Revista Brasileira de Psiquiatria最新文献

Objective: White matter hyperintensities (WMH) are associated with Major Depressive Episodes (MDE) in individuals aged 65 and over. WMH are prevalent in adults under 65, yet the association between their volume and MDE in this population remains uncertain. This study aimed to assess the association between WMH volume and MDE and its severity in patients < 65.

Methods: This cross-sectional study included subjects under the age of 65, 69 patients with MDE and 32 healthy controls (HCs). Severity was assessed with the Hamilton Rating Scale and WMH were quantified by 2 experts. Post-hoc mediation analyses were conducted if associations were found between independent variables and WMH.

Results: Mean was 34.5 (12.4) years old. There was no difference in WMH between patients and HCs. Higher WMH volume were observed in extremely severe MDE (2170.2 (3767.9) mm3 vs 416.6 (594.9) mm3 (r = 0.21; p < 0.05)), which completely mediated the effect of age on severity.

Conclusions: In adults under 65, this study failed to identify higher WMH volume in MDE compared to HCs. However, WMH may act as a mediator of the association between age and MDE severity. This finding suggests that WMH could contribute to more severe depression in late-life.

Objective: Recent studies have revealed a heterogeneous prevalence and presentation of PTSD across countries. It is crucial to assess the methodological and item-level measurement factors that contribute to variations in mental disorder rates across cultures. This study aimed to investigate the traumatic experiences of hospital workers by employing item analysis of the Impact of Event Scale-Revised (IES-R).

Methods: Data were collected from 1,000 employees of a large hospital during the COVID-19 pandemic and were further subjected to item response theory (IRT) analysis with respect to the discrimination (a) and difficulty (b) parameters of the item pool.

Results: Our results demonstrated that the IES-R items had a good discriminative ability (a) and covered a range of distress severity (b) associated with traumatic experiences. The IES-R was found to be a reliable and informative instrument for assessing individuals with moderate to severe trauma-related distress across the spectrum of traumatic symptoms. In particular, items #10 ("jumpy or easily startled") and #6 (" thought about it when didn't mean to"), reflecting the PTSD domains of hyperarousal and intrusion, excelled in discriminating between different levels of traumatic distress. Conversely, items related to avoidance and sleep disturbance showed diminished discriminative ability.

Conclusions: The item analysis of the IES-R may be used to assess trauma symptoms in the context of a traumatic exposure, thereby identifying the most discriminative and informative items of the PTSD measure in our context. Our findings may refine the IES-R and facilitate the development of a more effective scale with optimized item parameters.

Background: Given the increasing number of people with dementia in Brazil, there is an urgency for health and social systems to plan strategies to meet the needs of this population and their families. Therefore, research on dementia costs is essential. This study estimated direct and indirect costs related to dementia in Brazil.

Methods: We employed the cost of illness study methodology to estimate dementia-related costs. Moreover, we used household interview data from the ReNaDe project and public, free-of-charge national databases to collect service use and values information. The societal and the SUS (Brazilian Universal Health System) perspectives were adopted.

Results: The monthly cost of dementia per individual increases with the syndrome's progression from US$ 843.04 in the initial stage to US$ 1,317.81 in the intermediate stage, peaking at US$ 1,576.15 in the advanced stage. Indirect costs constitute at least 73% of total expenses. When considering the costs for Brazil, it is in the intermediate stage of dementia that the country's total expenses are the highest.

Conclusions: Family caregivers shoulder at least 73% of the health-related costs of dementia in Brazil, highlighting the need to improve and create supporting strategies for people with dementia and their families.

Objective: This study aims to assess the safety profile of Olanzapine by analyzing adverse events (AEs) reported in the FAERS database, particularly focusing on newly identified risks.

Method: The study involved adverse events (AEs) related to Olanzapine from January 1, 2004, to June 30, 2023. Four signal mining methods were used for a comprehensive analysis of the frequency and strength of AEs, including ROR, PRR, BCPNN, and EBGM.

