Resumo em Inglês:

Objective: The role of mood disorders in cancer onset is unclear. The aim of this study was to investigate the association between mood disorder and incident cancer in a population-based sample of women. Methods: Data were derived from women aged 28-94 years participating in the Geelong Osteoporosis Study. Mood disorder was identified via Clinical Interview (SCID-I/NP). Cancer data was obtained following linkage with the Victorian Cancer Registry. Demographic and lifestyle factors were self-reported. Nested case-control and retrospective study designs were utilized. Results: In the case-control study (n=807), mood disorder was documented for 18 of the 75 (9.3%) cancer cases and among 288 controls (24.0% vs. 39.3%, p = 0.009). Prior exposure to mood disorder was associated with reduced cancer incidence (OR 0.49, 95%CI 0.28-0.84); this was sustained following adjustment for confounders (ORadj 0.52, 95%CI 0.30-0.90). In the retrospective cohort study (n=655), among 154 women with a history of mood disorder at baseline, 13 (8.5%) developed incident cancer during follow-up, whereas among 501 women with no history of mood disorder, 54 (10.8%) developed incident cancer. Exposure to mood disorder was not associated with incident cancer over the follow-up period (HR 0.58, 95%CI 0.31-1.08, p = 0.09). Conclusion: Mood disorder was associated with reduced odds of cancer onset. However, this finding was not supported in the retrospective cohort study. Larger studies able to investigate specific cancers and mood disorders as well as underlying mechanisms in both men and women are warranted.

Resumo em Inglês:

Objective: Whether for spiritual, recreational, or potential therapeutic use, interest in ayahuasca has grown remarkably. Ayahuasca’s main active substances are N,N‐dimethyltryptamine and certain monoamine oxidase inhibitor β-carbolines. Possible drug interactions are a major concern, and research is lacking in this area. The objective of this study was to evaluate the safety of ritual ayahuasca use regarding adverse effects and risk factors. Methods: In this cross-sectional study, ayahuasca users from a religious institution answered an online questionnaire about its safety. Adverse effects, safety measures, and possible risk factors (psychiatric diagnosis and medications) were investigated. Results: The most frequent adverse effects among the 614 participants were transient gastrointestinal effects (nausea and vomiting). Fifty participants self-reported a psychiatric diagnosis (depression and anxiety were the most prevalent), and these participants experienced adverse effects more frequently. Psychiatric medication use was reported by 31 participants. No indication of increased adverse effects due to drug-drug interactions was found. Conclusion: A minority of participants reported being very negatively affected by persistent adverse effects. Psychiatric medication use while participating in ayahuasca rituals was not associated with increased adverse effects. For the most part, the institution’s practices seem sufficient to prevent exacerbated reactions. Future studies may focus on negatively affected users.

Resumo em Inglês:

Objectives: To investigate the prevalence of and factors associated with chronic insomnia and obstructive sleep apnea (CIOSA) comorbidity in obstructive sleep apnea (OSA) patients. Methods: Between March 2014 and March 2015, we conducted a prospective, cross-sectional study of 238 adults diagnosed with OSA according to polysomnography and International Classification of Sleep Disorders-Third Edition criteria. Results: The prevalence of CIOSA was 29%. There was a trend towards older age in the CIOSA group. Sex was not associated with CIOSA. Sleep-maintenance and sleep-onset insomnia predominated in the sample. Beck’s depression and anxiety inventory scores were higher in the CIOSA group. Both depression and anxiety symptoms were associated with CIOSA. The arousal and apnea-hypopnea indices were lower in the CIOSA group. CIOSA was also associated with age ≥ 60 years and current tobacco use. Severe OSA and alcohol use were negatively associated with CIOSA. Conclusions: Chronic insomnia is prevalent among OSA patients. Our study highlights the need for detailed evaluation of patients with sleep breathing disorders to diagnose other important sleep and mood disorders (such as depression and anxiety), given their frequent association.

Resumo em Inglês:

Objective: Chronic tobacco consumption, classified as tobacco use disorder (TUD), has been associated with a variety of health problems. Investigations of face processing in TUD are hampered by lack of evidence. Here, we evaluated facial detection in TUD and assessed test-retest reliability for a facial detection task. Methods: Participants were instructed to detect the orientation (either left or right) of a face when it was presented with a face/non-face pair on the monitor screen, using Bayesian entropy estimation. Bland-Altman analysis and intraclass correlation coefficients were used to test the reliability of the task. The general linear model and Bayesian statistics were then used to evaluate differences between TUD (n=48) and healthy controls (n=34). Results: The reliability of the task was high for the 96 stimuli presentations. Slower reaction times (p < 0.001) and lower discrimination index (p < 0.001) were observed in the TUD group than for healthy controls. Mediation analysis indicated direct effects of smoking duration on reaction time (p < 0.001) and discrimination index (p < 0.001). Conclusions: Overall, we observed high reliability of this task and reduction of facial detection in tobacco use disorder. We conclude our findings are significant for public health initiatives and call for follow-up studies.

