Artigos e Materiais de Revistas Científicas - HC/IPq

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Randomized clinical trial on the efficacy of a new transcranial direct current stimulation (tDCS) device in the treatment of depression: a low-cost option for developing countries?
(2023) RIBEIRO, Rafael Bernardon; GENEROSO, Marcelo Bruno; TAIAR, Ivan Trombino; LORD, Ana Elisa De Conti; MACHADO NETTO, Geraldo Teles; GOMES, July Silveira; GARROCINI, Lucas Pagnan; GIRÃO, Mara Fernandes Maranhão; ARAUJO, Maria Augusta Azevedo de; SILVA, Samuel Araújo Leite da; SHIOZAWA, Pedro; CORDEIRO, Quirino
ABSTRACT Objective: Verify the clinical efficacy and safety of a low-cost tDCS device, in a clinical trial for major depressive disorder. Methods: 168 persons were recruited; 32 depressed individuals with moderate or severe depressive symptoms (HDRS17 scores higher than 18) were included and randomized for the trial (16 individuals in each group). The intervention consisted of 10 active anodal tDCS sessions at 2 mA for 30 minutes over the left dorsolateral prefrontal cortex; or sham. The main outcome was HDRS17; secondary outcomes included satisfaction (TSQM II) and quality of life (WHOQOL-BREF). Assessments at baseline, endpoint and at 30 days follow-up. Results: The sample was composed by a total of 11 men and 21 women, mean age of 42.75 years (95% CI: 38.10-47.40). Active treatment was superior than sham: There was a significant interaction between group and time regarding HDRS-17 scores (F = 4.089, df = 2, p = 0.029; partial Eta squared = 0. 239). Post hoc analyses exhibited a statistically significant difference between active and sham group symptoms after a 30 days follow-up (difference = -7.75, p = 0.008, Cohen’s d = 1.069). There were 3 dropouts, all in the active group, due schedule issues. No severe adverse effects reported. Conclusion: The current active tDCS protocol was related with clinical improvement of depressive symptoms. Intervention was well-tolerated. Non-invasive brain stimulation techniques are still not routinely used, although a viable strategy for treatment-resistant patients, partial responders and people unable to use pharmacological treatment. We aim to increase knowledge and use of tDCS for the Brazilian population.
Comparing the Addiction Severity Index (ASI) and Measurements in the Addictions for Triage and Evaluation (MATE)
(2023) MARTINS-DA-SILVA, Anderson Sousa; MOURA, Welissa da Silva; MARCO, Ciro; GALVAO, Lucas; BALLIARI, Eric; CAVALLO, Isabela; BECKER, Ruth; SILVA, Lucina; OLIVEIRA, Eclesiaster; GIL, Felipe; NATHALIE, Moschetta Monteiro-Gil; CAMPOS, Marcela Waisman; TORALES, Julio; VENTRIGLIO, Antonio; PERICO, Cintia de Azevedo-Marques; CASTALDELLI-MAIA, Joao Mauricio
Substance use disorder (SUD) assessment and measurement in Brazil, as well as in many other countries, face significant shortcomings. The Measurement in the Addictions for Triage and Evaluation (MATE) was developed as a public domain tool, drawing from validated scales and incorporating World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework. The Brazilian version of the MATE (MATE-pt-BR) was evaluated for its reliability and validity, with a total of 239 subjects participating in the study, and data collected between 11/01/2021 and 09/01/2022. The majority were male (79.2%), with diverse racial backgrounds. The substances most prevalently used in the last 30 days were. Alcohol (73.2%), nicotine (63.6%), and cocaine (44.2%). The mean scores for MATE modules showed variations, with Module Q2 assessing psychological well-being having high internal consistency (Cronbach's alpha = 0.92). MATE-pt-BR demonstrated robust internal consistency, with Module 6 (personality) and Module 2 (medical and psychiatric consultation indicators) being exceptions. MATE-pt-BR exhibited significant correlations among its sections and strong discriminant validity. Moreover, the paper compares MATE-pt-BR with the Addiction Severity Index (ASI-6), which is considered the gold-standard measure for SUD assessments. MATE-pt-BR offers a valuable tool for assessing substance use and related functional impairments in the Brazilian context.
