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Abstract Lithium's well-documented efficacy in preventing suicide over the long term prompts consideration of its potential for more rapid antisuicidal effects. However, evidence supporting such acute efficacy is limited. Weighing against its possible rapid benefits are significant concerns regarding lithium's side-effect profile – particularly toxicity, renal impairment, and weight gain – and the often necessary delay in achieving therapeutic levels. Moreover, the multifaceted nature of suicidality complicates identifying short-term outcomes and disentangling lithium's effects on suicidal thoughts from broader reductions in depressive symptoms. While lithium may remain invaluable for some high-risk patients in emergency settings, its routine use as a rapid-acting agent for acute suicidality is currently not well supported.

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Abstract Psychedelics are a group of psychoactive substances that produce complex and subjective changes to consciousness and carry unique safety considerations. There is a growing body of work investigating the use of psychedelics in mental health treatment alongside increasing socio-cultural and political acceptance. This rapid evolution has prompted corporations to fund psychedelic clinical trials, leading to a potential rise in conflicts of interest in relevant studies and publications. However, the body of evidence for the safety and efficacy of psychedelic-assisted psychotherapy is early. There is concern regarding the introduction of bias in psychedelic clinical trials and the selective reporting of results amidst and beyond corporate involvement. At a crucial time in psychedelic drug reform, this paper explores the safety concerns associated with psychedelics, the potential influences of financial stakeholders on safety outcome reporting and the importance of balanced science communication in maintaining public health and safety.

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Abstract Neuroscience-based nomenclature (NbN) is a proposal to provide a nomenclature based on neuroscience and pharmacology instead of the old disease-based classification. The NbN is based on the mechanism of action and pharmacological target and aims to assist in rational prescription, to reduce stigma, and to increase treatment adherence. Currently, the NbN is endorsed by many psychiatric associations, has been adopted by several relevant journals, and is included in major psychiatry textbooks. Therefore, it is important that the NbN is known to psychiatrists.

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Abstract São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS])-II, CAPS-Alcohol and Drugs (CAPS-AD), outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol (Protocolo de Classificação de Risco à Saúde Mental) to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in low- and middle-income countries (LMICs) developing mental health programs.

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Abstract Objective: Digital psychiatry holds promise for expanding accessibility to mental health treatment, but concerns exist regarding its inclusivity and the potential for exacerbation of digital exclusion among vulnerable populations. This study aims to evaluate the inclusivity of digital psychiatry research and interventions, and to explore their potential to worsen digital exclusion. Methods: We conducted a cross-sectional analysis of sociodemographic data from two clinical trials that utilize psychiatric online treatment modalities in Brazil. Participants were recruited nationwide through digital media platforms. Results: The sample comprised 224 individuals, predominantly female (95.1%) and Caucasian (71.87%) participants, with an average of 15.12 years of schooling. It was observed that White individuals were overrepresented compared to national averages (42.8%). Additionally, participants had a higher average number of years of schooling compared to the national average (10.1 years). Our analysis revealed a clear profile among psychiatric patients with access to and interest in digital interventions, predominantly younger, White, educated, and female individuals. Discussion: As digital therapeutic solutions advance, ensuring their inclusivity and accessibility for vulnerable individuals is crucial. Initiatives to promote digital inclusion and reassess participant recruitment strategies are needed to effectively address digital exclusion. By adopting multifaceted approaches, digital mental health care can be made more effective and accessible to all.

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Abstract The state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress, known as burnout syndrome (BS), is not only affecting the medical workforce but medical students in training. Gender, race, ethnicity, and potentially other variables can serve as significant risk factors contributing to BS among medical students. Despite the importance of understanding these disparities, very few studies in the U.S. have analyzed race or ethnicity amongst their cohorts. However, there exists extensive information on burnout in students from Latin America, which serves as the primary focus of this review. A systematic literature search was conducted using pertinent terms in English and Spanish. Our review found that the prevalence of BS in Latin American countries varies widely, ranging from 4.3 to 43.90% pre-COVID-19 pandemic. Variability in the educational environment and the complex interplay of cultural, academic, and systemic factors appear to contributing to burnout among students. Post-pandemic investigations reveal even higher prevalences, particularly among women. High rates of depression and anxiety are also reported during the COVID-19 pandemic. The reviewed data showed that BS can become further exacerbated and complicated by existing psychiatric comorbidities amongst Latin American medical students. It is possible that we may observe continued upward trajectories in burnout trends among both healthcare workers and medical students in this post-COVID-19 pandemic era. These insights call for tailored interventions addressing not only burnout but also the interconnected mental health challenges faced by medical students in Latin America.

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Abstract Objective Although research has shown that mood and anxiety disorders manifest disturbed emotion regulation, it is unclear whether anxiety disorders differ from each other in terms of their emotion regulation strategies. In the present study, we investigated whether patients with anxiety disorders present different affective styles. Methods We assessed the affective styles of 32 obsessive-compulsive disorder (OCD) patients, 29 social anxiety disorder (SAD) patients, 29 panic disorder (PD) patients, and 20 healthy controls using the Affective Style Questionnaire (ASQ). A multivariate analysis of covariance (MANCOVA) was conducted to compare affective styles across groups (OCD, SAD, PD, and control), while controlling for depression, anxiety symptoms, and age. Results The MANCOVA revealed a significant, small-medium, main effect of diagnostic group on affective styles. The planned contrasts revealed that OCD and SAD patients reported significantly lower scores for “tolerance” (ASQ-T) compared to the healthy controls. There were no differences between the PD group and healthy controls. Conclusion Our findings provide evidence that individuals with OCD and SAD have difficulty tolerating strong emotions existing in the present moment in an open and non-defensive way.

