Brazilian Journal of Psychiatry, Volume: 44, Issue: 3, Published: 2022
  • The notable humanist and scientist Aaron Beck (1921-2021), the revolutionary founder of cognitive therapy Editorial

    Mendlowicz, Mauro V.; Levitan, Michelle N.; Nardi, Antonio E.; Shorter, Edward
  • The first department of medical psychology in the world and its impact on medical education Editorial

    Crippa, José A.S.; Hallak, Jaime E.C.
  • The 400th anniversary of the birth of Thomas Willis (1621-1675): an invaluable contributor to neuroscience Editorial

    Monteiro, Fernanda C.; Nardi, Antonio E.; Gomes, Marleide M.
  • Philosophy and psychiatry: problems of clinicians and problems of life Editorial

    Stein, Dan J.
  • Problems of living meaningfully in psychiatry and philosophy Editorial

    Metz, Thaddeus
  • The appeal and challenges of an integrative approach to psychiatry Editorial

    Ambríz González, Rafael; Bortolotti, Lisa
  • On our minds: the state of child and adolescent mental health Editorial

    Buchweitz, Claudia; Caye, Arthur; Kieling, Christian
  • Emotion regulation and the COVID-19 pandemic: a practical guide to rehabilitating children and adolescents Editorial

    Khafif, Tatiana Cohab; Kleinman, Ana; Rotenberg, Luisa de Siqueira; Lafer, Beny
  • The pathophysiology of high-lethality suicide attempts: a vital area of suicide research Editorial

    Sher, Leo
  • The potential of brain stimulation techniques for substance use disorder treatment Editorial

    Webber, Heather E.; Schmitz, Joy M.
  • Secondary mechanisms by which SARS-CoV-2 affects the brain Editorial

    Finsterer, Josef; Scorza, Fulvio Alexandre; Scorza, Carla Alessandra; Fiorini, Ana Claudia
  • What is the role of microbial infection in Alzheimer’s disease? Editorial

    Barichello, Tatiana; Giridharan, Vijayasree V.; Comim, Clarissa M.; Morales, Rodrigo
  • Dependence on hypnotics: a comparative study between chronic users of benzodiazepines and Z-drugs Original Article

    Curado, Daniela F.; de Barros, Viviam V.; Noto, Ana R.; Opaleye, Emérita S.

    Abstract in English:

    Objective: To evaluate dependence among chronic benzodiazepine and Z-drug users in Brazil. Methods: Chronic users of benzodiazepines (n=94), Z-drugs (n=74), or both (n=11) were recruited from the community, underwent a psychiatric evaluation and completed self-report instruments on hypnotic dependence, insomnia, anxiety, and depression. Users of benzodiazepines and Z-drugs were compared using t-tests, and logistic regression models were employed to explore significant predictors of a dependence diagnosis. Results: There was no difference in the prevalence of dependence among benzodiazepine (77.2%) and Z-drug (69.4%) users. Benzodiazepine users reported increased psychosocial aspects of dependence, anxiety, and depression. Preoccupation with the availability of medication (prevalence ratio [PR] = 2.39 [1.15-5.20]) and insomnia (PR = 1.10 [1.02-1.19]) were associated with a diagnosis of dependence (n=175). Conclusion: The prevalence of dependence was similar among both drug classes. The increased self-reported dependence, anxiety, and depression among benzodiazepine users may be due to behavioral rather than pharmacological aspects of medication use. Behaviors related to hypnotic use were important predictors of dependence.
  • Underage drinking in Brazil: findings from a community household survey Original Article

    Rakovski, Coral; Cardoso, Taiane de Azevedo; da Mota, Jurema Corrêa; Bastos, Francisco I.; Kapczinski, Flavio; De Boni, Raquel Brandini

    Abstract in English:

    Objectives: Previous studies have estimated the 30-day prevalence of alcohol use to be approximately 21% among youth in Brazil, despite the legal drinking age of 18 years. The present study aimed to determine the prevalence of underage drinking and its associated factors among adolescents in Brazil. Methods: The 3rd National Survey on Drug Use by the Brazilian Population (III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira) is a nationwide, multi-stage, probability-sample household survey. Herein, youth between the ages of 12-17 years were included. Lifetime and 12-month alcohol use prevalence were estimated. Factors associated with 12-month alcohol use were evaluated through multivariate analysis considering survey weights and design. Results: Overall, 628 youth were interviewed. Estimated lifetime and 12-month alcohol use were 34.3% (standard error [SE] = 1.9) and 22.2% (SE = 1.7), respectively. Factors associated with 12-month drinking were: other/no religion vs. Christianity; living in rural vs. urban areas; self-reported diagnosis of depression vs. no self-reported depression; lifetime tobacco use vs. no history of tobacco use; and any illicit drug use vs. no history of illicit drug use. Conclusion: Considering that alcohol use is a major risk factor for early death among Brazilian youth, our findings highlight the importance of preventative measures to reduce underage drinking.
  • Adaptation and validation of the Mood Rhythm Instrument for use in Brazilian adolescents Original Article

    Francisco, Ana Paula; Cunha, Ana Maria Delgado; Tonon, Andre Comiran; Scop, Marina; Mathur, Salina; Caropreso, Luisa; Frey, Benicio Noronha; Hidalgo, Maria Paz

    Abstract in English:

    Objective: Adapt and validate the Mood Rhythm Instrument (MRhI), a self-reported questionnaire that assesses self-perceived rhythmicity of mood-related symptoms in adults, into a version that assesses and evaluates perceived mood-related symptoms in adolescents (MRhI-Y). Methods: Adaptation of the Brazilian Portuguese version of the MRhI for an adolescent population followed three steps: review by consultants, analysis by experts, and pilot testing through a visual analogue scale (VAS). The final questionnaire (MRhI-Y) was applied to 171 adolescents aged 12-17 years. Internal consistency was calculated using Cronbach’s alpha and McDonald’s omega. The psychometric properties of the MRhI-Y were evaluated using exploratory factor analysis (EFA). Results: The MRhI-Y was designed to use wording more appropriate for adolescents than that of the MRhI. Expert agreement about item quality ranged between 82 and 100%. Adolescents’ VAS ratings indicated good comprehension of the items. Cronbach’s alpha and McDonalds’ omega coefficients were 0.71 and 0.74. The EFA resulted in a three-factor solution (affective, cognitive, and somatic). Younger adolescents (ages 12 to 13) reported lower rhythmicity scores than older groups (ages 14 to 15 and 16 to 17), even controlling for chronotype. Conclusions: The Brazilian Portuguese version of the MRhI-Y presented adequate comprehension by adolescents and good internal consistency. The MRhI-Y is a promising tool to improve our understanding of the underlying characteristics of mood fluctuation in adolescence.
  • Patterns of impairment in decision-making capacity in Alzheimer’s disease and its relationship with cognitive and clinical variables Original Article

    Santos, Raquel Luiza; Simões Neto, José Pedro; Belfort, Tatiana; Lacerda, Isabel Barbeito; Dourado, Marcia Cristina Nascimento

    Abstract in English:

    Objectives: To investigate the patterns of impairment in decision-making abilities and their relationship with cognitive and clinical symptoms in people with Alzheimer’s disease. We hypothesized that decision-making abilities would not be impaired at the same level and would be related to impairment of global cognition and other clinical symptoms of the disease. Methods: Using a cross-sectional design, we included a consecutive sample of 102 people with Alzheimer’s disease and their respective caregivers. We investigated the relationship between decision-making capacity and quality of life (QoL), disease awareness, mood, functionality, neuropsychiatric symptoms, and cognition. Results: Different levels of impairment were observed in the participants’ decision-making abilities. Understanding, appreciation, and reasoning were correlated, but expressing a choice was only correlated with appreciation. Deficits in understanding were related to impaired disease awareness, lower self-reported QoL, and lower comprehension of spoken language. Better appreciation was related to better orientation and lower age. Better reasoning was related to better orientation and better self-reported QoL. Deficits in expressing a choice were related to lower self-reported QoL. Conclusion: The pattern of impairment in decision-making abilities was not linear. Each decision-making ability was related to different cognitive and clinical deficits. Therefore, cognitive functioning is an insufficient criterion for judging an individual’s decision-making ability.
  • Suicide attempt, impulsivity, and exposure to trauma in college students Original Article

