Revista Brasileira de Psiquiatria最新文献

Objective: Patient response to antipsychotic drugs varies and may be related to clinical and genetic heterogeneity. This study aimed to determine the performance of clinical, genetic, and hybrid models to predict the response of patients in first-episode psychosis (FEP) to the antipsychotic risperidone.

Methods: We evaluated 141 antipsychotic-naive FEP patients before and after 10 weeks of risperidone treatment. Patients who had a response rate equal to or higher than 50% on the Positive and Negative Syndrome Scale (PANSS) were considered responders (n=72; 51%). Analyses were performed using a support vector machine (SVM), k-nearest neighbors (kNN), and random forests (RF). Clinical and genetic (with single-nucleotide variants [SNVs]) models were created separately. Hybrid models (clinical + genetic factors) with and without feature selection were created.

Results: Clinical models presented greater balanced accuracy (63.3%; CI 0.46-0.69) with the SVM algorithm than the genetic models (balanced accuracy: 58.5% [CI 0.41-0.76], kNN algorithm). The hybrid model, which included duration of untreated psychosis, Clinical Global Impression-Severity (CGI-S) scale scores, age, cannabis use, and 406 SNVs, showed the best performance (balanced accuracy: 72.9% [CI 0.62-0.84], RF algorithm).

Conclusion: A hybrid model including clinical and genetic predictors can enhance prediction of response to antipsychotic treatment.

Objective: In this population-based cohort study, we compared the risks of incident hyperopia, myopia, astigmatism, and strabismus between children with autism spectrum disorder (ASD) and those without ASD.

Methods: This study included children who were born in Taiwan at any time between 2004 and 2017, using data from the Taiwan Maternal and Child Health Database (TMCHD). We included 20,688 children with ASD and 2,062,120 matched controls to estimate the risks of incident hyperopia, myopia, astigmatism, and strabismus. Cox proportional hazards regression models were conducted for risk assessment. Models were adjusted for sex, calendar year of birth, and gestational age at birth. Statistical significance was determined through adjusted hazard ratios (aHRs) and 95%CIs.

Results: Children with ASD had higher risks of incident hyperopia (aHR: 1.78; 95%CI 1.70-1.86), myopia (aHR: 1.27; 95%CI 1.24-1.30), astigmatism (aHR: 1.51; 95%CI 1.46-1.56), and strabismus (aHR: 2.18; 95%CI 2.05-2.32) compared to children without ASD.

Conclusion: Clinicians should screen children with ASD for potential eye conditions. Further studies are required to elucidate the mechanisms linking ASD with eye diseases. In addition, studies should explore how the type and severity of ASD symptoms influence the detection of these eye conditions.

Objective: To systematically review studies on schizophrenia in Brazil, addressing geographical coverage as an indicator of sampling representativeness - an essential precondition for inferences regarding the generalizability of findings - and, secondarily, of variation in research funding across different regions.

Methods: We searched for studies carried out until July 2023. The inclusion criteria were studies of patients diagnosed with schizophrenia (or its spectrum) recruited in Brazil. The following parameters were extracted: geographic region of the first and last authors, recruitment setting, research subfield, and funding sources. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Of 296 studies reviewed, most (63.18%) took place in the Southeast region, particularly the state of São Paulo (48.98%). Clinical trials comprised the majority (41.6%); genetic studies were primarily conducted in the Southeast or South (81.5%). Funding was reported in 64% of papers. The Northeast region was less likely to receive study funding compared to the Southeast.

Conclusion: Schizophrenia research in Brazil shows a clear geographic concentration, with significant disparities in funding allocation and underrepresentation of certain regions. Broadening research coverage through equitable distribution of funding opportunities and fostering collaborations with local institutions are of utmost importance to enhance the understanding and treatment of schizophrenia within Brazil's diverse socioeconomic and ethnic landscape.

Objective: This study investigated whether moral harassment contributes to anxiety, depression, and burnout among medical residents.

Methods: This three-stage longitudinal study involved 218 1st-year residents, of whom 76 (34.9%) participated in all stages. The questionnaire covered demographics, mental health (using the Patient Health Questionnaire-4), burnout (using the Maslach Burnout Inventory Human Services Survey), and harassment experiences. Mental health outcomes and harassment were analyzed using logistic regression.

Results: Anxiety and depression scores varied significantly, including a notable decrease in the personal accomplishment dimension of burnout. The prevalence of harassment was above 90%, and most victims were disturbed by the harassment they suffered. While a direct correlation between harassment victimization and reduced mental health was not found, seeking help exacerbated suffering, and depression and emotional exhaustion increased less among surgical residents.

Conclusion: To the extent of our knowledge, this is the first longitudinal study on mental health and harassment among medical residents. The mental suffering experienced after taking action against harassment suggests that safe environments for addressing these issues are lacking in medical residencies. Further studies concerning surgical residents could shed light on their lower levels of suffering. Institutional changes are needed to support victims and create a healthy environment.

Objective: We investigated whether a wide range of baseline mental disorders among university students predict Internet gaming disorder (IGD) 1 to 3 years later.

Methods: This prospective cohort study was conducted in six Mexican universities and had a 1- to 3-year follow-up period (September 2018 to June 2022). Participants were 1st-year university students (n=2,144) free of symptoms indicative of IGD at entry (baseline). Ten mental disorders (bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences, and attention deficit hyperactivity disorder) at baseline were investigated as risk factors for IGD at the end of the follow-up. We used Cox regression to model the IGD incidence rate.

Results: Any baseline mental disorder was associated with a 2.33 times (1.26-4.31) higher rate of IGD 1 to 3 years later. Several individual disorders were associated with rates of IGD in multiple models, with comorbid conditions diminishing most of these associations.

Conclusion: Only major depressive disorder and bipolar disorder remained associated with new cases of IGD. The discrepant results of longitudinal studies on the role of specific mental disorders in the development of IGD should be further investigated.

Objective: Disordered eating behaviors (DEB) are dysfunctional changes in eating behavior that do not meet the diagnostic criteria for eating disorders. DEB affect a significant percentage of individuals, yet the topic remains under-researched. The current study investigates the developmental trajectory and psychopathological correlates of DEB in children and adolescents in Brazil.

Methods: The sample included 1,583 participants from the Brazilian High-Risk Cohort who were assessed across three waves between 2010 (age 6-12 years) and 2019 (age 12-21 years). Psychopathology was assessed through the Development and Well-Being Assessment, and DEB was assessed through Development and Well-Being Assessment's eating disorder section. Dimensional psychopathology was measured with the Child Behavior Checklist.

Results: The participants were divided into dysfunctional and non-dysfunctional eating groups. DEB varied significantly, with few participants having a persistent pattern. DEB were strongly linked to higher internalizing symptoms, especially in girls, but less to externalizing behaviors. DEB increased the likelihood of eating disorders, major depressive disorder, and higher body mass index.

Conclusion: This study reveals that DEB are frequent among Brazilian children and adolescents and are linked to psychopathology (especially internalizing symptoms) and body mass index. Future research should investigate the underlying mechanisms of DEB and develop strategies for early detection and effective interventions.