Scoping review and expert-based consensus recommendations for assessment and management of psychogenic non-epileptic (functional) seizures (PNES) in children: A report from the Pediatric Psychiatric Issues Task Force of the International League Against Epilepsy
(2023) REILLY, Colin; JETTE, Nathalie; JOHNSON, Emma C.; KARIUKI, Symon M.; MEREDITH, Francesca; WIRRELL, Elaine; MULA, Marco; SMITH, Mary Lou; WALSH, Samantha; FONG, Choong Yi; WILMSHURST, Jo M.; KERR, Mike; VALENTE, Kette; AUVIN, Stephane
Limited guidance exists regarding the assessment and management of psychogenic non-epileptic seizures (PNES) in children. Our aim was to develop consensus-based recommendations to fill this gap. The members of the International League Against Epilepsy (ILAE) Task Force on Pediatric Psychiatric Issues conducted a scoping review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SR) standards. This was supplemented with a Delphi process sent to pediatric PNES experts. Consensus was defined as >= 80% agreement. The systematic search identified 77 studies, the majority (55%) of which were retrospective (only one randomized clinical trial). The primary means of PNES identification was video electroencephalography (vEEG) in 84% of studies. Better outcome was associated with access to counseling/psychological intervention. Children with PNES have more frequent psychiatric disorders than controls. The Delphi resulted in 22 recommendations: Assessment-There was consensus on the importance of (1) taking a comprehensive developmental history; (2) obtaining a description of the events; (3) asking about potential stressors; (4) the need to use vEEG if available parent, self, and school reports and video recordings can contribute to a ""probable"" diagnosis; and (5) that invasive provocation techniques or deceit should not be employed. Management-There was consensus about the (1) need for a professional with expertise in epilepsy to remain involved for a period after PNES diagnosis; (2) provision of appropriate educational materials to the child and caregivers; and (3) that the decision on treatment modality for PNES in children should consider the child's age, cognitive ability, and family factors. Comorbidities-There was consensus that all children with PNES should be screened for mental health and neurodevelopmental difficulties. Recommendations to facilitate the assessment and management of PNES in children were developed. Future directions to fill knowledge gaps were proposed.
Exploring correlates of involuntary treatment in substance use disorders: a global systematic review and meta-analysis
(2023) FOGO, Rodrigo Casa; MARTINS-DA-SILVA, Anderson Sousa; BLAAS, Israel Kanaan; GALVAO, Lucas Pequeno; HASEGAWA, Ellen Hiroe; CASTALDELLI, Fernando Ikeda; GIMENES, Gislaine Koch; PERICO, Cintia de Azevedo-Marques; PAIVA, Henrique; CASTALDELLI-MAIA, Joao Mauricio
Given the legislative heterogeneity about involuntary treatment and psychoactive substance users, we opted to perform a systematic review and meta-analysis of the correlates of involuntary substance use disorders (SUD) treatment across different countries. We conducted research on the Pubmed database, searching for involuntary SUD treatment data worldwide. The systematic review analysed a total of 36 articles and included a sample of 47,739 patients. Our review highlights the elevated risk of involuntary treatment among male, unmarried individuals with alcohol and/or opioid use disorders. Targeted preventive and therapeutic interventions should focus on addressing the underlying factors contributing to involuntary treatment, such as psychosis, aggressiveness, suicidal ideation, legal problems, and severe social exposure. By targeting these factors and providing comprehensive care, we can strive to improve outcomes and reduce the burden of substance use disorders in this vulnerable population. It is essential to critically examine and understand the factors contributing to the selection of patients for compulsory treatment. By doing so, we can identify potential gaps or inconsistencies in the current processes and work towards ensuring that decisions regarding compulsory treatment are based on sound clinical and ethical principles.
Good Psychiatric Management for Borderline Personality Disorder During the Perinatal Period: GPM-P
(2024) UCHOA, Caroline L. Mesquita; NADEL, Isabella L.; CHOI-KAIN, Lois W.
Purpose of ReviewWomen with borderline personality disorder (BPD) are especially at risk for experiencing adverse physiological, psychological, and social effects of pregnancy and postpartum. Those with BPD are vulnerable to these developmental transitions because of the interpersonal hypersensitivity that underpins the confusing oscillations of their symptoms.Recent FindingsGood Psychiatric Management (GPM) is a structured generalist intervention for patients with BPD found to be comparable in effectiveness to more intensive specialized psychotherapies such as DBT. GPM is adaptable to address the known vulnerabilities of patients in the perinatal period, during this critical time when mothers encountered critical transitions in identity and role transformation.SummaryThese brief, pragmatic clinical interventions can be adjunct to usual obstetric care to improve outcomes, both psychiatrically and medically. Expectant mothers with BPD and the clinical teams caring for them will benefit from the inherent flexibility of GPM, which incorporates (extra)conservative pharmacotherapy, increased family and social support network involvement, and increased attention to the social-emotional demands.