Resumo em Inglês:

Objective: Hopelessness is considered a risk factor for several mental and behavioral disorders. Research has shown that a stressful life event can be a significant predictor of hopelessness. The aim of the current research study was to explore the relationship between stressful life events and hopelessness, as well as to analyses the mediation effect of both mentalization and emotional dysregulation on this relationship. Methods: In a cross-sectional design, 607 participants recruited from the Spanish general population completed a series of measures. Results: Hopelessness was significantly related to stressful life events (r = 0.24, p < 0.001), emotion dysregulation variables (r = 0.18/0.38), and most measures of mentalization (r = 0.02/0.34). A good-fitting structural equation modeling-based mediation model (χ2/df = 2.04; root mean squared error of approximation = 0.042 [90%CI 0.033-0.050]; comparative fit index = 0.97; non-normed fit index = 0.97) showed that mentalization significantly mediated the relationship between stressful life events and hopelessness, while emotion dysregulation had no significant mediating effect. Conclusions: These results could have important clinical implications, such as the development of mentalization-based interventions for people living under a large number of stressors.

Resumo em Inglês:

Objective: To detect latent patterns of drug-related problems and their predictors among adolescents. Methods: A three-wave randomized controlled trial was conducted among 6,391 7th and 8th graders (51.02% girls) at 72 public schools in six Brazilian cities to evaluate the #Tamojunto school-based drug prevention program. Patterns of drug use and behavior problems were identified through latent class analysis, and logistic regression analyses were used to detect predictors of high-risk and low-risk groups. Results: Two groups were found that best explained the patterns of drug use and problem behaviors: high drug use/high problems and low drug use/low problems, representing 36.7 and 63.3% of the sample, respectively. No program effect was a determinant of the risk of belonging to these groups. Any reported problem behavior in the year preceding baseline assessment increased the likelihood of belonging to the high-risk group at the 21-month follow-up by 16 times. Alcohol use at baseline and female gender increased the likelihood of belonging to the high-risk group by 70%. Conclusion: Previous behavior problems and alcohol use were the strongest predictors of higher risk, suggesting that effective earlier interventions and early screening for alcohol use and behavioral problems are needed at schools, particularly for girls. Clinical trial registration: Registro Brasileiro de Ensaios Clínicos (REBEC), RBR-4mnv5g

Resumo em Inglês:

Objective: To describe and compare measures of maternal depression, anxiety, and posttraumatic stress symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic in a Brazilian birth cohort. Methods: All hospital births occurring in the municipality of Rio Grande (southern Brazil) during 2019 were identified. Mothers were invited to complete a standardized questionnaire on sociodemographic and health-related characteristics. Between May and July 2020, we tried to contact all cohort mothers of singletons, living in urban areas, to answer a standardized web-based questionnaire. They completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder 7-item (GAD-7) in both follow-ups, and the Impact of Event Scale (IES) in the online follow-up. Results: We located 1,136 eligible mothers (n=2,051). Of those, 40.5% had moderate to severe stress due to the current pandemic, 29.3% had depression, and 25.9% had GAD. Mothers reporting loss of income during the pandemic (57.2%) had the highest proportions of mental health problems. Compared to baseline, the prevalence of depression increased 5.7 fold and that of anxiety increased 2.4-fold during the pandemic (both p < 0.001). Conclusion: We found a high prevalence of personal distress due to the ongoing COVID-19 pandemic, and a clear rise in both maternal depression and anxiety.

Resumo em Inglês:

This paper discusses essential issues related to long-term lithium therapy and presents a case of successful 50-year lithium treatment. Lithium is currently regarded as the drug of choice for preventing manic and depressive recurrences in bipolar disorder. In 1/3 of patients with bipolar disorder, long-term monotherapy with lithium can completely prevent recurrences of abnormal mood. Numerous clinical and psychosocial factors associated with a good response to lithium have been described. Lithium is more efficacious than other mood stabilizers, and its long-term treatment significantly exceeds them. Lithium also exerts antisuicidal, immunomodulatory, and neuroprotective effects. The main problems associated with long-term lithium treatment include kidney, thyroid, and probably cognitive issues. In this paper, a case of successful continuous lithium treatment for 50 years in a 79-year-old female patient is presented. In this patient, apart from maintaining a euthymic state, long-term lithium treatment also exerted a favorable effect on general health, especially the elimination of viral and other respiratory infections. It is concluded that ultra-long term lithium therapy can enable good professional and psychosocial functioning for many patients, and the possible somatic side effects are manageable.

