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Abstract Eating disorders (ED) are a group of potentially severe mental disorders characterized by abnormal energy balance, cognitive dysfunction, and emotional distress. Cognitive inflexibility is a major challenge to successful ED treatment and dysregulated serotonergic function has been implicated in this symptomatic dimension. Moreover, there are few effective treatment options and long-term remission of ED symptoms is difficult to achieve. There is emerging evidence for the use of psychedelic-assisted psychotherapy (PAP) for a range of mental disorders. Psilocybin is a serotonergic psychedelic that has demonstrated therapeutic benefit in a variety of psychiatric illnesses characterized by rigid thought patterns and treatment resistance. The current paper presents a narrative review of the hypothesis that psilocybin may be an effective adjunctive treatment for individuals with EDs, based on biological plausibility, transdiagnostic evidence, and preliminary results. Limitations of the PAP model and proposed future directions for its application to eating behavior are also discussed. Although the literature to date is not sufficient to propose the incorporation of psilocybin in the treatment of disordered eating behaviors, preliminary evidence supports the need for more rigorous clinical trials as an important avenue for future investigation.

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Abstract Objectives Medical training negatively impacts the quality of life of students. Assessing the well-being of medical students could guide academic policies and future research for improving the mental and physical health status of the population at risk. This study aimed to identify the influence of medical training on the quality of life of Brazilian medical students. Methods A systematic review and meta-analysis was conducted according to the Cochrane criteria and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (PRISMA). The search was performed by two independent investigators using a predefined protocol registered on the PROSPERO database (CRD42021237926). Data were extracted from PubMed, Embase, and Biblioteca Virtual de Saúde (BVS). For quantitative synthesis, a meta-analysis was conducted to assess the mean difference in the quality of life between medical students at different stages in the academic cycle, stratified by sex. All data were analyzed using the random-effects model, with a confidence interval of 95% (95%CI). Results After evaluating the eligibility criteria, five studies were included in the meta-analysis. The data revealed that students in the pre-clinical cycle of the course exhibited higher quality of life scores in the physical (3.05 [1.48-4.62], p < 0.0001) and psychological (3.05 [0.80-5.30], p < 0.0001) domains than students in the clerkship cycle. No statistically significant differences were observed in the environmental (0.78 [-2.92-4.49], p = 0.68) or social domains (1.41 [-0.52-3.34], p = 0.15). Conclusion Our analysis revealed that the medical course is associated with decreased quality of life of medical students in the physical and psychological domains. This finding was observed in both men and women. However, these findings should be interpreted with caution given the study limitations. Registration number PROSPERO, CRD42021237926.

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Abstract Objectives The emergence of the coronavirus disease 2019 (COVID-19) pandemic and subsequent lockdowns and social distancing measures adopted worldwide raised questions about the possible health effects of human social isolation. Methods We conducted a systematic review on PubMed, Scopus, and Embase electronic databases using terms related to human social isolation – defined as the isolation of an individual from regular routines and usual social contact – and psychological stress, searching for simulated or naturalistic isolation environments. We present the main results, as well as the validity and limitations of each model. PROSPERO registry number: CRD42021241880. Results Despite the diversity of contexts reviewed, some outcomes almost ubiquitously relate to psychological stress, i.e., longer periods, expectation of a longer period, confinement, lack of social interaction, and support. Based on the results, and considering that most studies were not designed for the purpose of understanding isolation itself, we propose a group of recommendations for future experimental or naturalistic research on the topic. Conclusion Evidence on the impact of different situations in which individuals are subjected to social isolation can assist in development of directed preventive strategies to support people under similar circumstances. Such strategies might increase the general public’s compliance with social distancing as a non-pharmacological intervention for emerging infectious diseases.

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Abstract Objective This systematic review aims to describe the relationship between psychological resilience and mood disorders. Methods This is a systematic review and meta-analysis. The following databases were searched on November 6, 2020: PubMed, PsycINFO, and Embase. Results Twenty-three articles were included and the majority of the studies included (95.7%) showed that psychological resilience has a positive impact in mood disorders. Our meta-analysis showed that individuals with bipolar disorder presented significantly lower levels of psychological resilience compared to controls (standardized mean difference [SDM]: -0.99 [95% confidence interval {95%CI}: -1.13 to -0.85], p < 0.001). In addition, individuals with depression had significantly lower levels of psychological resilience compared to controls (SDM: -0.71 [95%CI -0.81 to -0.61], p < 0.001). Conclusion Our results showed that individuals with mood disorders are less resilient than individuals without mood disorders. Our findings reinforce the importance of investigating interventions that may help to improve psychological resilience considering its positive impact in the context of mood disorders.

