Revista Brasileira de Psiquiatria最新文献

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The association between schizophrenia and increased COVID-19 mortality in a cohort of over 2 million people in Brazil. 在巴西 200 多万人的队列中，精神分裂症与 COVID-19 死亡率增加之间的关系。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-18 DOI: 10.47626/1516-4446-2024-3540

Fabrício Emanuel Soares de Oliveira, S. Trezena, D. R. Martelli, M. C. Oliveira, Enrico A Colosimo, H. Martelli Júnior, E. A. Oliveira

OBJECTIVETo describe the clinical outcomes and risk factors of death related to mental disorders in a cohort of Brazilian hospitalized patients with COVID-19.METHODSThis retrospective cohort study utilized the Brazilian database SIVEP-Gripe to analyze patients aged ≥18 years who had been hospitalized with COVID-19 between 2020 and 2022. The exposure of interest were mental disorders (anxiety, depression, schizophrenia, and bipolar disorder), identified through self-reported fields. The primary outcome was in-hospital mortality. Covariates included demographic and clinical features. Descriptive statistics, t-tests, chi-square tests, and binary logistic regression were used to analyze the data.RESULTSA cohort of 2,124,285 patients was included in the analysis, with 23,246 individuals (1.1%) having self-reported mental disorders. Among these mental disorders, depression was the most prevalent (52.3%). The mortality rate of the patients with mental disorders was 30.8%. Analysis of risk factors for mortality revealed that age, gender, region, dyspnea, low oxygen saturation, and comorbidities were associated with an increased risk of death. Patients with schizophrenia had a higher mortality risk (aOR:1.68;95%CI:1.54-1.81).CONCLUSIONSPatients diagnosed with schizophrenia have a greater likelihood of COVID-19- related death than those without mental health conditions. These findings underscore the significant effect of serious mental disorders on COVID-19 mortality.

方法这项回顾性队列研究利用巴西数据库 SIVEP-Gripe，对 2020 年至 2022 年期间因 COVID-19 住院、年龄≥18 岁的患者进行分析。研究对象为精神障碍（焦虑症、抑郁症、精神分裂症和双相情感障碍），通过自我报告领域进行识别。主要结果是院内死亡率。协变量包括人口统计学特征和临床特征。结果分析对象包括 2,124,285 名患者，其中 23,246 人（1.1%）自述患有精神障碍。在这些精神障碍中，抑郁症的发病率最高（52.3%）。精神障碍患者的死亡率为 30.8%。对死亡风险因素的分析表明，年龄、性别、地区、呼吸困难、低血氧饱和度和合并症与死亡风险的增加有关。精神分裂症患者的死亡风险更高（aOR:1.68;95%CI:1.54-1.81）。这些发现强调了严重精神障碍对 COVID-19 死亡率的显著影响。

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引用次数: 0

Brazilian Psychiatric Association Consensus on the physical structure and ideal team for psychiatric emergencies services. 巴西精神病学协会关于精神病学急诊服务实体结构和理想团队的共识。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-18 DOI: 10.47626/1516-4446-2024-3567

L. Baldaçara, Flávia Ismael, Daniel Kawakami, Gislene Alves da Rocha, E. Calfat, Deisy M Porto, Beatriz Ferroli Cavalcante, B. Zaramella, Flávio Veloso Ribeiro, Roberto M Dos Santos, Roberta R Grudtner, Teng C Tung, Antônio Geraldo da Silva

INTRODUCTIONAn integral part of Brazil's public health system, the psychiatric emergency service (PES) has been instrumental in improving qualified support for crisis situations of mental disorders, equitable, universally accessible, and humanized. The purpose of this article is to present a systematic review and consensus about the physical area and facilities, and ideal team qualified for psychiatric emergencies services on both Brazilian settings.METHODSThe authors conducted a literature search using electronic databases such as MEDLINE (PubMed), Scielo, the Cochrane Database, and documents from the WHO, the Brazilian Ministry of Health, and others deemed relevant by experts. A total of 6839 manuscripts were found, but only 46 were selected. The analysis of article content summarizes consensus statements using the Delphi method and a series of interactive versions to provide a final report.RESULTSChanges to PES are evaluated considering various experiences and models. The authors highlighted that The Emergency Care Network (ECN) must be coordinated with qualified management, effective implementation of integration of all health equipment's and units. PES must have adequate infrastructure; qualified staff, including a psychiatrist; sufficient consultation and observational spaces; tools and resources for differential diagnosis; training for all staff members; and communication with the health care network to facilitate referrals following patient discharge are all necessary.CONCLUSIONThese standardized models need to be available to public health managers so that they can guide the installation of new services and adjust the existing ones, always looking for improvement. The authors propose requirements for PES as a model to be passed over.

