Revista Brasileira de Psiquiatria最新文献

Objective: We aim to evaluate whether a wide range of baseline mental disorders predict Internet Gaming Disorder (IGD) one to three years later, among university students.

Methods: Prospective cohort study with a follow-up period of one to three years (September 2018-June 2022) in 6 Mexican universities. Participants were first-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, attention deficit hyperactivity disorder) at baseline were the main risk factors for IGD at the end of the follow-up. We used Cox regression to model the IGD incidence rate.

Results: Any mental disorder at baseline was associated with an increase in 2.33 times (1.26-4.31) the 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.

Conclusions: Only major depressive disorder and bipolar disorder remained associated with a new case of IGD. Discrepant results from available longitudinal studies on the role of specific mental disorders in the development of IGD needs to be further investigated.

Digital therapeutics have evolved rapidly with technological advances in healthcare. Despite their increasing use, gaps remain in understanding their regulatory frameworks, integration, and efficacy for conditions like substance use disorder, insomnia, attention deficit hyperactivity disorder, and post-traumatic stress disorder. This study evaluates FDA-approved digital therapeutics and explores their potential to revolutionize psychiatric treatments amid ongoing technological and regulatory changes. We conducted a comprehensive review of major databases, focusing on articles published up to January 2024 on FDA-approved digital therapeutics. We excluded non-English articles and those lacking empirical data or focusing on non-FDA-approved therapeutics. Our analysis covered regulatory compliance, clinical outcomes, and integration with traditional treatments. The review of nine FDA-cleared digital therapeutics revealed benefits like improved treatment accessibility and potential reductions in healthcare costs. For example, Somryst, a cognitive-behavioral therapy-based treatment for insomnia, showed that over 40 percent of users overcame chronic insomnia, and 60 percent experienced improvements without adverse effects. However, challenges remain, including low provider adoption, inadequate insurance coverage, and high user dropout rates. While digital therapeutics enhance accessibility, they face regulatory challenges, reimbursement issues, and the need for robust clinical evidence. Success depends on collaboration among stakeholders to demonstrate value, ensure safety, and integrate them into existing healthcare systems.

Background: Clinical nurses have symptoms of post-traumatic stress disorder (PTSD), anxiety and depression, which seriously affect their physical and mental health. Narrative therapy (NT), a therapy for trauma-related psychological disorders, may be an effective intervention.

Objective: The aim of this study was to evaluate the effect of NT on improving PTSD symptoms, perceived stress, anxiety and depression in nurses.

Methods: A total of 92 participants who were clinical nurses and had positive PTSD symptom screening results were randomly assigned (1:1) to the intervention and control groups. The intervention group received NT and a psychological stress leaflet, while the control group received only a psychological stress leaflet. PTSD, perceived stress, anxiety, and depression were measured before and after the intervention to assess the effect of NT.

Results: After the intervention, the intervention group showed significantly lower levels of PTSD symptoms (P=0.025), perceived stress (P=0.033), anxiety (P=0.004), and depression (P=0.015) compared with the control group. Regarding the dichotomous outcomes of PTSD, anxiety, and depression, there was a statistically significant decrease in the number of positive cases of PTSD (P=0.030) and anxiety (P=0.002), while there was no statistically significant change in the number of positive cases of depression (P=0.060).

Conclusions: NT is expected to alleviate PTSD symptoms, stress, anxiety, and depression among clinical frontline nurses, and healthcare professionals should consider applying NT to improve nurses' mental health.

Objective: The large body of literature examining the association between parenthood and mortality in the general population contrasts with a lack of studies among older adults with schizophrenia. Identifying potential protective factors of premature death in this population is important to help guide prevention measures. Here, we examined whether all-cause and cause-specific mortality rates significantly differ between older adults with schizophrenia with and without children, during a 5-year follow-up.

Methods: We used data from a 5-year prospective multicenter sample of older adults with an ICD-10 diagnosis of schizophrenia (aged 55 years or more) recruited in France. We performed a forward stepwise logistic regression to examine the association between parenthood and all-cause mortality, including only those independent variables that best explain outcome.

Results: Of 323 older adults with schizophrenia, 133 (41.2%) had children (mean age=67.0, SD=6.1), whereas 190 were without children (mean age=67.2, SD=6.6). Following adjustments, parenthood was significantly associated with lower all-cause mortality compared to patients without children in this population (21.1% (n=28) versus 35.8% (n=68); AOR=0.50; 95%CI=0.27-0.94; p=0.032), without significant sex differences in this association.

Conclusions: Parenthood could be protective against mortality among older patients with schizophrenia who live in France. Further research is needed to understand the specific mechanisms underlying this association.

Objective: To examine the effect of nutritional counseling therapy (NCT) combined with transcranial direct current stimulation (tDCS) on Binge Eating Disorder (BED) symptoms.

