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Brazilian Journal of Psychiatry, Volume: 42, Número: 4, Publicado: 2020
  • Implementing changes in mental health among at-risk groups: a decade-long Brazilian roadmap Editorial

    Soares, Claudio N.
  • Biomarkers in Alzheimer disease: are we there yet? Editorial

    Generoso, Jaqueline S.; Morales, Rodrigo; Barichello, Tatiana
  • The respiratory subtype of panic disorder: reflections on the past and future of biological psychiatry Editorial

    Stein, Dan J.
  • Deep brain stimulation as a treatment for depressive disorder Editorial

    Gouveia, Flavia V.; Hamani, Clement
  • Why is deep brain stimulation for treatment-resistant depression a needed treatment option? Editorial

    Riva-Posse, Patricio
  • Challenges in deep brain stimulation for depression Editorial

    Fenoy, Albert
  • Challenges and opportunities in the science of research to practice: lessons learned from a randomized controlled trial of a sexual risk-reduction intervention for psychiatric patients in a public mental health system Original Article

    Wainberg, Milton L.; Mann, Claudio G.; Norcini-Pala, Andrea; McKinnon, Karen; Pinto, Diana; Pinho, Veronica; Cavalcanti, Maria T.; Cheng-Shiun, Leu; Guimarães, Mark D.; Mattos, Paulo; Hughes, Elizabeth; Palinkas, Lawrence A.; Otto-Salaj, Laura; Remien, Robert H.; Cournos, Francine

    Resumo em Inglês:

    Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers. Methods: The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services’ needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions. Results: HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions. Conclusion: Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step. Clinical trial registration: NCT00881699
  • Associations between primary health care strategies and outcomes of mental disorders Original Article

    Moscovici, Leonardo; Balco, Estenifer M.; Degani, Natalia C.; Bolsoni, Lívia M.; Marques, João M.A.; Zuardi, Antonio W.

    Resumo em Inglês:

    Objective: To investigate associations between the percentage and severity of mental disorders (MD) and three different primary health care (PHC) strategies in Brazil: traditional care (TC), the Family Health Strategy (FHS), and FHS with shared mental health care (FHS+SC). Methods: Random samples were selected from three different areas of a Brazilian city. Each area was served by a different PHC strategy (TC, FHS, or FHS+SC). Five mental health professionals, blinded to the type of PHC strategy delivered in each area, conducted interviews using the Mini International Neuropsychiatric Interview (MINI) and other specific instruments to assess the prevalence and severity of MD. Results: 530 subjects were interviewed. The TC strategy was significantly associated with a higher percentage of MD when compared to FHS and FHS+SC. These results were not affected by adjustment for sociodemographic variables. The difference in prevalence of MD between the two FHS areas (with and without SC) was not statistically significant. No significant differences in MD severity were observed across the three PHC strategies. Conclusion: Areas covered by FHS showed a lower percentage of MD than those covered by TC. Presence of SC did not influence the prevalence of MD, suggesting that mental-health training of FHS teams may have minimized the influence of SC.
  • Suicide and suicide attempts in adults: exploring suicide risk 24 months after a psychiatric emergency room visit Original Article

    Taron, Marisa; Nunes, Carla; Maia, Teresa

    Resumo em Inglês:

    Objective: Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization. Method: A convenience sample (n=147), recruited at a general hospital’s psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides. Results: After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve. Conclusions: The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.
  • Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study Original Article

    Kocakaya, Hanife; Songur, Emrah; Batmaz, Sedat; Çelikbaş, Zekiye; Küçük, Önder

    Resumo em Inglês:

