Revista Brasileira de Psiquiatria最新文献

Objective: Emotions affect health and health affects emotions. When properly recognized and interpreted, emotions can aid in the prevention, diagnosis, and treatment of many diseases. Affective computing, the use of computer technology to detect one or more signals associated with human emotions, is a promising field. However, research into the use of emotion recognition in healthcare remains scarce. It is crucial to explore the reasons behind this phenomenon and identify neglected methods with potential for human health. We review methods and technologies used in emotion recognition and their applications in healthcare, highlighting methods not discussed in previous reviews, including electroencephalography and electrocardiography, thermal imaging, bracelets, skin conductance, and audio.

Methods: A metric based on reproducibility and population was established to assess the quality of included articles. Based on the metrics established, we surveyed and analyzed studies in which affective computing tools were applied to health, to qualify and identify the challenges of the area.

Results: We found many challenges to be overcome in detecting and recognizing human emotions, related to sample size, low study quality, and reproducibility issues. We list and discuss the main current challenges, ways to overcome them, and perspectives for the future, focusing on the application of affective technologies in healthcare and the establishment of a gold standard.

Conclusion: Three suggestions are proposed: 1) to conduct studies focused on obtaining a gold standard; 2) to conduct studies with larger sample sizes, greater diversity, and in less controlled environments, using replicable methodologies and making data and methods available; and 3) to further explore the potential use of emotion detection in healthcare.

Objective: Bipolar disorder (BD) involves complex mood, neuropsychological, immunological, and physiological changes, with cognitive impairment persisting even during remission. Our study investigated the relationship between the second-to-fourth digit ratio (2D:4D) and cognitive function in BD patients.

Methods: This cross-sectional study, which included 47 BD patients in remission for = 6 months and 47 healthy volunteers, was designed to thoroughly determine the relationship between the 2D:4D and cognitive function in BD. The Stroop Test, the Wisconsin Card Sorting Test, and the Trail Making Test A and B forms were administered to all participants. The same researcher measured the 2D:4D ratio using a digital caliper to ensure consistency and accuracy.

Results: The left 2D:4D ratio was significantly higher in the patient group than the control group. There were also significant differences in all test scores between groups, with the BD group scoring higher and being more unsuccessful. We also observed a weak negative correlation between completion time of Form A of the Trail Making Test and right-hand 2D:4D finger ratio in the BD group.

Conclusions: Our findings have significant implications, revealing a marked difference in the 2D:4D of BD patients compared to healthy controls and a decline in cognitive function even during remission.

Objective: To assess longitudinal patterns of anxiety, depression, and posttraumatic stress symptoms, as well as their predictors, among workers at a referral hospital during the first two waves of the coronavirus disease 2019 (COVID-19) 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: the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Impact of Event Scale-Revised (IES-R). Predictor analysis included COVID-19-related events, fear of COVID-19, and institutional support. Statistical analysis involved linear mixed models (LMM) and local polynomial regressions.

Results: Anxiety and depression trended towards increased reactivity, while posttraumatic stress presented a downward trend over follow-up, with less fluctuation. Predictor analysis showed that higher levels of institutional support were associated with a reduced risk of all adverse mental health outcomes; conversely, greater fear of COVID-19 was positively associated with all such outcomes.

Conclusion: Our findings underscore the importance of allocating enhanced attention and resources to effectively addressing personal health challenges among the health workforce, emphasizing the significance of organizational support and continuous monitoring of emotional distress.

Clinical staging models are tools used in healthcare that have the potential to enhance diagnostic precision, improve treatment decisions, articulate more personalized care pathways, and optimize service models. In youth mental health, clinical staging has been increasingly applied to conditions where progression from non-specific symptoms to full-blown syndromes, such as schizophrenia, bipolar disorder, and depression, is possible. However, novel transdiagnostic staging models have also been proposed, recognizing the limitations of current classification systems and the substantial overlap of symptoms, particularly early in the illness course. Models incorporating an appropriate developmental and transdiagnostic lens may offer significant advances for research and clinical practice, supporting early intervention and secondary prevention. This narrative review critically examines theoretical premises and empirical applications of transdiagnostic clinical staging models in youth. Peer-reviewed studies were identified in PubMed using search terms related to clinical staging, focusing on sociodemographic, cognitive, and clinical factors investigated in youth samples (age 12-30 years). Evidence is synthesized in three main sections: progression, extension, and stage-based treatment. Additionally, a stage-based care model and directions for future research are presented. Early findings partially support important assumptions for the model, suggesting stage-related differences in cognition and functionality. Furthermore, new extension features have been recently proposed, including substance use, circadian disturbances, and physical illnesses. The long-term outcomes of stage-based interventions remain an open question. While the transdiagnostic clinical staging model offers a promising alternative for classifying youth psychopathology, further empirical validation is essential before its widespread implementation.

Objective: To determine clusters (groups) of substance use in crack cocaine users through severity scores on the sixth version of the Addiction Severity Index (ASI-6) and compare the groups in relation to risk factors, such as parental style, childhood maltreatment, and impulsivity.