Results: A total of 43,664 reports with Olanzapine as the primary suspect drug were collected. 776 PT signals involving 27 SOCs were identified. The main affected groups were females and the age group of 18 to 45 years. Psychiatric disorders and Nervous system disorders were the most common adverse reactions. Moreover, the analysis revealed some adverse reactions not recorded in the manual, including cardiovascular risks like Pancreatitis, Chylomicron increased, Hyperchylomicronaemia, and Myocardial reperfusion injury, as well as rare but serious adverse reactions like Neuroleptic malignant syndrome and Anosognosia.

Conclusion: This study identified new cardiovascular risks associated with Olanzapine, including pancreatitis and myocardial reperfusion injury, which require further investigation.

Objectives: To measure the levels of functionality and QoL of caregivers of patients with BD, investigating the association between them, as well as the relationship with clinical and sociodemographic data of these caregivers.

Method: A cross-sectional study was conducted between 2020 and 2022 with caregivers of patients with BD treated in an outpatient clinic of a university hospital. The following instruments were applied: Clinical and sociodemographic questionnaire, WHODAS 2.0, SF-36, MINI-PLUS, and SCID II.

Results: The median score on WHODAS 2.0 was less than 20. In SF-36, the medians found in its domains were above 60. Those who demonstrated greater functional impairment had lower QoL. Being younger, being a parent, having non-psychiatric clinical conditions, and having mental disorders were associated with worse QoL and lower functionality.

Conclusion: The results obtained indicate less functional impairment and a better perception of QoL when compared to literature data, demonstrating that there is a subgroup of caregivers who perform their caregiving role without significant compromise in these health aspects. Exploring other factors associated with functionality and QoL, such as resilience, the presence of psychological support, or others, may allow for better targeting of public health interventions, optimizing comprehensive bidirectional care for patients and caregivers.

Objectives: Suicide represents 1% of all deaths in the world. It's more prevalent in underdeveloped countries. Suicide mortality in Brazil has been growing in recent years. We Evaluated whether patients who committed suicide in Fortaleza sought the only psychiatric emergency service in the State before the act during the year 2022.

Methods: Retrospective cross-sectional study with data from electronic psychiatric emergency records and expert reports from the state forensic expertise service.

Results: 292 deaths were identified, which represents almost 2% of mortality in Fortaleza this year, 25% of which were female and 74.6% were male. Only 2.7% of individuals who committed suicide within this period requested a psychiatric emergency evaluation in the 3 months before the death. Among these individuals, 75% mentioned suicidal ideation. Furthermore, 70% of deaths were due to hanging.

Conclusions: The study found that the majority of patients who committed suicide in Fortaleza in 2022 did not seek the only psychiatric emergency service before the event, more studies are needed to investigate the causes of this behavior.

Objective: We aimed to assess the effect of N-acetylcysteine (NAC), as an adjuvant treatment, on treatment adherence (primary outcome), in peripheral biomarkers and clinical improvement (secondary outcomes) in alcohol use disorders (AUD) patients.

Methods: A 9-week randomized, double-blind, placebo-controlled trial (RCT) was conducted on 53 (n=25 NAC, n=28 placebo) inpatients with AUD. Neuropeptide Y (NPY), oxidative stress and inflammatory biomarkers, and hepatic parameters were analyzed in three-time moments.

Results: Seventeen (60.7%) subjects in placebo and sixteen (64%) in the NAC group completed the RCT. Levels of hepatic biomarkers significantly changed over time (p<0.001). Oxidized glutathione (GSSG) levels at admission were lower in NAC group ((ppairwise=0.043). By the end of the study, both groups had similar GSSG levels (p=0.868), showing a reduction in GSSG levels in the placebo group. In the NAC group, a decrease in superoxide dismutase (SOD) activity and an increase in NPY levels in the end of the intervention were observed. Both groups showed similar mean survival time to relapse, treatment adherence and clinical improvement.

Conclusion: Our findings reinforce the alcohol effects on oxidative stress and NPY parameters. However, our sample size may limit the generalizability of the results, especially for clinical outcomes. Future RCTs with less severe alcoholics and longer follow-up may be necessary to test if NAC could be helpful to reduce the mental health burden related to AUD.

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.