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Abstract Objective: Children grow up spending most of their time within the family social environment, where they can experience stressful situations such as marital conflict, a non-cohesive environment, parental alcohol use disorder, parental depression, and other parental mental health issues. All these factors are associated with children's developmental delays. We aimed to conduct a scoping review on associations between family stress and family resilience and child development delays to examine familial conditions associated with child development. Methods: We conducted a scoping review of observational studies published from January 2000 to July 2023 and indexed in the MEDLINE and LILACS databases. We included observational studies that assessed history of exposure to violence and behavioral or emotional symptoms or mental health problems among children aged 4-12. Data were independently extracted using a structured form. Results: Database searches identified 12,990 unique records. A total of 43 articles were included in the review. Three main findings emerged: (1) parental mental health problems, especially depressive symptoms in mothers, were associated with child developmental delays and mental health problems; (2) better parenting practices and a cohesive home environment were positively associated with child development; and (3) vulnerable social environments (e.g., poverty and housing insecurity) may be linked to child mental health problems. Conclusion: The studies reviewed show that promoting better family dynamics and increasing family cohesion, as well as improving parenting abilities, are beneficial to children's socioemotional development and prevention of child mental health problems. Moreover, increasing family and children's resilience improves the quality of life within family units.

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Abstract Objective Despite previous literature, the superiority of second-generation antipsychotics (SGAs) relative to first-generation antipsychotics – especially haloperidol – on cognitive management in schizophrenia is still controversial. Thus, we aimed to compare the effects of haloperidol versus SGAs on the cognitive performance of individuals with schizophrenia or related disorders. Methods We conducted an updated systematic review and nine pairwise meta-analyses of double-blinded randomized controlled trials published up to October 30th, 2022, using MEDLINE, Web of Science, and Embase. Results Twenty-eight trials were included, enrolling 1,932 individuals. Compared to SGAs, haloperidol performed worse on cognitive composite (mean difference [MD] −0.13; 95% confidence interval [95%CI] −0.33 to −0.03), processing speed (MD −0.17; 95%CI −0.28 to −0.07), attention (MD −0.14; 95%CI −0.26 to −0.02), motor performance (MD −0.17; 95%CI −0.31 to −0.03), memory and verbal learning (MD −0.21; 95%CI −0.35 to −0.08), and executive function (MD −0.27; 95%CI −0.43 to −0.11). In contrast, there were no significant differences between SGAs and haloperidol on working memory (MD 0.10; 95%CI −0.08 to 0.27), visual learning (MD 0.08; 95%CI −0.05 to 0.21), social cognition (MD 0.29; 95%CI −0.30 to 0.88), and visuoconstruction (MD 0.17; 95%CI −0.04 to 0.39). Conclusion Haloperidol had poorer performance in global cognition and in some cognitive domains, but with small effect sizes. Therefore, it was not possible to conclude that haloperidol is certainly worse than SGAs in the long-term cognitive management of schizophrenia.

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Abstract Objective: Recent guidelines on depressive disorders suggest a combination of antidepressants and psychotherapy in case of moderate to severe symptomatology. While cognitive behavioral therapy (CBT) and interpersonal therapy (ITP) are the most investigated interventions, psychodynamic psychotherapies have been less explored. The aim of this paper is to systematically review literature data on the efficacy of short-term psychodynamic psychotherapy (STPP) in combination with antidepressants in the treatment of depressive disorders, focusing on both short and long-term results and on potential moderators that could influence its effectiveness. Methods: This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched were PubMed, Ovid, Scopus, and Cochrane Library, from inception to August 2023. Results: Adding STPP to medications in the first 6 months of treatment did not influence remission rates, but did improve acceptability, work adjustment, interpersonal relationships, social role functioning, hospitalization rates, and cost-effectiveness. After 12 months, a significant difference in remission rates arose, favoring combined therapy. From a long-term perspective, adding STPP to pharmacotherapy reduced the recurrence rate by almost 50%. STPP has proven to be more effective in longer depressive episodes, in more severe depression, and in patients with a history of childhood abuse. However, STPP had no impact on major depressive disorder (MDD) with comorbid obsessive-compulsive disorder (OCD). Conclusions: Combining STPP with antidepressants appeared to be helpful from both short-term and long-term perspectives. Still, there are few rigorous studies with large samples and further research is needed to identify which subgroups of patients may benefit more from STPP.

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Abstract Objective: There is growing concern about the occurrence of burnout syndrome in university students worldwide. This systematic review aimed to estimate the prevalence of burnout syndrome and its associated factors among health sciences students (HSS) in Spain. Methods: Five databases (MEDLINE/PubMed, PsycINFO, EMBASE, Dialnet and MEDES) were searched up to January 5, 2023, adhering to PRISMA guidelines. Quantitative studies reporting the prevalence of burnout syndrome among HSS in Spanish universities were considered. The reference lists of the selected studies were hand searched. Data were extracted from peer-reviewed articles. Results: Twenty-six studies were included with a total of 14,437 HSS. Most studies included nursing students (k = 11), followed by medicine students (k = 8), psychology students (k = 5), dental students (k = 2), physiotherapy students (k = 1) and pharmacy students (k = 1). Overall, study quality was fair. The most widely used instrument was the Maslach Burnout Inventory. The mean prevalence of burnout was 35.3% (k = 11 studies). However, rates varied widely between studies, which may be due to methodological differences. Inconsistent associations were found with gender and year of study. The relationship of burnout with academic and mental-health related variables was consistent across studies. Personal attributes, such as higher resilience, are likely protective against burnout. Conclusion: Burnout appears to be prevalent among HSS in Spain, and may be affected by academic, mental health and personality factors. Identifying risk and protective factors for burnout could help to develop preventive and management strategies to ultimately reduce its negative consequences in this population. Systematic review registration: PROSPERO (CRD42023387460).

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Abstract Objective: Medication non-adherence is frequently reported in patients with major depressive disorder (MDD). The objective of this review is to consolidate data on the prevalence of non-adherence to antidepressant in MDD. Methods: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021199987. Studies assessing medication adherence in MDD were searched in PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. The data extraction was performed by two independents authors. Meta-analysis used random effects model and performed a subgroup analysis. Results: From the articles retrieved, 11 studies were considered eligible for the final analysis. Most of them assessed non-adherence by self-report scales, followed by Pharmacy Dispensation Records, Monitoring Events Medication System (MEMS), and blood tests. The pooled proportion of non-adherence was 42% (95% confidence interval [95%CI] 30-54), but heterogeneity was very large (I² = 99%). Conclusion: Data from the selected studies suggests that a high number of individuals with MDD do not adequately take their medication as prescribed. The high heterogenicity of measures used for the assessment of adherence may have impacted the great variability of the results. The results suggest it is necessary that health care professionals should address this issue in order to achieve a better treatment outcome in major depression.