Specific cognitive and psychological alterations are more strongly linked to increased migraine disability than chronic migraine diagnosis
(2024) ZAMPARELLA, Tatiana Castro; CARPINELLA, Mariela; PERES, Mario; CUELLO, Florencia Patricia; MAZA, Pilar; GANSEN, Melanie Van; FILIPCHUK, Marcelo; BALASZCZUK, Veronica; MALDONADO, Carolina; SCARNATO, Pablo; MAGRIS, Diego Conci; LISICKI, Marco
IntroductionThe efficiency of The International Classification of Headache Disorders (ICHD-3) in reflecting patients' disability has recently been questioned. This prompts consideration that clinical features beyond pain may more accurately indicate the extent of underlying brain impairment than the mere frequency of headache days. Important cognitive dysfunctions and psychological impairment have been reported in burdensome cases of migraine, and the presence of these alterations has been associated with biological changes in the nervous system. This study aimed to compare migraine-related disability within a specific patient group, classified using ICHD-3 criteria or classified based on findings from a neuropsychological evaluation using machine learning. Additionally, a complementary voxel-based morphometry (VBM) comparison was conducted to explore potential neuroanatomical differences between the resulting groups.Patients and methodsThe study included episodic and chronic migraine patients seeking consultation at a specialized headache department. A neuropsychological evaluation protocol, encompassing validated standardized tests for cognition, anxiety, depression, perceived stress, and headache-related impact (HIT-6) and disability (MIDAS), was administered. Results from this evaluation were input into an automated K-means clustering algorithm, with a predefined K=2 for comparative purposes. A supplementary Voxel-based Morphometry (VBM) evaluation was conducted to investigate neuroanatomical contrasts between the two distinct grouping configurations.ResultsThe study involved 111 participants, with 49 having chronic migraine and 62 having episodic migraine. Seventy-four patients were assigned to cluster one, and 37 patients were assigned to cluster two. Cluster two exhibited significantly higher levels of depression, anxiety, and perceived stress, and performed worse in alternating and focalized attention tests. Differences in HIT-6 and MIDAS scores between episodic and chronic migraine patients did not reach statistical significance (HIT-6: 64.39 (+/- 7,31) vs 62.92 (+/- 11,61); p= 0. 42 / MIDAS: 73.63 (+/- 68,61) vs 84.33 (+/- 63,62); p=0.40). In contrast, patients in cluster two exhibited significantly higher HIT-6 (62.32 (+/- 10,11) vs 66.57 (+/- 7,21); p=0.03) and MIDAS (68.69 (+/- 62,58) vs 97.68 (+/- 70,31); p=0.03) scores than patients in cluster one. Furthermore, significant differences in grey matter volume between the two clusters were noted, particularly involving the precuneus, while differences between chronic and episodic migraine patients did not withstand correction for multiple comparisons.ConclusionsThe classification of migraine patients based on neuropsychological characteristics demonstrates a more effective separation of groups in terms of disability compared to categorizing them based on the chronic or episodic diagnosis of ICHD-3. These findings could reveal biological changes that might explain differences in treatment responses among apparently similar patients.
Mood disorders among adolescents in conflict with the law and in custody
(2024) GUILHERME, Eduardo Alves; MORENO, Ricardo Alberto
The high prevalence of psychiatric symptoms among juvenile delinquents is a well-replicated international finding. This study aimed to find the prevalence of mood disorders and their relationship with serious criminal acts in a population of adolescents in conflict with the law and in custody. A total of 123 male inmates aged 14 to 17 years were interviewed and assessed. Mood disorders were diagnosed in 15% of the sample for current episode and 31% for lifetime, making them third most prevalent after dependence disorders and disruptive disorders. The psychopathological profile of the adolescents who had committed violent crimes corroborates other studies reporting a high prevalence of mood disorders in this population. Several factors have been found to influence the formation of juvenile delinquency, including absence of family structure, social inequality, lack of quality school education, alcohol and drug abuse/addiction and disruptive disorders. The present results confirm mood disorders as another such factor.
Survivin: A Potential Marker of Resistance to Somatostatin Receptor Ligands
(2023) HERKENHOFF, Clarissa G. Borba; TRARBACH, Ericka B.; BATISTA, Rafael Loch; SOARES, Ibere Cauduro; FRASSETTO, Fernando Pereira; NASCIMENTO, Felipe Barjud Pereira do; GRANDE, Isabella Pacetti Pajaro; SILVA, Paula P. B.; DUARTE, Felipe H. G.; BRONSTEIN, Marcello D.; JALLAD, Raquel S.
Context Invasive and somatostatin receptor ligand (SRL)-resistant pituitary tumors represent a challenge in the clinical practice of endocrinologists. Efforts have been made to elucidate reliable makers for both. Survivin and eukaryotic translation initiation factor-binding protein 1 (4EBP1) are upregulated in several cancers and involved in apoptosis and cell proliferation. Objective We explored the role of these markers in somatotropinomas. Methods Immunostains for survivin and 4EBP1, and also for somatostatin receptor type 2 (SSTR2), Ki-67, and cytokeratin 18, were analyzed in tissue microarrays containing 52 somatotropinoma samples. Tumor invasiveness was evaluated in all samples while drug resistance was evaluated in 34 patients who received SRL treatment. All these parameters were correlated with first-generation SRL (fg-SRL) responsiveness and tumor invasiveness. Results Low survivin expression (P = 0.04), hyperintense signal on T2 weighted image (T2WI) (P = 0.01), younger age (P = 0.01), sparsely granular adenomas (SGA) (P = 0.04), high postoperative growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels (P = 0.049 and P < 0.001, respectively), and large postoperative tumor size (P = 0.02) were associated with resistance to fg-SRL. Low survivin and SSTR2 expression and high 4EBP1 expression were associated with SGA (P = 0.04, P = 0.01, and P = 0.001, respectively). Younger age (P = 0.03), large tumor pre- and postoperative (P = 0.04 and P = 0.006, respectively), low SSTR2 expression (P = 0.03), and high baseline GH and IGF-1 (P = 0.01 and P = 0.02, respectively) were associated with tumor invasiveness. However, survivin, 4EBP1, Ki-67, and granulation patterns were not associated with tumor invasion. Conclusion This study suggests that low survivin expression is predictive of resistance to fg-SRL in somatotropinomas, but not of tumor invasiveness.
