Brazilian Journal of Psychiatry, Volume: 43, Issue: 5, Published: 2021
  • Cannabidiol and mental health: possibilities, uncertainties, and controversies for addiction treatment Editorial

    Kessler, Felix H.; von Diemen, Lisia; Ornell, Felipe; Sordi, Anne O.
  • Advancing the use of non-invasive brain stimulation through systematic data review Editorial

    Fitzgerald, Paul B.
  • Pressure is not a privilege: what we can learn from Simone Biles Editorial

    Tardelli, Vitor S.; Parmigiano, Tathiana R.; Castaldelli-Maia, João M.; Fidalgo, Thiago M.
  • Convergent evidence for the antiviral effects of several FDA-approved phenothiazine antipsychotics against SARS-CoV-2 and other coronaviruses Editorial

    Machado-Vieira, Rodrigo; Quevedo, João; Shahani, Lokesh; Soares, Jair C.
  • Guidelines for assessing and treating suicidal individuals: toward validated approaches for difficult clinical cases Editorial

    Pompili, Maurizio
  • Cannabidiol for the treatment of crack-cocaine craving: an exploratory double-blind study Original Article

    Meneses-Gaya, Carolina de; Crippa, José A.; Hallak, Jaime E.; Miguel, André Q.; Laranjeira, Ronaldo; Bressan, Rodrigo A.; Zuardi, Antonio W.; Lacerda, Acioly L.

    Abstract in English:

    Objective: To assess the efficacy of cannabidiol (CBD) in the management of crack-cocaine craving and the treatment of frequent withdrawal symptoms. Methods: Thirty-one men with a diagnosis of crack-cocaine dependence were enrolled in a randomized, double-blind, placebo-controlled trial. We applied neuropsychological tests and assessed craving intensity, anxiety and depression symptoms, and substance use patterns at baseline and at the end of the trial. The participants were treated with CBD 300 mg/day or placebo for 10 days. During this period, we used a technique to induce craving and assessed the intensity of symptoms before and after the induction procedure. Results: Craving levels reduced significantly over the 10 days of the trial, although no differences were found between the CBD and placebo groups. Craving induction was successful in both groups, with no significant differences between them. Indicators of anxiety, depression, and sleep alterations before and after treatment also did not differ across groups. Conclusion: Under the conditions of this trial, CBD was unable to interfere with symptoms of crack-cocaine withdrawal. Further studies with larger outpatient samples involving different doses and treatment periods would be desirable and timely to elucidate the potential of CBD to induce reductions in crack-cocaine self-administration.
  • Increased body sway in phobic patients exposed to images of spiders Original Article

    Linares, Ila M.P.; Nardi, Antonio E.; Guimarães, Francisco S.; Arrais, Katia C.; Chagas, Marcos H.; Osório, Flavia L.; Hallak, Jaime E.; Zuardi, Antonio W.; Coimbra, Norberto C.; Crippa, José A.

    Abstract in English:

    Objective: The aim of the present study was to analyze the body sway response in specific phobia (SP) patients and healthy controls while viewing neutral, phobic, and disgusting images. Methods: The participants’ heart rate (HR) and skin conductance were also recorded during the procedure. Nineteen patients with arachnophobia and 19 healthy volunteers matched by age, gender, and years of education underwent a postural control test on a stabilometric platform. Results: The platform recorded increased body sway in the SP group when exposed to spider images (SPI). The SP group presented increases in most parameters (SD, velocity, frequency, area, p ≤ 0.05) when viewing pictures of the SPI category. Psychometric measures of subjective anxiety (State-Trait Anxiety Inventory, STAI) and physiological states (HR; skin conductance responses; spontaneous fluctuations in skin conductance) showed increased anxiety (p ≤ 0.05) in the SP group compared to healthy volunteers. High anxiety levels were observed throughout the assessment, including the task of exposure to SPI (p ≤ 0.05). No significant effect or correlation was found between skin conductance and body sway measures (p > 0.05). Conclusions: The results of the postural control test suggest the occurrence of a defensive escape response in SP, in agreement with previous evidence.
  • Nitrous oxide as an adjunctive therapy in major depressive disorder: a randomized controlled double-blind pilot trial Original Article

    Guimarães, Mara C.; Guimarães, Tiago M.; Hallak, Jaime E.; Abrão, João; Machado-de-Sousa, João P.