    Lira, Sidnei B.; Vieira, Flávia; Cavalcanti, Diogo E.; Souza-Marques, Breno; Netto, Liana R.; Correia-Melo, Fernanda S.; Leal, Gustavo C.; Pereira, Juliana L.; Santos, Lene L.; Guedes, Gisela M.; Teles, Carlos A.; Cardoso, Taiane de A.; Miranda-Scippa, Ângela; Kapczinski, Flavio; Lacerda, Acioly L.T.; Koenen, Karestan C.; Turecki, Gustavo; Quarantini, Lucas C.

    Abstract in English:

    Objectives: Past suicide attempt (SA) is one of the most important risk factors for suicide death. An ideation-to-action framework posits that impulsivity, potentially traumatic events, and mental disorders also play a role in increasing suicide risk. This study aimed to assess the association between trait impulsivity, lifetime exposure to trauma, and post-traumatic stress disorder (PTSD) with SA in a sample of Brazilian college students. Methods: A total of 2,137 participants filled self-reported questionnaires consisting of a sociodemographic and clinical questionnaire, Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist – Civilian version, and Barratt Impulsiveness Scale. Results: Our findings suggest that trait impulsivity may be interpreted as exerting a distal effect on SA, even in the presence of other variables – such as trauma history, psychological neglect, and PTSD – which also increase the odds of SA. High and medium levels of impulsivity, history of trauma, and PTSD increased the likelihood of SA. Conclusions: Intervention strategies to prevent SA may target trait impulsivity and exposure to traumatic experiences.
  • Do varsity college athletes have a greater likelihood of risky alcohol and cannabis use than non-athletes? Results from a National Survey in Brazil Original Article

    Mannes, Zachary L.; Hasin, Deborah S.; Martins, Silvia S.; Gonçalves, Priscila D.; Livne, Ofir; de Oliveira, Lucio G.; de Andrade, Arthur G.; McReynolds, Larkin S.; McDuff, David; Hainline, Brian; Castaldelli-Maia, João M.

    Abstract in English:

    Objective: We examined the prevalence of risky alcohol and cannabis use among Brazilian varsity college athletes and whether this group had a greater likelihood of risky use than non-athletes. Methods: In 2009, Brazilian college students (n=12,711) were recruited for a national stratified random survey. Their sociodemographic characteristics, mental health, substance use, and participation in varsity sports were assessed. Binary logistic regression models were used to examine the association between varsity athlete status and moderate to high-risk alcohol and cannabis use. Results: Among varsity athletes, 67.6 and 10.7% reported risky alcohol and cannabis use, respectively. Varsity athletes had greater odds of risky alcohol consumption than non-athletes (aOR = 2.02, 95%CI 1.08-3.78). Varsity athletes also had greater odds of risky cannabis use than non-athletes in unadjusted analyses (OR = 2.57, 95%CI 1.05-6.28), although this relationship was attenuated after covariate adjustment. Conclusions: Among college students in Brazil, varsity athletes had a higher prevalence of risky alcohol and cannabis use than non-athletes. The rates were considerably higher than those observed among samples of U.S. college athletes. Future research should examine the use of these substances among varsity college athletes in other middle-income countries since these findings will likely guide prevention and treatment efforts.
  • The anxiolytic effect of cannabidiol depends on the nature of the trauma when patients with post-traumatic stress disorder recall their trigger event Original Article

    Bolsoni, Lívia Maria; Crippa, José Alexandre S.; Hallak, Jaime Eduardo Cecílio; Guimarães, Francisco Silveira; Zuardi, Antonio Waldo

    Abstract in English:

    Objectives: We assessed whether administering cannabidiol (CBD) before recalling the traumatic event that triggered their disorder attenuates anxiety in patients with post-traumatic stress disorder (PTSD). As an exploratory pilot analysis, we also investigated whether this effect depends on the nature of the event (sexual vs. nonsexual trauma). Methods: Thirty-three patients of both sexes with PTSD were recruited and randomized 1:1 into two groups. One group received oral CBD (300 mg), and the other received a placebo before listening to a digital audio playback of their previously recorded report of the trigger event. Subjective and physiological measurements were taken before and after recall. We analyzed the data in two subsamples: trigger events involving sexual and nonsexual trauma. Results: In the nonsexual trauma group, the differences between measurements before and after recall were significantly smaller with CBD than placebo; this held true for anxiety and cognitive impairment. However, in the sexual trauma group, the differences were non-significant for both measurements. Conclusion: A single dose of CBD (300mg) attenuated the increased anxiety and cognitive impairment induced by recalling a traumatic event in patients with PTSD when the event involved nonsexual trauma.
  • Real world evidence in involuntary psychiatric hospitalizations: 64,685 cases Brief Communication

    Fornazari, Christina; Canfield, Martha; Laranjeira, Ronaldo

    Abstract in English:

    Objective: We explored hospitalization patterns and the clinical and individual characteristics of a large cohort of patients who underwent involuntary psychiatric hospitalization in Brazil (n=64,685). Methods: Data were collected from the District Attorney's Office of the State of São Paulo (Ministério Público do Estado de São Paulo) on all involuntary psychiatric hospitalizations in the city of São Paulo between January 2003 and February 2020. The annual involuntary psychiatric hospitalization rate was calculated and descriptive statistics of the characteristics were produced. Results: Involuntary psychiatric hospitalizations increased from 5.8 to 25.5 per 100,000 population, with an eight-folder increase in the first 10-year period (2003-2013). The majority of admissions were to public institutions (86.6%), involved a psychotic disorder in the primary diagnosis (26.1%), involved more than one diagnosis (83.7%), and lasted less than 7 days (52.4%). The majority of the patients were aged 18 to 39 years and were single, and readmission was relatively common (13%). Although the reason for admission was missing in many reports (44%), the risk of harm to self or others was the most common (68.5%). Conclusion: This is one of the largest cohorts of involuntary psychiatric hospitalization records ever explored. These findings build upon existing international evidence about involuntary psychiatric hospitalizations and show recent trends in admission rates in the largest city in Brazil.
  • Physical activity and depressive symptoms among adolescents in a school-based sample Brief Communication

    Velazquez, Bruna; Petresco, Sandra; Pereira, Rivka; Buchweitz, Claudia; Manfro, Pedro H.; Caye, Arthur; Fisher, Helen L.; Kohrt, Brandon A.; Mondelli, Valeria; Kieling, Christian

    Abstract in English:

    Objective: To explore associations between self-reported weekly physical activity and depressive symptomatology among adolescents in a school-based sample from Brazil. Methods: We surveyed 7,405 adolescents aged 14 to 16 years in 101 public schools in Porto Alegre, Brazil. We assessed physical activity using an adapted version of the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition – Adolescent Physical Activity Measure (PACE+), and depressive symptoms using the Brazilian Portuguese version of the Patient Health Questionnaire – Adolescent Version. We compared the depressive symptom scores among adolescents with varying levels of physical activity. Results: Of the overall sample, 84.4% exercised less than the recommended frequency of 60 minutes/day, at least 5 days/week, of moderate to intense physical activity (PACE+ score ≥ 5). Adolescents whose physical activity levels fell below that threshold had higher median depression scores (8 [IQR = 10] vs. 7 [IQR = 9], W = 4060461, p < 0.001). A similar pattern was observed for depression scores in those with PACE+ < 1 (median of 10 [IQR = 11]) and ≥ 1 (7 [IQR = 9], W = 7457608, p < 0.001). Conclusion: In this large sample of Brazilian adolescents, those who exercised less frequently and vigorously than their peers reported more depressive symptoms.
  • A narrative review on invasive brain stimulation for treatment-resistant depression Special Article