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Abstract Objective: Human sleep is fundamental for the proper occurrence of organic functions. Hence, lack of sleep can impair cognitive function, resulting in emotional problems, memory changes, and disease onset. However, it is worth noting that sleep is influenced by outside factors, such as drug use. In this sense, the aim of this review is to analyze studies that researched the influence of recreational marijuana on the sleep quality of adults. Methods: High-sensitivity searches were conducted on databases (Biblioteca Virtual em Saúde [BVS], MEDLINE via PubMed, Cochrane, Embase, Web of Science, and Scopus) using descriptors related to marijuana and sleep habits. Results: Eighteen studies from four countries were included with a total sample size of 29,858 participants. It was found that marijuana affects sleep characteristics – such as latency and duration – with these changes being more evident in users who make greater use of marijuana and in those with early onset of marijuana use. Conclusion: It was observed that most articles demonstrated a detrimental effect of recreational cannabis use on the quality of sleep in adults.

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Abstract Objectives: The increase in mental health problems among youth highlights the need for accessible and cost-effective psychological interventions. Blended interventions, which combine face-to-face and online sessions, can be an adequate response to the increase in demand for youth mental health services. Although this can be a promising approach, effective dissemination depends on its acceptability to professionals. This study aimed to explore the acceptability of and intention to use blended interventions among psychologists working with children with emotional disorders and to examine predictors of these variables, including previous knowledge, expectancies (i.e., performance expectancy, effort expectancy, social influence, and facilitating conditions), and attitudes toward evidence-based practices (EBPs). Methods: The sample comprised 76 Portuguese psychologists (Mage = 37.26 years, standard deviation [SD] = 10.47; 92.1% female) working in youth mental health services. The participants completed an online questionnaire to evaluate the different dimensions included in the study. Results: The results showed that most participants demonstrated moderate to high acceptance of blended psychological interventions for emotional disorders in youth and intended to use them in the future. Regression analysis showed that performance expectancy and positive attitudes toward EBPs were significant predictors of acceptance of blended interventions and that social influence was a significant predictor of both acceptance of and intention to use blended interventions. Conclusion: These results emphasize the importance of sharing the findings of blended interventions, changing professionals’ attitudes toward EBPs, and of collaborating more closely with organizations and institutions to advance standards that encourage the adoption of this intervention format.

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Abstract Objective Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been linked to dysregulation in the cholinergic and endocannabinoid (EC) systems. This study systematically reviews the present literature on treatment strategies aimed at enhancing the activity of both systems in ASD models. Methods We performed a systematic evaluation of literatures that investigated the effects of different therapeutic interventions on the components of the cholinergic and EC systems in ASD models, following the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Four databases were searched: Google Scholar, Web of science, EMBASE, and MEDLINE/PubMed, for articles published from August 2012 to February 2023. References cited in the selected research papers were also examined. Twelve papers (five on the cholinergic system, six on the EC system, and one on both) were reviewed in this study of prior work on relevant treatment strategies that impact these systems. The paper cites a total of 77 studies. Results The majority of research revealed that different therapeutic interventions downregulated cannabinoid 1 (CB1) receptors, and the system’s hydrolyzing enzymes and upregulated EC, alpha 7 nicotinic acetylcholine receptor (α7-nAChR), and ACh signaling molecules. Regulation of the components of the cholinergic and EC systems by these therapies generally enhanced behaviors in ASD models. Conclusion It is possible that the therapeutic interventions assessed in one or both of these systems may be effective for treating the core ASD-associated phenotype. The benefits of the therapeutic interventions reviewed in this study merit further investigation in randomized, blinded, placebo-controlled clinical trials.

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Abstract Objective: The internet has become an important element in people's lives. The increasing use of smartphones and other electronic devices has promoted an increase in digital interactions, resulting in significant problems in the field of mental health. However, one of the implications of excessive internet use is impaired sleep quality, especially among users who use the internet before bed. Methods: We searched the PubMed, Web of Science and PsycINFO databases to identify articles that addressed the association between excessive internet use and sleep quality. Studies in which participants had a previous diagnosis of insomnia or used psychoactive substances were excluded. Results: The initial search resulted in a total of 3269 articles, 25 of which met the inclusion criteria. The results suggested an association between excessive internet use and sleep quality. Conclusion: Excessive internet use significantly compromises sleep quality, directly affecting users’ mental and physical health. This study highlights the importance of strategies that promote digital education to raise awareness about the risks of excessive use of screens. Systematic review registration: PROSPERO, CRD 42024610542.

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Abstract Objective: Major depressive disorder (MDD) is a prevalent mood disorder characterized by persistent low mood and anhedonia, significantly impacting cognitive function and daily living. Despite available pharmacological treatments, nearly one-third of individuals with MDD do not achieve adequate symptom relief with conventional treatments. The ketogenic diet (KD), a high-fat, low-carbohydrate diet that induces ketosis, has emerged as a potential non-pharmacological intervention for MDD. The objective of this study was to provide a comprehensive perspective on the current knowledge and gaps regarding the potential antidepressant effect of the KD, emphasizing its safety, efficacy, and mechanistic pathways. Methods: This narrative review synthesizes data from preclinical and clinical studies on the effects of KD on mood, cognitive function, and its potential as an antidepressant. Mechanistic insights from animal and human studies are explored to elucidate possible pathways through which KD may exert its effects on MDD. Results: Evidence from animal models suggests that KD may reduce depressive-like behaviors and improve cognitive function. Preliminary human studies, including case reports and observational studies, indicate potential benefits such as mood stabilization, increased energy, and reduced depression severity. Proposed mechanisms include immune-inflammatory regulation, correction of mitochondrial dysfunction, and neurotransmitter modulation. However, key gaps remain, particularly regarding the therapeutic window, long-term efficacy, and specific mechanisms of action in MDD. Conclusions: KD represents a promising avenue for further investigation as a non-pharmacological treatment of MDD. Further research is needed to establish its clinical utility, identify predictors of response, and assess its feasibility as a treatment option for MDD.