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Abstract Objectives To present the Brazilian Psychiatric Association’s Consensus on the Management of Acute Intoxication. Methods A group of experts selected by the Brazilian Psychiatric Association searched for articles on the MEDLINE (by PubMed) and Cochrane databases, limited to human studies and acute intoxication. Working groups reviewed these materials for appropriateness to the topic and the quality of the work. A survey was conducted using the Delphi method to produce a table of agreed recommendations presented at the end of the systematic review. Three survey rounds were held to reach consensus. Results Support for intoxication should start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For this, the group proposed the following sequence of assessments: A (airway), B (breathing), C (circulation), D.1 (disability), D.2 (differential diagnosis), D.3 (decontamination), D.4 (drug antidotes), E (enhanced elimination). The group of experts then presented specific interventions for the main drugs of abuse. Conclusions Management of intoxication with drugs of abuse is complex and requires systematic protocols. The group suggests adoption of the A-B-C-D-E technique first, with constant investigation. Then, specific conduct and support until remission of intoxication. The literature is still scarce in evidence on the subject. Therefore, this consensus was necessary. We believe that at present this document can help psychiatric, general, and emergency physicians deal with emergency psychiatric episodes due to acute intoxication. This work could stimulate future studies on the topic.

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Abstract Objectives: Mindfulness has generated considerable interest in the last 2 decades in clinical and research settings. The efficacy of mindfulness has been evaluated for the sexual dysfunctions recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and other sexual problems, such as compulsive sexual behavior disorder (CSBD), also known as sex addiction or hypersexuality. Here, we review the evidence for various mindfulness-based treatments (MBT), such as mindfulness-based cognitive-behavioral treatment or mindfulness-based relapse prevention, for different problems related to sexuality to answer our question: "Are mindfulness-based treatments effective in reducing the symptomatology of sexuality-related disorders?" Methods: Through a systematic search conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we found 11 studies that met the following inclusion criteria: (I) articles using MBT for sexuality-related problems; (II) clinical population; (III) no date range limits were applied; (IV) only empirical studies were included; (V) language; and (VI) quality of studies. Results: Evidence shows that mindfulness practice could be effective for some sexual disorders, such as female sexual arousal/desire disorder. However, due to scarcity of studies on other sexual problems such as situational erectile dysfunction, genitopelvic pain/penetration disorder, childhood sexual abuse, or CSBD, the findings cannot be generalized. Conclusion: There is evidence that mindfulness-based therapies can reduce the symptomatology associated with various sexual problems. However, more studies are needed for these sexual problems. The study concludes with a discussion of future directions and implications.

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Abstract Objectives: There has been growing concern about the long-term effects of coronavirus disease 2019 (COVID-19) on mental health. The biological factors common to psychiatric conditions and COVID-19 are not yet fully understood. Methods: We narratively reviewed prospective longitudinal studies that measured metabolic or inflammatory markers and assessed psychiatric sequelae and cognitive impairment in individuals with COVID-19 at least 3 months after infection. A literature search identified three relevant cohort studies. Results: Overall, depressive symptomatology and cognitive deficits persisted for up to 1 year after COVID-19; depression and cognitive changes were predicted by acute inflammatory markers, and changes in these markers correlated with changes in depressive symptomatology; female sex, obesity, and the presence of inflammatory markers were associated with more severe clusters of physical and mental health status in patients’ self-perceived recovery; and plasma metabolic profiles of patients continued to differ from those of healthy controls 3 months after hospital discharge, which were associated with widespread alterations in neuroimaging, reflecting issues with white matter integrity. Conclusion: In individuals affected by COVID-19, prolonged exposure to stress and alterations in metabolic and inflammatory markers play a central role in psychiatric sequelae and cognitive deficits in the long term.

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Abstract Objective To evaluate the impacts of a nutritional education intervention for patients with multiple chronic conditions during smoking cessation. Methods The non-probabilistic sample comprised 18 adults and seniors of both sexes recruited from a smoking cessation treatment group. At the beginning of treatment, smoking history, degree of dependence, and stage of motivation were assessed. Degree of craving was evaluated weekly for the 1st month. Anthropometric and biochemical assessments were conducted at baseline, at 1 month, and at 3 months. Dietary intake was assessed with the “How is your diet?” questionnaire. The nutritional intervention was delivered in three sessions. The themes covered were energy balance and physical activity, healthy eating, and the importance of fruit and vegetables in the diet. Statistical analysis was conducted with the Shapiro Wilk test of normality, the paired t test, and the Wilcoxon or Mann-Whitney U tests (significance ≤ 0.05). Results Most people (55.6%) in the intervention group had a high degree of smoking dependence, while the frequency in the control group was 22.2%. Degree of craving decreased significantly after 1 month of treatment (p = 0.017). After 3 months, both groups had a positive variation in mean body weight, although below 3%. In both groups, the average percentage of weight gain was less than 3%, suggesting that delivery of the nutritional education sessions and the nutritionist’s use of the protocol proposed by the Instituto Nacional de Câncer (INCA) helped to control weight gain. Blood glucose and homeostasis model assessment-insulin resistance (HOMA-IR) both increased significantly in the intervention group (p = 0.15 and p = 0.50, respectively). Conclusion Greater proximity and more frequent intervention by a nutritionist assists and encourages healthy eating practices during the smoking cessation process, which can benefit individuals’ control of chronic diseases over the long term.

