: Few previous investigations have assessed neurobiological substrates for differentiating AttentionDeficit/Hyperactivity Disorder (ADHD) types through the use of modern neuroimaging techniques. Methods: We assessed the neurometabolic profile in frontal-striatal-thalamic right and left regions through 1H-magnetic resonance spectroscopy (1H-MRS) in three groups of subjects (age range: 15-24 years’ old): ADHD inattentive type (ADHD-I; n 10), ADHD combined type (ADHD-C; n =10) and non-ADHD controls (n 12). Compounds that can be visualized with 1H-MRS include N-acetyl-aspartate (NAA), glutamate/glutamine/γ-aminobutyric acid (Glx), creatinine/phosphocreatine(Cr), and choline compounds (Cho). Results: Major differences were detected in metabolic ratios in subjects with ADHD-C compared with those with ADHD-I and controls, even after adjustments for comorbidity. Subjects with ADHD-C showed a lower mI/Cr ratio in the right ventromedial prefrontal cortex (VMPFC) than controls (p 0.004), higher Cho/Cr ratio in the left pulvinar (thalamus posterior) than the ADHD-I group (p 0.02), and higher Glx/Cr ratio in left putamen nucleus than both individuals with ADHD-I and controls (p=0,049). No differences were detected between subjects with ADHD-I and non-ADHD controls. NAA/Cr ratio differed between patients and controls in the left VMPFC only when all ADHD subjects were grouped together (p=0.03). Conclusions: Our findings corroborate previous results suggesting a different neurobiological profile between the two main ADHD subtypes, and suggest that ADHD-C is associated with an energetic deficit in frontal-striatal-thalamic regions. There are two main possibilities to explain our findings in patients with ADHD-C. One is related to interference with neuronal energy-producing mechanisms and the other with neurotransmitter imbalance. Both are probably inter-related within a neurochemical-energetic framework. This neuronal metabolic profile is in line with the ADHD theory of ‘energetic deficit’ in frontal-striatalthalamic structures. Mioinositol, glutamate/glutamine (Glx) and choline are all related to the energetic neuronal cycle. Furthermore, the reduced mI/Cr in the right VMPFC and increased Cho/Cr in the left pulvinar found in the group with ADHD-C may influence secondary messenger systems bearing upon cyclic-AMP production. The evidence presented here suggests that 1H-MRS of metabolic ratios of mI, Cho, and Glx related to creatinine may differentiate groups of patients with ADHD-C and ADHD-I, without differentiating the inattentive subtype from normal controls. An intriguing explanation for these findings is that these differential metabolic profiles may, at least in part, reveal a greater reduction in the energetic metabolism of frontal-striatal-thalamic structures in the combined subtype of ADHD. ABSTRACT-2 impaireD occupational anD social functioning in schizophrenia linkeD to DecreaseD Dorsolateral prefrontal metabolism: a proton magnetic resonance spectroscopic imaging stuDy2 impaireD occupational anD social functioning in schizophrenia linkeD to DecreaseD Dorsolateral prefrontal metabolism: a proton magnetic resonance spectroscopic imaging stuDy Eloísa Elena Silveira Ferreira, Paulo Belmonte-de-Abreu, André Palmini Universidade Católica do Rio Grande do Sul. Unidade Psiquiatra do Hospital São Lucas da PUCRS. Introduction: Reduced frontal N-acetylaspartate (NAA) has been repeatedly found in dorsolateral prefrontal cortex (DLPFC) of chronic schizophrenia and suggests neuronal Dement Neuropsychol 2008 June;2(2):157-160 158 Doing neuroscience in Brazil loss or disfunction. These neuroimaging studies revealed a positive association with reduced NAA and cognitive deficit and severity. Unfortunately, few studies have focused on the association of brain metabolism and impairment in social and occupational functioning. Objectives: To assess the association among DLPFC metabolism by proton magnetic resonance spectroscopic imaging (1H-MRS), with occupational and social handicaps in schizophrenics. Methods: 25 subjects with DSM-IV schizophrenia and 12 healthy controls were assessed by 1H-MRS and by selected Scales of Functional Outcomes (SOFAS Social and Occupational Functioning Assessment Scale), (GAS Global Assessment Scale), cognitive deficit (WCST Wisconsin Card Sorting Test) and symptom severity (BPRSBrief Psychiatric Rating Scale). Differences among means and medians of measures of patients and controls were assessed by Student’s t test and the Mann Whitney test, respectively, confirmed by Covariance Analysis (Ancova), in General Linear Models with SPSS 10.0 software using age, sex, education, age of onset and illness severity as covariates. Results: There was a significant difference in metabolism among schizophrenics and controls regarding several parameters. Schizophrenics displayed lower Right DLPFC metabolism in NAA/Cr ratios (p=0,009). In the Right DLPFC among schizophrenics, NAA/Co ratio (p=0.009) was associated