Revista Brasileira de Psiquiatria最新文献

Objective: From a preventive perspective, this study reviewed the literature on protective factors against depressive symptoms in high-risk children and adolescents.

Methods: We conducted a thorough search of the PubMed, APA, EMCare, and Embase databases for studies published between 1946 and August 25, 2023. We included only longitudinal studies that analyzed protective factors for depressive symptoms in high-risk children or adolescents, excluding cross-sectional studies, reviews, and pre-clinical studies.

Results: A total of 29 studies with 62,405 participants were analyzed and 38 protective factors were identified. Positive individual characteristics, family factors, peer relationships, school-related aspects, neighborhood characteristics, and intrinsic religiosity were associated with improved depression outcomes.

Conclusion: These findings have important implications for preventive strategies in this population. Addressing protective factors can help prevent depression and enhance lifetime mental health.

Objective: We investigated whether manipulating levels of uncertainty would influence performance in a decision-making task in people with obsessive-compulsive disorder.

Methods: This case-control study compares Beads Task (measuring reflection/decisional impulsivity) performance and trait impulsivity (Short Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency [UPPS-P] Impulsive Behavior Scale) in patients with obsessive-compulsive disorder (n = 65) and non-clinical controls (n = 45). Differences between groups were assessed with the Mann Whitney U test.

Results: The obsessive-compulsive disorder group had significantly fewer draws to decision (U = 1,845, p = 0.019) and less subjective decision-certainty (U = 1,518, p = 0.00) in the low uncertainty (85:15) condition, and higher negative urgency scores (U = 2,163, p ≤ 0.001) and lower sensation-seeking scores (U = 907.5, p = 0.001) in UPPS-P. However, differences in Beads Task performance did not survive correction for multiple comparisons.

Conclusion: Patients with obsessive-compulsive disorder engage in more impulsive decision-making in the lower uncertainty condition than healthy controls, despite low subjective certainty of the decision. They also had higher scores for the trait impulsivity factor of negative urgency. Future studies should explore the contribution of trait impulsivity, as well as symptom severity, anxiety, and decision-certainty, to impulsivity in obsessive-compulsive disorder.

Generalized anxiety disorder is a highly prevalent mental disorder. Previous data indicate that more than 18 million Brazilians suffer from this condition. Traditionally, generalized anxiety disorder has been considered a mild mental health disorder, despite its links to lower life expectancy, cardiovascular disease, and suicide. The aim of this article is to combine elements of systematic and critical reviews to produce a synthesis of the best evidence about generalized anxiety disorder treatment. Systematic reviews, meta-analyses, and randomized controlled trials were included. The descriptor used in the search was "generalized anxiety disorder," which resulted in 4,860 articles and seven other studies, of which 59 were selected. Antidepressants and benzodiazepines were indicated, as was pregabalin, and atypical antipsychotics, such as quetiapine, have been studied. Individual cognitive behavior therapy (third wave) has proven effective. There is extensive literature on many effective treatments for generalized anxiety disorder. The present review summarizes the therapeutic possibilities, emphasizing those available in Brazil. Further studies are needed to compare other available medications, assess psychotherapies and new treatments in greater depth, as well as to assess the ideal duration of therapy.

Objective: To evaluate the direct, indirect, and total prospective effects of serum concentrations of 25-hydroxycholecalciferol (25[OH]D) on depressive symptoms in older adults.

Methods: Data from the second (2013-2015) and third (2017-2019) waves of the EpiFloripa Aging Cohort Study (= 60 years) were analyzed. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale. 25(OH)D levels were measured using the microparticle chemiluminescence method. A directed acyclic graph was constructed to identify the minimum set of adjustments. Structural equation modeling analysis was used to determine the effects of 25(OH)D on depressive symptoms.

Results: Data from 574 older adults (63.1% female) were analyzed. In the follow-up (n=390), 16.2% of them presented severe depressive symptoms (= 6 points). Structural equation modeling analysis revealed that 25(OH)D had a small direct negative effect (ß = -0.11, p < 0.05) and an overall negative effect (ß = -0.13; p < 0.05) on depressive symptoms in wave 3 (increased 25[OH]D led to decreased depressive symptoms). No direct or indirect effect on depressive symptoms was found in wave 2.

Conclusion: Our findings indicate a prospective association between 25(OH)D and depressive symptoms, suggesting a long-term effect in older adults from southern Brazil.

Objectives: Evidence from diffusion tensor imaging (DTI) and postmortem studies has demonstrated white-matter (WM) deficits in bipolar disorder (BD). Changes in peripheral blood biomarkers have also been observed; however, studies evaluating the potential relationship between brain alterations and the periphery are scarce. The objective of this systematic review is to investigate the relationship between blood-based biomarkers and WM in BD.

Methods: PubMed, Embase, and PsycINFO were used to conduct literature searches. Cross-sectional or longitudinal studies reporting original data which investigated both a blood-based biomarker and WM (by neuroimaging) in BD were included.

Results: Of 3,750 studies retrieved, 23 were included. Several classes of biomarkers were found to have a significant relationship with WM in BD. These included cytokines and growth factors (interleukin-8 [IL-8], tumor necrosis factor alpha [TNF-a], and insulin-like growth factor binding protein 3 [IGFBP-3]), innate immune system (natural killer cells [NK]), metabolic markers (lipid hydroperoxidase, cholesterol, triglycerides), the kynurenine (Kyn) pathway (5-hydroxyindoleacetic acid, kynurenic acid [Kyna]), and various gene polymorphisms (serotonin-transporter-linked promoter region).

Conclusion: This systematic review revealed that blood-based biomarkers are associated with markers of WM deficits observed in BD. Longitudinal studies investigating the potential clinical utility of these specific biomarkers are encouraged.

Objective: Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional connectivity (FC) and network abnormalities. We used whole-brain FC, modular networks, and graph-theory analysis to investigate extensive network profiles in PD.

Methods: Functional magnetic resonance imaging (fMRI) data from 82 subjects with PD and 97 healthy controls were included. Intrinsic FC between each pair of 160 regions, six intra-network, and 15 inter-network FCs were analyzed. Topological properties were explored.

Results: PD patients showed altered FCs within the right insula, between frontal cortex-posterior cingulate cortex (PCC), frontal cortex-cerebellum, and PCC-occipital cortex (corrected p < 0.001). Lower connections within the sensorimotor network (SMN) and SMN-occipital network (OCN) were detected (p < 0.05). Various decreased global and local network features were found in PD (p < 0.05). In addition, significant correlations were found between PD symptoms and nodal efficiency (Ne) in the insula (r = -0.273, p = 0.016) and intra-insula FC (r = -0.226, p = 0.041).

Conclusion: PD patients present with abnormal functional brain networks, especially decreased FC and Ne within the insula, suggesting that dysfunction of information integration plays an important role in PD.