简介作为巴西公共卫生系统不可或缺的一部分，精神科急诊服务（PES）在提高精神障碍危机情况下的合格支持、公平性、普及性和人性化方面发挥了重要作用。本文旨在对巴西两种环境下精神科急救服务的物理区域和设施以及理想的合格团队进行系统回顾并达成共识。方法作者使用 MEDLINE (PubMed)、Scielo、Cochrane 数据库等电子数据库以及世界卫生组织、巴西卫生部和其他专家认为相关的文件进行了文献检索。共找到 6839 篇手稿，但只有 46 篇被选中。文章内容分析采用德尔菲法和一系列互动版本对共识声明进行了总结，并提供了最终报告。结果考虑到各种经验和模式，对 PES 的变化进行了评估。作者强调，急诊网络（ECN）必须与合格的管理层协调，有效实施所有医疗设备和单位的整合。公共卫生服务系统必须具备充足的基础设施、合格的工作人员（包括一名精神病医生）、足够的咨询和观察空间、用于鉴别诊断的工具和资源、对所有工作人员的培训以及与医疗保健网络的沟通，以促进病人出院后的转诊。作者提出了对公共卫生服务系统的要求，并将其作为一种可借鉴的模式。

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引用次数: 0

Trajectories of positive attributes from childhood to young adulthood and its associations with threat and deprivation. 从童年到青年时期积极特质的轨迹及其与威胁和贫困的关系。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-09 DOI: 10.47626/1516-4446-2023-3456

Aline Romani-Sponchiado, R. Damiano, L. Axelrud, Julia Schafer, M. Hoffmann, G. A. Salum

OBJECTIVEThe aims of this study are to investigate the trajectory of positive attributes from childhood to early adulthood and to explore how those trajectories can be modified by two domains of childhood adversity - threat and deprivation.METHODSA large prospective school-based community cohort of youths (n=2,511, 6-14 years of age, 45% female) was assessed and followed up for 3 years (80% retention) and 6 years (71% retention). Positive attributes were assessed by the Youth Strength Inventory (YSI). Childhood exposure to threat and deprivation were assessed by a composite measure using multiple indicators.RESULTSTrajectories of YSI scores were non-linear and distinct for boys and girls. While boys presented a more stable trajectory; girls showed higher levels of positive attributes early in life that decrease over time around adolescence. Both exposure to threat and deprivation presented negative linear association with YSI over time. Furthermore, we found interactions between developmental stage and both adversity domains meaning that the effects of exposure to adversity were stronger at earlier developmental stages and almost non-significant closer to early adulthood.CONCLUSIONOur findings provide new evidence on trajectories of positive attributes in youth and reveal and how experiences of adversity in early life impact not only mental disorder but also positive aspects of mental health.

本研究的目的是调查积极属性从童年到成年早期的轨迹，并探讨这些轨迹如何会因童年逆境的两个方面--威胁和贫困--而发生改变。方法对以学校为基础的大型社区青少年队列（n=2,511，6-14 岁，45% 为女性）进行了评估，并分别进行了 3 年（80% 的保留率）和 6 年（71% 的保留率）的随访。正面特质通过青少年力量量表（YSI）进行评估。结果：男孩和女孩的 YSI 分数轨迹是非线性的，且截然不同。男孩的轨迹更为稳定，而女孩则在生命早期表现出较高的积极属性，并在青春期前后逐渐降低。随着时间的推移，受到威胁和被剥夺都与 YSI 呈负线性关系。此外，我们还发现了发展阶段与两个逆境领域之间的交互作用，这意味着在较早的发展阶段，逆境的影响更大，而在接近成年早期时，逆境的影响几乎不显著。

