Abstract The world is experiencing a moment of political polarization between liberal and conservative ideas, which has aggravated since the arrival of the Covid-19. Many countries (Brazil included) have been experiencing the generalized occurrence of people fighting over politics, in contexts including family, workplace, friendships, and romantic relationships. Over the past 2 years, it has been possible to observe an unexpected and overwhelming effect of the political climate on psychotherapy patients, some of whom have started to actively look for therapists who share their convictions. Brazil is experiencing a moment of severe sanitary, economic, social, and political crisis, which is directly affecting our patients. Nevertheless, the impact of the political climate on our population has not been systematically investigated. However, as the political environment is an inherent part of the social component of the psychosocial model, it is important that mental health professionals be prepared to have this conversation with their patients. This highlights the need to address these difficulties in supervision, rounds, and clinical discussions.

Objective: To investigate the prevalence rates of suicidal ideation (SI) and suicide attempts (SA) and their association with substance use in a nationally representative sample of Brazilians. Methods: The Second Brazilian National Alcohol and Drug Survey (II BNADS) is a household cross-sectional survey that investigated the consumption of psychotropic drugs and associated risk factors. This national probability sample survey used a multistage cluster design to select 4,607 participants aged 14 or older and had a total response rate of 77%. Illegal drug use, SI and SA were obtained by confidential self-report assessment. Results: SI and SA were reported by 9.9 and 5.4% of the sample, respectively. This prevalence was 20.8 and 12.4% among individuals with alcohol use disorders (AUD), 31.5 and 16.5% among cannabis users and 40.0 and 20.8% among cocaine users. After adjusting for demographic characteristics, tobacco use, family history of suicide and depression, both SI and SA were positively associated with AUD, cannabis and cocaine use. Conclusion: AUD, cannabis and cocaine use were significantly associated with SI and SA, even after the adjustments. Public health initiatives targeting suicide prevention should consider including assessment and management of substance misuse, and therapeutic approaches to substance misuse should include assessment of suicidality.

Resumo “Má notícia”, definida como informação que carrega grande peso emocional e potencial de mudar perspectivas pessoais, é, por definição, desafio para os médicos. Entretanto, nem sempre esse assunto é abordado em faculdades de medicina. Esta revisão sistemática contém todos os artigos encontrados sobre comunicação de más notícias em bases de dados por “medical school” e “bad news” em inglês, português e espanhol. O critério de inclusão abrangia artigos que elucidavam técnicas de ensino. De todos os 313 artigos, 27 foram incluídos, tendo suas estratégias classificadas. A maioria dos resultados mostrou que as estratégias mistas são mais comuns e que, em geral, o tema é bem aceito e valorizado pelos estudantes, que afirmam melhora na capacidade comunicativa depois do treinamento. Conclui-se que todas as técnicas são válidas e que as faculdades de medicina devem focar em integrar esse treinamento no currículo regular.

Abstract “Bad news”, defined as information with huge emotional valence and potential to change personal perspectives, is, by definition, a challenge for physicians. However, the subject is not always taught in medical schools. This systematic literature review compiles all articles regarding communication of bad news after researching in databases for “medical school” and “bad news” in English, Portuguese and Spanish. The criterion was to include articles that elucidated about teaching techniques. From all 313 papers, we included 27 and classified their strategies. Most results showed that mixed strategies are more common and that, in general, the subject is well-received and appreciated by students, who reported an improvement in communicative capability after the training. We conclude that all techniques are valid and medical schools should focus on integrating this training in their regular curriculum.

