• Individuals with untreated psychiatric disorders and suicide in the COVID-19 era EDITORIAL

    Sher, Leo
  • New technologies for social inclusion of people with psychosocial disabilities in the era of COVID-19 and beyond EDITORIAL

    Carta, Mauro G.; Nardi, Antonio E.; Bhugra, Dinesh
  • Domestic violence in the COVID-19 pandemic: a forensic psychiatric perspective EDITORIAL

    Telles, Lisieux E. de Borba; Valença, Alexandre M.; Barros, Alcina J.S.; da Silva, Antônio Geraldo
  • The frontier between residual and subsyndromal symptoms in bipolar disorder: revisiting concepts and discussing clinical relevance EDITORIAL

    Léda-Rêgo, Gabriela; Miranda-Scippa, Ângela
  • The remarkable Juliano Moreira (1872-1933): an Afro-Brazilian psychiatrist, scientist, and humanist in an environment of slavery and racism EDITORIAL

    Nardi, Antonio E.; Carta, Mauro G.; Shorter, Edward
  • Risk factors for eating disorders: a work in progress EDITORIAL

    Appolinario, Jose C.; Hay, Phillipa
  • Serum tumor necrosis factor-like weak inducer of apoptosis levels are elevated in schizophrenia ORIGINAL ARTICLE

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

    Abstract in English:

    Objective: The purpose of this study was to assess serum Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) concentrations to determine whether changes in patients with schizophrenia could have etiopathogenetic importance. Since very little research has addressed the connection between the inflammatory marker TWEAK and schizophrenia, we wanted to examine alterations of TWEAK and investigate the possible correlation between clinical symptomatology and serum concentrations. Methods: A total of 45 schizophrenia patients and 40 healthy controls were included in this study. The Positive Symptom Assessment scale and the Negative Symptom Assessment scale were administered to determine symptom severity. Venous blood samples were collected and serum TWEAK levels were measured. Results: Serum TWEAK levels were significantly higher in the schizophrenia group than the control group, independently of potential confounders, including sex, age, body mass index and smoking status. Conclusion: The results indicate that TWEAK is elevated in schizophrenia patients, which could deepen our understanding of the role of inflammation in the pathogenesis of schizophrenia.
  • Depressive symptoms as an independent risk factor for mortality ORIGINAL ARTICLE

    Corrêa, Vanessa P.; Confortin, Susana C.; d’Orsi, Eleonora; de Sá-Junior, Antônio R.; de Oliveira, Cesar; Schneider, Ione J.C.

    Abstract in English:

    Objective: To evaluate the relationship between presence of depressive symptoms and risk of death in older adults residing in a municipality in Southern Brazil. Methods: Between 2009 and 2014, 1,391 people participated in the EpiFloripa Aging Cohort Study, a population-based longitudinal study. Depressive symptoms were assessed through the Geriatric Depression Scale. The initial time was considered the age at the first interview, and the end time, the age at the last contact or death. Cox regression models were used to estimate the mortality risk associated with depressive symptoms, adjusted by sex, education, income, paid work, smoking status, alcohol consumption, morbidities, medication use, physical activity, disability, cognitive impairment, and body mass index. Results: The prevalence of depressive symptoms was 23.5% (95%CI 20.4-26.9). On crude analysis, the risk of mortality was 1.86 (95%CI 1.35-2.55) for individuals with depressive symptoms; in adjusted models, the risk of mortality was 1.67 (95%CI 1.15-2.40). Conclusion: Depressive symptoms are an independent risk factor for mortality in older Brazilian adults. Our findings highlight the importance of screening this population for depression and the practice of preventive actions.
  • Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study ORIGINAL ARTICLE

    Bertola, Laiss; Benseñor, Isabela M.; Gross, Alden L.; Caramelli, Paulo; Barreto, Sandhi Maria; Moreno, Arlinda B.; Griep, Rosane H.; Viana, Maria Carmen; Lotufo, Paulo A.; Suemoto, Claudia K.