    Objective: The metabolic syndrome (MS) is highly prevalent among patients with bipolar disorder (BD), and may affect progression, functioning, and comorbid conditions in BD. The aim of this study was to investigate the effect of clinical variables and MS on overall functioning and specific areas of functioning in patients with BD. Methods: A total of 210 participants (140 participants with BD I and BD II in remission and 70 non-psychiatric control subjects) were included. The investigators administered the Young Mania Rating Scale (YMRS), the Bipolar Depression Rating Scale (BDRS), the Global Assessment of Functioning Scale (GAF), and the Bipolar Disorder Functioning Scale (BDFS). The participants completed the Beck Depression Scale (BDS) and the Beck Anxiety Scale (BAS). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Hierarchical regression analysis was used to investigate potential correlations of comorbid MS with clinical variables and level of functioning. Results: Level of functioning did not differ between patients with and without MS. However, there were significant correlations between the level of functioning subscales and the number of depressive episodes (p = 0.033), level of general functioning (p = 0.012), duration of illness (p = 0.012), BDS (p = 0.005), BDRS (p = 0.021), BAS total scores (p = 0.021), number of hypomanic episodes (p = 0.022), number of hospitalizations (p = 0.003), employment status (p = 0.032), and diagnosis of BD I (p = 0.007) and BD II (p = 0.044). Conclusion: Our findings suggest that clinical variables had a greater effect on functioning than MS in BD patients.
  • Impulsivity influences food intake in women with generalized anxiety disorder Original Article

    Fonseca, Natasha Kim de O. da; Molle, Roberta D.; Costa, Marianna de A.; Gonçalves, Francine G.; Silva, Alice C.; Rodrigues, Ylana; Price, Menna; Silveira, Patrícia P.; Manfro, Gisele G.

    Resumo em Inglês:

    Objective: Eating behavior is affected by psychological and neurocognitive factors. However, little is known about this relationship in anxious patients. Our aim was to investigate the associations between impulsivity, inhibitory control, energy-dense food consumption, and body mass index (BMI) in women with generalized anxiety disorder (GAD). Methods: In this cross-sectional study, 51 adult females with GAD answered the Barratt Impulsiveness Scale (BIS-11) and participated in a go/no-go task using food images. Anthropometric measurements were evaluated. A food frequency questionnaire and a snack test were used to study eating behavior. Pearson correlation and multiple linear regression were performed to analyze the variables of interest, adjusted by age. Results: Impulsivity predicted intake of sugar (p = 0.016, 95%CI 0.67-6.05), total fat (p = 0.007, 95%CI 0.62-3.71), and saturated fat (p = 0.004, 95%CI 0.30-1.48). The snack test showed a positive correlation between presence of impulsivity and intake of biscuits (R = 0.296; p = 0.051). Response inhibition to food images in the go/no-go task paradigm did not predict BMI or food intake. Conclusion: Impulsivity was predictive of higher sugar and saturated fat intake in women diagnosed with GAD. Our findings add to the literature regarding the association between neuropsychological factors and food consumption in this specific population.
  • Validation of the Portuguese version of the Community Assessment of Psychic Experiences and characterization of psychotic experiences in a Brazilian sample Original Article

    Ragazzi, Taciana C.C.; Shuhama, Rosana; Sinval, Jorge; Marôco, João; Corsi-Zuelli, Fabiana; Roza, Daiane L. da; van Os, Jim; Menezes, Paulo R.; Del-Ben, Cristina M.

    Resumo em Inglês:

    Objective: We investigated: i) the reliability and validity of a Brazilian version of the Community Assessment of Psychic Experiences (CAPE), developed to detect and characterize psychotic experiences in the general population; and ii) the association between psychotic experiences, childhood adversity, and cannabis use in a population-based sample. Methods: We performed factorial analyses and generalized linear models with CAPE scores as the dependent variable in a sample composed of 217 first-episode psychosis patients, 104 unaffected biological siblings, and 319 non-psychotic population-based participants. Results: After removing seven items from its positive dimension and two items from its negative dimension, a 33-item Brazilian version of the CAPE showed acceptable adjustment indices (confirmatory fit index = 0.895; goodness of fit index = 0.822; parsimony goodness of fit index = 0.761; root mean square error of approximation [RMSEA] = 0.055, p [RMSEA ≤ 0.05] = 0.04) and internal consistency in all its dimensions (> 0.70). Childhood adversity was associated with higher scores in all three dimensions, as well as with total score. Lifetime cannabis use was associated with higher scores only in the positive dimension. Conclusion: The proposed Brazilian version of the CAPE corroborates the tridimensional approach for assessing psychosis-proneness, and the frequency and severity of psychotic manifestations are distributed as a spectrum in the general population.
  • Serum galectin-3 levels are decreased in schizophrenia Original Article