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引用次数: 0

A meta-analysis of randomized sham-controlled trials of repetitive transcranial magnetic stimulation for attention-deficit/hyperactivity disorder. 重复经颅磁刺激治疗注意力缺陷/多动症的随机假对照试验荟萃分析。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-09 DOI: 10.47626/1516-4446-2023-3428

Chia-Min Chen, Shun-Chin Liang, Cheuk-Kwan Sun, Yu-Shian Cheng, Kuo-Chuan Hung

Objective: To investigate efficacy of repetitive transcranial magnetic stimulation (rTMS) on attention-deficit/hyperactivity disorder (ADHD).

Methods: Randomized sham-controlled trials (RCTs) were identified from major databases from the inception date of January 1990 to January 2023. Primary outcome was improvement in total symptoms of ADHD. Subgroup analysis focused on rTMS efficacy targeting different brain regions. Secondary outcomes were associations of rTMS with improvements in different symptoms of ADHD. Outcomes were expressed as effect size (ES) based on standardized mean difference (SMD) (continuous data), and odds ratios (ORs) with 95% confidence interval (CI) (categorical data).

Results: Meta-analysis of six RCTs involving 169 participants demonstrated no difference in total ADHD symptoms between rTMS-treated participants and sham controls (SMD=-0.24,p=0.17). Subgroup analysis revealed better efficacy of rTMS than sham controls when targeting right prefrontal cortex (rPFC) (SMD=-0.49,p=0.03), but not left prefrontal cortex (lPFC) (SMD= 0.01,p=0.67). rTMS treatment correlated with better improvement in symptoms of inattention (SMD=-0.76,p=0.0002), but not hyperactivity (p=0.86), impulsivity (p=0.41), and depression (p=0.95). The apparently higher risk of dropout in the rTMS group than sham controls was not statistically significant (OR=1.65,p=0.26).

Conclusions: Our study only supported the therapeutic efficacy of rTMS targeting rPFC for the symptoms of ADHD, especially inattention, but not that targeting lPFC. Further large-scale randomized sham-controlled trials are required to verify our findings.

目的研究重复经颅磁刺激（rTMS）对注意力缺陷/多动症（ADHD）的疗效：从1990年1月至2023年1月的主要数据库中筛选出随机假对照试验（RCT）。主要结果是ADHD总症状的改善情况。分组分析侧重于针对不同脑区的经颅磁刺激疗效。次要结果是经颅磁刺激与ADHD不同症状改善之间的关联。结果以基于标准化均值差异（SMD）的效应大小（ES）（连续数据）和带有95%置信区间（CI）的几率比（ORs）（分类数据）表示：对涉及 169 名参与者的六项 RCT 进行的 Meta 分析表明，经颅磁刺激治疗的参与者与假对照组之间在总的 ADHD 症状方面没有差异（SMD=-0.24,p=0.17）。亚组分析显示，经颅磁刺激针对右侧前额叶皮层（rPFC）的疗效优于假对照组（SMD=-0.49,p=0.03），但针对左侧前额叶皮层（lPFC）的疗效不佳（SMD= 0.经颅磁刺激治疗与注意力不集中（SMD=-0.76,p=0.0002）症状的改善相关，但与多动（p=0.86）、冲动（p=0.41）和抑郁（p=0.95）症状的改善无关。）经颅磁刺激组的辍学风险明显高于假对照组，但没有统计学意义（OR=1.65,p=0.26）：我们的研究仅支持以rPFC为靶点的经颅磁刺激对多动症症状（尤其是注意力不集中）的疗效，但不支持以lPFC为靶点的经颅磁刺激的疗效。要验证我们的研究结果，还需要进一步开展大规模随机假对照试验。

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引用次数: 0

Social support and suicidality during the COVID-19 pandemic among Brazilian healthcare workers: a longitudinal assessment of an online repeated cross-sectional survey. 巴西医护人员在 COVID-19 大流行期间的社会支持和自杀倾向：对在线重复横断面调查的纵向评估。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-08 DOI: 10.47626/1516-4446-2023-3466