    Dandekar, Manoj P.; Diaz, Alexandre P.; Rahman, Ziaur; Silva, Ritele H.; Nahas, Ziad; Aaronson, Scott; Selvaraj, Sudhakar; Fenoy, Albert J.; Sanches, Marsal; Soares, Jair C.; Riva-Posse, Patricio; Quevedo, Joao

    Abstract in English:

    While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.
  • Web-based exercise interventions for patients with depressive and anxiety disorders: a systematic review of randomized controlled trials Review Article

    Carneiro, Lara; Rosenbaum, Simon; Ward, Philip B.; Clemente, Filipe M.; Ramirez-Campillo, Rodrigo; Monteiro-Júnior, Renato S.; Martins, Alexandre; Afonso, José

    Abstract in English:

    Objective: The number of people suffering from depression and/or anxiety has increased steadily due to the coronavirus disease 2019 (COVID-19) pandemic. In this context, web-based exercise interventions have emerged as a potential treatment strategy. The objective of this study was to synthetize evidence from randomized controlled trials regarding the effects of web-based exercise interventions on patients with depressive and/or anxiety disorders. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Six databases were searched (Cochrane Library, EBSCO, PubMed, SciELO, Scopus, and Web of Science), and eligible articles were identified according to a PICOS inclusion-exclusion approach (participants with depressive or anxiety disorders; web-based exercise interventions; active or passive control group; assessment of changes in depressive or anxiety disorders; randomized design). Primary outcomes were depressive and/or anxiety symptoms. The quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Results: Of 7,846 search results, three studies met the inclusion criteria (172 participants between 18 and 65 years of age, 95.9% women). The web-based exercise interventions lasted 8-12 weeks and involved endurance training, yoga, or combined endurance and strength training. The comparators involved non-exercise controls or active controls. Compliance rates were low. Web-based exercise interventions were not superior to controls regarding anxiety symptoms, and only one study found benefits for depressive symptoms (p ≤ 0.05). The quality of the cumulative evidence was low. Conclusion: The available data regarding the effects of web-based exercise interventions on depression and/or anxiety symptoms is scarce, the risk of bias is high, and the quality of the cumulative results is low. Currently, no clear recommendations can be provided. Registration number: PROSPERO CRD42021225938.
  • Melatonin use during pregnancy and lactation: A scoping review of human studies Review Article

    Vine, Tya; Brown, Gregory M.; Frey, Benicio N.

    Abstract in English:

    Objective: The prevalence of sleep disorders during the perinatal period is high and large health administrative database surveys have shown that the use of exogenous melatonin in pregnant populations is quite common, about 4%. Much of the concern about using melatonin during pregnancy and breastfeeding stems from animal research. Thus, the objective of this article is to provide a critical review of human studies related to exogenous melatonin use during pregnancy and breastfeeding. Methods: The electronic databases Ovid, MEDLINE, Embase, and the Cochrane Library were searched using terms and keywords related to melatonin, pregnancy, and breastfeeding. Results: Fifteen studies were included in this review. Eight focused on melatonin use during pregnancy and seven focused on melatonin use during breastfeeding. There was a variety of study designs, including case reports, cohort studies, and clinical trials. There is a lack of randomized, controlled trials examining the efficacy and safety of melatonin as a treatment for sleep disorders during pregnancy or breastfeeding and, notably, insomnia was not the primary outcome measure in any of the studies included in this review. Clinical trials that used exogenous melatonin during pregnancy and breastfeeding for other clinical conditions have not suggested major safety concerns or adverse events. Conclusion: Contrary to what animal studies have suggested, evidence from clinical studies to date suggests that melatonin use during pregnancy and breastfeeding is probably safe in humans. This review further emphasizes the need for clinical studies on sleep disorders, including exogenous melatonin, during pregnancy and lactation.
  • Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis Review Article

    Sayyah, Mehdi; Delirrooyfard, Ali; Rahim, Fakher

    Abstract in English:

    Objective: The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD). Methods: We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed. Results: Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II). Conclusion: The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.
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