Revista Brasileira de Psiquiatria最新文献

Objective: To study the impacts of maternal depressive symptoms trajectories and harsh parenting and explore if the maternal quality of life mediates this association.

Methods: We used data from the 2004 Pelotas Birth Cohort, a population-based longitudinal study from Pelotas, Brazil (N = 3285 mothers, complete cases analysis). We used the Edinburgh Postnatal Depression Scale to assess maternal depressive symptoms and the trajectories from three months until the 11-year follow-up were calculated using a group-based modelling approach. Psychological and physical aggression were measured using the Parent-Child Conflict Tactics Scale. Maternal quality of life was measured by the question "How is your quality of life?". Data were analyzed using path models in Mplus.

Results: Our findings showed that all maternal depressive symptoms trajectories increased the frequency of psychological and physical aggression at early adolescence when compared to the reference group. Mediation analysis indicated that maternal depressive symptoms led to low levels of perceived maternal quality of life, which in turn was associated with the increased use of harsh parenting. The proportion of total effect explained by maternal quality of life ranged from 4.04% (0.00%-5.58%) to 16.31% (10.88%-19.10%).

Conclusion: Our findings support the evidence showing that maternal depressive symptoms are associated with harsh parenting within a longitudinal framework from a middle-income country. Our results also suggest that one mechanism underlying this association is a women's lower perceived quality of life.

Background: Depressive symptoms during perinatal significantly impact mothers and infants. Emerging evidence suggests a connection between gut microbiota and mood regulation. This study investigated whether depressive symptoms are associated with changes in the gut microbiota of women during the perinatal period.

Method: A total of 34 pregnant women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS) and categorized based on symptom severity. Stool samples were collected during the third trimester and at two postpartum timepoints. All samples underwent 16S rRNA gene sequencing and Quantification of Short-Chain Fatty Acids (SCFA) using a gas chromatograph-mass spectrometer (GC-MS).

Results: No differences in SCFA concentrations were observed between groups (p>0.05). However, postpartum women with moderate to severe symptoms (MG group) had a significant increase in Enterobacteriaceae abundance compared to the mild and absent group (AL group) (p<0.05). The Bifidobacterium genus increased significantly in both groups over time (p<0.05). The MG group showed a reduction in depressive symptoms during psychiatric treatment (p<0.05).

Conclusion: These findings suggest a link between gut microbiota and perinatal depressive symptoms. Further research is needed to understand the broader implications for maternal health through microbiome-targeted approaches.

Single-session interventions (SSI) are an effective strategy reducing emotional distress. Enhanced psychoeducation (EP), which includes empathic listening, risk stratification, symptom monitoring, and habit modification is particularly suitable for SSIs. We investigate predictors of response to an online EP intervention among essential service professionals during COVID-19 in Brazil. TELEPSI Project financed by the Ministry of Health of Brazil, nationwide initiative, which served more than 3,300 individuals in various psychotherapeutic modalities. Data from April 2020 to December 2021. We included all participants who received SSIs with high levels of emotional distress. Final sample: 460 subjects, 89.1% female, and 81.1% health professionals. 300 subjects underwent reassessment in one month. Participants with harmful use of social networks, spending time on social media, playing video games, smoking, drinking alcohol, spending time with pets had a less pronounced symptom decrease. Participants who played instruments or already received some psychological treatment showed a greater magnitude of symptom decrease. This highlighted the impact of lifestyle factors on the efficacy of SSIs. These results underscore the importance of considering individual lifestyle factors when implementing SSIs and contribute to growing body of evidence supporting the tailored application of psychoeducational strategies in mental health interventions, particularly in high-stress environments.

Schizophrenia patients represent a heterogeneous group in clinical presentation and severity. Although severity has been operationalized in different ways, mostly on a gradient between symptom severity and functional impairment, such approaches are limited in capturing real-world functioning. We suggest adopting the severity model proposed by DSM-5 for autism spectrum disorders. The model defines three levels of severity, based on the support required, directly addressing two barriers from previous models: real-world functioning and ease of implementation. Our adapted model includes three new features: First, this severity specifier is global, rather than for each symptom domain. Second, the centrality of occupational functioning is emphasized to define the level of support. Third, we propose a one-month timeframe for severity appraisal, standardizing the assessment process. Considering practical utility, we indicate how severity assessment can guide clinical practice towards rehabilitation. Additionally, we outlined operational definitions for severity and functioning in schizophrenia, aligned with the premises of our model. Finally, we acknowledge potential limitations, the most relevant being the need for empirical validation. The model is presented to foster discussion. Additional studies will follow to investigate inter-rater reliability and convergent validation with standard measures of symptom and functioning severity.