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Abstract Objective: Autism spectrum disorder (ASD) and bipolar disorder (BD) pose significant diagnostic challenges due to their clinical complexity. This review aims to examine the interface and overlapping features of these conditions, with a particular focus on the challenges associated with their comorbidity. Methods: We conducted a narrative review to examine clinical overlap, common psychiatric comorbidities, and a shared neurobiological basis between ASD and BD. Results: There is a notable convergence of symptoms in ASD and BD, including mood instability and emotional dysregulation; irritability, impulsivity, and aggressive behavior; deficits in social skills and social cognition; impairments in executive functions; sleep disturbances; problematic sexual behaviors; and sensory sensitivities. Common psychiatric comorbidities and shared neurobiological basis further underscore this potential interplay. Conclusion: Despite distinct clinical trajectories and diagnostic criteria, our findings indicate a significant overlap in symptoms and clinical presentations between ASD and BD. This complexity makes it challenging to identify the co-occurrence of ASD and BD, which can lead to difficulties in accurately diagnosing and managing both conditions simultaneously.

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Abstract Objective: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 7% of children and 5% of adolescents worldwide. ADHD is characterized by inattention, hyperactivity and impulsivity as symptoms. The exact mechanism underlying this disorder is still unclear, but genetic and environmental factors play important roles. In recent years, research and treatment options have increased, including medication and/or therapeutic interventions such as music therapy. There is evidence showing benefits of music therapy on mental health, such as autism spectrum disorder (ASD). However, results regarding ADHD are limited. The aim of this meta-analysis was to verify whether music therapy is an effective tool for improving symptoms in children and adolescents with ADHD. Methods: In accordance with PRISMA guidelines, we systematically searched the Virtual Health Library, SciELO, PubMed and Cochrane Library databases. This article included original research that investigated the effect of music therapy on hyperactive and impulsive symptoms in children and adolescents with ADHD. Results: Music therapy was associated with a trend of efficacy involving ADHD symptoms (effect size: 1.18; CI: −3.8 – 0.21; p = 0.08). Additionally, a significant amount of heterogeneity among trials was found (I2 = 92 %). The lack of studies involving music therapy, ADHD and brain imaging, as well as limited investigation of inattention symptoms in studied articles are limitations of this article. Conclusion: Music therapy is an important therapeutic tool for ADHD. Therefore, future research should include more robust samples and measurement scales, follow-up after experiments and further exploration of the potential connections among ADHD, music therapy, neuroimaging and neuroscientific fields.

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Abstract Objectives We investigated relationships between the triarchic model of psychopathy, coping styles, and externalizing and internalizing symptoms, and verified the mediating effect of coping styles. Methods Participants were 957 adults who answered the Triarchic Psychopathy Measure (TriPM), the Inventory of Depression and Anxiety Symptoms Expanded Version (IDAS-II), and the Crime and Analogous Behavior Scale (CAB). Results Data were analyzed using four path analyses to test our hypotheses, indicating each triarchic trait is differently associated with psychological symptoms and coping styles. We also observed preferences for some coping styles affecting the association between triarchic traits and psychological symptoms. Conclusion Our findings suggest that coping styles only affect the interaction between boldness and distress, as well as between boldness and fear, indicating that specific coping strategies can account for variations in distress and fear linked to boldness.

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Abstract Objectives Death anxiety (DA) is a predictor of exacerbation of both physical and psychological symptoms of chronic diseases. Therefore, having short and easy-to-apply instruments to assess the presence of DA and adopting a multidisciplinary approach to address it are important. This study analyzes the psychometric properties of the Death Anxiety Scale (DAS), originally developed by Donald Templer, in a Colombian population of adult patients diagnosed with a chronic disease. Methods The original instrument was linguistically, conceptually, and culturally adapted to Colombian Spanish to be subsequently administered to 301 adult patients with chronic diseases. Results The exploratory factor analysis revealed a three-factor structure, which explained 47% of variance. Internal consistency was demonstrated (Cronbach’s alpha: 0.71; McDonald’s omega: 0.76; Guttman’s lambda 6 [G6]: 0.74; greatest lower bound: 0.54). A correlation coefficient of 0.64 was found between the total score of the DAS and the Beck Anxiety Inventory (BAI). Conclusion When comparing the results with the versions of the DAS in Spanish from Mexico and Spain, variability in the psychometric properties was observed. Language cannot therefore be assumed to be a guarantee of the reliability and validity of the instrument.

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Abstract Objective: Cardiovascular patients experience various psychological problems due to the conditions caused by their disease, making it worse if left untreated. The purpose of the current study was to evaluate the effects of acceptance and commitment therapy (ACT) on distress, emotion regulation, and self-compassion in patients with cardiovascular disease. Methods: This study was a randomized clinical trial with pre-test, post-test, and 2-month and 4-month follow-up periods accompanying a control group and an experimental group. Patients filled out questionnaires at four stages; a Depression, Anxiety, and Stress Scale (DASS-21), an Emotion Regulation Questionnaire (ERQ), and a Self-Compassion Scale (SCS). The experimental group underwent a treatment protocol based on ACT. Data were then analyzed using SPSS-25 with repeated measures analysis of variance (ANOVA). Results: ACT significantly reduced depression, anxiety, and stress, enhanced self-compassion, and improved emotion regulation in cardiac patients. Between-subjects (group) partial Eta squared (η²) for depression, anxiety, stress, reappraisal, suppression, and self-compassion were 0.61, 0.64, 0.66, 0.62, 0.66, and 0.65, respectively. Treatment efficacy was maintained at the 2-month and 6-month follow-up visits. Conclusion: The results of this study suggest that treating cardiac patients’ psychological problems in an ACT-focused manner may have an impact on how well they respond to their treatment.

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Abstract Objective: Major depressive disorder (MDD) is a global concern due to its widespread prevalence and morbidity. It is crucial to identify protective factors in high-risk individuals, including those with a familial predisposition, maltreatment history, and socioeconomic vulnerabilities. Methods: We assessed a high-risk subsample within a young adult population cohort (n = 791; mean age = 31.94 [standard deviation {SD} = 2.18]) across three waves, using multiple regression models to analyze higher education, feeling supported, spirituality, psychotherapy access, higher socioeconomic status, involvement in activities, cohabitation, and family unity in waves 1 and 2 and their association with MDD resilience at wave 3. Results: In the high-risk group, MDD incidence was 13.7% (n = 24). Paternal support had a protective effect on MDD incidence (odds ratio [OR] = 0.366; 95% confidence interval [95%CI] 0.137 to 0.955; p = 0.040) and suicide attempt risk (OR = 0.380; 95%CI 0.150 to 0.956; p = 0.038). Higher resilience scores were also protective (OR = 0.975; 95%CI 0.953 to 0.997; p = 0.030), correlating with reduced Beck Depression Inventory (BDI) (r = 0.0484; B = −0.2202; 95%CI −0.3572 to −0.0738; p = 0.003) and Montgomery-Åsberg Depression Rating Scale (MADRS) scores (r = 0.0485; B = −0.2204; 95%CI −0.3574 to −0.0741; p = 0.003). Conclusion: Our paper emphasizes reorienting the MDD approach, focusing on positive prevention strategies. It highlights the crucial role of fathers in family-based interventions and in promoting resilience in high-risk populations.