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Abstract Objective Grazing is a disturbed eating pattern that has been associated with eating disorders and obesity. One of the new measures to investigate this eating behavior is the Short Inventory of Grazing (SIG), a two-item questionnaire that assesses grazing in general and grazing associated with the feeling of loss of control over eating (LOC grazing). However, the psychometric properties of the SIG have not been assessed in the Brazilian population. The present study aimed to cross-culturally adapt and validate a Brazilian version of the SIG. Methods The SIG was adapted to the Brazilian context following international guidelines. Then, 90 undergraduate students completed an online survey including questions from the SIG, the Binge Eating Scale (BES), the Patient Health Questionnaire-9 (PHQ9), the Generalized Anxiety Disorder-7 (GAD7), and a question related to self-reported health status. The internal consistency, test-retest reliability, and convergent validity of the questionnaire were assessed. Results The prevalence rates of at least one weekly episode of grazing in general and LOC grazing were 71.1 and 54.5%, respectively. The internal consistence of the SIG was acceptable (0.81). In addition, SIG scores on both items were positively and significantly associated with BES, GAD7, and PHQ9 scores, and with poorer self-rated health. However, SIG test and retest scores differed significantly. Conclusion Overall, the Brazilian version of the SIG demonstrated adequate psychometric properties. The instrument had adequate internal consistency, with both items exhibiting good convergent validity with related measures.

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Abstract Objective Borderline personality disorder (BPD) is a serious and extremely prevalent mental disorder. Early diagnosis is vital for treatment. However, there are no specific screening instruments validated for Brazilian Portuguese. This study aimed to adapt the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) to the Brazilian context. The MSI-BPD is a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), that enables fast and reliable assessment of BPD, with measures of sensitivity (SN) and specificity (SP) similar to the diagnostic interview for the DSM-5 (Structured Clinical Interview for DSM-V Axis II Disorders [SCID-II]), taken as the gold standard. Methods Two independent translations, a synthesis version, back-translation, and analysis by experts were employed to create the final version of the instrument in Brazilian Portuguese. The translated instrument was administered to 1,702 adults aged 18-59 years to verify evidence of validity relating to content, internal structure, relationship with other variables, and reliability. Results The exploratory and confirmatory factor analyses show that the one-factor structure is adequate. The scale showed satisfactory internal consistency (Kuder-Richardson coefficient [KR-20] of Cronbach’s alpha = 0.691) and good test-retest reliability (intraclass correlation coefficient [ICC] = 0.802). Logistic regression analysis using the Personality Inventory for the DSM-5-Brief Form (PID-5-BF) (DSM-5) as reference established an ideal cut-off point of eight symptoms, with adequate SN (0.79) and SP (0.75), similar to the original instrument. The area under the curve (AUC) was 0.830 (95% confidence interval: 0.802-0.858), with a positive predictive value of 89.2%. Conclusion The Brazilian version of the MSI-BPD has adequate psychometric properties for use as a BPD screening tool by clinicians.

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Abstract Objective Childhood maltreatment is extremely harmful to health, especially in relation to development of the psychiatric disorders throughout life. The objective of this study was to describe the prevalence and types of maltreatment in a sample of adolescent schoolchildren and to investigate associations between maltreatment types and anxiety and depressive symptoms, sociodemographic variables, and risk behaviors. The study also identified which variables were the greatest predictors of anxiety and depressive symptoms. Methods We conducted a cross-sectional study with a sample of 654 school students aged 11 to 17 years. We collected sociodemographic data and administered the Revised Child Anxiety and Depression Scale (RCADS-47) to measure anxiety and depressive symptoms as well as the Childhood Trauma Questionnaire (CTQ) to evaluate maltreatment and adverse experiences such as abuse and negligence during childhood and adolescence. Statistical analyses were conducted to estimate correlations between sociodemographic data, anxiety, depression, and types of maltreatment. A regression analysis was also conducted to identify maltreatment types that predict psychological symptoms. Results Emotional abuse and emotional neglect were the most prevalent types of maltreatment. Statistically, emotional abuse was the maltreatment type most strongly correlated with depression and anxiety and tended to co-occur with other types of maltreatment. Additionally, emotional and sexual abuse were the greatest predictors of anxiety and depression in adolescents. Conclusion The above results reinforce the findings of previous studies in terms of understanding the effects of maltreatment. They identify emotional abuse as the main predictor of depressive and anxiety symptoms.

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Abstract Background Teaching is very stressful and demanding and it intensifies psychological and related disorders compared to other occupations. Most teachers in Nigeria are battling emotional distress, burnout, depression, and anxiety due to excess workload, which has affected their psychological well-being. This study assessed the sociodemographic and psychological well-being of primary school teachers in Enugu State, Nigeria. Methods This is a study with a cross-sectional design. The psychological well-being of 254 primary school teachers was assessed using a psychological well-being scale and a sociodemographic information inventory was also used to ascertain their personal information. The data collected were analyzed using chi-square, mean, standard deviation, and bivariate correlation statistics. Results The results showed that the majority of primary school teachers experience unhealthy psychological well-being irrespective of age, gender, working status, qualification, and years of teaching experience. These teachers’ sociodemographic variables are significantly correlated with psychological well-being. Only location is not significantly correlated with psychological well-being. Conclusion Therefore, this study concluded that primary school teachers’ psychological well-being is not positive or healthy and is significantly related to their sociodemographic characteristics.