Alexandre Paim Díaz, A. Pinto, Maria Isabel Chaves Araújo, R. M. Joaquim, Danielle de Souza Costa, A. Serpa, Anthony R. Pisani, Y. Conwell, D. M. Miranda, L. Malloy-Diniz, A. G. da Silva

INTRODUCTIONHealthcare workers (HCWs) are at an increased risk of suicide compared to non-healthcare workers. This study aims to investigate the association between social support and suicidal ideation and behavior (SIB) during the COVID-19 pandemic among Brazilian HCWs.METHODSThis study utilizes data from 10,885 participants who answered the first (time point 1 - between May and June of 2020) and second (time point 2 - between December 2020 and February 2021) assessments of an online repeated cross-sectional survey for evaluating mental health and quality of life of HCWs during the COVID-19 pandemic in Brazil. Logistic regression analysis was conducted to investigate the relationship between social support as the independent variable (time point 1) and SIB as the outcomes (time point 2).RESULTSHigher social support was associated with a significantly lower chance of reporting SIB in the month prior to follow-up assessment (adjusted odds ratio [AOR]: 0.71, CI 95% 0.66 - 0.76 and AOR 0.61, CI 95% 0.54 - 0.68, respectively). These associations were independent of sex, age, feelings of loneliness, and self-reported psychiatric disorders.CONCLUSIONSocial support is associated with a lower chance of suicidality among HCWs, a protective role that is probably more evident for suicidal behavior.

简介与非医疗保健工作者相比，医疗保健工作者（HCWs）的自杀风险更高。本研究旨在调查在 COVID-19 大流行期间，巴西医护人员的社会支持与自杀意念和行为（SIB）之间的关系。方法本研究使用了 10885 名参与者的数据，这些参与者回答了在线重复横断面调查的第一次评估（时间点 1 - 2020 年 5 月至 6 月）和第二次评估（时间点 2 - 2020 年 12 月至 2021 年 2 月），该调查旨在评估巴西 COVID-19 大流行期间医护人员的心理健康和生活质量。结果较高的社会支持与后续评估前一个月内报告 SIB 的几率显著降低相关（调整后的几率比 [AOR]：0.71，CI 95%）：分别为 0.71，CI 95% 0.66 - 0.76 和 AOR 0.61，CI 95% 0.54 - 0.68）。这些关联与性别、年龄、孤独感和自我报告的精神障碍无关。结论社会支持与高危职业工作者较低的自杀几率有关，这种保护作用可能对自杀行为更为明显。

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引用次数: 0

Bridging the Gap: Psychiatry's Role in the New Era of Obesity Treatment. 缩小差距：精神病学在肥胖症治疗新时代中的作用》（Bridging the Gap: Psychiatry's Role in the New Era of Obesity Treatment）。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-08 DOI: 10.47626/1516-4446-2024-3604

Jose Carlos Appolinario, Phillipa Hay, Walmir Coutinho

引用次数: 0

Knowledge and perceived confidence of Brazilian psychiatrists about eating disorders´ diagnosis and treatment recommendations. 巴西精神科医生对饮食失调症诊断和治疗建议的了解和信心。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-04-08 DOI: 10.47626/1516-4446-2023-3516

M. C. Almeida, Adriano Segal, Christina Almeida, João C Hiluy, Maria Amália Pedrosa, Maria Angélica Nunes, Patrícia Lemos, Táki Cordás, Antônio Geraldo da Silva, J. C. Appolinario

OBJECTIVETo investigate Brazilian psychiatrists ́ knowledge and perceived confidence, both in diagnosis and in evidence-based treatments for eating disorders (ED).METHODSIn this cross-sectional study, 259 psychiatrists filled out an online form including: sociodemographic data, questions about ED diagnosis and management based on standard guidelines. Descriptive statistics described sample characteristics and levels of ED knowledge and perceived confidence.RESULTSSample was composed mainly by women (65,64%), with mean age of 42.86, from the Southeast of Brazil (56,37%), working predominantly in private practice (59,85%), with less than ten years of experience in Psychiatry (51,74%). We found that 33.21% of participants correctly chose diagnostic criteria for anorexia nervosa (AN); 29.73% for bulimia nervosa (BN), and 38.22% for binge eating disorder (BED). Correct answers for therapeutic options were similar in BN and BED (20.8%), being considerably lower for AN (2.7%). Additionally, reported ED training were: 15.1% during medical school; 59.8% during medical residency/postgraduate studies; 58.7% as complementary training. Only 8.89% felt satisfied with their ED training; 50.97% felt confident diagnosing ED and 37.07% in managing ED patients.CONCLUSIONThese results demonstrated an important gap in ED knowledge of Brazilian psychiatrists, and its consequences on their confidence and competence in managing ED patients.