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Abstract Objective In recent decades, there have been considerable advances in treatment and prevention of acute ischemic stroke (IS). However, even after treatment, approximately two-thirds of patients with IS have some degree of disability that requires rehabilitation, along with an increased likelihood of developing psychiatric disorders, particularly depression. The objective of this study was to determine the predictors of post-stroke depression in a 6-month period in patients with IS. Methods Ninety-seven patients with IS without previous depression were included in the study. The study protocol was applied during hospitalization and at 30, 90, and 180 days after hospital discharge. A binary logistic regression was then conducted. Age, sex, marital status, occupation, educational level, thrombolysis, National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) score, Barthel Index (BI), and Mini-Mental State Examination (MMSE) score were included as independent variables. Results Of the 97 patients, 24% of patients developed post-stroke depression. In the longitudinal follow-up, an mRS score of > 0 was the lone significant predictor of development of depression (odds ratio [OR] = 5.38; 95% confidence interval [95%CI] 1.25-23.12; p < 0.05). Conclusion Our results showed that in patients without previous depression, functional impairment of any degree is associated with a 5-fold greater chance of development of depression in the first 6 months post-stroke compared to patients without functional impairment.

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Abstract Objective Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy. Methods This study is a secondary analysis of data from a two-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of either esketamine (0.25 mg/kg) or racemic ketamine (0.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. Variations in depression scores were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hours, 72 hours, and 7 days following infusion. Results Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of −0.5 (standard deviation [SD] = 0.25; p = 0.04) of predicted MADRS score from baseline to 24 hours. The results for 72 hours and 7 days following infusion were not significant. Since the original trial was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, confounding variables for this relationship were not controlled. Conclusion We suggest a positive relationship between dissociation intensity measured with the CADSS and the antidepressant effects of ketamine and esketamine 24 hours after infusion for CADSS scores of up to 15 points.

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Abstract Objective Medical students are a population at increased risk for anxiety due to their demanding schedule and concerns about potential stigmatization, which often discourage them from seeking help. It has been reported that the coronavirus disease (COVID-19) pandemic worsened this issue by restricting social interaction and mobility. An innovative method has been developed to address this problem, known as the asynchronous Digital Cognitive Education Gadjah Mada Anxiety Intervention for Medical Students (DCE GAMA-AIMS). Compared to traditional therapy, this modality can be accessed independently without the guidance of a therapist. The objective of this study was to compare the effectiveness of DCE GAMA-AIMS compared to therapist-guided brief cognitive behavioral therapy (bCBT) for reducing anxiety scores. Methods A non-blinded randomized clinical trial (RCT) was conducted with 66 medical students. The participants were equally divided into two groups, an intervention and a control group. The intervention group was given DCE GAMA-AIMS, while guided bCBT was administered to the controls. The data obtained were analyzed using independent t tests and analysis of variance (ANOVA). Results The application had a significant effect, reducing anxiety scores from the 2nd week (M Taylor Manifest Anxiety Scale [TMAS] = 18) to the 8th week (M TMAS = 13). A faster and more significant improvement was observed in the intervention group from the 1st to the 2nd week compared to the controls, who began to improve in the 4th week. Furthermore, the intervention group had larger effect size (1.32) compared to the control (0.79) from the 1st to 8th weeks. Conclusion Asynchronous DCE GAMA-AIMS and guided bCBT both reduced TMAS scores in medical students with anxiety, but DCE GAMA-AIMS yielded a larger effect size.

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Abstract Objective Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the Short Multidimensional Inventory on Lifestyle Evaluation (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students. Methods Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis (EFA) to obtain the most parsimonious, interpretable, and good-fitting model. Results The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r = 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the Patient Health Questionnaire (PHQ-9) (Spearman's r = −0.517), and Generalized Anxiety Disorder Questionnaire (GAD-7) (Spearman's r = −0.356), two validated instruments to screen for depression and anxiety, respectively. Conclusion Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

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Abstract Objective One of the most popular ways to meet new people in the modern world is through dating apps. However, their use may facilitate casual sexual encounters and quick partner changes, both of which are associated with endangering sexual health in different populations. The objective of this study is to describe the use of mobile dating apps among undergraduate students at a major Brazilian public university and investigate its associations with sexual risk behaviors and sociodemographic factors. Methods This is a cross-sectional study based on a web survey. The link for participation was made available to students enrolled in undergraduate courses at the eight units of Universidade de São Paulo, Campus Ribeirão Preto. Use of dating apps, sociodemographic/behavioral profile, and sexual risk behaviors were among the variables studied. The distribution of app users was calculated for each variable of interest, and prevalence ratios (PRs) were used for comparisons. PRs were reported with 95% confidence intervals (95%CI). Results A total of 487 students participated, with 32.9% reporting using dating apps. Male participants were more likely to use apps. Use of dating apps was associated with having multiple sexual partners and risky behaviors such as smoking, alcohol consumption, and substance abuse. Conclusion It is critical to describe the pattern of app use by undergraduate students and understand its influence on sexual health in order to avoid stigmatizing users. Additionally, this information can be helpful to guide the creation of strategies for using these apps as resources to promote health, such as through sharing information regarding sexual health.

