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Brazilian Journal of Psychiatry, Volume: 44, Issue: 5, Published: 2022
  • Should psychiatrists be more cautious about the use of antipsychotics for patients with borderline personality disorder? Editorial

    Damiano, Rodolfo Furlan; Soares, Jair C.
  • Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder Original Article

    Scaini, Carolina Rheingantz; Vieira, Igor Soares; Machado, Rosiene; de Azevedo Cardoso, Taiane; Mondin, Thaise; Souza, Luciano; Molina, Mariane Lopez; Jansen, Karen; da Silva, Ricardo Azevedo

    Abstract in English:

    Objective: To evaluate the impact of defense mechanisms at baseline on depressive symptoms after brief psychotherapies and after 6-months of follow-up among depressed patients with and without cluster B personality disorders (PDs). Methods: This quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. The Millon Clinical Multiaxial Inventory-III was applied to assess PD, the Defense Style Questionnaire 40 was used to analyze defense mechanisms, and the Beck Depression Inventory was used to measure the severity of depressive symptoms. Adjusted analysis was performed by linear regression. Results: The final sample consisted of 177 patients diagnosed with major depressive disorder, of whom 39.5% had cluster B PDs. Immature defenses at baseline significantly predicted the persistence of depressive symptoms at post-intervention and at 6-months of follow-up only in patients with PDs. Conclusion: In depressed patients with cluster B PDs, immature defenses predicted a poor response to brief therapies. The assessment of immature defenses at baseline can help identify patients at greater risk of poor therapeutic results and enable more appropriate treatment choices.
  • Gender differences in progression to crack-cocaine use and the role of sexual and physical violence Original Article

    Rebelatto, Fernando Pezzini; Ornell, Felipe; Roglio, Vinícius Serafini; Sanvicente-Vieira, Breno; Grassi-Oliveira, Rodrigo; Pechansky, Flavio; Kessler, Felix Henrique Paim; Schuch, Jaqueline Bohrer; von Diemen, Lisia

    Abstract in English:

    Objective: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. Methods: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. Results: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01). Conclusions: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.
  • The mind possessed: well-being, personality, and cognitive characteristics of individuals regularly experiencing religious possession Original Article

    Delmonte, Roma; Farias, Miguel; Bastos Júnior, Marco Aurélio V.; Madeira, Leandro; Sonego, Beatriz

    Abstract in English:

    Objective: To further our understanding of religious possession experiences by focusing on personality, cognitive, and quality of life outcomes. Methods: Data collection was undertaken at Umbanda sessions in Brazilian cities. Participants were mediums who regularly experienced possession (n=334) or those who attended the same rituals but had never been possessed (n=54). Results: We found that mediums were not significantly different across variables from the control group, except for anxiety, which was lower among mediums. Correlational and regression analysis showed that the level of meaningfulness attributed to possession and fusion with the spiritual entity were strongly positively correlated with most quality-of-life dimensions, and negatively with anxiety; in addition, level of meaningfulness predicted lower anxiety, and psychological quality of life was predicted by level of fusion and meaningfulness. Contrary to expectations, there were no detrimental effects of a lower level of bodily control over the possession experience. Conclusion: Together, these results suggest that individuals regularly experiencing possession within a religious context are psychologically similar to those who attend the same rituals without experiencing possession, and that the way they appraise their experiences as meaningful, as well as the level of spiritual fusion, are predictors of well-being.
  • Evaluation of 10-minute post-injection 11C-PiB PET and its correlation with 18F-FDG PET in older adults who are cognitively healthy, mildly impaired, or with probable Alzheimer’s disease Original Article

    Carneiro, Camila de Godoi; Faria, Daniele de Paula; Coutinho, Artur Martins; Ono, Carla Rachel; Duran, Fábio Luís de Souza; da Costa, Naomi Antunes; Garcez, Alexandre Teles; da Silveira, Paula Squarzoni; Forlenza, Orestes Vicente; Brucki, Sonia Maria Dozzi; Nitrini, Ricardo; Busatto Filho, Geraldo; Buchpiguel, Carlos Alberto

    Abstract in English:

    Objective: Positron emission tomography (PET) allows in vivo evaluation of molecular targets in neurodegenerative diseases, such as Alzheimer’s disease. Mild cognitive impairment is an intermediate stage between normal cognition and Alzheimer-type dementia. In vivo fibrillar amyloid-beta can be detected in PET using [11C]-labeled Pittsburgh compound B (11C-PiB). In contrast, [18F]fluoro-2-deoxy-d-glucose (18F-FDG) is a neurodegeneration biomarker used to evaluate cerebral glucose metabolism, indicating neuronal injury and synaptic dysfunction. In addition, early cerebral uptake of amyloid-PET tracers can determine regional cerebral blood flow. The present study compared early-phase 11C-PiB and 18F-FDG in older adults without cognitive impairment, amnestic mild cognitive impairment, and clinical diagnosis of probable Alzheimer’s disease. Methods: We selected 90 older adults, clinically classified as healthy controls, with amnestic mild cognitive impairment, or with probable Alzheimer’s disease, who underwent an 18F-FDG PET, early-phase 11C-PiB PET and magnetic resonance imaging. All participants were also classified as amyloid-positive or -negative in late-phase 11C-PiB. The data were analyzed using statistical parametric mapping. Results: We found that the probable Alzheimer’s disease and amnestic mild cognitive impairment group had lower early-phase 11C-PiB uptake in limbic structures than 18F-FDG uptake. The images showed significant interactions between amyloid-beta status (negative or positive). However, early-phase 11C-PiB appears to provide different information from 18F-FDG about neurodegeneration. Conclusions: Our study suggests that early-phase 11C-PiB uptake correlates with 18F-FDG, irrespective of the particular amyloid-beta status. In addition, we observed distinct regional distribution patterns between both biomarkers, reinforcing the need for more robust studies to investigate the real clinical value of early-phase amyloid-PET imaging.
  • Brief counseling for smoking cessation and alcohol use reduction concomitant with hospital procedures: a randomized clinical trial Original Article