Resumen “Mala noticia”, definida como una información que conlleva un gran peso emocional y tiene el potencial de cambiar las perspectivas personales; constituye un desafío para los médicos. Sin embargo, este tema no siempre es enseñado en las facultades de medicina. Esta revisión sistemática de la literatura compila todos los artículos encontrados sobre la comunicación de malas noticias luego de buscar “medical school” y “bad news”, en inglés, portugués y español, en bases de datos. El criterio empleado fue incluir artículos que tratasen sobre técnicas de enseñanza. De los 313 artículos, incluimos 27 y clasificamos sus estrategias. La mayoría de los resultados mostró que las estrategias mixtas son las más comunes y que, en general, el tema es bien recibido y valorado por los estudiantes, quienes informan que obtienen una mejora en la capacidad comunicativa luego de la formación. Concluimos que todas estas técnicas son válidas y que las facultades de medicina deben enfocarse en integrar esta capacitación en su currículo regular.

Resumo Introdução Inteligência emocional (IE) é definida como a habilidade de perceber, compreender, utilizar e manejar emoções. Estudos em IE são potencialmente úteis na compreensão de comportamentos relacionados a adições, assim como no planejamento de intervenções. Objetivos Realizar revisão crítica da literatura em comprometimento da IE em adições. Métodos A busca foi realizada nas plataformas MEDLINE/PubMed, Google Scholar, Cochrane, LILACS e SciELO. Artigos que utilizaram o Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) para a avaliação de IE em adições e controles saudáveis foram incluídos na revisão. Resultados Nós selecionamos sete artigos que avaliaram IE e sua associação com dependência química e não química, especialmente abuso de álcool e dependência de cocaína. A maior parte dos estudos reportou que indivíduos com transtornos relacionados ao uso de substâncias apresentaram valores inferiores na MSCEIT em comparação a controles saudáveis. Conclusão De forma geral, os estudos revisados demostraram uma associação entre dependência química e déficits em IE na comparação com controles saudáveis. No entanto, a reduzida quantidade de transtornos de uso de substância analisada, problemas metodológicos relacionados a instrumentos de avaliação de IE e a ausência de seguimento dos sujeitos incluídos nos estudos são limitações significativas.

Abstract Introduction Emotional intelligence (EI) has been defined as the ability to perceive, understand, use and manage emotions. Studying EI could potentially be useful in understanding addictive behaviors as well as for designing and planning interventions. Objectives To conduct a critical review on EI impairment in addiction disorders. Methods MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, and SciELO databases were searched. Articles that used the standardized Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) instrument to assess EI in people with addictions and healthy controls were selected for the review. Results We selected seven articles assessing EI and its associations with addiction disorders, mainly alcohol abuse and cocaine dependence. Most studies reported that individuals with addiction disorders had worse EI scores when compared to controls. Conclusion Overall, the studies reviewed demonstrated that addictions are associated with EI deficits, compared to controls. However, aspects such as the small number of addictive disorders analyzed, methodological issues related to instruments for assessment of IE and the lack of follow-up remain significant limitations.

Resumo Introdução Inteligência emocional (IE) é um constructo postulado por Mayer e Salovey para designar a habilidade de perceber, entender, utilizar e gerenciar emoções. O estudo de IE em esquizofrenia oferece novos insights quanto ao impacto deste transtorno em funções cognitivas e funcionais. Objetivos Conduzir revisão da literatura que analisa o prejuízo em IE nos transtornos do espectro da esquizofrenia utilizando instrumentos padronizados. Métodos Buscas foram realizadas nos bancos de dados MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov e SciELO. O único instrumento validado utilizado foi a Multifactor Emotional Intelligence Scale (MSCEIT). Artigos que utilizaram todas as ramificações da MSCEIT para avaliar IE em transtornos do espectro da esquizofrenia e em controles saudáveis foram incluídos na revisão. Resultados Encontramos 30 artigos no tópico estudado. Os estudos analisados mostraram um prejuízo significativo da IE pela MSCEIT em pacientes com transtornos do espectro da esquizofrenia quando comparados com controles saudáveis. Em relação às ramificações da MSCEIT, compreensão das emoções e gerenciamento das emoções foram as ramificações com maior prejuízo. Conclusão Devido à maior parte dos estudos serem estudos transversais, não é possível estabelecer uma relação de causa e efeito entre os déficits em IE e transtornos do espectro da esquizofrenia. Portanto, estudos longitudinais são necessários para se estabelecer uma relação mais clara entre essas variáveis. Assim, talvez possamos intervir na prevenção e manejo desses transtornos, para uma melhor qualidade de vida dos pacientes.