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Abstract Objective Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction and by restricted and repetitive patterns of behavior. Some studies have shown that substances derived from Cannabis sativa improve the quality of life of children with ASD without causing serious adverse effects, thus providing an alternative therapeutic option. The objective of this study was to evaluate the efficacy and safety of a cannabis extract rich in cannabidiol (CBD) in children with ASD. Methods In this randomized, double-blind, placebo-controlled clinical trial, 60 children, aged from 5 to 11 years, were selected and divided into two groups: the treatment group, which received the CBD-rich cannabis extract, and the control group, which received the placebo. They both used their respective products for a period of 12 weeks. Statistical analysis was done by two-factor mixed analysis of variance (two-way ANOVA). Results Significant results were found for social interaction (F1,116 = 14.13, p = 0.0002), anxiety (F1,116 = 5.99, p = 0.016), psychomotor agitation (F1,116 = 9.22, p = 0.003), number of meals a day (F1,116 = 4.11, p = 0.04), and concentration (F1,48 = 6.75, p = 0.01), the last of which was only significant in mild ASD cases. Regarding safety, it was found that only three children in the treatment group (9.7%) had adverse effects, namely dizziness, insomnia, colic, and weight gain. Conclusion CBD-rich cannabis extract was found to improve one of the diagnostic criteria for ASD (social interaction), as well as features that often co-exist with ASD, and to have few serious adverse effects.

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Abstract Objective Existing scales that seek to measure alterations in self-experience were developed based on studies conducted in developed countries. Therefore, the aim of this study was to evaluate the psychometric properties of the Ego Dissolution Inventory (EDI) after translating and adapting it for the Brazilian context. Methods The measure was translated by two translators fluent in both English and Portuguese, followed by back-translation into English to ensure there was no loss of meaning. The scale was used in an online survey exploring substance use. A total of 528 participants answered the full scale. We calculated the Kaiser-Meyer-Olkin (KMO) measure to evaluate sampling adequacy, then ran exploratory factor analysis (EFAs) to investigate the factor structure of the EDI. Results The scale showed acceptable psychometric properties, with excellent internal consistency and sampling adequacy for factor analysis. Kaiser-Guttman’s criteria and Hull’s method indicated a three-factor solution, while parallel analysis suggested a two-factor solution. All items showed salient loadings, with two items exhibiting cross-loading. Positive but weak correlations were found between EDI factors 1 and 2 and nature relatedness. Conclusions The validated scale showed solid psychometric properties, with potential differences in factor structure in relation to the English version. Considering validation is an ongoing process, it is recommended that studies be conducted comparing ego dissolution scores across distinct substances and different regions of the country.

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Abstract Objective To investigate the role of optimism, hope, and gratitude as psychosocial factors for healthy development, especially with regard to anxiety in college students in the context of coronavirus disease 2019 (COVID-19). Methods This is a quantitative, descriptive cross-sectional study. A sociodemographic questionnaire, the Brazilian Gratitude Scale (Escala Brasileira de Gratidão [B-GRAT]), and the Brazilian versions of an anxiety subscale, the Revised Life Orientation Test (LOT-R), Hope Index Scale, and BIG-FIVE were administered. Data were analyzed using the Mann-Whitney U test, the Kruskal-Wallis test, Spearman correlations, and hierarchical linear regression. Results A total of 297 students were assessed. The relationship between gratitude and anxiety became positive in the hierarchical linear analysis, contradicting the initial negative association between these variables according to the Spearman coefficients. This contradiction may be a result of the suppression effect. When gratitude was added to the model, these three variables together accounted for 38% of the variance in anxiety. This indicates that optimism, hope, and gratitude together are significant predictors, although optimism alone accounts for the greater part of the variance in decreased anxiety. Conclusion The data confirm that family and religiosity are protective factors against mental illness, specifically non-adaptive anxiety. Furthermore, developing optimism as a protective factor makes it possible to experience less anxiety while hope has the potential to provide the individual with multiple pathways to healthy development. This study highlights that gratitude plays a dual role in these relationships as it has the potential to be associated with anxious feelings with likely negative outcomes while at the same time it can drive positive psychosocial factors of optimism and hope, decreasing anxiety.

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Abstract Introduction The Iowa-Netherlands Comparison Orientation Measure (INCOM) was developed to measure individual differences in social comparison orientation and has been widely used in research and various different settings. Objectives The aim of this study was to adapt the online version of the INCOM and to evaluate its psychometric parameters when applied to a Brazilian population of university students. Methods The procedures were divided into two steps: step 1 – cross-cultural adaptation and analysis of content validity, and step 2 – assessment of psychometric characteristics. Step 1 comprised the processes of translation, evaluation by an expert committee, evaluation by the target population, and back-translation. For step 2, 1,065 university students were recruited and then factor analysis, analysis of reliability, and analysis of validity based on external measures were performed. Results The adaptation process yielded satisfactory results, including good indicators of content validity. Exploratory factor analysis revealed a two-dimensional structure and adequate factor loadings, except for item 11, which was excluded from the final version. Additionally, the final version of the scale had adequate fit indices (χ2 = 148.45, degrees of freedom [df] = 26; p < 0.001; root mean square error of approximation [RMSEA] = 0.06; comparative fit index [CFI] = 0.99; and Tucker-Lewis index [TLI] = 0.98). Evidence of reliability (Cronbach’s alpha = 0.83) was observed and there were positive correlations with negative affect (r = 0.36) and negative correlations with positive affect and self-esteem (r = -0.15; r = -0.41, respectively). Conclusion The Brazilian version of the INCOM presents satisfactory psychometric parameters and can thus be used to measure social comparison orientation.