    Abstract in English:

    Objective: Longitudinal measurement invariance analyses are an important way to assess a test’s ability to estimate the underlying construct over time, ensuring that cognitive scores across visits represent a similar underlying construct, and that changes in test performance are attributable to individual change in cognitive abilities. We aimed to evaluate longitudinal measurement invariance in a large, social and culturally diverse sample over time. Methods: A total of 5,949 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included, whose cognition was reassessed after four years. Longitudinal measurement invariance analysis was performed by comparing a nested series of multiple-group confirmatory factor analysis models (for memory and executive function factors). Results: Configural, metric, scalar and strict invariance were tested and supported over time. Conclusion: Cognitive temporal changes in this sample are more likely to be due to normal and/or pathological aging. Testing longitudinal measurement invariance is essential for diverse samples at high risk of dementia, such as in low- and middle-income countries.
  • Stigma toward individuals with mental disorders among Brazilian psychiatrists: a latent class analysis ORIGINAL ARTICLE

    da Silva, Antônio G.; Loch, Alexandre A.; Leal, Vanessa P.; da Silva, Paulo R.; Rosa, Monike M.; Bomfim, Ozeias da C.; Malloy-Diniz, Leandro F.; Schwarzbold, Marcelo L.; Diaz, Alexandre P.; Palha, Antônio P.

    Abstract in English:

    Objective: The stigma toward individuals with mental disorders is highly prevalent, not only in the general population but among health care providers as well. The aim of this study was to identify subgroups based on stigmatizing beliefs related to psychiatric disorders among Brazilian psychiatrists, as well as to investigate their association with clinical and personality characteristics. Methods: Latent cluster analysis was used to find subgroups of cases in multivariate data according to a psychotic (schizophrenia) and a nonpsychotic disorder (attention-deficit hyperactivity disorder). The clusters for each psychiatric disorder were compared according to sociodemographic, emotional traits, and personality characteristics. Results: A total of 779 psychiatrists answered the questionnaire. Three different subgroups of stigma levels were identified regarding schizophrenia: the highest (n=202 [51.7%]), intermediate (108 [27.6%]), and the lowest (81 [20.7%]). Participants from the highest stigma group had a significantly longer time since graduation, higher anxiety-state scores, and lower positive affect. Two subgroups were identified with respect to attention-deficit hyperactivity disorder, although there were no differences between them in sociodemographic or clinical variables. Conclusion: There were more subgroups of stigmatizing beliefs regarding psychotic disorders. Individual characteristics, such as those related to trait anxiety and affect, can be associated with high stigma toward schizophrenia.
  • Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge ORIGINAL ARTICLE

    Calsavara, Allan J.; Costa, Priscila A.; Nobre, Vandack; Teixeira, Antonio L.

    Abstract in English:

    Objective: Sepsis survivors present a wide range of sequelae; few studies have evaluated psychiatric disorders after sepsis. The objective of this study was to define the prevalence of and risk factors for anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in sepsis survivors. Method: Anxiety, depression and post-traumatic stress symptoms in severe sepsis and septic shock survivors 24 h and 1 year after intensive care unit (ICU) discharge were assessed using the Beck Anxiety/Depression Inventories and the PTSD Checklist-Civilian Version. Differences in psychiatric symptoms over time and the influence of variables on these symptoms were calculated with marginal models. Results: A total of 33 patients were enrolled in the study. The frequencies of anxiety, depression and PTSD 24 h after ICU discharge were 67%, 49%, and 46%, respectively and, among patients re-evaluated 1 year after ICU discharge, the frequencies were 38%, 50%, and 31%, respectively. Factors associated with PTSD included serum S100B level, age, and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score. Factors associated with depression included patient age and cumulative dose of dobutamine. IQCODE score and cumulative dose of haloperidol in the ICU were associated with anxiety after ICU discharge. Conclusion: Patients who survive sepsis have high levels of psychiatric symptoms. Sepsis and associated treatment-related exposures may have a role in increasing the risk of subsequent depression, anxiety, and PTSD.
  • Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause ORIGINAL ARTICLE

    Jaeger, Marianna de B.; Miná, Camila S.; Alves, Sofia; Schuh, Gabriela J.; Wender, Maria C.; Manfro, Gisele G.