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Abstract Objective: The present study has the following objectives: 1) identify differentially expressed proteins and pathways in blood samples of bipolar disorder (BD) compared to healthy controls (HC) by employing high-throughput proteomics and bioinformatics; and 2) characterize disease-related molecular signatures through in-depth analysis of the differentially expressed proteins and pathways. Methods: Blood samples from patients with BD (n = 10) classified into high (BD+) or poor functioning (BD-), based on functional and cognitive status, and HC (n = 5) were analyzed using mass spectrometry-based proteomic analysis. Bioinformatics was performed to detect biological processes, pathways, and diseases related to BD. Results: Eight proteins exclusively characterized the molecular profile of patients with BD+ compared to HC, while 26 altered proteins were observed in the BD- group. These altered proteins were mainly enriched in biological processes related to lipid metabolism, complement system and coagulation cascade, and cardiovascular diseases; all these changes were more prominent in the BD- group. Conclusion: These findings may represent systemic alterations that occur with the progression of the illness and a possible link between BD and medical comorbidities. Such comprehensive understanding provides valuable insights for targeted interventions, addressing mental and physical health aspects in subjects with BD. Despite these promising findings, further research is warranted, encompassing larger sample cohorts and incorporating biological validation through molecular biology methods.

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Abstract Objective: Risky drinking (RD) is associated with an increased risk of chronic and infectious diseases, injuries, and violence. This study aimed to assess changes in RD in Brazil after coronavirus disease 2019 (COVID-19) outbreak, both overall and among individuals with self-reported chronic diseases and mental health disorders. Methods: We conducted three independent, anonymous web surveys in Brazil including adult participants: Survey 1 (S1) (April/2020, n = 19,257), S2 (August/2020, n = 1,590), and S3 (January/2021, n = 859). Participants were recruited through adapted snowball sampling and sponsored social network advertisements. RD was assessed using the Alcohol Use Disorder Identification Test-Concise (AUDIT-C), designed to identify individuals at risk of alcohol-related problems. Logistic regression analyses with bootstrapping (B = 2,000) were performed, with stratification by sex, age, education, employment, household size, and the presence of chronic and mental health conditions, as well as lifestyle factors, to address sample imbalances. Results: The estimated prevalence of RD was 45.8% (95% confidence interval [95%CI] 45.5-46.1) in S1, 35.3% (95%CI 34.9-35.6) in S2, and 33.7% (95%CI 33.3-34.0) in S3. Participants with chronic diseases consistently presented lower RD prevalence across all three surveys, compared to those without such conditions. Conversely, individuals with mental health disorders presented higher RD prevalence than those without such diagnoses in S1 and S2, but not in S3. Conclusion: Despite the decrease in RD prevalence, monitoring of alcohol consumption trends remains essential for shaping effective public health policies. Additionally, the observed variations among individuals reporting chronic and mental health disorders highlight the need for targeted interventions in future crises.

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Abstract Objective: Women with premenstrual dysphoric disorder (PMDD) are more likely to report suicide ideation and behavior when compared to women without PMDD. However, there is a lack of studies investigating the risk factors for suicide risk in women with PMDD. Thus, the aim of this study is to assess the factors associated with suicide risk in young women with PMDD. Methods: This is a cross-sectional study including 128 young women with PMDD who were recruited from the community. PMDD and suicide risk were assessed by trained psychologists using the Mini International Neuropsychiatric Interview (MINI-PLUS). Suicide risk evaluation includes six questions that assess suicidal intention, planning, and previous attempts. Subjects who answer yes to any of the six questions are classified as having current suicide risk. Results: The prevalence of current suicide risk in women with PMDD was 28.1%. The factors associated with suicide risk in this population were: presenting current panic disorder (odds ratio [OR]: 18.71 [95% confidence interval {95%CI} 1.02-343.27], p = 0.048), a non-white skin color (OR: 4.18 [95%CI 1.28-13.61], p = 0.018), greater severity of depressive symptoms (OR: 1.22 [95%CI 1.12-1.32], p < 0.001), and history of childhood trauma (OR: 1.04 [95%CI 1.01-1.08], p = 0.010). Conclusion: Our findings indicate that there are key sociodemographic and clinical factors associated with suicide risk in young women with PMDD, enabling clinicians to identify at-risk individuals who could benefit from further screening and interventions.

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Abstract Objective: Incarcerated individuals exhibit higher suicide rates compared to the general population. Investigating risk factors aids in developing effective public policies and interventions. The goal of this study was to assess and analyze factors predicting both suicidal thoughts and suicide attempts in a population of male incarcerated individuals who engage in the use of multiple psychoactive substances. Methods: A cross-sectional observational study was conducted. A total of 174 male individuals deprived of liberty participated in the study, all of whom were serving a closed prison sentence during the data collection steps. Participants were assessed with the following instruments: the Addiction Severity Index (ASI-6) and the Barratt Impulsiveness Scale (BIS-11). Results: Amongst our sample, observed prevalences were 36.7% for suicidal ideation and 16% for suicide attempts. Impulsivity (odds ratio [OR] = 1.098, 95% confidence interval [95%CI] 1.008-1.197), social support (OR = 0.281, 95%CI 0.085-0.925), witnessing someone being killed or beaten (OR = 5.173, 95%CI 2.143-12.486), cigarette use (OR = 3.309, 95%CI 1.063-10.293), and cocaine use (OR = 2.678, 95%CI 1.040-6.897) were found to be associated with suicidal ideation. No significant associations were found between drug use and suicide attempts. Conclusion: A high prevalence of suicidal behaviors was observed among the study sample, with findings demonstrating that impulsivity moderately differentiates between the groups "with" and "without" suicidal ideation. Traumatic life events and substance use were also associated with suicide ideation, while social support was established as a protective factor against it.

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Abstract Objective: This study aimed to evaluate mental health factors in individuals affected by the floods in Rio Grande do Sul from May 10 to June 6, 2024. Methods: A real-time survey was conducted with 1,552 participants. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Acute Stress Disorder (ASD) symptom checklist were used to assess mental health outcomes. Sociodemographic factors, trauma exposure, rescue participation, and psychological support were evaluated. Statistical analyses included t-tests, ANOVA, linear regression, and MANCOVA. Results: High rates of depressive and anxious symptoms were found, with over half of the individuals with moderate to severe symptoms reporting no prior history of these conditions. Participants directly affected by the floods, and those with close ones affected, had higher PHQ-9, GAD-7, and ASD scores compared to the unaffected group. Moreover, younger age, female sex, lower family income, participation in rescues, and unmet psychological support needs were correlated with worse mental health outcomes. Individuals who participated in rescues had significantly higher rates of suicide ideation. Notably, psychological support had the largest effect size in mitigating mental health symptoms, regardless of trauma exposure status, when controlled for age, sex, and income, according to MANCOVA. Conclusion: The findings highlight the critical role of psychological support in disaster response and the importance of community resilience. Real-time data collection during crises can inform targeted interventions, emphasizing the need for robust mental health services and community support networks. These efforts are essential to reduce long-term psychological morbidity and foster recovery in vulnerable populations.