    Kiliç, Faruk; Işik, Ümit; Demirdaş, Arif; Usta, Ayşe

    Resumo em Inglês:

    Objective: To determine whether changes in serum galectin-3 (gal-3) concentrations in schizophrenia patients have etiopathogenetic importance. Since very little research has assessed the connection between galectins and schizophrenia, we wanted to examine alterations in the inflammatory marker gal-3 in schizophrenia and investigate possible correlations between clinical symptomatology and serum concentrations. Methods: Forty-eight schizophrenia patients and 44 healthy controls were included in this study. The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) were administered to determine symptom severity. Venous blood samples were collected, and serum gal-3 levels were measured. Results: Mean serum gal-3 levels were significantly lower in schizophrenia patients, and there were no significant differences in age or sex with the control group. There was also a significant positive correlation between serum gal-3 concentrations and negative schizophrenia symptoms according to the SANS. Conclusion: The results indicate that gal-3 is decreased in schizophrenia patients, which could contribute to inflammation in the pathogenesis of schizophrenia.
  • Precision non-implantable neuromodulation therapies: a perspective for the depressed brain Special Article

    Borrione, Lucas; Bellini, Helena; Razza, Lais Boralli; Avila, Ana G.; Baeken, Chris; Brem, Anna-Katharine; Busatto, Geraldo; Carvalho, Andre F.; Chekroud, Adam; Daskalakis, Zafiris J.; Deng, Zhi-De; Downar, Jonathan; Gattaz, Wagner; Loo, Colleen; Lotufo, Paulo A.; Martin, Maria da Graça M.; McClintock, Shawn M.; O’Shea, Jacinta; Padberg, Frank; Passos, Ives C.; Salum, Giovanni A.; Vanderhasselt, Marie-Anne; Fraguas, Renerio; Benseñor, Isabela; Valiengo, Leandro; Brunoni, Andre R.

    Resumo em Inglês:

    Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
  • Panic disorder respiratory subtype: psychopathology and challenge tests – an update Special Article

    Okuro, Renata T.; Freire, Rafael C.; Zin, Walter A.; Quagliato, Laiana A.; Nardi, Antonio E.

    Resumo em Inglês:

    Panic disorder (PD) pathophysiology is very heterogeneous, and the discrimination of distinct subtypes could be very useful. A subtype based on respiratory symptoms is known to constitute a specific subgroup. However, evidence to support the respiratory subtype (RS) as a distinct subgroup of PD with a well-defined phenotype remains controversial. Studies have focused on characterization of the RS based on symptoms and response to CO2. In this line, we described clinical and biological aspects focused on symptomatology and CO2 challenge tests in PD RS. The main symptoms that characterize RS are dyspnea (shortness of breath) and a choking sensation. Moreover, patients with the RS tended to be more responsive to CO2 challenge tests, which triggered more panic attacks in this subgroup. Future studies should focus on discriminating respiratory-related clusters and exploring psychophysiological and neuroimaging outcomes in order to provide robust evidence to confirm RS as a distinct subtype of PD.
  • Early diagnosis and treatment of Alzheimer’s disease: new definitions and challenges Special Article

    Pais, Marcos; Martinez, Luana; Ribeiro, Octávio; Loureiro, Júlia; Fernandez, Romel; Valiengo, Leandro; Canineu, Paulo; Stella, Florindo; Talib, Leda; Radanovic, Marcia; Forlenza, Orestes V.