A Systematic Review of Interventions Based on Judeo-Christian Principles for Patients with Substance Dependence
(2023) ANDRADE, Vinicius Oliveira de; MONTEIRO, Bruno Massayuki Makimoto; SOUZA, Vitor Cruz Rosa Pires de; SOUZA, Jose Carlos Rosa Pires de
Substance use disorders have significant consequences for patients and those around them. A qualitative systematic review was conducted to examine the effectiveness of religiosity and spirituality (R/S) interventions based on Judeo-Christian principles during the multidisciplinary treatment of patients with substance dependence disorder. Studies of patients of both sexes, at any age, of any nationality, and from any geographic location who were participating in treatment programs with religious elements explicitly tied to Christianity or Judaism were eligible for inclusion. Other religious interventions were excluded. Seven electronic databases were searched to identify eligible intervention studies published in English until August 2021. Two reviewers independently screened studies and extracted data. JBI tools were used to assess risk of bias. Of 146 articles retrieved for full text reading, five were ultimately included in this review published from July 2008 to August 2021. The R/S interventions used in the included studies were music therapy in a religious context, reading of the Bible or Torah, reflexive readings, personal prayer and reflection, and religiously integrated cognitive behavioral psychotherapy with or without a comparison group. Despite the broad search, there were found only a small number of studies and little homogeneity in the data of patients that reported positive impacts of treatments. Well-designed controlled studies are needed to truly investigate the efficacy of Judeo-Christian religious interventions for helping people with substance use problems, so as to strengthen the evidence of the benefits of these type of approaches in the treatment of drug addicts.
The functional connectome in obsessive-compulsive disorder: resting-state mega-analysis and machine learning classification for the ENIGMA-OCD consortium
(2023) BRUIN, Willem B.; ABE, Yoshinari; ALONSO, Pino; ANTICEVIC, Alan; BACKHAUSEN, Lea L.; BALACHANDER, Srinivas; BARGALLO, Nuria; BATISTUZZO, Marcelo C.; BENEDETTI, Francesco; TRIQUELL, Sara Bertolin; BREM, Silvia; CALESELLA, Federico; COUTO, Beatriz; DENYS, Damiaan A. J. P.; ECHEVARRIA, Marco A. N.; ENG, Goi Khia; FERREIRA, Sonia; FEUSNER, Jamie D.; GRAZIOPLENE, Rachael G.; GRUNER, Patricia; GUO, Joyce Y.; HAGEN, Kristen; HANSEN, Bjarne; HIRANO, Yoshiyuki; HOEXTER, Marcelo Q.; JAHANSHAD, Neda; JASPERS-FAYER, Fern; KASPRZAK, Selina; KIM, Minah; KOCH, Kathrin; KWAK, Yoo Bin; KWON, Jun Soo; LAZARO, Luisa; LI, Chiang-Shan R.; LOCHNER, Christine; MARSH, Rachel; MARTINEZ-ZALACAIN, Ignacio; MENCHON, Jose M.; MOREIRA, Pedro S.; MORGADO, Pedro; NAKAGAWA, Akiko; NAKAO, Tomohiro; NARAYANASWAMY, Janardhanan C.; NURMI, Erika; ZORRILLA, Jose C. Pariente; PIACENTINI, John; PICO-PEREZ, Maria; PIRAS, Fabrizio; PIRAS, Federica; PITTENGER, Christopher; REDDY, Janardhan Y. C.; RODRIGUEZ-MANRIQUE, Daniela; SAKAI, Yuki; SHIMIZU, Eiji; SHIVAKUMAR, Venkataram; SIMPSON, Blair H.; SORIANO-MAS, Carles; SOUSA, Nuno M.; SPALLETTA, Gianfranco; STERN, Emily R.; STEWART, S. Evelyn; SZESZKO, Philip; TANG, Jinsong; I, Sophia Thomopoulos; THORSEN, Anders L.; TOKIKO, Yoshida; TOMIYAMA, Hirofumi; VAI, Benedetta; VEER, Ilya M.; VENKATASUBRAMANIAN, Ganesan; VETTER, Nora C.; VRIEND, Chris; WALITZA, Susanne; WALLER, Lea; WANG, Zhen; WATANABE, Anri; WOLFF, Nicole; YUN, Je-Yeon; ZHAO, Qing; LEEUWEN, Wieke A. van; MARLE, Hein J. F. van; MORTEL, Laurens A. van de; STRATEN, Anouk van der; WERF, Ysbrand D. van der; THOMPSON, Paul M.; STEIN, Dan J.; HEUVEL, Odile A. van den; WINGEN, Guido A. van