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Abstract Objective: Excessive smartphone use has been linked to mental health impairments and may potentially alter human behavior. These effects are particularly pronounced among younger individuals, with university students being especially susceptible to the negative influences of smartphone use. Methods: This observational, cross-sectional study was conducted in a sample of 781 Brazilian university students. We assessed socio-economic variables, smartphone addiction, depression, anxiety, stress outcomes, eating behavior, body image satisfaction, and self-reported physical activity. Multivariate analysis of variance (MANOVA) and chi-square tests were performed to compare continuous and categorical variables between genders. K-means clustering was used to identify participant profiles based on various self-reported variables, with differences between clusters validated using the Z-test and the silhouette coefficient. Results: Three clusters were identified. Cluster 1 featured participants with a significant disparity between their perceived and desired body image, higher scores on eating disorders, smartphone addiction, and mental health questionnaires, and lower levels of physical exercise. Cluster 2 consisted of older participants who scored lower for smartphone addiction and mental health and had a higher body mass index (BMI). Cluster 3 included younger participants with a smaller Silhouette Scale disparity, lower eating disorder scores, and lower BMI. Smartphone addiction showed significant associations with eating disorders in the overall eating disorders classification (χ² = 13.4; p < 0.001), bulimic behavior (χ² = 20.0; p < 0.001), and social pressure to eat (χ² = 4.3; p < 0.001). It also negatively correlated with physical exercise (χ² = 5.7; p = 0.017), but not with dieting concerns (χ² = 0.23; p = 0.688). Conclusion: Smartphone addiction is associated with eating disorders, stress, depression, anxiety, and lower levels of physical activity.

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Abstract Objective Neutrophil-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelets-lymphocyte ratio (PLR) are biomarkers easy-to-obtain and could be used in clinical practice to verify an inflammatory status and are associated with alcohol use disorder (AUD) and cocaine use disorder (CUD). Our aim was to compare NLR, MLR, and PLR among men with AUD and CUD and to assess the relationship between these biomarkers and addiction-related outcomes. Methods This is a cross-sectional study comprising 979 inpatient men diagnosed with substance use disorder (391 with AUD and 588 with CUD) under hospital treatment for drug addiction. Results Individuals with AUD had higher NLR and MLR (p = 0.041, p < 0.001 respectively) compared to individuals with CUD. In the AUD group, positive correlations between age and MLR (r = 0.111; p = 0.029), NLR and liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) (r = 0.103, p = 0.043; r = 0.155, p = 0.002; respectively), and MLR and ALT, AST and gamma-glutamyl transferase (GGT) levels were observed (r = 0.173, p = 0.001; r = 0.242, p < 0.001; r = 0.167, p = 0.001, respectively). Individuals with CUD showed a positive correlation between age and NLR (r = 0.113; p = 0.006). The presence of clinical comorbidities, human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis were not associated with NLR, MLR, and PLR (p > 0.05). Conclusion These biomarkers are a rapid and inexpensive way to assess the effects of substance use on the inflammatory profile. Our findings contribute with valuable insights into the distinctive inflammatory profiles associated with AUD and CUD. These insights could guide further research and the development of more studies, which could include control groups, in order to refine the clinical applicability of these biomarkers.

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Abstract Objective This study aimed to examine the discriminative capacity of the Dimensional Clinical Personality Inventory 2 (IDCP-2) factors for identifying individuals with elevated borderline personality disorder (BPD) traits within a Brazilian community sample while proposing an optimal cutoff score for distinguishing high BPD trait levels. Methods The participant cohort consisted of 1,469 adults who completed assessments, including the Level of Personality Functioning Scale – Brief Form 2.0 (LPFS), the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) (PID-5), the IDCP-2, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) – Personality Questionnaire (PQ-SCID-II). We categorized participants into three groups utilizing the traits outlined in the Alternative Model of Personality Disorders (AMPD) from DSM-5 Section III. Furthermore, latent profile analysis based on PID-5 facets revealed the existence of three empirically derived profiles. Results Our findings demonstrate that IDCP-2 factors exhibited substantial discriminative power, marked by large effect sizes across most factors. To minimize false negatives, we suggest a conservative cutoff score of 22 as the most effective threshold for identifying individuals with high levels of BPD traits. Conclusion The BPD score generated from IDCP-2 factors holds significant promise in clinical practice, offering valuable insights into a patient’s propensity to exhibit a BPD profile and providing a comprehensive clinical profile.

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Abstract Objective Approximately 6 to 13% of women suffer from antenatal depression (AD) around the world. AD can lead to several health problems for mother and baby. Vitamin D is a molecule that appears to have great preventive/therapeutic potential against neuropsychiatric disorders. The present study aimed to analyze the association between vitamin D deficiency and AD in pregnant women in a city in the south of Brazil (Pelotas, Rio Grande do Sul). We hypothesize that pregnant women with a positive AD diagnosis have deficient levels of 25-hydroxyvitamin D (25(OH)D). Methods This cross-sectional study was conducted within a cohort study (CEP/UCPEL 47807915.4.0000.5339). From this cohort, 180 pregnant women at up to 24 weeks gestation were selected (130 non-depressed and 50 depressed), and depression was diagnosed using the Mini International Neuropsychiatric Interview (MINI-Plus). Blood was collected and stored for later analysis of vitamin D 25(OH)D by the chemiluminescence method. The SPSS program was used for data analysis and results with p < 0.05 were considered statistically significant. Results In our study, we showed a significant association between current major depressive episode in the antenatal period and vitamin D deficiency (odds ratio [OR]: 0.9; 95%CI 0.9-1.0, p = 0.003). Conclusion Our results demonstrate that vitamin D deficiency may be involved in major depressive disorder in the antenatal period. It is thus advisable to monitor vitamin D levels during the pregnancy-puerperal cycle to minimize mental health problems in women and prevent developmental deficits in children.