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Abstract Objective Coronavirus disease 2019 (COVID-19) was declared a global pandemic early in 2020, followed by a period during which governments imposed strict social distancing measures to slow transmission. However, most essential services remained open, and those working in offices faced a higher risk of infection compared to those working at home. We compare the occurrence and potential determinants of mental health outcomes, functioning, and quality of life (QoL) in a subset of a sample of Brazilian individuals who worked from home and a subset who worked in the office during the first wave of COVID-19. Methods Data were collected during the first wave of COVID-19, using an online survey to assess sociodemographic and clinical variables, functioning with the Digital Functioning Assessment Short Test (D-FAST), QoL with the European Health Interview Surveys QoL instrument (EUROHIS-QOL), depression with the Patient-Reported Outcomes Measurement Information System (PROMIS) depression instrument, anxiety with the PROMIS anxiety instrument, and stress symptoms with the Impact of Event Scale-Revised (IES-R) in a large sample comprising individuals who worked in offices (n = 1685) or worked from home (n = 1,338). Results Analysis revealed that depressive and post-traumatic stress symptoms were less prevalent in individuals who worked from home and showed that they had higher functioning and QoL than those working in the office. Individuals who worked in the office were younger, more likely to be female, had lower household income, had low educational level, and were more likely to be unmarried than the home working group. Conclusion Our findings support the notion of the negative impact of the COVID-19 pandemic on mental health in both office workers and those working from home. However, the group who worked from home seem to be more resilient with fewer psychiatric symptoms and better functioning.

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Abstract Objective To analyze the trend of hospitalizations for alcohol use disorder (AUD) in Brazil, by region, and establish its relationship with mental health care facilities. Methods Data were collected through the Brazilian Unified Health System’s (SIH/SUS) Hospital Information System (Sistema de Informação Hospitalar) and the National Register of Health Establishments of Brazil (Cadastro Nacional de Estabelecimentos de Saúde [CNES]). We used linear regression models to estimate the effect of SUS psychiatric beds and Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS]) numbers on AUD hospitalizations. Results From 2015 to 2020, 298,735 hospitalizations for AUD were recorded. Most of the patients admitted for AUD were male (88.8%). Individuals aged 60 years and older accounted for 11.7% of our cohort. The highest concentration of hospitalizations occurred in the South region (40.1%). The rate of hospitalizations per hospital bed remained relatively constant. The number of CAPS has a negative effect on SUS psychiatric beds in Brazil (average effect -22.31 [95% confidence interval {95%CI} -26.92, -17.70]). Psychiatric beds have a positive effect on AUD hospitalizations in the country (average effect 1.82 [95%CI 0.91, 2.74]). Conclusion Prioritization guidelines for other forms of care are associated with a decrease in hospitalizations for AUD, so we highlight the importance of adequate training of health care professionals for proper referral of these patients to hospital admission when necessary.

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Abstract Objective In the DSM-III and the DSM-IV, bipolar disorder (BD) is classified as a mood disorder and diagnosis requires presence of a mood change, i.e., euphoria or irritability. In contrast, DSM-5 states that there must be some increase in energy or motor activity in addition to the mood change. Our aim was to identify which types of symptoms (i.e., mood or energy/activity-related symptoms) are the most informative in a manic episode. Methods Symptoms of manic episodes in 106 outpatients with BD were assessed in a naturalistic study using the Young Mania Rating Scale (YMRS) between November 2002 and November 2015. The scale items were divided into three groups according to clinical criteria: mood, energy/activity, and other. For comparisons between groups, the Samejima graded response model from Item Response Theory (IRT) and the Test Information Function (TIF) were computed. Chi-square tests were used to verify the association between the groups of symptoms by comparing the area under the curve of the TIF results. Results The information accounted for by energy/activity represents 77% of the proportion of the total TIF; about 23% is related to mood and other groups of symptoms. These proportions are statistically different (χ2[1] = 30.42, p < 0.001) Conclusion On average, changes in energy/activity tend to be more informative than mood changes during the manic phases of BD.

