Brazilian Journal of Psychiatry, Volume: 43, Issue: 6, Published: 2021
  • Unveiling ayahuasca psychopharmacology: the accomplishments of Jordi Riba (1968-2020) Editorial

    dos Santos, Rafael G.; Araujo, Draulio B.; Sanches, Rafael F.; Hallak, Jaime E.
  • Mental illnesses and their impact on the Brazilian workforce: an analysis of the cost of sick leave and pensions Editorial

    da Silva, Antônio G.; Serpa, Alexandre L.; Nardi, Antonio E.; Kessler, Felix H.P.; Pinheiro, Mayra I.; Bezerra, Josierton C.; Malloy-Diniz, Leandro F.
  • Abstinence, anti-drug psychosocial care centers and therapeutic communities: pillars for reorienting the Brazilian Mental Health and Drug Policy Editorial

    Weber, César A.; da Silva, Antônio G.; Nardi, Antonio E.; Juruena, Mario F.
  • The increasing risk of domestic violence, including parricide, during the COVID-19 pandemic: reflections and recommendations Editorial

    Valença, Alexandre M.; Telles, Lisieux E.; da Silva, Antônio G.; Barros, Alcina J.
  • Independent and combined associations of sugar-sweetened beverage consumption, TV viewing, and physical activity with severe depressive symptoms among 59,402 adults Original Article

    Werneck, André O.; Schuch, Felipe B.; Stubbs, Brendon; Oyeyemi, Adewale L.; Szwarcwald, Célia L.; Vancampfort, Davy; Silva, Danilo R.

    Abstract in English:

    Objective: Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association. Methods: We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses. Results: The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association. Conclusion: Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.
  • Body image is associated with leisure-time physical activity and sedentary behavior in adolescents: data from the Brazilian National School-based Health Survey (PeNSE 2015) Original Article

    Gomes, Maria L.B.; Tornquist, Luciana; Tornquist, Débora; Caputo, Eduardo L.

    Abstract in English:

    Objective: To evaluate the association of leisure-time physical activity and sedentary behavior with body image concern and satisfaction in Brazilian adolescents. Methods: Data were extracted from the 2015 Brazilian National Adolescent School-based Health Survey (Pesquisa Nacional de Saúde do Escolar [PeNSE]). Information regarding body image concern and satisfaction, as well as exposures (physical activity and sedentary behavior) and covariates (maternal education, age, smoking, and alcohol intake), were assessed through a questionnaire. Results: Logistic regression analysis revealed that engagement in recommended levels of physical activity (≥ 300 min/week) was associated with a decreased concern with body image and a high satisfaction in boys. Four or more hours spent in sedentary activities were associated with increased concern with body image and dissatisfaction among boys and girls. Conclusion: These findings support the relevance of programs aiming to promote physical activity and reduce sedentary behavior in the adolescent population. Such programs play a protective role against body dissatisfaction and are important for the development of a healthy body image in adolescence.
  • “I don’t need any treatment” – barriers to mental health treatment in the general population of a megacity Original Article

    Coêlho, Bruno M.; Santana, Geilson L.; Viana, Maria C.; Wang, Yuan-Pang; Andrade, Laura H.

    Abstract in English:

    Objective: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. Methods: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. Results: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). Conclusion: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.
  • First-time administration of the Sydney Melancholia Prototype Index (SMPI) to non-English-speaking patients: a study from Brazil Original Article

    Messinger, Mateus F.; Caldieraro, Marco A.; Mosqueiro, Bruno P.; da Costa, Felipe B.; Barcelos, William dos S.; Santos, Pedro V.; Parker, Gordon; Fleck, Marcelo P.