    Abstract in English:

    Objective: Vasomotor symptoms affect 60-80% of women during the menopausal transition. Anxiety, depression, and anxiety sensitivity can have an important role in the distressful experience of vasomotor symptoms. Our aim was to evaluate the prevalence and association of vasomotor and negative affect symptoms. Methods: A cross-sectional study was conducted with 89 perimenopausal women aged 45-55 years. Broad psychiatric and clinical evaluations were carried out. The primary outcome was the vasomotor symptom problem rating and the main study factor was anxiety sensitivity. Linear regression analyses were conducted to examine the associations between the study factors and the primary outcome, and a multiple regression model was created to assess which variables were independently associated with vasomotor symptom problem rating. Results: The prevalence of anxiety, depression, and vasomotor symptoms were 58, 62, and 73%, respectively. Negative affect symptoms were positively associated with vasomotor symptom problem rating. The association of anxiety sensitivity and vasomotor symptom problem rating remained significant after controlling for perimenopausal stage, thyrotropin, follicle-stimulating hormone levels, and psychotropic medication use (β = 0.314, p = 0.002). Conclusion: A better understanding of the experience of vasomotor symptoms is needed, especially the role of negative affect symptoms and anxiety sensitivity. New strategies focusing on related thoughts and behaviors could improve the quality of life of perimenopausal women.
  • Influence of migration on the thought process of individuals at ultra-high risk for psychosis BRIEF COMMUNICATION

    Nogueira, Arthur S.; Andrade, Julio C.; Serpa, Mauricio H.; Alves, Tania M.; Freitas, Elder L.; Hortêncio, Lucas; van de Bilt, Martinus T.; Rössler, Wulf; Gattaz, Wagner F.; Loch, Alexandre A.

    Abstract in English:

    Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student’s t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.
  • Predictors of gaming disorder in children and adolescents: a school-based study BRIEF COMMUNICATION

    Ferreira, Felipe de M.; Bambini, Beatriz B.; Tonsig, Gabriela K.; Fonseca, Lais; Picon, Felipe A.; Pan, Pedro M.; Salum, Giovanni A.; Jackowski, Andrea; Miguel, Eurípedes C.; Rohde, Luis A.; Bressan, Rodrigo A.; Gadelha, Ary

    Abstract in English:

    Objective: To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses. Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder. Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.
  • The role of the microbiota-gut-brain axis in neuropsychiatric disorders SPECIAL ARTICLE

    Generoso, Jaqueline S.; Giridharan, Vijayasree V.; Lee, Juneyoung; Macedo, Danielle; Barichello, Tatiana

    Abstract in English:

    The microbiota-gut-brain axis is a bidirectional signaling mechanism between the gastrointestinal tract and the central nervous system. The complexity of the intestinal ecosystem is extraordinary; it comprises more than 100 trillion microbial cells that inhabit the small and large intestine, and this interaction between microbiota and intestinal epithelium can cause physiological changes in the brain and influence mood and behavior. Currently, there has been an emphasis on how such interactions affect mental health. Evidence indicates that intestinal microbiota are involved in neurological and psychiatric disorders. This review covers evidence for the influence of gut microbiota on the brain and behavior in Alzheimer disease, dementia, anxiety, autism spectrum disorder, bipolar disorder, major depressive disorder, Parkinson’s disease, and schizophrenia. The primary focus is on the pathways involved in intestinal metabolites of microbial origin, including short-chain fatty acids, tryptophan metabolites, and bacterial components that can activate the host’s immune system. We also list clinical evidence regarding prebiotics, probiotics, and fecal microbiota transplantation as adjuvant therapies for neuropsychiatric disorders.
  • Efficacy and safety of Morinda officinalis oligosaccharide capsules for depressive disorder: a systematic review and meta-analysis SPECIAL ARTICLE