    Resumo em Inglês:

    The prevalence of Alzheimer’s disease (AD), a progressive neurodegenerative disorder, is expected to more than double by 2050. Studies on the pathophysiology of AD have been changing our understanding of this disorder and setting a new scenario for drug development and other therapies. Concepts like the “amyloid cascade” and the “continuum of AD,” discussed in this article, are now well established. From updated classifications and recommendations to advances in biomarkers of AD, we aim to critically assess the literature on AD, addressing new definitions and challenges that emerged from recent studies on the subject. Updates on the status of major clinical trials are also given, and future perspectives are discussed.
  • Population neuroscience: challenges and opportunities for psychiatric research in low- and middle-income countries Review Article

    Cirillo, Alessandra; Diniz, Elton; Gadelha, Ary; Asevedo, Elson; Axelrud, Luiza K.; Miguel, Eurípedes C.; Rohde, Luis Augusto; Bressan, Rodrigo A.; Pan, Pedro; Mari, Jair de J.

    Resumo em Inglês:

    Objective: Population neuroscience is an emerging field that combines epidemiology and neuroscience to study how genes and the environment shape typical and atypical brain functioning. The objective of this study was to review key studies on population neuroscience from low- and middle-income countries (LMICs) and to identify potential gaps vis-à-vis studies conducted in high-income countries. Methods: We conducted a systematic review to search for longitudinal cohort studies investigating the development of psychiatric disorders in children and adolescents in LMICs. We performed an electronic search in the EMBASE and MEDLINE databases from inception to July 5th, 2019. Results: We found six cohorts from four countries that met our search criteria: three cohorts from Brazil, one from China, one from South Africa, and one from Mauritius. Relevant examples of findings from these studies are reported. Conclusion: Our results demonstrate the impact of the valuable science output these cohort designs promote, allowing LMICs to have a share in frontline global psychiatry research. National and international funding agencies should invest in LMIC population neuroscience in order to promote replication and generalization of research from high-income countries.
  • Why psychiatric treatment must not be neglected during the COVID-19 pandemic Letters To The Editors

    Correa, Humberto; Malloy-Diniz, Leandro F.; da Silva, Antonio G.
  • The impact of COVID-19 on Brazilian mental health through vicarious traumatization Letters To The Editors

    Serafim, Antonio de P.; Gonçalves, Priscila D.; Rocca, Cristiana C.; Lotufo Neto, Francisco
  • Comment on “Mental health: why it still matters in the midst of a pandemic” Letters To The Editors

    Gonzalez-Diaz, Jairo M.; Lozano-Lesmes, Lina; Campo-Arias, Adalberto
  • Supporting people with severe mental health conditions during the COVID-19 pandemic: considerations for low- and middle-income countries using telehealth case management Letters To The Editors

    Salum, Giovanni A.; Rehmenklau, Jaqueline F.; Csordas, Michele C.; Pereira, Flavia P.; Castan, Juliana U.; Ferreira, Anderson B.; Delgado, Vera B.; Bolzan, Liana de M.; de Lima, Miguel A.; Blauth, Juarez H.; dos Reis, José R.; Rocha, Paula B.; Guerra, Tadeu A.; Saraiva, Izabela M.; Gramz, Bruna de C.; Ronchi, Bruna R.; Ribeiro, Bruna L.; Konig, Dienifer F.; Grevet, Eugênio H.; de Pinho, Leandro B.; Schneider, Jacó F.; Eustáquio, Paula R.; Ramos, Márcia Z.; Marques, Myriam F.; Axelrud, Luiza K.; Baeza, Fernanda L.; Lacko, Sara E.
  • Melatonin and cocaine: role of mitochondria, immunity, and gut microbiome Letters To The Editors

    Anderson, George
  • Forensic psychiatry assessment during parental alienation claims: two cases with different outcomes Letters To The Editors

    Pena, Roberta; Lauar, Hélio; Barros, Alcina
  • Multimodal treatment for a Brazilian case of hikikomori Letters To The Editors

    Roza, Thiago H.; Spritzer, Daniel T.; Lovato, Lucas M.; Passos, Ives C.
  • Measures to reduce smoking: Brazil takes the lead Letters To The Editors

    Galduróz, José C.; Tomita, Nadia; Bezerra, Andréia G.
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