    Abstract in English:

    Objective: The Sydney Melancholia Prototype Index (SMPI) is a scale that uses a non-conventional strategy to assess melancholia status based on prototypic symptoms and illness course variables. This study aimed to evaluate the performance of the first translation of this instrument in a non-English-speaking population. Methods: A sample comprising 106 Brazilian outpatients with depression was evaluated simultaneously with the Brazilian version of the self-rated SMPI (SMPI-SR) and clinician-rated SMPI (SMPI-CR). The kappa coefficient and t test were used to evaluate concurrent validity vs. DSM-IV, CORE system, Hamilton Depression Rating Scale-6 item (HAM-D6), and HAM-D17 assignments to a melancholic or non-melancholic class. The prevalence of melancholia as well as sensitivity and specificity were calculated across instruments. Results: The prevalence of melancholia was highest using DSM-IV criteria (56.6%). The kappa agreement between SMPI-CR and DSM-IV melancholia assignment was moderate (kappa 0.44, p ≤ 0.001). SMPI-CR-assigned melancholic patients had significantly higher CORE, HAM-D17, and HAM-D6 scores. The test-retest consistency values for the SMPI were modest at best, and somewhat superior for the CR version. Conclusion: The Brazilian SMPI-CR presented satisfactory psychometric properties (which were superior to those of the SMPI-SR), and therefore appears to be a useful option for identifying melancholia and studying its causes and optimal treatments.
  • Neural correlates of negative and disease-specific emotional stimuli in panic disorder: a functional magnetic resonance imaging study Original Article

    Lopes, Fabiana L.; Faria, Clara G.F.; Dias, Gisele P.; Mallmann, Mariana B.; Mendes, Victoria; Horato, Natia; de-Melo-Neto, Valfrido L.; Veras, Andre B.; Magalhães, Fabio V.; Malaspina, Dolores; Nardi, Antonio E.

    Abstract in English:

    Objective: Decades of research have highlighted the involvement of the prefrontal cortex, anterior cingulated cortex, and limbic areas (amygdala) in panic disorder (PD). However, little attention has been given specifically to the inferior frontal gyrus. The current study aimed to investigate the neural substrates, including the inferior frontal gyrus, of both panic-related and negative conditions among individuals with PD and healthy controls. Methods: We examined 13 medication-free PD patients and 14 healthy controls with functional magnetic resonance imaging (fMRI) during exposure to negative and neutral pictures and a set of specific panic-related pictures. Results: Subtraction between the conditions indicated activation of the left amygdala region and the right inferior frontal gyrus in PD patients during the specific panic-related condition, whereas the left amygdalar region and left inferior frontal gyrus were activated during the negative condition in controls. Conclusion: These results suggest that in patients with PD, a prominent bottom-up process is involved in specific panic-related conditions, which might be associated with weak modulation of the left frontal area. These data add to our current understanding of the neural correlates of PD and can contribute to future clinical interventions targeting the functional reestablishment of these regions.
  • The Brazilian version of the SCOFF questionnaire to screen eating disorders in young adults: cultural adaptation and validation study in a university population Brief Communication

    Teixeira, Ananda A.; Roque, Marco A.; de Freitas, André A.; dos Santos, Nicole F.; Garcia, Flávia M.; Khoury, Júlia M.; Albuquerque, Maicon R.; das Neves, Maila de C.; Garcia, Frederico D.

    Abstract in English:

    Objective: This study translated, culturally adapted, and validated a Brazilian Portuguese version (SCOFF-BR) of the Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF) to screen eating disorders in young adults. Methods: This study used back-translation to culturally adapt the questionnaire according to International Society of Pharmacoeconomics and Outcome Research principles. The SCOFF-BR validation process involved a sample of men and women aged 18-32 years from a university community. After the participants completed the SCOFF-BR questionnaire, pre-trained researchers interviewed them with the Mini International Neuropsychiatric Interview (MINI). The presence of eating disorders was determined according to DSM-5 criteria. Results: Of the 361 subjects, 9.7% had an eating disorder (2.2% anorexia nervosa, 5% bulimia nervosa, and 2.5% binge-eating disorder). Using a cutoff point of two positive responses, we obtained a sensitivity of 80% and a specificity of 71.5%, with an accuracy of 72.3%. The positive and negative predictive values were 23.1% and 97.1%, respectively. Conclusion: This study demonstrated that the Brazilian version of the SCOFF questionnaire presents satisfactory accuracy and reliability to screen eating disorders among young adults in the Brazilian university community.
  • Olanzapine and quetiapine in the prevention of a new mood episode in women with bipolar disorder during the postpartum period: a retrospective cohort study Brief Communication