    Du, Yun; Zheng, Qin; Ou, Zheng-Hang; Cao, Yu-Jia; Su, Xiao-Peng; Li, Chunbo; Qu, Miao

    Abstract in English:

    Objective: To evaluate the efficacy and safety of Morinda officinalis oligosaccharide (MOO) capsules for depressive disorder. Methods: Eight electronic databases were searched for relevant studies from inception to April 19, 2020. Randomized controlled trials comparing MOO capsules with antidepressants were included. Data analysis was conducted using Review Manager 5.3 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of the studies was evaluated by two researchers using the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) software. Results: Seven studies involving 1,384 participants were included in this study. The effect of MOO capsules for moderate depressive disorder was not different from that of antidepressants (risk ratio [RR] = 0.99, 95%CI 0.92-1.06). Regarding adverse events, no significant difference was found between MOO capsules and antidepressants (RR = 0.84, 95%CI 0.65-1.07). In addition, the quality of evidence related to these adverse events was rated as low. Conclusion: This systematic review suggests that the efficacy of MOO capsules in the treatment of mild to moderate depression is not inferior to that of conventional antidepressants, which may provide a new direction for clinical alternative selection of antidepressants. However, more high-quality research and detailed assessments are needed.
  • Risk factors for eating disorders: an umbrella review of published meta-analyses REVIEW ARTICLE

    Solmi, Marco; Radua, Joaquim; Stubbs, Brendon; Ricca, Valdo; Moretti, Davide; Busatta, Daniele; Carvalho, Andre F.; Dragioti, Elena; Favaro, Angela; Monteleone, Alessio Maria; Shin, Jae Il; Fusar-Poli, Paolo; Castellini, Giovanni

    Abstract in English:

    Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.
  • The safety and efficacy of acceptance and commitment therapy against psychotic symptomatology: a systematic review and meta-analysis REVIEW ARTICLE

    Brown, Ellie; Shrestha, Monika; Gray, Richard

    Abstract in English:

    Objective: Acceptance and commitment therapy (ACT) is a third-wave psychological intervention that has attracted considerable clinical and research attention. A previous meta-analysis of ACT trials in psychosis reported a large effect size of ACT against overall psychotic symptomatology. However, there were critical methodological issues in the review that justify replication. Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) testing ACT vs. any comparator condition in a sample of adults with psychosis. The outcome of interest was overall psychotic symptomatology. Results: The search identified seven published and eight unpublished trials (of which we were able to obtain data from one). Data on symptomatology were extracted from six trials that involved 274 participants. The summary effect size (Hedge’s G) for overall symptomatology was small and not significant (-0.21, 95%CI -0.60-0.18). Trials were generally rated as having a high risk of bias. Safety reporting was inadequate across included trials. Conclusions: Our observed effect size contrasted with that reported in a previous meta-analysis; differences were likely explained by errors in data extraction. The findings of this review suggest that there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology. Systematic review registration: CRD42018097200
  • Increased depression and anxiety during the COVID-19 pandemic in Brazilian mothers: a longitudinal study LETTERS TO THE EDITORS

    Loret de Mola, Christian; Blumenberg, Cauane; Martins, Rafaela C.; Martins-Silva, Thais; Carpena, Marina X.; Del-Ponte, Bianca; Pearson, Rebecca; Soares, Ana L.; Cesar, Juraci A.
  • A Brazilian adaptation of the Affective and Cognitive Measure of Empathy LETTERS TO THE EDITORS

    Ellis, Myddryn; Reis, Samara; Vachon, David D.
  • Return to work after severe traumatic brain injury: further investigation of the role of personality changes LETTERS TO THE EDITORS

    Balan, Alexandre B.; Walz, Roger; Diaz, Alexandre P.; Schwarzbold, Marcelo L.
  • Ditching candidate gene association studies: lessons from psychiatric genetics LETTERS TO THE EDITORS

    Duarte, Rodrigo R.R.; Brentani, Helena; Powell, Timothy R.
  • Corrigendum Corrigendum

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