Abstract Introduction Emotional intelligence (EI) is a theoretical construct postulated by Mayer and Salovey to designate the ability to perceive, understand, use and manage emotions. The study of EI in schizophrenia offers new insights into the disorder’s cognitive and functional impacts. Objectives To comprehensively review studies analyzing EI impairment in schizophrenia spectrum disorders using standardized instruments. Methods Searches were run on MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov and SciELO databases. The only validated instrument used was the Multifactor Emotional Intelligence Scale (MSCEIT). Articles that used all branches of the MSCEIT to assess EI in schizophrenia spectrum disorders and healthy controls were included in the review. Results We found 30 articles on this topic. The studies analyzed showed a significant impairment of MSCEIT total score in patients with schizophrenia spectrum disorders when compared to healthy controls. In relation to the MSCEIT branches, understanding of emotions and management of emotions are the most impaired branches. Conclusion Since most studies are cross-sectional, it is not possible to establish a cause and effect relationship between EI deficits and schizophrenia spectrum disorders. Therefore, longitudinal studies are needed to establish a clearer relationship between these variables. By so doing, we may be able to intervene for prevention and management of these disorders, aiming at better quality of life for patients.

Resumo Introdução: O Programa Moradia Monitorada (MM) foi iniciado em São Paulo com o objetivo de prover tratamento para transotrnos de uso de substâncias e problemas relacionados a moradia e emprego. O objetivo do presente estudo foi descrever o modelo com base nos primeiros 11 meses de operação (o programa foi lançado em junho de 2016 no Brasil). Métodos: Realizamos um estudo retrospectivo utilizando os registros de todos os indivíduos tratados no MM do Programa Recomeço desde a sua criação. Resultados: Sessenta e nove indivíduos foram incluídos. Trinta e cinco (51%) permaneceram no tratamento até o fim ou foram reinseridos socialmente com sucesso. Trinta e quatro sujeitos (49%) apresentaram recidiva durante a permanência. Destes, 16 (47%) se voluntariaram para tratamento em comunidades terapêuticas ou hospitais psiquiátricos, 8 (23,5%) escolheram permanecer apenas no tratamento ambulatorial, 6 (17.7%) retornaram para suas famílias e continuaram o tratamento em uma unidade ambulatorial próxima ao domicílio, e 4 (11.8%) descontinuaram o tratamento. Dos 35 pacientes que completaram o tratamento, 28 (80%) estavam empregados em serviço regular e 7 (20%) recebiam aposentadoria por questões clínicas e/ou psiquiátricas. Conclusão: O modelo MM pode ser um componente importante na via de cuidados integrados e é utilizado em vários países. Apesar de controverso, o uso de análise de urina para vigilância da recidiva e da recorrência parece ter um impacto positivo na adesão ao tratamento e na manutenção da abstinência. Nossos achados preliminares corroboram, com claras limitações, os resultados reportados previamente na literatura, de que os programas de MM são efetivos no tratamento da dependência química.

