Revista Brasileira de Psiquiatria最新文献

Objective: We assessed the effect of N-acetylcysteine, as an adjuvant treatment, on treatment adherence (primary outcome) according to peripheral biomarkers and clinical improvement (secondary outcomes) in patients with alcohol use disorder.

Methods: A 9-week randomized, double-blind, placebo-controlled clinical trial was conducted on 53 (n = 25 N-acetylcysteine, n = 28 placebo) inpatients with alcohol use disorder. Neuropeptide Y, oxidative stress and inflammatory biomarkers, and hepatic parameters were analyzed at 3 time points.

Results: Seventeen (60.7%) patients in the placebo group and 16 (64%) patients in the N-acetylcysteine group completed the trial. Hepatic biomarker levels changed significantly over time (p < 0.001). Oxidized glutathione levels at admission were lower in the N-acetylcysteine group (ppairwise = 0.043). By the end of the study, both groups had similar oxidized glutathione levels (p = 0.868), and oxidized glutathione levels were lower in the placebo group. At the end of the intervention, superoxide dismutase activity had decreased and neuropeptide Y levels had increased in the N-acetylcysteine group. Both groups showed similar mean time to relapse, treatment adherence, and clinical improvement.

Conclusion: Our findings reinforce the effects of alcohol on oxidative stress and neuropeptide Y parameters. However, our sample size may limit the generalizability of the results, especially for clinical outcomes. Future randomized clinical trials including patients with less severe alcohol use disorder and longer follow-up may be needed to determine whether N-acetylcysteine could help reduce the mental health burden of this disorder.

Objective: This study aimed to mine and analyze adverse event signals of fluoxetine using the U.S. Food and Drug Administration's Adverse Event Reporting System database.

Methods: This study focused on suspected adverse drug reaction reports between the first quarter of 2004 and the second quarter of 2023 in which fluoxetine was the primary suspected drug. Four signal mining and analysis methods were employed to comprehensively assess adverse event signals.

Results: A total of 19,932,732 reports were collected, of which 22,884 primarily suspected fluoxetine. Through analysis, 862 signs involving 27 system organ classes were identified. More adverse events were reported by female patients (58.81%) than male patients (26.84%), with the largest percentage being in the 18-45 year age group. The signal strength of adverse events related to pregnancy and neonatal conditions was notable, including fetal exposure during pregnancy, exposure during pregnancy, and neonatal health-related adverse events, such as atrial septal defect, premature baby, ventricular septal defect, and maternal drugs affecting the fetus.

Conclusions: Although fluoxetine has been extensively approved and applied, its use in women who are pregnant or planning to conceive should be approached with caution.

Objective: This study assessed the safety profile of olanzapine by analyzing adverse events reported in the U.S. Food and Drug Administration's Adverse Event Reporting System database, particularly focusing on newly identified risks.

Methods: The study involved olanzapine-related adverse events that occurred between January 1, 2004, and June 30, 2023. Four signal mining methods were used for a comprehensive analysis of the frequency and strength of adverse events, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and empirical Bayesian geometric mean.

Results: A total of 43,664 reports with olanzapine as the primary suspect drug were collected, and 776 preferred terms signals involving 27 system organ classes were identified. The main affected groups were females and individuals between 18 and 45 years of age. Psychiatric disorders and nervous system disorders were the most common adverse reactions. The analysis also revealed some adverse reactions not recorded in the manual, including cardiovascular risk, such as pancreatitis, increased chylomicron, hyperchylomicronemia, and myocardial reperfusion injury, as well as rare but serious adverse reactions like neuroleptic malignant syndrome and anosognosia.

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

Objective: White matter hyperintensities (WMH) are associated with major depressive episodes (MDE) in individuals aged 65 and older. 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 of WMH volume with MDE and its severity in patients aged < 65.

Methods: Cross-sectional study (ancillary to clinical trial NCT02051413) of subjects under the age of 65. Overall, 69 patients with MDE and 32 healthy controls (HCs) were included. Severity was assessed with the Hamilton Rating Scale (HRS) and WMH were quantified by two experts. Post-hoc mediation analyses were conducted if associations were found between independent variables and WMH.

Results: Mean age was 34.5 (12.4) years. There was no difference in WMH between patients and HCs. Higher WMH volumes were observed in extremely severe MDE (2,170.2 [3,767.9] mm3 vs. 416.6 [594.9] mm3 [r = 0.21; p < 0.05]), which completely mediated the effect of age on severity.

Conclusions: In a sample of adults under 65, this study failed to identify higher WMH volume in patients with 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: This study aimed to explore the association between major depressive disorder (MDD) and suicide risk in patients with dementia.

Methods: A cohort of 625,218 individuals aged = 40 years with dementia was identified from Taiwan's National Health Insurance Research Database (NHIRD) between 2007 and 2018. After excluding prevalent cases in 2007, a nested case-control study enrolling 1,256 suicide cases and 5,022 matched controls was conducted. The frequencies of MDD-related outpatient or inpatient visits over a 7-year period preceding the event dates were calculated and analyzed for association using conditional logistic regression.

Results: Dementia comorbid with MDD was associated with increased suicide risk (adjusted OR [AOR]: 2.67), particularly in individuals with = 1.0 MDD episodes per year (AOR: 2.85). A similar association was observed only in individuals aged = 65 years and males, with a pronounced risk of suicide in those experiencing = 1.0 MDD episodes per year (AOR: 3.08 for individuals aged = 65 years; AOR: 3.28 for males). Conversely, the risk increase was evident with > 1.0 MDD episodes per year in those aged < 65 years (AOR: 3.04) and females (AOR: 2.45).