Current knowledge about functional connectivity in obsessive-compulsive disorder (OCD) is based on small-scale studies, limiting the generalizability of results. Moreover, the majority of studies have focused only on predefined regions or functional networks rather than connectivity throughout the entire brain. Here, we investigated differences in resting-state functional connectivity between OCD patients and healthy controls (HC) using mega-analysis of data from 1024 OCD patients and 1028 HC from 28 independent samples of the ENIGMA-OCD consortium. We assessed group differences in whole-brain functional connectivity at both the regional and network level, and investigated whether functional connectivity could serve as biomarker to identify patient status at the individual level using machine learning analysis. The mega-analyses revealed widespread abnormalities in functional connectivity in OCD, with global hypo-connectivity (Cohen's d: -0.27 to -0.13) and few hyper-connections, mainly with the thalamus (Cohen's d: 0.19 to 0.22). Most hypo-connections were located within the sensorimotor network and no fronto-striatal abnormalities were found. Overall, classification performances were poor, with area-under-the-receiver-operating-characteristic curve (AUC) scores ranging between 0.567 and 0.673, with better classification for medicated (AUC = 0.702) than unmedicated (AUC = 0.608) patients versus healthy controls. These findings provide partial support for existing pathophysiological models of OCD and highlight the important role of the sensorimotor network in OCD. However, resting-state connectivity does not so far provide an accurate biomarker for identifying patients at the individual level.
The functional connectome in obsessive-compulsive disorder: resting-state mega-analysis and machine learning classification for the ENIGMA-OCD consortium (May, 10.1038/s41380-023-02077-0, 2023)
(2023) BRUIN, Willem; ABE, Yoshinari; ALONSO, Pino; ANTICEVIC, Alan; BACKHAUSEN, Lea; BALACHANDER, Srinivas; BARGALLO, Nuria; BATISTUZZO, Marcelo; BENEDETTI, Francesco D.; TRIQUELL, Sara G. Bertolin; BREM, Silvia; CALESELLA, Federico Y.; COUTO, Beatriz; DENYS, Damiaan A. J. P.; ECHEVARRIA, Marco A. N.; ENG, Goi Khia Q.; FERREIRA, Sonia; FEUSNER, Jamie; GRAZIOPLENE, Rachael; GRUNER, Patricia; GUO, Joyce; HAGEN, Kristen; HANSEN, Bjarne; HIRANO, Yoshiyuki; HOEXTER, Marcelo; JAHANSHAD, Neda; JASPERS-FAYER, Fern; KASPRZAK, Selina; KIM, Minah M.; KOCH, Kathrin S.; KWAK, Yoo Bin; KWON, Jun Soo; LAZARO, Luisa; LI, Chiang-Shan R. C.; LOCHNER, Christine L.; MARSH, Rachel; MARTINEZ-ZALACAIN, Ignacio; MENCHON, Jose; MOREIRA, Pedro; MORGADO, Pedro; NAKAGAWA, Akiko; NAKAO, Tomohiro; NARAYANASWAMY, Janardhanan; NURMI, Erika; ZORRILLA, Jose C. Pariente; PIACENTINI, John; PICO-PEREZ, Maria H.; PIRAS, Fabrizio; PIRAS, Federica; PITTENGER, Christopher; REDDY, Janardhan Y. C. R.; RODRIGUEZ-MANRIQUE, Daniela; SAKAI, Yuki R.; SHIMIZU, Eiji; SHIVAKUMAR, Venkataram I.; SIMPSON, Blair L.; SORIANO-MAS, Carles; SOUSA, Nuno; SPALLETTA, Gianfranco; STERN, Emily M.; STEWART, S. Evelyn; SZESZKO, Philip C.; TANG, Jinsong; THOMOPOULOS, Sophia; THORSEN, Anders; YOSHIDA, Tokiko; TOMIYAMA, Hirofumi; VAI, Benedetta; VEER, Ilya; VENKATASUBRAMANIAN, Ganesan; VETTER, Nora A.; VRIEND, Chris; WALITZA, Susanne A.; WALLER, Lea; WANG, Zhen D.; WATANABE, Anri; WOLFF, Nicole; YUN, Je-Yeon; ZHAO, Qing; LEEUWEN, Wieke van; MARLE, Hein J. F. van; MORTEL, Laurens van de; STRATEN, Anouk van der; WERF, Ysbrand van der; ARAI, Honami C.; BOLLETTINI, Irene; ESCALONA, Rosa Calvo; COELHO, Ana; COLOMBO, Federica; DARWICH, Leila; FONTAINE, Martine; IKUTA, Toshikazu; IPSER, Jonathan; JUANEDA-SEGUI, Asier; KITAGAWA, Hitomi; KVALE, Gerd; MACHADO-SOUSA, Mafalda R.; MORER, Astrid; NAKAMAE, Takashi G.; NARUMOTO, Jin J.; O'NEILL, Joseph; OKAWA, Sho A.; REAL, Eva; ROESSNER, Veit A.; SATO, Joao; SEGALAS, Cinto D.; SHAVITT, Roseli A.; VELTMAN, Dick A.; YAMADA, Kei M.; THOMPSON, Paul J.; STEIN, Dan A.; HEUVEL, Odile A. van den; WINGEN, Guido van
Executive Functions Beyond the ""Holy Trinity"": A Scoping Review
(2024) DIAS, Natalia Martins; HELSDINGEN, Isabela Espezin; LINS, Eduarda Kammers Rita Momm de; ETCHEVERRIA, Camila Erlinda; DECHEN, Vanessa de Araujo; STEFFEN, Luana; CARDOSO, Caroline de Oliveira; LOPES, Fernanda Machado