to occupational and social handicap in EAFSO, and NAA/Co ratios (p=0.005) in GAF, and NAA/Cr ratios (p=0.050) were negatively associated to symptom severity (BPRS). On the DLPFC, NAA/Co ratios were negatively associated (p=0.050) to WCST number of completed categories. Conclusions: The study provides fresh evidence about prefrontal metabolism in schizophrenia. The new finding is that lower Right DLPFC metabolism is associated to lower occupational and social functioning in schizophrenia. The additional evidences are (i) lower NAA metabolism (NAA/ Cr and NAA/Co ratios) in schizophrenics compared to normal controls, (ii) lower NAA metabolism and functional handicap (measured by EAFSO and GAF, (iii) cognitive deficit (measured by WCST) and (iv) negative association among DLPFC NAA and symptom severity (measured by BPRS). The confirmation of frontal metabolic deficits in schizophrenics compared to normal controls, providing further insight about physiopathology of the illness. This study of metabolic deficits in schizophrenia, if confirmed by additional studies in high risk populations, will strengthen the understanding of neuronal dysfunction and/or neuronal loss, probably preceding schizophrenia onset. Increased brain dysfunction after illness onset would result in decreased coping ability for daily life demands and worse occupational outcomes in schizophrenia. ABSTRACT-3 prevalence of psychiatric comorbiDities in patients with temporal lobe epilepsy José Augusto Bragatti, Juliana Bohn Assmann, Vivian Fontana, Clarice Rigotti, Maria Paz Hidalgo, Renata Gomes Londero, Gisele Gus Manfro, Sandra Leistner-Segal, Carolina Machado Torres, Marino Muxfeldt Bianchin Universidade Federal do Rio Grande do Sul. Psychiatric disorders are common in epileptic patients. However, the prevalence of psychiatric comorbidities might be different depending on the group of patients studied and tools used to evaluate neuropsychiatric disorders. Although some studies have evaluated psychiatric comorbidities in epileptic patients, well-controlled studies, using representative patient groups with valid and standardized diagnostic instruments, are still lacking. The objective of this study was to evaluate the prevalence of major psychiatric comorbidities in a series of patients of our population with diagnosis of temporal lobe epilepsy (TLE), using a validated structured clinical interview. We analyzed 57 patients with TLE, diagnosed according to the 1989 International League Against Epilepsy (ILAE) Classification of Epilepsies and Epileptic Syndromes, using clinical, electroencephalographic, and neuroimaging criteria. All patients were submitted to neuropsychiatric evaluation using the SCID (Structured Clinical interview for DSM-IV axis I Disorders), divided into four major categories: mood disorders, anxiety disorders, psychotic disorders, and drugs and alcohol abuse. Variables studied were age, age of epilepsy onset, duration of epilepsy, gender, family history for epilepsy, seizure frequency, seizure control and psychiatric diagnostics. There were 21 (36.8%) men and 36 (63.2%) women, with a mean age of 41.8 years, and mean epilepsy duration of 26.1 years. Thirty four patients (59.6%) had major psychiatric comorbidities. Mood disorders, the most commonly occurring, were observed in 22 patients (38.6% of all patients and 64.7% of patients with neuropsychiatric comorbidities). Anxiety disorders were the second most frequent disorder, observed in seven patients (12.3% of all patients and 20.6% of SCID-positive patients). Three patients had psychotic disorders, and another three patients presented drugs or alcohol abuse (5.3% of all patients and 8.8% of patients with neuropsychiatric comorbidities). There were no differences among SCID-positive and SCIDnegative patients regarding age, age of epilepsy onset, time of epilepsy duration, gender, family history for epilepsy, seizure frequency, and seizure control. Dement Neuropsychol 2008 June;2(2):157-160 Doing neuroscience in Brazil 159 Our results (psychiatric disorder in 59.6% of patients with TLE) are in line with literature. Most authors have reported psychiatric problems in 19 to 80% of epileptic patients. This large variation is probably attributable to the different patient groups investigated and the even greater variety of diagnostic methods. Due to high prevalence of major psychiatric disorders found in our patients, we believe that centers with psychiatric service dedicated to the evaluation and treatment of psychiatric comorbidities might offer much better clinical care for epileptic patients. ABSTRACT-4 patterns of sleep anD levels of stress in hospitalizeD chilDren who play or not During hospitalization4 patterns of sleep anD levels of stress in hospitalizeD chilDren who play or not During hospitalization Clarisse Potasz, Patrícia G. Ferraz, Luciane Bizari de Carvalho, Lucila F. do Prado, Gilmar F do Prado Hospital Infantil Candido Fontoura. Faculdade Metropolitanas Unidas