Revista Brasileira de Psiquiatria最新文献

Objective: This study examined the effects of socioeconomic status as a possible moderator of the effects of family conflict on externalizing/internalizing behavior and hippocampal and amygdala volume.

Methods: A longitudinal complete-case analysis of 714 children and adolescents (mean age: 11.2 years; 46.2% female) was conducted using data from the Brazilian High-Risk Cohort Study for Psychiatric Disorders in Childhood. At baseline, parents/guardians completed the Family Environment Scale and a socioeconomic status scale. Three years after baseline assessment, the same participants underwent brain magnetic resonance imaging, and the Child Behavior Checklist was administered. Automated segmentation of the amygdala and hippocampus was performed in FreeSurfer 5.1.

Results: Although family conflict at baseline predicted externalizing/internalizing behavior at follow-up, we found no evidence that family conflict and socioeconomic status affected brain structure or that family conflict had a moderating effect on psychopathology and brain outcomes conditioned on socioeconomic status.

Conclusion: These results are consistent with emerging evidence that family conflict is a risk factor for externalizing/internalizing behavior in youth. These findings warrant further attention, focusing on prevention and intervention efforts and social policy development.

Objective: Given the increasing number of people with dementia in Brazil, health and social systems must urgently 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 dementia-related costs in Brazil.

Methods: We used a cost-of-illness methodology to estimate dementia-related costs, in addition to household interview data from the National Report on Dementia in Brazil (ReNaDe) and public national databases to collect data on health service use and costs. Both a social and a health system perspective were used.

Results: The monthly cost of dementia per patient increases with advancing stages of the syndrome: USD 843.04 in the initial stage, USD 1,317.81 in the intermediate stage, and USD 1,576.15 in the advanced stage. Indirect costs represent = 73% of total expenses. The country's total expenses are the highest during the intermediate stage of dementia.

Conclusion: Family caregivers shoulder at least 73% of the health-related costs of dementia in Brazil, highlighting the need for better support strategies for people with dementia and their families.

Objective: Patients at risk of psychosis present a variety of symptoms, and identifying the most discriminative symptoms is essential for efficient detection and treatment.

Methods: This cross-sectional online study analyzed individuals from the general population to better assess their risk of symptoms classified as clinical high risk (CHR) for psychosis. The 16-item Prodromal Questionnaire was applied as a self-report screening tool. Item response theory with a graded response model was used to assess the discrimination and difficulty of the questionnaire's criteria.

Results: The analysis included 936 participants (mean age: 21.5 years; 71.9% women). "Déjà vu" stood out for its high discriminative power, while the "voices or whispers" and "seeing things" items had greater precision than the other CHR-related symptoms. Conversely, the "smell or taste" and "changing faces" items were associated with the most severe cases.

Conclusion: This study identified the most indicative CHR-related symptoms for accurate assessment of psychosis severity, which can be used to guide targeted preventative interventions.

Objective: This study's purpose was to characterize copy number variations in a Brazilian cohort regarding frequency and inheritance patterns and to determine the effect of copy number variations previously associated with mental health disorders on the risk of developing these disorders.

Methods: A total of 2,250 probands and 3,174 parents (897 trios) from the Brazilian High-Risk Cohort Study for Mental Conditions (BHRCS) were genotyped, with copy number variations detected using PennCNV software.

Results: In total, 56.03% of the copy number variations were inherited. Among the distinct copy number variations, 96.15% were rare (frequency < 1% in the BHRCS). Duplications in 2q13 and 15q13.3 were less frequent, while those in 2q11.2 and 16p11.2 were more frequent in the BHRCS than in databases such as the Database of Genomic Variants and the Genome Aggregation Database. Of the 40 copy number variations previously associated with mental health disorders, 18 were identified in the sample. While duplication in 7q11.2 has been considered protective for schizophrenia, we found that deletion in 7q11.2 was protective for mental health disorders (p = 0.033, OR = 0.103). No significant results were found for the other copy number variations, despite mild effect sizes.

Conclusions: This is one of the largest copy number variation studies to have been conducted in a Brazilian sample, and it will be a valuable resource for future meta-analysis, advancing our understanding of the genetics of mental health disorders, especially in diverse populations.

Objective: Post-stroke depression affects approximately 40% of stroke survivors, with cognitive deficits being frequently observed. Transcranial direct current stimulation (tDCS) has shown promise in improving cognitive performance in stroke patients. We explored the effects of tDCS on cognitive performance in post-stroke depression.

Methods: We conducted an exploratory analysis of 48 patients from a double-blinded, shamcontrolled, randomized clinical trial that investigated the effects of tDCS on post-stroke depression. A neuropsychological battery was applied at baseline and endpoint. We assessed three key domains: 1) the Stroop effect, measured with Stroop Test components (the color-naming, word-reading, and word-color interference tasks); 2) processing speed, measured with the Trail Making Test and the Digit Symbol-Coding task; 3) executive function, assessed with the Digit Span test and the Frontal Assessment Battery. Linear mixed regression models were used to evaluate group-wise changes.

Results: We found that executive function worsened slightly in the active tDCS group and improved in the sham group in the adjusted models. Significant interactions were also found for the Frontal Assessment Battery.

Conclusions: We found no consistent evidence that tDCS significantly improved cognitive domains. The bidirectional association with cognition analysis suggests that the effects of tDCS may vary based on depression severity and task complexity.

Objective: This study investigated the association between childhood family adversity and depression in a cohort of Brazilian adults over three visits.