    Alba, Luz Helena; Peñaloza, Maylin; Olejua, Peter; Cespedes, Eliana; Cuevas, Virginia; Almonacid, Ingrid; Olaya, Lina; Becerra, Nelci

    Abstract in English:

    Objective: To evaluate the effect of brief counseling on patient readiness for behavioral change and cessation/reduction of tobacco and alcohol use. Methods: This clinical trial randomized patients in blocks, stratified by risk factor. Adult smokers or at-risk drinkers undergoing surgical or diagnostic procedures were recruited. Outcome assessments and analyses were blinded. Brief counseling was compared with educational materials for the outcomes progress in stage of change and smoking/alcohol cessation/reduction. Results: Overall, 222 participants were randomly assigned to the intervention group and 218 to the control group. Among them, 28 and 18 patients were lost to follow-up, respectively. Progress in change stage was 94.1% at 1 month in both groups (RR = 1.00; 95%CI 0.95-1.05) and 94.8 vs. 90.5% at 3 months (RR = 1.05; 95%CI 0.99-1.11) in the intervention and control groups, respectively. Smoking cessation and alcohol reduction rates at 3 months were 57.2 vs. 41% (RR = 1.40; 95%CI 1.14-1.71) in the intervention and control groups, respectively. Only brief counseling led to significant differences in smoking cessation (51.4 vs. 35.1%; RR = 1.46; 95%CI 1.12-1.92). Conclusions: Brief counseling and educational materials improved patient motivation for behavioral change, but brief counseling had a greater effect on smoking cessation. Clinical trial registration: NCT03521622
  • A potential syndemic effect associated with symptoms of depression among men who have sex with men Brief Communication

    Guimarães, Mark D.C.; McKinnon, Karen; Dourado, Inês; Veras, Maria Amelia; Magno, Laio; Almeida, Marcelo; Wainberg, Milton; Kendall, Carl; Kerr, Ligia; Cournos, Francine

    Abstract in English:

    Introduction: Globally, depression rates are high among men who have sex with men (MSM). Multiple factors may interact synergistically to increase this risk. This analysis assessed the prevalence of symptoms of depression among MSM in Brazil and synergistic effects of several factors. Methods: Cross-sectional study conducted in 12 cities using respondent-driven sampling. Sociodemographic and behavioral characteristics were collected. The PHQ-9 was used to screen for depression. Having moderate-severe depressive symptoms was compared to none-mild using logistic regression. The syndemic factor was a composite of hazardous alcohol use, sexual violence, and discrimination due to sexual orientation. Those with one to three of these factors were compared to those with none. Results: The weighted prevalence of moderate-severe depressive symptoms was 24.9% (95%CI = 21.8-28.8) and 16.2%, 22.9%, 46.0% and 51.0% when none, one, two, or three syndemic factors were present, respectively, indicating a dose-response effect. Perception of HIV risk, high level of HIV knowledge, known HIV infection, and health self-rated as poor or very poor were also associated with depressive symptoms. Conclusion: The prevalence of moderate-severe depressive symptoms among MSM in Brazil is high, and selected factors act synergistically in increasing their prevalence. Public health policies should consider holistic depression prevention and treatment interventions for this population.
  • Abuse of tropicamide eye drops: review of clinical data Special Article

    Bellman, Val; Ukolova, Anastasia; Erovichenkova, Elena; Lam, Sarah; Srivastava, Hirsch K.; Bruce, Jared; Burgess, Douglass M.