    Abstract in English:

    Objective: Major depressive disorder (MDD) is related to glutamatergic dysfunction. Antagonists of glutamatergic N-methyl-D-aspartate receptor (NMDAR), such as ketamine, have antidepressant properties. Nitrous oxide (N2O) is also a NMDAR antagonist. Thus, this study aimed to evaluate the effects of augmenting antidepressant treatment with N2O. Methods: This double blind, placebo-controlled randomized parallel pilot trial was conducted from June 2016 to June 2018 at the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Twenty-three subjects with MDD (aged 18 to 65, on antidepressants, with a score > 17 on the 17-item-Hamilton Depression Rating Scale [HAM-D17]) received 50% N2O (n=12; 37.17±13.59 years) or placebo (100% oxygen) (n=11; 37.18±12.77 years) for 60 minutes twice a week for 4 weeks. The primary outcome was changes in HAM-D17 from baseline to week 4. Results: Depressive symptoms improved significantly in the N2O group (N2O: from 22.58±3.83 to 5.92±4.08; placebo: from 22.44±3.54 to 12.89±5.39, p < 0.005). A total of 91.7% and 75% of the N2O group subjects achieved response (≥ 50% reduction in HAM-D17 score) and remission (HAM-D17 < 7), respectively. The predominant adverse effects of N2O treatment were nausea, vomiting, and headache. Conclusion: N2O treatment led to a statistically significant reduction in HAM-D17 scores compared to placebo. Clinical trial registration: Brazilian Register of Clinical Trials, RBR-5rz5ch
  • Mental health problems among healthcare workers involved with the COVID-19 outbreak Original Article

    Robles, Rebeca; Rodríguez, Evelyn; Vega-Ramírez, Hamid; Álvarez-Icaza, Dení; Madrigal, Eduardo; Durand, Sol; Morales-Chainé, Silvia; Astudillo, Claudia; Real-Ramírez, Janet; Medina-Mora, María-Elena; Becerra, Claudia; Escamilla, Raúl; Alcocer-Castillejos, Natasha; Ascencio, Leticia; Díaz, Dulce; González, Hugo; Barrón-Velázquez, Evalinda; Fresán, Ana; Rodríguez-Bores, Lorena; Quijada-Gaytán, Juan-Manuel; Zabicky, Gady; Tejadilla-Orozco, Diana; González-Olvera, Jorge-Julio; Reyes-Terán, Gustavo

    Abstract in English:

    Objective: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers’ mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. Methods: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. Results: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). Conclusion: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.
  • Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial Brief Communication

    El Rafihi-Ferreira, Renatha; Morin, Charles M.; Toscanini, Andrea C.; Lotufo Neto, Francisco; Brasil, Israel S.; Gallinaro, João G.; Borges, Daniel Suzuki; Conway, Silvia G.; Hasan, Rosa

    Abstract in English:

    Objective: To evaluate a protocol for acceptance and commitment therapy-based behavioral intervention for insomnia (ACT-BBI-I) in adults compared to cognitive behavioral therapy for insomnia (CBT-I). Methods: Forty-five adults with chronic insomnia were randomized to ACT-BBI-I or CBT-I. Both interventions were performed in six weekly group sessions. The common treatment elements in both protocols included stimulus control and sleep restriction. CBT-I is focused on the cognitive restructuring of maladaptive beliefs about sleep and the daytime effects of insomnia. ACT-BBI-I focuses on therapeutic processes of acceptance, availability, values, defusion, and commitment. The results were evaluated through the following instruments: a sleep diary, the Insomnia Severity Index, the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, the Acceptance and Action Questionnaire-II, and the Dysfunctional Beliefs and Attitudes about Sleep scale. Results: Both interventions had a significant positive impact on sleep patterns, insomnia, anxiety, beliefs about sleep, and psychological flexibility. All improvement was maintained at the 6-month follow-up. Conclusion: The results suggest that integrating principles of ACT with behavioral techniques may be useful for treating insomnia. Further research should identify whether the principles of ACT result in added effectiveness compared to behavioral components alone. Clinical trial registration: RBR-7nc5wq
  • Subjective sleep parameters in prodromal Alzheimer’s disease: a case-control study Brief Communication

    Borges, Conrado R.; Piovezan, Ronaldo D.; Poyares, Dalva R.; Busatto Filho, Geraldo; Studart-Neto, Adalberto; Coutinho, Artur M.; Tufik, Sergio; Nitrini, Ricardo; Brucki, Sonia M.