    Uguz, Faruk; Kirkas, Aysegul

    Abstract in English:

    Objective: To examine whether olanzapine and quetiapine are useful in the prevention of a new mood episode during the postpartum period. Methods: Data on 23 patients (n=14 for olanzapine and n=9 for quetiapine) with bipolar disorder who met the criteria for this study were retrospectively gathered. The diagnosis of bipolar disorder was determined by means of the DSM-IV. Results: The mean follow-up period was 33.95±12.07 weeks. Six (26.1%) of 23 patients experienced recurrent mood episodes during the postpartum period. Four of these six patients were taking olanzapine and two were taking quetiapine. Patients with recurrent mood episodes had a significantly stronger family history of bipolar disorder, higher number of past episodes, and earlier onset and longer duration of illness compared to patients without recurrent mood episodes. Conclusion: Monotherapy with olanzapine or quetiapine can be considered as an alternative to mood stabilizers in preventing the development of new mood episodes after childbirth.
  • Physical health in affective disorders: a narrative review of the literature Special Article

    Colomer, Lluc; Anmella, Gerard; Vieta, Eduard; Grande, Iria

    Abstract in English:

    This article reviews the most common non-psychiatric comorbidities associated with affective disorders, examining the implications of their possible bidirectional link. A narrative review was conducted on the association among the three most common non-psychiatric diseases in major depressive disorder and bipolar disorder (obesity, metabolic syndrome, and cardiovascular diseases) in articles published from January 1994 to April 2020. The evidence suggests that obesity, metabolic syndrome, and cardiovascular diseases are highly prevalent in patients diagnosed with affective disorders. The presence of non-psychiatric comorbidities significantly worsens the therapeutic management and prognosis of affective disorders and vice versa. In many cases, these comorbidities may precede the onset of affective disorders, although in most cases they appear after it. The presence of these concurrent non-psychiatric diseases in an individual diagnosed with an affective disorder is associated with a more complex disease presentation and management. For professionals, the evidence unequivocally supports routine surveillance of comorbidities from a multidisciplinary approach.
  • Diversity matters: opportunities in the study of the genetics of psychotic disorders in low- and middle-income countries in Latin America Special Article

    Fonseca, Lais; Sena, Brena F.; Crossley, Nicolas; Lopez-Jaramillo, Carlos; Koenen, Karestan; Freimer, Nelson B.; Bressan, Rodrigo A.; Belangero, Sintia I.; Santoro, Marcos L.; Gadelha, Ary

    Abstract in English:

    Lack of diversity regarding genetic and environmental backgrounds weakens the generalization and clinical applicability of research findings on psychotic disorders. Notably, Latin Americans have been generally neglected in genetic studies, comprising less than 2% of genome-wide association study samples. But Latin American populations represent a unique opportunity for research, given the exceptionally high ethnic admixture of this group. Increasing genetic diversity is essential to improve the fine mapping of known regions associated with psychotic disorders, discover novel genetic associations, and replicate studies. Additionally, Latin America is characterized by massive social, political, and economic inequalities, all known risk factors for mental health issues, including psychotic disorders. This article aims to 1) discuss the challenges and advantages of studying Latin America’s particular genetic makeup and environmental context; 2) review previous studies conducted in the region; and 3) describe three Latin American research initiatives in progress: the Neuropsychiatric Genetics of Psychosis in Mexican Populations (NeuroMEX), the Paisa, and the Latin American Network for the Study of Early Psychosis (ANDES) studies.
  • Translating science into policy: mental health challenges during the COVID-19 pandemic Special Article

    Mari, Jair J.; Gadelha, Ary; Kieling, Christian; Ferri, Cleusa P.; Kapczinski, Flavio; Nardi, Antonio E.; Almeida-Filho, Naomar; Sanchez, Zila M.; Salum, Giovanni A.