Methods: A total of 12,636 participants from the Longitudinal Study of Adult Health (ELSA-Brasil), baseline (2008-2010) and followed up in 2012-2014 and 2017-2019, were included. Five types of family dysfunction and the childhood family dysfunction score (0, 1, and = 2 dysfunctions) were used. The Clinical Interview Schedule-Revised was used to assess depression in visits 1 and 2 or 3. Multinomial logistic regression models estimated crude and adjusted OR and 95%CI.

Results: The mean age of the sample was 59.6 (SD, 8.8) years, 7.4% presented depression in one visit, and 2.2% presented it in two or three visits. After adjustment, compared to no family dysfunction, mental disorder (OR = 3.91; 95%%CI 2.94-5.21), substance abuse (OR = 2.14; 95%CI 1.65-2.77), and parental separation/divorce (OR = 1.55; 95%CI 1.12-2.15) increased the odds of depression in two or three visits. Exposure to = 2 types of family dysfunction increased the odds of depression in one, and two or three visits in a dose-response gradient.

Conclusion: Exposure to childhood family dysfunction contributes to the occurrence and recurrence of depression in adults. Interventions to prevent dysfunctional family environments and their repercussions on children can reduce the burden of depression.

Objective: Recent studies have revealed a heterogeneous prevalence and presentation of post-traumatic stress disorder 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.

Methods: Data were collected from 1,000 employees of a large hospital during the coronavirus disease 2019 pandemic and were analyzed according to item response theory analysis regarding item pool discrimination (a) and difficulty (b) parameters.

Results: The Impact of Event Scale-Revised items had good discriminative ability (a) and covered a range of distress severity (b) associated with traumatic experiences. According to our results, the Impact of Event Scale-Revised is a reliable and informative instrument for assessing individuals with moderate to severe trauma-related distress across the spectrum of trauma symptoms. In particular, items 10 ("jumpy or easily startled") and 6 ("I thought about it when I didn't mean to") reflected the post-traumatic stress disorder domains of hyperarousal and intrusion and excelled in discriminating between different levels of post-traumatic distress. Conversely, items related to avoidance and sleep disturbance showed lower discriminative ability.

Conclusions: Item analysis of the Impact of Event Scale-Revised may be used to assess trauma symptoms in the context of a trauma exposure, identifying the most discriminative and informative items for measuring post-traumatic stress disorder in our context. Our findings may help refine the Impact of Event Scale-Revised and facilitate the development of a more effective scale with optimized item parameters.

Digital therapeutics have evolved rapidly with technological advances in healthcare. Despite their increasing use, gaps remain in understanding their regulatory frameworks, integration, and efficacy for conditions like substance use disorder, insomnia, attention deficit hyperactivity disorder, and posttraumatic stress disorder. This study evaluates U.S. Food and Drug Administration (FDA)-approved digital therapeutics and explores their potential to revolutionize psychiatric treatments amid ongoing technological and regulatory changes. We conducted a comprehensive review of major databases, focusing on articles published until January 2024 about FDA-approved digital therapeutics. We excluded non-English articles, those lacking empirical data, and those focusing on non-FDA-approved therapeutics. Our analysis covered regulatory compliance, clinical outcomes, and integration with traditional treatments. A review of nine FDA-cleared digital therapeutics revealed benefits, such as improved treatment accessibility and potential reductions in healthcare costs. For example, through Somryst, a cognitive-behavioral therapy-based treatment for insomnia, over 40% of users overcame chronic insomnia, and 60% experienced improvements without adverse effects. However, challenges remain, including low provider adoption, inadequate insurance coverage, and high user dropout rates. While digital therapeutics enhance accessibility, they face regulatory challenges, reimbursement issues, and require robust clinical evidence. Success depends on collaboration among stakeholders to demonstrate value, ensure safety, and integrate them into existing healthcare systems.

Objective: Internalizing problems disproportionately affect females in adolescence and adulthood, but research at earlier ages is limited 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 (CBCL 1.5-5) as administered in the Preschool Mental Health Study (PreK Survey), involving 1,292 children aged 4 to 5 in Embu das Artes, state of São Paulo, Brazil. Confirmatory factor analysis and comparisons of means explored internalizing problems and gender variations.

Results: A two-factor model best fit both internalizing and externalizing problems. A 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 the withdrawn syndrome, while girls scored higher in the somatic complaint 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.

Objective: Functionality and quality of life levels were measured in caregivers of patients with bipolar disorder, investigating the associations between them and with clinical and sociodemographic data.

Method: A cross-sectional study was conducted between 2020 and 2022 with caregivers of patients with bipolar disorder treated in a university hospital's outpatient clinic. The following instruments were applied: a clinical and sociodemographic questionnaire, the World Health Organization Disability Assessment Schedule 2.0, the 36-Item Short Form Health Survey, the Mini International Neuropsychiatric Interview Plus, and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders.

Results: The median World Health Organization Disability Assessment Schedule 2.0 score was < 20, and the median score on the 36-Item Short Form Health Survey domains was > 60. Caregivers with greater functional impairment had lower quality of life. Being younger, being a parent, having non-psychiatric clinical conditions, and having mental disorders were associated with lower quality of life and functionality.

Conclusion: These results indicate less functional impairment and better perceived quality of life than what has been reported in the literature, demonstrating that there is a subgroup of caregivers who perform their role without significant compromise to these health aspects. Exploring other factors associated with functionality and quality of life, such as resilience, psychological support, etc., may allow for more targeted public health interventions, optimizing comprehensive bidirectional care for patients and caregivers.