Objective: To identify the effects of amygdala neuromodulation in the management disruptive behavior in patients, as well as changes in their quality of life and its relationship with epilepsy.

Methods: MEDLINE, OVID, WoS, Central Cochrane, and Scopus databases were systematically searched up to March 2023 for studies examining extremely aggressive patients who underwent ablative surgeries or deep brain stimulation (DBS) of the amygdala as the unique therapeutic target, with a six-month follow-up at least.

Results: The search yielded 1352 studies excluding duplicates, but only 11 case series, and 3 case reports met the inclusion criteria. They were published between 1963-2023 with a total of 1033 patients, mostly male, aged between 5 and 61 years. Most studies implemented amygdalotomy and only one DBS. More than 70% of the patients improved their behavior; approximately 30% had seizures, of which 40% presented improvement. Two studies reported worsening behavior.

Conclusions: Although we found that amygdalotomy has a positive effect on the behavior of patients and the control of their seizures, it is necessary to carry out updated studies with greater epidemiological power. Future research should analyze the DBS use and the role of connectomics of the different neural networks involved with this brain structure.

Objective: To investigate the association between depressive symptoms and social support among a representative sample of the Brazilian population aged 50 years or older.

Methodology: Cross-sectional study, based on 8,074 participants of the second wave of the Brazilian Longitudinal Study on Aging - ELSI-Brasil. Depressive symptoms were screened based on the CES-D8 instrument, and social support was investigated in its structural and functional dimensions. Sociodemographic variables and health conditions were considered for adjustment in investigating the association between social support and depressive symptoms using the Poisson regression model.

Results: The prevalence of depressive symptoms was estimated at 19.1% (95% CI:16.7;21.7). In the analysis adjusted for possible confounding factors, depressive symptoms were independently associated with negative social support in the items "not married" (RP=1.24; 95% CI: 1.07-1.44), "not having someone to trust" (RP=1.31; 95% CI: 1.10-1.56) and "not having someone to borrow money or an object from, in case of need" (RP=1.46; 95% CI: 1.21-1.75).

Conclusion: The present results highlight the importance of social relations in determining the presence of depressive symptoms and reinforce the need to implement public policies aimed at strengthening social networks to minimize this public health problem.

Objective: Within the context of patients at-risk of psychosis, where a variety of symptoms are present, identifying the most discriminative symptoms is essential for efficient detection and management.

Methods: This cross-sectional online study analyzed individuals from the general population in order to better assess their risk of presenting symptoms belonging to the clinical high risk (CHR) for psychosis, called "CHR-related symptoms". The Prodromal Questionnaire-16 (PQ-16) served as a self-report screening tool. Item response theory (IRT) with a graded response model was used to assess the discrimination and difficulty of its criteria.

Results: The analysis included 936 participants (mean age: 21.5 years; 28.1% male, 71.9% female). "Déjà vu" stood out for its high discriminative power, while "Voices or whispers" and "Seen things" demonstrated strong precision relatively to the other CHR-related symptoms. Conversely, "Smell or taste" and "Changing face" were associated with the most severe cases relatively to the other CHR-related symptoms.

Conclusion: This study identified the most indicative CHR-related symptoms to emphasize their significance in accurately assessing severity and guiding targeted preventative interventions.

Background: Globally, internalizing problems disproportionately affect females in adolescence and adulthood, with limited research at earlier ages due to a focus on disruptive behaviors. Our study addresses this gap by exploring the structure of internalizing problems and gender differences in Brazilian preschoolers.

Methods: We analyzed data from the Child Behavioral Checklist 1.5-5 in the Preschool Mental Health Study, involving 1,292 children aged 4 to 5 in Embu das Artes, São Paulo, Brazil. Confirmatory factor analysis and mean comparisons explored internalizing problems and gender variations.

Results: A two-factor model best fit both internalizing and externalizing problems.The hierarchical model with four factors (Emotionally Reactive, Anxiety/Depression, Somatic Complaints, and Withdrawn) best fit internalizing problems, achieving partial invariance between boys and girls. Boys scored higher in Withdrawn Syndrome, while girls scored higher in Somatic Complaints Syndrome.

Conclusions: Preschoolers' internalizing problems warrant attention beyond their link to externalizing problems. While the overall construct is similar in boys and girls, divergent syndrome scores indicate potential distinct risk patterns requiring further exploration.