Resumo em Inglês:

The development of “omic” technologies and deep phenotyping may facilitate a systems biology approach to understanding anxiety disorders. Systems biology approaches incorporate data from multiple modalities (e.g., genomic, neuroimaging) with functional analyses (e.g., animal and tissue culture models) and mathematical modeling (e.g., machine learning) to investigate pathological biophysical networks at various scales. Here we review: i) the neurobiology of anxiety disorders; ii) how systems biology approaches have advanced this work; and iii) the clinical implications and future directions of this research. Systems biology approaches have provided an improved functional understanding of candidate biomarkers and have suggested future potential for refining the diagnosis, prognosis, and treatment of anxiety disorders. The systems biology approach for anxiety disorders is, however, in its infancy and in some instances is characterized by insufficient power and replication. The studies reviewed here represent important steps to further untangling the pathophysiology of anxiety disorders.

Resumo em Inglês:

Objective: To propose a core curriculum for religiosity and spirituality (R/S) in clinical practice for psychiatry residency programs based on the available evidence. Methods: After performing a review of studies on the implementation of R/S curricula and identifying the most commonly taught topics and teaching methods, an R/S curriculum was developed based on the most prevalent strategies, as well as recommendations from psychiatric associations, resulting in a fairly comprehensive R/S curriculum that is simple enough to be easily implemented, even where there is a shortage of time and of faculty expertise. Results: The curriculum is a twelve-hour course (six 2-hour sessions). The topics include: concepts and evidence regarding R/S and mental health relationships, taking a spiritual history/case formulation, historical aspects and research, main local R/S traditions, differential diagnosis between spiritual experiences and mental disorders, and R/S integration in the approach to treatment. The teaching methods include: classes, group discussions, studying guidelines, taking spiritual histories, panels, field visits, case presentations, and clinical supervision. The evaluation of residents includes: taking a spiritual history and formulating an R/S case. The program evaluation includes: quantitative and qualitative written feedback. Conclusions: A brief and feasible core R/S curriculum for psychiatry residency programs is proposed; further investigation of the impact of this educational intervention is needed.

Resumo em Inglês:

Objective: Positive psychology interventions (PPIs) incorporate principles of personal strengths with the view that mental health recovery transcends symptom relief. Severe psychiatric conditions, such as schizophrenia, may benefit from such interventions. This study aims to gather the current evidence on the impact of PPIs on increasing well-being in patients on the schizophrenia spectrum and assess reductions in negative or positive symptoms. Methods: A systematic review of PPI studies with schizophrenia-spectrum patients was carried out following PRISMA recommendations. The PubMed, PsycINFO, Web of Science, and Scopus databases were searched for relevant publications in order to understand the possible effects of these interventions on well-being measures and psychotic symptoms in this population. Results: Nine studies (four controlled) were included. Meta-analysis of the controlled studies showed a significant effect (p = 0.04) for improvement of well-being (Z = 2.01). Overall, the reviewed evidence suggests well-being improvement. The effect on reduction of negative symptoms was unclear. Conclusion: Used as an adjunctive therapy, PPIs appear to be a promising resource for patients on the schizophrenia spectrum, with possible effects on well-being and symptom reduction.

Resumo em Inglês:

Objective: To assess the association between exposure to toxoplasmosis and major psychiatric disorders through a systematic review of the literature. Methods: The literature review was performed in the MEDLINE, SciELO, and PsycINFO databases. To evaluate the quality of the studies included in the review, the Newcastle-Ottawa Scale was used. Results: Thirty-one studies were included, and the majority found an association between exposure to toxoplasmosis and schizophrenia or bipolar disorder (58.3 and 54.5% of the included papers, respectively), but not major depressive disorder. We found no significant difference in mean quality scores between studies that corroborated and contradicted the association hypothesis for either schizophrenia or bipolar disorder. All included papers were considered at least satisfactory according to the Newcastle-Ottawa Scale (total scores ≥ 6 out of 9). Conclusion: Although there was no association between exposure to toxoplasmosis and major depressive disorder, the results indicate an association with both bipolar disorder and schizophrenia, despite their heterogeneity. Further studies should be performed with more specific variables so that the nature of these relationships can be elucidated.