Methods: 40 women with BED were randomly (ratio of 2:2:2) allocated to one of the groups: active tDCS (a-tDCS), NCT, sham tDCS (s-tDCS) with NCT, and a-tDCS with NCT. Home-based tDCS was applied to the dorsolateral prefrontal cortex for 28 sessions.

Results: A mixed analysis of variance showed no main effect between groups or a time × group interaction. However, a significant main effect was found for time on the primary outcome: Binge Eating Scale (p = 0.001; eta2p= 0.325), which tended to decrease during treatment and follow-up. A significant main effect was found on the secondary outcome: short-interval intracortical inhibition (SICI) (p = 0.02; eta2p= 0.112), a measure of inhibitory function, which increased from baseline to the final period in the a-tDCS group, without significant differences between groups.

Conclusions: These findings reveal that the combined therapy did not have a synergic effect on BED symptoms. Since this is a pilot study and this is a promising area, we provide data to plan future larger-scale studies investigating the effects of tDCS and behavioral interventions in BED 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 children without ASD.

Methods: This study included children who were born in Taiwan at any time between 2004 and 2017. Data were collected from the Taiwan Maternal and Child Health Database. 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 constructed for risk assessment. The models were adjusted for sex, calendar year of birth, and gestational age at birth. Statistical significance was determined by calculating adjusted hazard ratios (aHRs) and 95% confidence intervals (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) than did those without it.

Conclusion: Clinicians should screen children with ASD for potential ophthalmic conditions. Further studies are required to elucidate the mechanisms underlying the associations between ASD and ophthalmic diseases. The roles of types and severities of ASD symptoms in detecting ophthalmic disease also requires further study.

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

Methods: This three-stage longitudinal study involves 218 first-year residents, with 76 (34.9%) participating throughout all stages. The questionnaire covered demographics, mental health (using Patient Health Questionnaire - 4 - PHQ-4), burnout (using Maslach Burnout Inventory Human Services Survey - MBI-HSS), and harassment experiences. Logistic regression analyzed mental health outcomes and harassment.

Results: The study found significant variations in anxiety and depression scores, along with a notable decrease in the personal accomplishment dimension of burnout. Harassment prevalence was above 90%, and most victims were disturbed by harassment suffered. While a direct correlation between harassment victimization and decreased mental health was not found, seeking help exacerbated suffering, and surgical program residents had a smaller increase in depression and emotional exhaustion.

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

Objectives: This study aimed to assess longitudinal patterns of anxiety, depression, and posttraumatic stress symptoms, as well as their predictors, in a reference hospital workforce during the first two waves of the pandemic in Brazil.

Methods: Data were collected between July 2020 and June 2021 (N = 1,078). Anxiety, depression, and posttraumatic stress symptoms were assessed using three self-report scales (GAD-7, PHQ-9, IES-R). Predictor analysis included COVID-19-related events, fear of COVID-19, and institutional support. Statistical analysis involved linear mixed models and local polynomial regressions.

Results: Anxiety and depression showed a tendency towards increased reactivity, while posttraumatic stress presented a tendency towards reduction with less fluctuation. Predictor analysis showed that higher levels of institutional support were associated with a reduced risk of all mental health outcomes. Conversely, greater fear of COVID-19 was positively associated with all of them.

Conclusions: Our findings underscore the importance of allocating enhanced attention and resources to effectively address pressing personal health challenges, emphasizing the significance of organizational support and continuous monitoring of emotional distress.

Objective: This study aimed to explore the association between major depressive disorder (MDD) and suicide risk in dementia patients.

Methods: A cohort of 625,218 individuals aged ≥40 years with dementia between 2007 and 2018 was identified from Taiwan's National Health Insurance Research Database. After excluding prevalent cases in 2007. Subsequently, a nested case-control study enrolled 1,256 suicide cases and 5,022 matched controls was conducted. The frequencies of MDD-related outpatient or inpatient visits over a 7-year period preceding the event dates were calculated and analyzed for association using conditional logistic regression.

Results: Dementia comorbid with MDD was associated with increased suicide risk (adjusted odds ratio [AOR]: 2.67), particularly in individuals with ≤1.0 MDD episodes per year (AOR: 2.85). Similar association was observed only in individuals aged ≥65 years and males, with a pronounced risk of suicide in those ≤1.0 MDD episodes per year (AOR: 3.08 for individuals aged ≥65 years; AOR: 3.28 for males). Conversely, the risk increase was evident with >1.0 MDD episodes per year in those aged <65 years (AOR: 3.04) and females (AOR: 2.45).

Conclusions: MDD is associated with suicide risk in dementia patients, with the strength of this association possibly varying by age and gender.