Objective: Executive functions (EFs) are a multifaceted construct, important for several outcomes throughout life. The most commonly addressed executive components are inhibitory control, working memory, and cognitive flexibility. To map how other executive components are addressed conceptually and methodologically in the literature, a scoping review was carried out. Method: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline was used. The database search (2017-2022) was carried out on the APA PsycInfo, Medline, Scopus, LILACS, and SciELO databases. A total of 3,473 articles were identified; 1,302 remained after screening. Given the large number of articles, a sample calculation was performed (95% CI and 5% error), with 297 articles randomly selected for full-text reading and 242 studies included for analysis. Results: There was a predominance of health application studies in adults and older adults and in developed countries. There is relative conceptual consensus that EF are a multidimensional construct; however, there is no explicit identification of the theoretical model used in the studies. A diversity of EF was evidenced, which broadens the understanding of the construct, its assessment, and intervention targets. Furthermore, there was a variety of instruments used to assess these skills, with a predominance of performance tests, often with construct-instrument ambivalence between studies. Conclusions: The mapping showed a diversity of skills referred to as EF in addition to the core components and identified the instruments used in their assessment. Greater conceptual and structural clarity and greater methodological care are fundamental to support the assessment of EF and their intervention.
Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report
(2024) HARRIS, Meredith G.; KAZDIN, Alan E.; MUNTHALI, Richard J.; VIGO, Daniel V.; STEIN, Dan J.; VIANA, Maria Carmen; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura Helena; BUNTING, Brendan; CHARDOUL, Stephanie; GUREJE, Oye; HU, Chiyi; HWANG, Irving; KARAM, Elie G.; NAVARRO-MATEU, Fernando; NISHI, Daisuke; OROZCO, Ricardo; SAMPSON, Nancy A.; SCOTT, Kate M.; VLADESCU, Cristian; WOJTYNIAK, Bogdan; XAVIER, Miguel; ZARKOV, Zahari; KESSLER, Ronald C.
BackgroundMental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health.MethodsData were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248).ResultsMost treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction.ConclusionsSatisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.
Addressing the threat of loneliness and depression in older adults
(2024) SCAZUFCA, Marcia; SEWARD, Nadine
Response letter: Neuropsychiatric presentation of Covid-19-related encephalitis: Case report
(2022) PORTO, F. H. de Gobbi; ORSINI, M.
Covid-19-related encephalitis is a heterogeneous syndrome characterized by a combination of clinical, laboratory, and imaging features related to inflammation of the brain, where the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is presumably the causative agent. We reported a case of Covid-19-related encephalitis presenting with neuropsychiatric symptoms, including intense agitation. Reverse-transcriptase polymerase-chain-reaction in cerebrospinal fluid was positive for SARS-CoV-2. Our case expands the literature about neurologic manifestations of Covid-19 and emphasizes the possibility of prominent behavioral symptoms as the initial manifestation.
Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries
(2023) MCGRATH, J. J.; AL-HAMZAWI, A.; ALONSO, J.; ALTWAIJRI, Y.; ANDRADE, L. H.; BROMET, E. J.; BRUFFAERTS, R.; ALMEIDA, J. M. C. de; CHARDOUL, S.; CHIU, W. T.; DEGENHARDT, L.; DEMLER, O. V.; FERRY, F.; GUREJE, O.; HARO, J. M.; KARAM, E. G.; KARAM, G.; KHALED, S. M.; KOVESS-MASFETY, V.; MAGNO, M.; MEDINA-MORA, M. E.; MOSKALEWICZ, J.; NAVARRO-MATEU, F.; NISHI, D.; PLANA-RIPOLL, O.; POSADA-VILLA, J.; RAPSEY, C.; SAMPSON, N. A.; STAGNARO, J. C.; STEIN, D. J.; HAVE, M. ten; TORRES, Y.; VLADESCU, C.; WOODRUFF, P. W.; ZARKOV, Z.; KESSLER, R. C.; AGUILAR-GAXIOLA, S.; ALTWAIJRI, Y. A.; ATWOLI, L.; BENJET, C.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; CARDOSO, G.; CíA, A. H.; GIROLAMO, G. De; HARRIS, M. G.; HINKOV, H.; HU, C.-Y.; JONGE, P. De; KARAM, A. N.; KAZDIN, A. E.; KAWAKAMI, N.; KESSLER, R. C.; KIEJNA, A.; MCGRATH, J. J.; PIAZZA, M.; SCOTT, K. M.; STEIN, D. J.; VIANA, M. C.; VIGO, D. V.; WILLIAMS, D. R.; WOODRUFF, P.; WOJTYNIAK, B.; XAVIER, M.; ZASLAVSKY, A. M.