Abstract Introduction: The recovery housing (RH) program was initiated in São Paulo with the objective of providing treatment for substance use disorders and addressing users’ housing and employment problems. The purpose of this study was to describe the model based on its first 11 months of operation, it was launched in June 2016 in Brazil. Method: We carried out a retrospective analysis of the records of all subjects treated in the RH of the Restart Program (Programa Recomeço) since its creation, from June 2016 to May 2017. Results: Sixty-nine subjects were included. Thirty-five (51%) remained in the household until the end of treatment or were reinserted in society. Thirty-four (49%) presented recurrence during their stay, of which 16 (47%) volunteered for treatment in a therapeutic community or psychiatric hospital, 8 (23.5%) chose to continue with outpatient treatment only, 6 (17.7%) returned to their families and continued to receive outpatient treatment, and 4 (11.8%) discontinued the treatment. Of the 35 subjects who completed the RH program, 28 (80%) were in employment and 7 (20%) received governmental support for permanent disability on medical or psychiatric grounds. Conclusion: RH can be an important component of integrated care and is used in several countries. Although controversial, the use of urine tests to control relapse seems to have a positive impact on adherence to treatment and maintenance of abstinence. These preliminary findings corroborate, with clear limitations, the evidence available in the literature showing that RH programs are effective for the treatment of addictions.

Objective: There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. Methods: The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. Results: Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. Conclusions: Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.

Resumo Objetivo: O presente estudo consiste em uma revisão e análise crítica da ocorrência de mania tratamento-emergente (TEM) relacionada a estimulação transcraniana por corrente contínua (ETCC) e estimulação do nervo trigêmeo (TNS). Método: Apresentamos uma revisão sistemática de literatura sobre TEM relacionada a ETCC e TNS no tratamento de transtorno depressivo maior (TDM), conduzida de acordo com as recomendações do Grupo Cochrane e protocolo PRISMA. Resultados: A pesquisa identificou poucos relatos de TEM na literatura. Na verdade, foram encontrados 11 ensaios clínicos com foco no tratamento de TDM (sete estudos controlados de ETCC e quatro de TNS, sendo três abertos e um controlado). Destacamos a necessidade de avaliações de segurança em pesquisas clínicas para se estabelecer com maior precisão e em amostras maiores os riscos inerentes à técnica sob investigação. Conclusão: Avaliação de segurança é fundamental na pesquisa clínica. A TEM é um efeito adverso importante no tratamento do TDM. Maiores ensaios clínicos controlados ajudarão a esclarecer os efeitos clínicos e a segurança da combinação de psicotrópicos e ETCC ou TNS.

Abstract Objective: This study is a critical review analyzing occurrence of treatment-emergent mania (TEM) related to transcranial direct current stimulation (tDCS) and trigeminal nerve stimulation (TNS). Method: We present a systematic review of the literature on TEM related to tDCS and TNS treatment for major depressive disorder (MDD), conducted in accordance with the recommendations from Cochrane Group and the PRISMA guidelines. Results: Our search identified few reported episodes of TEM in the literature. In fact, we found 11 trials focused on treatment of MDD (seven controlled trials of tDCS and four trials of TNS, three open label and one controlled). We highlight the need for safety assessment in clinical research settings to establish with precision and in larger samples the risks inherent to the technique under investigation. Conclusion: Safety assessment is of fundamental importance in clinical research. TEM is a very important safety issue in MDD trials. Further and larger controlled trials will help to clarify both the safety and the clinical effects of combinations of pharmacotherapy and tDCS or TNS in daily clinical practice.

Recently, attention in the field of bipolar disorder (BD) has focused on prevention, including early detection and intervention, as these strategies have the potential to delay, lessen the severity, or even prevent full-blown episodes of BD. Although knowledge of the neurobiology of BD has advanced substantially in the last two decades, most research was conducted with chronic patients. The objective of this paper is to comprehensively review the literature regarding the early stages of BD, to explore recent discoveries on the neurobiology of these stages, and to discuss implications for research and clinical care. The following databases were searched: PubMed, PsycINFO, Cochrane Library, and SciELO. Articles published in English from inception to December 2015 were retrieved. Several research approaches were used, including examination of offspring studies, retrospective studies, prospective studies of clinical high-risk populations, and exploration of the progression after the first manic episode. Investigations with neuroimaging, cognition assessments, and biomarkers provide promising (although not definitive) evidence of alterations in the neural substrate during the at-risk stage. Research on BD should be expanded to encompass at-risk states and aligned with recent methodological progress in neuroscience.