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Abstract Objective: Individuals with insomnia disorder often exhibit differences between reported experiences of sleep and objectively measured sleep parameters; however, the implications of this subjective-objective sleep discrepancy during treatment remains unclear. The aim of this study was to investigate the impact of cognitive behavioural therapy for insomnia (CBT-I) on the discrepancy between objective and subjective measures of sleep, and to assess whether changes in clinical variables such as depression, anxiety, fatigue, and beliefs about sleep, were related to changes in discrepancy. Methods: Twenty-five participants with insomnia disorder were enrolled in group CBT-I. Sleep measures were continually sampled from baseline until 2 weeks post-treatment with both objective (i.e., actigraphy) and subjective (i.e., sleep diary) methods. Results: The subjective-objective discrepancy significantly decreased from baseline early on in treatment (following the second session) and were maintained at post-treatment for sleep onset latency, wake after sleep onset (WASO) and sleep efficiency (SE). Total sleep time (TST) discrepancy and misperception decreased from baseline to post-treatment. Improvement in depression symptoms, fatigue symptoms, and negative beliefs about sleep were significantly correlated with the decrease in the discrepancy for WASO and SE. Conclusion: These findings suggest that CBT-I resolves the mismatch between objective and subjective sleep parameters early in treatment for adults with insomnia. Sleep misperception improved from underestimating to accurately estimating TST. Improvement of psychological symptoms were related to decrease in sleep discrepancies across treatment. Future research is needed to explore how feedback on objective and subjective sleep discrepancy may impact sleep perception across treatment with CBT-I.

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Abstract Objective: Depression is a prevalent mental health condition with a significant global burden, yet treatment coverage remains limited. Digital interventions offer a promising avenue for expanding access to evidence-based interventions. Methods: In a three-arm randomized clinical trial, we evaluated the efficacy and safety of an app-based intervention and an online group cognitive behavioral therapy (GCBT) to reduce depressive symptoms compared to a waiting list control (WLC). Participants (N = 109) with PHQ-9 scores ≥ 9 were randomized into three groups. Informed consent was obtained. The primary outcome, depressive symptoms, was assessed at baseline and every 4 weeks over 12 weeks. Secondary outcomes included anxiety symptoms, loneliness perception, and treatment-related adverse effects. We used one-tailed Student's t-tests and Mann-Whitney U tests, adjusting p-values for false discovery rate. Statistical significance was set at 5%. ClinicalTrials.gov identifier: NCT05450614. Results: After excluding dropouts, 58 participants remained (28 app; 19 GCBT; 11 WLC). Most were women (app: 86%; GCBT: 89%; WLC: 100%) and identified as white (app: 61%; GCBT: 63%; WLC: 82%), aged 36 to 39, with high income and education. Only GCBT showed a significant reduction in anxiety (t(23.92) = 2.20, p = 0.019; padj = 0.038; Cohen's d = 0.81, 95%CI [0.17, ∞). The remaining comparisons were not statistically significant. Conclusion: While only GCBT showed significant improvement in anxiety symptoms, both treatments showed trends toward depressive symptom reduction. High dropout rates and a small sample may have impacted results. Further research should assess the long-term impact and scalability of digital interventions in mental health.

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Abstract Objective: Substance use is strongly associated with suicide attempts (SA) throughout life. We aimed to investigate the prevalence of SA and associated factors in life in patients with alcohol use disorder (AUD). Methods: The sample consisted of 424 men with AUD who underwent treatment at the Addiction Psychiatry Unit of the Hospital de Clínicas de Porto Alegre. The clinical evaluation included the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), the Barratt Impulsiveness Scale (BIS), and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID). Variables that showed p < 0.05 in the bivariate analyses were included in a hierarchical regression model with robust variance to investigate associations with SA in life via estimation of adjusted prevalence ratios (PR). Results: The lifetime prevalence of SA among alcohol users was 36.6%. Patients with childhood maltreatment, borderline personality disorder (BPD), and higher impulsivity scores had a higher lifetime prevalence of SA. Conclusion: Our findings indicate that male inpatient alcoholics present an important prevalence of SA. The study also corroborates the relationship between maltreatment, impulsivity, and BPD with SA among inpatients in treatment for AUD.

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Abstract Objective Atomoxetine is widely used in the treatment of attention deficit hyperactivity disorder (ADHD), offering reduced risks of adverse motor effects and chemical dependence. However, its pharmacokinetic properties and toxicological risks require further exploration. This study aimed to predict the physicochemical profile, medicinal chemistry characteristics, and ADMET (absorption, distribution, metabolism, excretion, and toxicity) properties of atomoxetine using in silico web-based tools. Methods Physicochemical, medicinal chemistry, and pharmacokinetic parameters of atomoxetine were analyzed using predictive computational models. Emphasis was placed on properties that influence drug efficacy and safety, particularly in the context of ADHD treatment. Results In silico analyses revealed that atomoxetine may carry potential risks of hepatotoxicity, cardiotoxicity, neurotoxicity, nephrotoxicity, respiratory system toxicity, skin toxicity, and carcinogenicity. These predicted toxicological effects highlight the importance of further investigation into atomoxetine’s safety, especially across diverse patient populations and varying durations of treatment. Conclusion The findings from this predictive study suggest that careful monitoring of atomoxetine use is warranted in clinical settings. Furthermore, additional controlled studies are needed to develop personalized dosing protocols that account for individual variability in metabolism and toxicity response, enabling a safer and more effective use of the drug.

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Abstract Objective Climate change is happening and feeling anxiety can be seen as a natural response to it. Climate anxiety is worry about the climate crisis and can be related to specific emotions and thoughts. The aims of this study were to assess the prevalence of worry about climate change and describe the emotions and thoughts associated with it in Brazilian adults. Methods A cross-sectional study was conducted with participants aged 18-42 years (n = 323). Data were collected online using a questionnaire developed by Hickman et al., which assesses worry, thoughts, and feelings about climate change. Results 88.5% of the participants were worried about climate change. Those who were worried reported feelings of sadness, powerlessness, fear, and anxiety more often. The most frequent thoughts were “People have failed to take care of the planet,” “The future is frightening,” “My family’s security will be threatened,” and “Humanity is doomed.” Conclusion In this sample, the majority of the individuals were concerned about climate change and showed more negative emotions and thoughts when compared to individuals who were not concerned. Future studies should take care not to interpret natural worries and anxiety responses to climate change as pathological.