    Abstract in English:

    Objective: People with Alzheimer’s disease (AD) dementia have impaired sleep. However, the characteristics of sleep in the early stages of AD are not well known, and studies with the aid of biomarkers are lacking. We assessed the subjective sleep characteristics of non-demented older adults and compared their amyloid profiles. Methods: We enrolled 30 participants aged ≥ 60 years, with no dementia or major clinical and psychiatric diseases. They underwent [11C]PiB-PET-CT, neuropsychological evaluations, and completed two standardized sleep assessments (Pittsburgh Sleep Quality Inventory and Epworth Sleep Scale). Results: Comparative analysis of subjective sleep parameters across the two groups showed longer times in bed (p = 0.024) and reduced sleep efficiency (p = 0.05) in individuals with positive amyloid. No differences in other subjective sleep parameters were observed. We also found that people with multiple-domain mild cognitive impairment (MCI) had shorter self-reported total sleep times (p = 0.034) and worse overall sleep quality (p = 0.027) compared to those with single-domain MCI. Conclusions: Older adults testing positive for amyloid had a longer time in bed and lower sleep efficiency, regardless of cognitive status. In parallel, individuals with multiple-domain MCI reported shorter sleep duration and lower overall sleep quality.
  • Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials Special Article

    Razza, Laís B.; Afonso dos Santos, Leonardo; Borrione, Lucas; Bellini, Helena; Branco, Luis C.; Cretaz, Eric; Duarte, Dante; Ferrão, Ygor; Galhardoni, Ricardo; Quevedo, João; Simis, Marcel; Fregni, Felipe; Correll, Christoph U.; Padberg, Frank; Trevizol, Alisson; Daskalakis, Zafiris J.; Carvalho, Andre F.; Solmi, Marco; Brunoni, André R.

    Abstract in English:

    Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.
  • Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment Special Article

    Baldaçara, Leonardo; Rocha, Gislene A.; Leite, Verônica da S.; Porto, Deisy M.; Grudtner, Roberta R.; Diaz, Alexandre P.; Meleiro, Alexandrina; Correa, Humberto; Tung, Teng C.; Quevedo, João; da Silva, Antônio G.

    Abstract in English:

    Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517
  • Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention Special Article

    Baldaçara, Leonardo; Grudtner, Roberta R.; da S. Leite, Verônica; Porto, Deisy M.; Robis, Kelly P.; Fidalgo, Thiago M.; Rocha, Gislene A.; Diaz, Alexandre P.; Meleiro, Alexandrina; Correa, Humberto; Tung, Teng C.; Malloy-Diniz, Leandro; Quevedo, João; da Silva, Antônio G.

    Abstract in English:

    This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517
  • Treatment compliance and risk and protective factors for suicide ideation to completed suicide in adolescents: a systematic review Review Article

    Rufino, Natalia C.; Fidalgo, Thiago M.; dos Santos, Juliana P.; Tardelli, Vítor S.; Lima, Marcelo G.; Frick, Luana P.; Mirkovic, Bojan; da Silveira, Dartiu X.; Cohen, David

    Abstract in English:

    Objective: To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts. Methods: PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples. Results: Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts. Conclusion: Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.
  • Increased risk-taking behavior during the COVID-19 pandemic: psychological underpinnings and implications Letters To The Editors

    Mackolil, Julia; Mackolil, Joby
  • Translation and validation of the Structured Interview for Prodromal Syndromes (SIPS) to Portuguese Letters To The Editors

    Diniz, Gabriel N.; Santos, Pedro A.M.F.; Andrade, Julio C.; Alves, Tania M.; Hortêncio, Lucas; van de Bilt, Martinus T.; Rössler, Wulf; Gattaz, Wagner F.; Loch, Alexandre A.
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