Revista Brasileira de Psiquiatria最新文献

Objective: To assess nuclear distribution element-like 1 (Ndel1) enzyme activity following acute administration of sodium nitroprusside (sNP) in a rodent model of schizophrenia (SCZ) and in a cohort of chronic SCZ patients.

Methods: Ndel1 activity was measured following sNP infusions in spontaneously hypertensive rats (SHR) (2.5 or 5.0 mg/kg) and in a double-blind randomized trial with 15 SCZ patients (0.5 µg/kg/min). Patients were randomized into two groups (group I: n=7; group II: n=8), with one group receiving placebo and the other sNP in phase A. In phase B, the groups switched treatments. sNP was administered as an infusion of 0.5 µg/kg/min, for 4 h, while placebo was a 5% glucose solution infused under the same conditions. The infusions were administered once weekly over 4 weeks. Psychopathology was assessed using the 18-item figure 5 (BPRS-18 - Bech's version) and the negative subscale of the Positive and Negative Syndrome Scale.

Results: Ndel1 activity was significantly reduced after sNP infusion in SHR and in patients receiving sNP (t = 7.756, degrees of freedom [df] = 97, p < 0.0001, dcohen=1.44) compared to placebo. Reduced Ndel1 activity from baseline to the end of infusion was only seen in patients after treatment with sNP.

Conclusion: SCZ patients may benefit from adjunctive therapy with sNP and that the Ndel1 enzyme is a candidate biomarker of psychopathology in the disorder. Future research should look into the role of Ndel1 in SCZ and the potential effects of sNP and drugs with similar profiles of action in both animals and patients.

Objective: Post-traumatic stress disorder (PTSD) is triggered by traumatic events, but genetic vulnerability and a history of childhood trauma may also increase the risk of PTSD onset. Thus, we investigated the interaction between genetic susceptibility according to polygenic risk score (PRS), and traumatic events.

Methods: We evaluated 68 women with PTSD who had been sexually assaulted and 63 healthy controls with no history of sexual assault. DNA was genotyped using the Infinium Global Screening Array (Illumina, San Diego, CA, USA), and PRS analysis was performed using PRSice. Logistic regression models were also used to determine the interaction between childhood trauma, traumatic life events, and PRS and how they contribute to PTSD risk.

Results: We found a significant association between PRS, childhood trauma (p = 0.03; OR = 1.241), and PTSD. There was also an interaction between PRS, traumatic life events, and childhood trauma, particularly physical and emotional neglect (p = 0.028; OR = 1.010). When examining neglect separately, we found a modest association between emotional neglect and PTSD (p = 0.014; OR = 1.086).

Conclusion: Our findings highlight the importance of considering genetic vulnerability and traumatic experiences in understanding the etiology of PTSD.

This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the use of digital health in mental health care, the implementation of interventional psychiatry, and the design of innovative mental health systems that integrate principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients in general hospitals, where their mental health and physical needs are addressed, should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that can advance innovation, uphold human rights, and strive for the highest standards in mental health care.

Objective: To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO).

Methods: The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization - suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension - in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models.

Results: Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively).

Conclusion: There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial.

Clinical trial registration: NCT02846662 (São Paulo, Brazil - SP), NCT03026426 (Lima, Peru - LI).

This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment, among others. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of mental disorders emerging in life. Utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote health and safety of their student population, thereby paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

Objective: To determine whether the stigma associated with schizophrenia has also been directed towards people at ultra-high risk of psychosis (UHR), the present review aimed to synthetize the literature to update and extend our understanding of this topic.

Methods: A systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in the PubMed, EMBASE, Cochrane, and Web of Science databases for articles published until April 30, 2023, using a combination of search terms describing at-risk mental states for psychosis, stigma, and related terms.

Results: Thirty-eight studies were included. Twenty-nine addressed individuals with UHR directly, and nine conducted interviews with non-patients regarding UHR. A total of 2,560 individuals with UHR were assessed, with a mean sample size of 88.3 participants. Most were quantitative non-randomized/observational studies with young adults, 71.4% used the Structured Interview for Psychosis-Risk Syndromes, and 25% used the Comprehensive Assessment of At-Risk Mental States. Overall, the studies mainly involved patients of UHR clinics from high-income Western countries. The described stigma can be grouped into five forms, the most frequently explored of which was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress, and associative stigma. Quantitative nonrandomized studies predominated: only one was an interventional study. Most of the results confirmed the presence of stigma toward individuals with UHR.

Conclusion: Despite the knowledge gaps and scarcity of research on UHR-related stigma, the results suggest that stigma toward people with UHR exists and that it is already present at early stages of psychosis.

Objective: Single-session interventions are an effective strategy for reducing emotional distress. Enhanced psychoeducation, which includes empathic listening, risk stratification, symptom monitoring, and habit modification is particularly suitable for single-session interventions. We investigated predictors of response to an online enhanced psychoeducation intervention among essential service professionals during the COVID-19 pandemic in Brazil.

Methods: The TelePSI Project, financed by the Brazilian Ministry of Health, was a nationwide initiative that served more than 3,300 individuals in various psychotherapeutic modalities. Data were collected from April 2020 to December 2021. We included all participants with high levels of emotional distress who received single-session interventions. The final sample included 460 individuals (89.1% women, 81.1% health professionals). After 1 month, 300 participants were reassessed.

Results: Overuse of social media, use of social networks to contact family and friends, playing video games, smoking, drinking alcohol, and spending time with pets were associated with less improvement in symptoms, whereas playing an instrument and previous psychological treatment were associated with greater symptom improvement. This highlights the impact of lifestyle factors on the efficacy of single-session interventions.

Conclusion: These results underscore the importance of considering individual lifestyle factors when implementing single-session interventions and contribute to a growing body of evidence that supports tailored application of psychoeducational strategies in mental health interventions, particularly in high-stress environments.