Conclusion: MDD is associated with suicide risk in patients with dementia. The strength of this association possibly varies with age and gender.

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

Methods: We used data from the 2004 Pelotas Birth Cohort, a population-based longitudinal study from Pelotas, Brazil (n=3,285 mothers, complete cases analysis). We used the Edinburgh Postnatal Depression Scale (EPDS) to assess maternal depressive symptoms and calculated their trajectories from 3 months until the 11-year follow-up using a group-based modeling approach. Psychological and physical aggression were measured using the Parent-Child Conflict Tactics Scale (CTSPC). Maternal QoL was measured by the question "How is your quality of life?" Data were analyzed using path models in Mplus.

Results: 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 QoL, which in turn was associated with increased use of harsh parenting. The proportion of total effect explained by maternal QoL ranged from 4.04% (0.00-5.58%) to 16.31% (10.88-19.10%).

Conclusion: Our findings, within a longitudinal framework from a middle-income country, support existing evidence that maternal depressive symptoms are associated with harsh parenting. Our results also suggest that one mechanism underlying this association is lower perceived maternal QoL.

Objective: To evaluate the effect of narrative therapy on post-traumatic stress disorder (PTSD) symptoms, perceived stress, anxiety, and depression in nurses.

Methods: A total of 92 clinical nurses with positive PTSD symptom screening results were randomly assigned (1:1) to the intervention or control group. The intervention group received narrative therapy and a psychological stress leaflet, while the control group received only a psychological stress leaflet. PTSD, perceived stress, anxiety, and depression were measured before and after the intervention to assess the effect of narrative therapy.

Results: After the intervention, the intervention group showed significantly lower PTSD symptom levels (p = 0.025), perceived stress (p = 0.033), anxiety (p = 0.004), and depression (p = 0.015) than the control group. Regarding the dichotomous PTSD, anxiety, and depression outcomes, there was a statistically significant decrease in the number of positive cases of PTSD (p = 0.030) and anxiety (p = 0.002), but no significant change in the number of positive cases of depression (p = 0.060).

Conclusion: Narrative therapy is expected to alleviate PTSD symptoms, stress, anxiety, and depression among frontline clinical nurses, and healthcare managers should consider narrative therapy interventions to improve the mental health of their nursing staff.

Clinical trial registration: ChiCTR2200058472. Registration date: April 09, 2022. Date of first recruitment: June 1, 2022.

Objective: The large body of literature examining the association between parenthood and mortality in the general population contrasts with a lack of such studies on older adults with schizophrenia. Identifying potential protective factors of premature death in this population is important to help guide prevention measures. Here, we examined whether all-cause and cause-specific mortality rates significantly differ between older parents and non-parents with schizophrenia during a 5-year follow-up.

Methods: We used data from a 5-year prospective multicenter sample of older adults with an ICD-10 diagnosis of schizophrenia (aged 55 years or more) recruited in France. We performed a forward stepwise logistic regression to examine the association between parenthood and all-cause mortality, including only independent variables that best explain outcome.

Results: Of the 323 older adults with schizophrenia, 133 (41.2%) were parents (mean age = 67.0, SD = 6.1) and 190 were not (mean age = 67.2, SD = 6.6). Following adjustments, parenthood was significantly associated with lower all-cause mortality compared to patients without children (21.1% [n=28] vs. 35.8% [n=68]; AOR = 0.50; 95%CI 0.27-0.94; p = 0.032); the association involved no significant sex differences.

Conclusion: Parenthood could be a protective factor against mortality among older patients with schizophrenia who live in France. Further research is needed to understand the specific mechanisms underlying this association.

Objective: Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, they have some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia; in recent years, interest in its use in patients with psychotic disorders has been increasing. This meta-analysis aims to evaluate the effectiveness of CBT-I for sleep problems in patients with psychotic disorders.

Methods: A systematic search of the PubMed, Scopus, and EBSCO (MEDLINE) databases was conducted to identify relevant studies. The inclusion criteria were randomized controlled trials (RCTs) and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had had sleep problems for at least 1 month, and who were receiving treatment. The initial search yielded 246 studies, of which eight were ultimately selected for meta-analysis after screening and applying inclusion and exclusion criteria. Statistical analysis was conducted in the R software environment.

Results: CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders in both the short and long term. Additionally, CBT-I leads to significant improvement in psychotic symptoms in the short-term period and contributes significantly to improvement in mental well-being in both short- and long-term follow-up.

Conclusions: CBT-I is an effective, valuable method for sleep problems in patients with psychotic disorders. Its widespread use for this purpose is recommended.

Objective: Suicide represents 1% of all deaths in the world, and it is more prevalent in developing countries. Because suicide mortality has been growing in recent years in Brazil, we investigated whether patients who committed suicide in 2022 in Fortaleza sought care in the state's only psychiatric emergency service before the act.

Methods: This retrospective cross-sectional study used data from electronic psychiatric emergency records and reports from the state department of forensics.

Results: A total of 292 deaths (25% women) were identified, representing almost 2% of mortality in Fortaleza that year. Only 2.7% of those who committed suicide during this period requested an emergency psychiatric evaluation in the 3 months prior to death. Of these individuals, 75% mentioned suicidal ideation. Most deaths (70%) were due to hanging.

Conclusion: The majority of patients who committed suicide in Fortaleza in 2022 did not seek care from the psychiatric emergency service prior to the event; further studies are needed to investigate the causes of this behavior.