    Abstract in English:

    Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.
  • Neurobiology of COVID-19: how can the virus affect the brain? Special Article

    Generoso, Jaqueline S.; Barichello de Quevedo, João L.; Cattani, Matias; Lodetti, Bruna F.; Sousa, Lucas; Collodel, Allan; Diaz, Alexandre P.; Dal-Pizzol, Felipe

    Abstract in English:

    Severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) causes the coronavirus disease 2019 (COVID-19), which has been declared a public health emergency of international interest, with confirmed cases in most countries. COVID-19 presents manifestations that can range from asymptomatic or mild infections up to severe manifestations that lead to hospitalization and death. A growing amount of evidence indicates that the virus may cause neuroinvasion. Postmortem brain study findings have included edema, hemorrhage, hydrocephalus, atrophy, encephalitis, infarcts, swollen axons, myelin loss, gliosis, neuronal satellitosis, hypoxic-ischemic damage, arteriolosclerosis, leptomeningeal inflammation, neuronal loss, and axon degeneration. In addition, the COVID-19 pandemic is causing dangerous effects on the mental health of the world population, some of which can be attributed to its social impact (social distancing, financial issues, and quarantine). There is also a concern that environmental stressors, enhanced by psychological factors, are contributing to the emergence of psychiatric outcomes during the pandemic. Although clinical studies and diagnosing SARS-CoV-2-related neurological disease can be challenging, they are necessary to help define the manifestations and burden of COVID-19 in neurological and psychiatric symptoms during and after the pandemic. This review aims to present the neurobiology of coronavirus and postmortem neuropathological hallmarks.
  • Mental health interventions following COVID-19 and other coronavirus infections: a systematic review of current recommendations and meta-analysis of randomized controlled trials Review Article

    Damiano, Rodolfo F.; Di Santi, Talita; Beach, Scott; Pan, Pedro M.; Lucchetti, Alessandra L.; Smith, Felicia A.; Forlenza, Orestes V.; Fricchione, Gregory L.; Miguel, Eurípedes C.; Lucchetti, Giancarlo

    Abstract in English:

    Objective: To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics. Methods: We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analysis was performed with data from randomized controlled trials (RCTs). For non-RCT studies, a critical description of recommendations was performed. Results: From a total of 2,825 articles, 125 were included. Of those, three RCTs were included in the meta-analysis. The meta-analysis revealed that the interventions promoted better overall mental health outcomes as compared to control groups (standardized mean difference [SMD] = 0.87 [95%CI 0.33-1.41], p < 0.001, I2 = 69.2%), but did not specifically improve anxiety (SMD = 0.98 [95%CI -0.17 to 2.13], p > 0.05; I2 = 36.8%). Concerning the systematic review, we found a large body of scientific literature proposing recommendations involving psychological/psychiatric interventions, self-care, education, governmental programs, and the use of technology and media. Conclusions: We found a large body of expert recommendations that may help health practitioners, institutional and governmental leaders, and the general population cope with mental health issues during a pandemic or a crisis period. However, most articles had a low level of evidence, stressing the need for more studies with better design (especially RCTs) investigating potential mental health interventions during COVID-19. PROSPERO registration: CRD42020190212.
  • Concomitant deep brain stimulation and vagus nerve stimulation for treatment-resistant depression: a case report Letters To The Editors

    Nascimento, Flavio; Diaz, Alexandre Paim; Sanches, Marsal; Fenoy, Albert J.; Soares, Jair C.; Quevedo, Joao
  • Clinical perspective on antipsychotic receptor binding affinities Letters To The Editors

    Crapanzano, Calogero; Laurenzi, Pier Francesco; Amendola, Chiara; Casolaro, Ilaria
  • Corrigendum Corrigendum

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