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Abstract Objective: This study investigated the incidence of suicidal ideation and its associated risk factors in the state of São Paulo in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto [ELSA-Brasil]) cohort during the coronavirus disease 2019 (COVID-19) pandemic. Methods: In a pre-pandemic ELSA-Brasil onsite assessment in 2016-2018 (wave 3) and a pandemic online assessment in May-July 2020 (wave COVID), we assessed suicidal ideation using the Clinical Interview Schedule-Revised (CIS-R). Single and multi predictor logistic regressions were performed using sociodemographic characteristics, household financial impact during the pandemic, presence of previous chronic diseases, alcohol abuse, adverse childhood experiences (ACE), living alone, and previous common mental disorders (CMD) as predictors. Incidence of suicidal ideation was used as outcome. Results: Out of 4,191 participants in wave 3, 2,117 (50.5%) also answered the COVID wave. There was a threefold increase in suicide ideation, from 34 (1.8%) to 104 (5.6%) participants. In multiple predictor models, we found that previous CMD (odds ratio [OR] 7.17; 95% confidence interval [95%CI] 4.43 - 11.58) and ACE (OR 1.72; 95%CI 1.09 - 2.72) increased the odds of incident suicidal ideation. The sociodemographic predictors female sex, younger age, and low income were significant risk factors in the single predictor models only. Conclusion: These findings underscore the importance of monitoring and supporting individuals who suffered ACE and have a history of mental health disorders. This is especially critical in times of heightened societal stress, such as the COVID-19 pandemic.

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Abstract Objective: Peer violence is a serious type of school violence that is associated with emotional and behavioral problems. The objective of this study was to analyze violence between peers and its associations with students’ social skills. Methods: We used a cross-sectional survey nested within a cluster-randomized controlled trial (REBEC/Brazil, U1111-1228-2342) to evaluate peer violence among elementary school students and its association with prosocial behaviors and mental problems. Teachers answered an adapted version of the Revised Olweus Bully/Victim Questionnaire (OBVQ) and the Brazilian adaptation of the Teacher Observation of Classroom Adaptation-Checklist (TOCA-C) scale for each student. Children completed a sociodemographic questionnaire. The participants were 1,152 5-to-14-year-old children from Brazilian public schools, 79.70% of whom reported being involved in violent situations. Results: Children who had both committed and suffered violence were less likely to exhibit prosocial behaviors. Children who committed and suffered violence and those who only committed violence were more likely to experience concentration problems and exhibit disruptive behaviors. Conclusion: This study suggests that peer violence is associated with fewer prosocial behaviors and more behavioral problems. Thus, more specialized mental health care is required for children involved in peer violence, in addition to implementation and maintenance of programs to prevent and reduce violence and develop prosocial behaviors in schools.

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Abstract Objective: The aim of this study is to compare stigmatizing attitudes, reported and intended behavior, and knowledge of mental illness between university students and the general population. Methods: An online cross-sectional observational study was conducted. The survey included sociodemographic data and validated stigma questionnaires (the Attribution Questionnaire [AQ-27], the Reported and Intended Behaviour Scale [RIBS], and the Mental Health Knowledge Schedule [MAKS]). Descriptive statistics, bivariate analyses, and multiple regression modeling were employed to analyze the data. Results: A total of 506 participants completed the survey, including 226 (44.7%) university students (61.1% women), and 280 (55.3%) individuals from the general population (69.3% women). For both groups, women and individuals who had lived with someone with mental health problems exhibited more positive attitudes (p < 0.05). University students reported greater knowledge of mental illness (p < 0.05) than the general population. After controlling for covariates, university students only scored higher than the general population in the blame factor of the AQ-27 (p < 0.05). Additionally, older participants from both groups exhibited higher levels of stigmatizing attitudes compared to those of a younger age. Conclusion: These findings suggest that university students exhibit similar levels of stigmatizing attitudes to the general population. Among both groups, female sex, older age, previous contact with individuals with mental illness, and greater knowledge of mental health are all associated with less stigma toward people with mental illness. Tailored interventions grounded in contact with mental illness have the potential to help reduce stigmatizing attitudes within both groups.

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Abstract Introduction: The Posttraumatic Cognitions Inventory (PTCI) is a widely used measure for assessing negative posttraumatic cognitions that are common among individuals with trauma-related disorders. There was a need for a valid and reliable short form of the PTCI in Persian. Objectives: This study aimed to translate the 9-item version of the PTCI (PTCI-9) into Persian and evaluate its characteristics and psychometric properties. Methods: This was a cross-sectional psychometric study using the translation and back-translation technique. Experts assessed the scale's content validity. Participants were 207 Iranian individuals recruited from the general population, 151 of whom were trauma-exposed. Participants completed the Persian version of the PTCI-9, the Beck Depression Inventory (BDI-II), and the World Health Organization Quality of Life (WHO-QOL) scale. The psychometric properties of the Persian version of PTCI-9 were assessed using exploratory and confirmatory factor analysis (CFA) methods. Cronbach's α coefficient and Pearson's correlation coefficients were also calculated. Results: Factor analyses supported a three-factor model including the Self, World, and Self-Blame subscales. The Cronbach's alpha of the Persian version of PTCI-9 (α = 0.74) and its subscales (0.76, 0.82, 0.78) demonstrated acceptable reliability. The Persian PTCI-9 also had strong test-retest reliability (r = 0.79). The correlations between the Persian version of the PTCI-9 and the BDI-II (r = 0.60) and the WHO-QOL (r = −0.54) indicated that the scale also has convergent validity. Conclusion: The Persian version of the PTCI-9 showed acceptable psychometric properties. It is a brief and pragmatic measure that can be used in Iranian trauma-exposed patients for research and clinical purposes.