Methods: This cross-sectional study included 531 men with substance use disorder who were admitted to an inpatient addiction treatment unit in southern Brazil. To detect more homogeneousgroups of individuals, the K-means clustering based on ASI-6 scores was used to create groups of individuals with similar severity scores in different areas. Parenting styles were assessed using the Measure of Parental Style, childhood trauma was assessed using the Childhood Trauma Questionnaire, and impulsivity was measured using the Barratt Impulsivity Scale 11. Poisson regression was used for association analysis.

Results: Two distinct clusters were identified, which differed significantly across all composite scores (p < 0.001). These associations were further confirmed through Poisson regression analysis. The more severe cluster showed significantly higher scores for maternal abuse (p = 0.026), sexual abuse (p = 0.003), motor impulsivity (p = 0.014), and unplanned impulsivity above the 75th percentile (p =0.032) than the less severe group. Other parenting styles, trauma types, and impulsivity did not differsignificantly between the groups.

Conclusions: Dividing patients into severity clusters can contribute to more targeted treatments. Further research on outpatients would reinforce the importance of early life factors and impulsivity treatment.

Objective: Sleep quality is essential for health, and sleep deprivation is linked to physical and mental issues. Homeless populations face additional sleep challenges, yet this topic remains underexplored. This study assessed sleep quality among homeless individuals in Sa˜o Paulo, Brazil, considering demographics and substance use.

Methods: A psychiatrist conducted interviews to collect demographic and substance use data assessing sleep quality using the Pittsburgh Sleep Quality Index (PSQI). A generalized linear model was used to analyze PSQI scores, considering sleeping location, sex, substance use, and interactions as fixed factors, with homelessness duration as a covariate. The sample comprised 177 participants (22% female, of whom seven were transgender; mean age: 42.8 6 11.4 years), with an average homelessness duration of 10.5 (SD, 8.4) years (range: 1-40). Among them, 33% slept in shelters, 83% used depressants, 83% used stimulants, and 59% used hallucinogens.

Results: Approximately 67% reported good subjective sleep quality (mean PSQI: 4.9 6 2.7). Depressant and stimulant use correlated with poorer sleep. Women had poorer sleep, longer sleep latency, and greater daytime dysfunction than men.

Conclusion: Positive sleep quality reports may reflect adaptive expectations from prolonged adversity and substance use. The findings highlight the need for improved shelters and targeted interventions to address sleep challenges in this vulnerable population.

Objective: This study aimed to explore the relationship between suicidal behavior and various factors, including peripheral inflammatory markers, atherogenic indices, serum albumin levels, impulsivity, and aggression.

Methods: This cross-sectional study included 100 patients hospitalized for a recent suicide attempt, 74 individuals with psychiatric disorders without a recent suicide attempt, and 85 healthy controls (HC). Peripheral inflammatory markers, atherogenic indices, and serum albumin levels were assessed using fasting blood samples. Impulsivity and aggression were measured with the Barratt Impulsiveness Scale-11 (BIS-11) and the Buss-Perry Aggression Questionnaire (BPAQ).

Results: Serum albumin levels were significantly lower (p = 0.001), and the neutrophil-to-albumin ratio (NAR) was significantly higher (p < 0.001) in individuals who had recently attempted suicide, compared to both individuals with psychiatric disorders without a recent suicide attempt and the HC group. Logistic regression identified NAR (p = 0.001), low albumin levels (p = 0.017), impulsivity (p = 0.001), and aggression (p < 0.001) as significant predictors of suicidal behavior. Lower education (p = 0.001) and lifetime substance use disorders (p = 0.003) were also significant predictors. No significant differences were found in atherogenic indices.

Conclusion: Low albumin levels and increased NAR are key predictors of suicide risk, underscoring the role of inflammation. Additionally, addressing educational disparities and substance use is crucial for suicide prevention strategies.

Social anxiety disorder (SAD), one of the most prevalent anxiety disorders, is not well recognized. In most cases, SAD follows an unremitted and chronic course, affecting individual functioning in relationships, education, and work. Due to the disorder's relevance in Brazil, guideline-based treatments adapted to the Brazilian social and economic context are needed. We conducted a systematic review assessing several treatment modalities for SAD. PubMed, Cochrane, SciELO, and ClinicalTrials.gov were searched using the Medical Subject Headings social anxiety disorder and social phobia. Of the 438 selected articles, 20 were selected. Selective serotonin reuptake inhibitors are considered a first-line treatment for SAD due to their large effect size and database of evidence. Monoamine oxidase inhibitors, benzodiazepines, and the anticonvulsants pregabalin and gabapentin are also effective. Divergent results have been found for the serotonin-norepinephrine reuptake inhibitor venlafaxine. Among psychological interventions, robust data support cognitive behavioral therapy (whether individual, group, or remote) as a first-line option. Psychodynamic psychotherapy, exposure and social skills therapy, self-help therapies (with or without support), cognitive bias modification, virtual reality exposure therapy, and mindfulness-based therapy are also effective techniques. Psychological interventions are better tolerated and there is evidence that they provide better long-term benefits than pharmacological agents. Access to treatment (considering the Brazilian socioeconomic context), treatment adherence, short and long-term response rates, and side effects must be considered when choosing the best treatment strategy.