    Abstract in English:

    Over the past 15 years, the increasing nonmedical use of tropicamide ophthalmic drops has been reported in Europe, coinciding with an increase in opioid addiction and drug-related mortality. Although tropicamide is generally known as a cheap alternative to heroin in Eastern Europe, it still appears to be a relatively new phenomenon that has arisen over the last decade. A narrative review was conducted of all the relevant sources published in more than five countries between January 1, 1975 and January 10, 2021. For bibliographic accuracy, the materials published in Russian and Italian were professionally translated to English. During the preparation of this report, we were able to interview five Russian-speaking patients who injected tropicamide in the past and we discuss another case of intravenous tropicamide use. This review was acknowledged by the institutional review board of the University of Missouri-Kansas City. All patients interviewed at the Unica Medical Center consented for their clinical information to be reported in a medical publication. We analyzed data from 50+ various sources and covered a variety of drug-related issues, including information on the extent, patterns, and trends in tropicamide use, its health consequences, and other clinical findings. The information provided in this article may help providers better detect tropicamide abuse and incorporate new rehabilitation strategies into the management of these patients.
  • A systematic review of observational, naturalistic, and neurophysiological outcome measures of nonpharmacological interventions for autism Review Article

    Godoy, Priscilla Brandi Gomes; Sumiya, Fernando Mitsuo; Seda, Leonardo; Shephard, Elizabeth

    Abstract in English:

    Objective: Naturalistic and neurophysiological assessments are relevant as outcome measures in autism intervention trials because they provide, respectively, ecologically valid information about functioning and underlying neurocognitive mechanisms. We conducted a systematic review to highlight which specific neurophysiological techniques, experimental tasks, and naturalistic protocols have been used to assess neural and behavioral functioning in autism intervention studies. Methods: Studies were collected from four electronic databases between October 2019 and February 2020: MEDLINE (via PubMed), PsycINFO, LILACS, and Web of Science, and were included if they used structured observational, naturalistic, or neurophysiological measures to assess the efficacy of a nonpharmacological intervention for ASD. Results: Fourteen different measures were used by 64 studies, with the Autism Diagnostic Observation Schedule the most frequently used instrument. Thirty-seven different coding systems of naturalistic measures were used across 51 studies, most of which used different protocols. Twenty-four neurophysiological measures were used in 16 studies, with different experimental paradigms and neurophysiological components used across studies. Conclusions: Cross-study variability in assessing the outcomes of autism interventions may obscure comparisons and conclusions about how different behavioral interventions affect autistic social communication and underlying neurophysiological mechanisms.
  • Inflammatory cytokines and alcohol use disorder: systematic review and meta-analysis Review Article

    Moura, Helena F.; Hansen, Fernanda; Galland, Fabiana; Silvelo, Daiane; Rebelatto, Fernando P.; Ornell, Felipe; Massuda, Raffael; Scherer, Juliana N.; Schuch, Felipe; Kessler, Felix H.; von Diemen, Lisia

    Abstract in English:

    Objective: To assess differences in blood inflammatory cytokines between people with alcohol use disorder (AUD) and healthy controls (HC). Methods: Searches were performed from inception through April 14, 2021. Meta-analyses with random-effects models were used to calculate the standardized mean difference ([SMD], 95%CI), and potential sources of heterogeneity were explored trough meta-regressions and subgroup analysis. Results: The meta-analysis included 23 studies on the following 14 cytokines: tumor necrosis factor (TNF)-α, IL-1, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-13, IL15, interferon (IFN)-γ and sCD14. There were significantly higher concentrations of IL-6 (n=462 AUD and 408 HC; SMD = 0.523; 95%CI 0.136-0.909; p = 0.008) in AUD than HC. No significant differences were found in the other 13 cytokines. Conclusion: We found that IL-6 levels were significantly higher in individuals with AUD than HC and that other cytokines were not altered. This can be explained by the small number of studies, their methodological heterogeneity, and confounding factors (active use, abstinence, quantity, and physical or psychiatric illnesses, for example). Despite a great deal of evidence about alcohol and inflammatory diseases, studies assessing the role of neuroimmune signaling in the development and severity of AUD are still lacking.
  • Predominant polarity and associated post-traumatic stress disorder in patients with comorbid bipolar disorder and borderline personality disorder: a cross-sectional study Letters To The Editors

    Wolfenberger, Taylor; Diaz, Alexandre Paim; Bockmann, Taya; Selvaraj, Sudhakar; Sanches, Marsal; Soares, Jair C.
  • Negative dimension stability across clinical stages and sociodemographic characteristics in schizophrenia Letters To The Editors

    Koga, Gabriela; Haguiara, Bernardo; Ortiz, Bruno; Noto, Cristiano; Freitas, Rosana Ramos; Elkis, Helio; Bressan, Rodrigo; Ziebold, Carolina; Gadelha, Ary
  • Cervical cancer screening and psychosis: a longitudinal retrospective study comparing women with schizophrenia spectrum disorders and the general population Letters To The Editors

    Vázquez-Bourgon, Javier; Gómez-Revuelta, Marcos; Erasun Mora, Diego; Viejo Casas, Ana; Crespo-Facorro, Benedicto
  • Double cone coil repetitive transcranial magnetic stimulation for severe obsessive-compulsive disorder after reversible cerebral vasoconstriction syndrome with intracerebral hemorrhage: a case report Letters To The Editors

    Silveira, Julia Belizário; Damiano, Rodolfo Furlan; Abelama Neto, Emilio; Gomes, Raphael Neves dos Santos Mosqueira; Klein, Izio; Borrione, Lucas; Sudbrack, Pedro; Gentil, André Felix; Shephard, Elizabeth; Brunoni, André Russowski; Miguel, Eurípedes Constantino; Echevarria, Marco Antonio Nocito
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