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Abstract Objective: Despite growing recognition of gaming disorder as a mental disorder, there is still debate about how best to screen for it. This is especially relevant in countries where prevalence studies that could support evidence-based policymaking have not yet been conducted. This study aims to evaluate the psychometric properties of the Brazilian Portuguese version of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and to explore its association with functional impairment. Methods: An online convenience sample of 805 Brazilian adults who reported playing games completed the adapted version of the IGDT-10 and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), as well as the Problematic Internet Use Questionnaire (PIUQ), the Center for Epidemiologic Studies-Depression Scale (CES-D), the Rosenberg Self-Esteem Scale (RSES), and a socio-demographic questionnaire. Results: The Brazilian Portuguese version of the IGDT-10 demonstrated a unidimensional structure in both confirmatory and exploratory factor analyses with satisfactory internal consistency and adequate temporal stability. Participants who scored five or more on the IGDT-10 presented higher levels of functional impairment compared to those who scored positive for four symptoms or fewer. The difference between the two groups was statistically significant with a moderate effect size. Network analysis showed a direct connection between IGDT-10 scores and functional impairment and identified "negative consequences" as the most relevant item connecting these variables. Conclusion: The IGDT-10 is a brief, easy-to-understand, valid, and reliable instrument, proving to be a suitable candidate for screening gaming disorder in future epidemiological studies.

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Abstract Objective: To evaluate relative expression of genes with the potential to translate environmental stimuli into long-term alterations in the brain, namely early growth response (EGR)1, EGR3, and cryptochrome circadian regulator (CRY)2 genes, in peripheral blood from patients with bipolar disorder (BD), schizophrenia (SZ), and major depressive disorder (MDD) and from healthy controls (HC). Methods: Thirty individuals ranging from 18 to 60 years old were recruited for each group (BD, SZ, MDD, or HC) from a Brazilian public hospital. These individuals’ peripheral blood was collected and EGR1, EGR3, and CRY2 gene expression analyzed by real-time polymerase chain reaction (qPCR). Results: EGR1 mRNA levels were significantly lower in psychiatric patients when compared to HC, but there were no differences for EGR3 or CRY2. Exploring the findings for each diagnosis separately, there were only significant differences between each of the diagnostic groups and controls for EGR1, which was lower in BD, MDD, and SZ compared to HC. No significant correlations were found between gene expression and clinical features. Conclusion: EGR1 is downregulated in psychiatric patients, regardless of diagnosis, and may be a potential common target in major psychiatric disorders. As a transcription factor, EGR1 modulates many other genes and participates in crucial neuronal and synaptic processes, such as plasticity, neurotransmitter metabolism, vesicular transport, and signaling pathways. The study of EGR1 and its upstream regulators might lead to potential new therapeutic targets in psychiatry.

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Abstract Objectives: Patients with post-traumatic stress disorder (PTSD) present a variety of symptoms, with different intensities, causing impairment in individual, social, and occupational functioning. The aim of this study was to understand the psychodynamic functioning of patients with PTSD, exploring relationships between symptom severity, quality of life, subjective suffering, conflicts, and psychic structure and sociodemographic characteristics, styles, and defensive mechanisms. Methods: This is a cross-sectional quantitative study with 60 participants. The following instruments were used: a sociodemographic questionnaire, the Operationalized Psychodynamic Diagnosis-2 (OPD-2), and the Defensive Style Questionnaire (DSQ-40). Results: Participants had moderate to high symptom severity, with significant subjective suffering and isolation. The main conflict was need for care vs. self-sufficiency and the level of total structure was moderate/low. Use of immature, neurotic, and mature defensive styles was observed. More primitive personality structures, more rigid defenses, and greater dependence were found in patients with history of past trauma. Other mental disorders were also associated. Conclusion: The OPD-2 was effective for assessment of the psychodynamic functioning characteristics of patients with PTSD. Therapeutic treatment should focus on the psychic structure and not only on symptom control. Prevention strategies should target vulnerability factors while strengthening protective factors.

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Abstract Objective: Yellow September (YS) (Setembro Amarelo) is a Brazilian suicide prevention campaign launched in 2015, however, its effectiveness at reducing mortality is still unknown. This is an ecologically interrupted time series study that analyzed the trend in suicide rates in Brazil between 2011 and 2019 and its association with the implementation of YS at a national level. Methods: A segmented interrupted series regression analysis was performed, using a generalized linear Poisson model, with correction for seasonal trends. Data were provided by the Mortality Information System (Sistema de Informações Sobre Mortalidade [SIM]). Results: There was an increase in the annual rates of suicide deaths between 2011 and 2019, with 4.99 and 6.41 suicides per 100,000 inhabitants, respectively. The null hypothesis, that the YS did not change the historical trend of growth in suicides in Brazil after its implementation, was confirmed. However, there was a significant increase of 6.2% in the risk of mortality in 2017 and a significant increase of 8.6% in 2019. Conclusion: The results are consistent with the literature, which proposes that campaigns focused solely on publicity in the media generate unsound findings regarding the effective reduction in the number of deaths by suicide. The lack of initiatives involving multisectoral actions may explain the failure of YS to change rates of death by suicide. Therefore, implementation of new lines of action focused on training professionals and expanding the care network could make it an effective instrument for reducing mortality from suicide.