Background: Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. Methods: In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. Findings: We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9–29·2) for male respondents and 29·8% (29·2–30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9–47·8) for male respondents and 53·1% (51·9–54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14–32) for male respondents and 20 years (12–36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. Interpretation: By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. Funding: None.
Linkage between International Classification of Functioning, Disability and Health Qualifiers and Functional Levels of the Functional Independence Measure: a Proposal for Applicability in Clinical Practice
(2023) MONTEIRO, B. C.; ROGATTO, F. B. T.; YONEYAMA, S. M.; MENEGATTI, G.; RODRIGUES, S. P. N.; CASTRO, L. C. A. De; SILVA, S. M.
Purpose: This study aimed to propose a link between Functional Independence Measure (FIM) levels and International Classification of Functioning, Disability and Health (ICF) qualifiers for use in low-or middle-income countries such as Brazil. Method: A multidisciplinary committee was formed to discuss the need for standardisation of the classification so that different professionals could accurately record the functioning and for the standardisation to be meaningful for the individual and his/her support group, allowing observation and participation in the rehabilitation process. The proposed steps to adapt linking ICF qualifiers with FIM scores and functional levels were: 1. Inversion, 2. Parity, 3.Transposition, and 4. Adaptation. Results: FIM’s seven levels of functioning have been linked to the five ICF qualifiers. FIM levels “7 (independent)” and “6 (modified independence)” have been linked to qualifiers “0 (no problem)” and “1 (mild problem)”, respectively. FIM levels “4” and “5” have been grouped and linked to ICF qualifier “2 (moderate)”. FIM levels “3” and “2” have been related to qualifier “3 (severe)”. FIM level “1” which indicates complete dependence has been linked to qualifier “4 (complete)”. Conclusion: This methodology allows for the creation of a link between the FIM and ICF, preserving clinically important information and having a description and clear relationship. It is thus able to facilitate clinical use of the ICF.
Glioneuronal and Neuronal Tumors: Who? When? Where? An Update Based on the 2021 World Health Organization Classification
(2023) AYRES, A. S.; BANDEIRA, G. A.; FERRACIOLLI, S. F.; TAKAHASHI, J. T.; MORENO, R. A.; GODOY, L. F. de Souza; CASAL, Y. R.; LIMA, L. G. C. A. de; FRASSETO, F. P.; LUCATO, L. T.
Neuronal and glioneuronal tumors usually have a benign course and may have typical imaging characteristics, allowing their diagnosis based on MR imaging findings. The most common lesions are dysembryoplastic neuroepithelial tumors and gangliogliomas, which have typical imaging characteristics. The fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System, recently published in 2021, places greater emphasis on molecular markers to classify tumors of the CNS, leading to extensive changes in the classification of tumors, including neuronal and glioneuronal tumors. The 2021 revision included 3 new tumors types: multinodular and vacuolating neuronal tumor, diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (a provisional type), and myxoid glioneuronal tumor. Following these recent changes in the World Health Organization classification, we aimed to review the main imaging features of these lesions in relation to their histopathologic and molecular features. Learning Objectives: To list the neuronal and glioneuronal tumors; recognize the main imaging findings and histologic characteristics of neuronal and glioneuronal tumors; know the typical location of each neuronal and glioneuronal tumor; and become familiar with the main molecular alterations of neuronal and glioneuronal tumors to better understand their behavior
An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels
(2023) LEON, J. de; SCHORETSANITIS, G.; SMITH, R. L.; MOLDEN, E.; SOLISMAA, A.; SEPPäLä, N.; KOPEčEK, M.; ŠVANCER, P.; OLMOS, I.; RICCIARDI, C.; IGLESIAS-GARCIA, C.; ORTIZ, B. B.; ELKIS, H.; PALHA, A. J. Pacheco; LLERENA, A.; FERNANDEZ-EGEA, E.; SISKIND, D.; WEIZMAN, A.; MASMOUDI, R.; SAFFIAN, S. Mohd; LEUNG, J. G.; BUCKLEY, P. F.; MARDER, S. R.; CITROME, L.; FREUDENREICH, O.; CORRELL, C. U.; MüLLER, D. J.; IGLESIAS-ALONSO, A.; SPINA, E.; RUAN, C.-J.; WANG, C.-Y.; WANG, G.; TANG, Y.-L.; LIN, S.-K.; LANE, H.-Y.; KIM, Y. S.; KIM, S. H.; RAJKUMAR, A. P.; GONZáLEZ-ESQUIVEL, D. F.; JUNG-COOK, H.; BAPTISTA, T.; ROHDE, C.; NIELSEN, J.; VERDOUX, H.; QUILES, C.; SANZ, E. J.; CUEVAS, C. De las; COHEN, D.; SCHULTE, P. F. J.; ERTUğRUL, A.; YAğCıOğLU, A. E. Anıl; CHOPRA, N.; MCCOLLUM, B.; SHELTON, C.; COTES, R. O.; KAITHI, A. R.; KANE, J. M.; FAROOQ, S.; NG, C. H.; BILBILY, J.; HIEMKE, C.; LóPEZ-JARAMILLO, C.; MCGRANE, I.; LANA, F.; EAP, C. B.; ARROJO-ROMERO, M.; RăDULESCU, F.Ş.; SEIFRITZ, E.; EVERY-PALMER, S.; BOUSMAN, C. A.; BEBAWI, E.; BHATTACHARYA, R.; KELLY, D. L.; OTSUKA, Y.; LAZARY, J.; TORRES, R.; YECORA, A.; MOTUCA, M.; CHAN, S. K. W.; ZOLEZZI, M.; OUANES, S.; BERARDIS, D. De; GROVER, S.; PROCYSHYN, R. M.; ADEBAYO, R. A.; KIRILOCHEV, O. O.; SOLOVIEV, A.; FOUNTOULAKIS, K. N.; WILKOWSKA, A.; CUBAłA, W. J.; AYUB, M.; SILVA, A.; BONELLI, R. M.; VILLAGRáN-MORENO, J. M.; CRESPO-FACORRO, B.; TEMMINGH, H.; DECLOEDT, E.; PEDRO, M. R.; TAKEUCHI, H.; TSUKAHARA, M.; GRüNDER, G.; SAGUD, M.; CELOFIGA, A.; RISTIC, D. Ignjatovic
This is the Spanish translation of an international guideline which proposes improving clozapine package inserts worldwide by using ancestry-based: 1) dosing and 2) titration. Adverse drug reaction (ADR) databases suggest clozapine: 1) is the third most toxic drug in the United States (US), and 2) produces worldwide pneumonia mortality four times greater than that of agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers require the lowest dose and male smokers the highest dose). Poor metabolizer (PM) status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity or inflammation with C-reactive protein (CRP) elevations. People with ancestry from Asia (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/ml. Daily doses of 300-600 mg/day are recommended in the US. Slow personalized titration may prevent early ADRs (including syncope, myocarditis and pneumonia). The core of this guideline consists of six personalized titration schedules for inpatients: 1) Asian/Amerindian ancestry with lower metabolism (in cases of obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) Asian/Amerindian ancestry with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (in cases of obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US of non-Asian/Amerindian ancestry with lower clozapine metabolism (in cases of obesity or valproate) needing 150-300 mg/day, and 6) in the US of non-Asian/Amerindian ancestry with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least 4 weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.
Variants in 46,XY DSD-Related Genes in Syndromic and Non-Syndromic Small for Gestational Age Children with Hypospadias
(2022) BRAGA, B. L.; GOMES, N. L.; NISHI, M. Y.; FREIRE, B. L.; BATISTA, R. L.; FARIA JUNIOR, J. A. D.; FUNARI, M. F. A.; BENEDETTI, A. F. F.; NARCIZO, A. De Moraes; CARDOSO, L. Cavalca; LERARIO, A. M.; GUERRA-JUNIOR, G.; COSTA, E. M. F.; DOMENICE, S.; JORGE, A. A. L.; MENDONCA, B. B.
Hypospadias is a common congenital disorder of male genital formation. Children born small for gestational age (SGA) present a high frequency of hypospadias of undetermined etiology. No previous study investigated the molecular etiology of hypospadias in boys born SGA using massively parallel sequencing. Our objective is to report the genetic findings of a cohort of patients born SGA with medium or proximal hypospadias. We identified 46 individuals with this phenotype from a large cohort of 46,XY DSD patients, including 5 individuals with syndromic features. DNA samples from subjects were studied by either whole exome sequencing or target gene panel approach. Three of the syndromic patients have 5 main clinical features of Silver-Russell syndrome (SRS) and were first studied by MLPA. Among the syndromic patients, loss of DNA methylation at the imprinting control region H19/IGF2 was identified in 2 individuals with SRS clinical diagnosis. Two novel pathogenic variants in compound heterozygous state were identified in the CUL7 gene establishing the diagnosis of 3M syndrome in one patient, and a novel homozygous variant in TRIM37 was identified in another boy with Mulibrey nanism phenotype. Among the non-syndromic subjects, 7 rare heterozygous variants were identified in 6 DSD-related genes. However, none of the variants found can explain the phenotype by themselves. In conclusion, a genetic defect that clarifies the etiology of hypospadias was not found in most of the non-syndromic SGA children, supporting the hypothesis that multifactorial causes, new genes, and/or unidentified epigenetic defects may have an influence in this condition.

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