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Abstract Objectives: Intimate partner violence (IPV) increased extensively around the world during the pandemic, causing severe harm to women's mental health. However, there are no studies showing these effects in Brazil. The objectives of this study were to assess perpetration of IPV and presence of depression and suicidal ideation in women living in Brazil during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Cross-sectional online survey including women living in Brazil from July 2020 to June 2021. Participants answered a 43-item self-administered questionnaire exploring their characteristics and life changes due to the pandemic (CoRonavIruS Health Impact Survey [CRISIS]), IPV (World Health Organization Violence Against Women [WHO-VAW]), and depressive symptoms or suicidal ideation (Patient Health Questionnaire-9 [PHQ-9]). We used Poisson multiple regression analyses with robust variance to model associations between IPV and mental health outcomes, considering aspects of social vulnerability as covariates. Results: We found high frequencies of IPV (33.3%), depression (36.1%), and suicidal ideation (19.8%) among the participants. IPV was significantly associated with depression (prevalence ratio [PR] = 1.502, p = 0.001 for one type of IPV; PR = 2.702, p < 0.001 for two or three types of IPV) and with suicidal ideation (PR = 2.264, p < 0.001 for one type of VPI; PR = 3.272, p < 0.001 for two or three types of IPV). Food insecurity, being black, lower educational levels, and being in a relationship with a person of the same gender were associated with one or both mental health outcomes. Conclusions: We demonstrated associations between IPV and higher frequencies of depression and suicidal ideation in women living in Brazil during the COVID-19 pandemic, highlighting the urgency of strengthening strategies to protect women during adversity.

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Abstract Objective: Food intake during binge eating episodes (BEE) has been found to be associated with symptoms of depression and anxiety in individuals with eating disorders (EDs). The objective of this study was to evaluate the association between caloric intake during BEE and psychopathology in individuals with binge eating spectrum disorders (BSD). Methods: One-hundred and fourteen outpatients diagnosed with bulimia nervosa (BN) and binge eating disorder (BED) were sequentially assessed. The Mini International Neuropsychiatric Interview Plus (MINI PLUS) was used to assess psychiatric diagnoses. Validated self-report instruments were used to assess general and eating-related psychopathology. The Dietpro Clinical Program® was used for assessment of calorie consumption during BEE. Data were analyzed with independent Student's t tests, effect size (Cohen's d), and Pearson's correlation coefficients. Results: Participants with BSD comorbid with a depressive disorder consumed significantly more calories during BEE than those without depression. Furthermore, participants with BSD and higher levels of impulsivity had higher caloric intake during episodes. Specifically regarding BN, participants with greater disease severity consumed more calories during episodes than those with lesser severity. Conclusion: Overall, depression and high impulsivity were associated with higher caloric intake during BEE in individuals with BSD. For those with BN, disease severity was associated with greater calorie consumption during episodes. Our results support the relevance of early identification of psychiatric comorbidities and implementation of strategies to control mood and impulsivity, aiming for better prognosis in the treatment of BSD.

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Abstract Objective This study aimed at investigating a set of peripheral cytokines in elderly female patients with MDD, comparing them to controls, and assessing the potential influence of clinical comorbidities on inflammatory markers. Methods Twenty-five elderly female patients diagnosed with MDD and 19 age-matched female controls were enrolled on this study. Plasma levels of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were evaluated with commercially-available assays. Results Elderly female patients with MDD exhibited higher plasma IL-6 and IL-4 levels when compared to controls. In a logistic regression model taking cytokine levels, comorbidities, and age into account, only type 2 diabetes mellitus (DM2) remained associated with MDD. Conclusion Diabetes influences the association between MDD and higher levels of cytokines in elderly female patients. Future studies should take this evidence into account in order to mitigate confounding factors.

Abstract in English:

Abstract Objective Although there is a general perception that adolescent social media use is a global phenomenon, there is a scarcity of data on patterns and preferences of social media use among youth in low- and middle-income countries (LMICs). We here describe self-reported prevalence and perceived effects of social media use in a school-based sample of Brazilian adolescents. Methods We analyzed cross-sectional data on 7,113 adolescents aged 14 to 16 years enrolled at 101 public state schools between 2018 and 2019 in Porto Alegre, state of Rio Grande do Sul, Brazil. Results Of the 7,113 adolescents with complete data for analyses, 54.9% were female, and 60.6% reported their skin color as white. At least one social media platform was used by 97.7% of adolescents every day, and 64.7% reported being online “almost constantly.” YouTube and WhatsApp were the most popular platforms. Most participants perceived the effect on their lives of social media use as neutral. Conclusion The pattern of social media use by adolescents in Porto Alegre, Brazil, is similar to that reported for samples from high income countries. Also, we found that those who reported being constantly online were also more likely to report socializing with their friends offline.