方法在这项横断面研究中，259 名精神科医生填写了一份在线表格，其中包括社会人口学数据、有关饮食失调症（ED）诊断的问题以及基于标准指南的管理。结果样本主要由女性组成（65.64%），平均年龄为 42.86 岁，来自巴西东南部（56.37%），主要在私人诊所工作（59.85%），从事精神病学工作不到十年（51.74%）。我们发现，33.21% 的参与者正确选择了神经性厌食症（AN）的诊断标准；29.73% 的参与者正确选择了神经性贪食症（BN）的诊断标准，38.22% 的参与者正确选择了暴饮暴食症（BED）的诊断标准。BN 和 BED 治疗方案的正确答案相似（20.8%），但 AN 的正确答案要低得多（2.7%）。此外，报告的 ED 培训情况如下15.1%在医学院学习期间接受过培训；59.8%在实习医生/研究生学习期间接受过培训；58.7%接受过补充培训。只有 8.89% 的人对他们接受的 ED 培训感到满意；50.97% 的人对诊断 ED 有信心，37.07% 的人对管理 ED 患者有信心。

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引用次数: 0

Incidental Choroid Plexus Papilloma in a Forensic Psychiatric Inpatient: A Case Report. 一名法医精神病住院患者的偶然性脉络丛乳头状瘤：病例报告。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-03-18 DOI: 10.47626/1516-4446-2024-3537

Pınar Celikkiran Erdem, Gamze Onar, Ahmet Türkcan

引用次数: 0

Suicide or accident?; a call for expansion of psychological autopsy studies. 自杀还是意外；呼吁扩大心理尸检研究。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-03-18 DOI: 10.47626/1516-4446-2024-3594

Ricky Burns, Leo Sher

引用次数: 0

Abbreviated Suicidal Narrative Inventory: Factor Structure, Internal Consistency, and Validity in a Brazilian Sample. 简略自杀叙事量表：巴西样本的因子结构、内部一致性和有效性。

3区医学 Q1 Medicine

Revista Brasileira de Psiquiatria

Pub Date : 2024-03-11 DOI: 10.47626/1516-4446-2023-3270

Jefté Peper-Nascimento, Megan L Rogers, Alexandre Paim Diaz, Gabriela Serafim Keller, Jenelle A Richards, Luciane B Ceretta, Lisa J Cohen, João Quevedo, Igor Galynker, Samira S Valvassori

Aim: To investigate the factor structure, reliability, and validity of the Brazilian version of the Abbreviated Suicidal Narrative Inventory (SNI-38).

Methods: We used an anonymous online questionnaire of the SNI-38 and self-report measures administered between November 2020 and October 2021 in the Brazilian community. Participants were recruited through social media advertisements. Confirmatory factor analysis was carried out to test the factor structure of the SNI-38. In addition, we examined internal consistency, and convergent validity against stressful life events, the suicide crisis syndrome, suicidal ideation, and suicide attempts.

Results: 2660 participants were included. The eight-factor model SNI-38 had a good model fit (χ2[637] = 7,473.98, p < .001, CFI = .99, TLI = .99, RMSEA = .07, SRMR = .06); all items were significantly and positively loaded onto their respective factors (factor loadings ≥ .45). Reliability was good to high in all subscales except goal disengagement. Additionally, all subscales - except goal disengagement - were correlated positively which the suicide crisis syndrome, stressful life events, lifetime/past-month suicidal ideation, and lifetime suicide attempts.

Conclusions: These findings provide preliminary support for the validity of the Brazilian version of the SNI-38, being an appropriate and valid tool for measuring suicidal narrative among Brazilian samples.

目的：研究巴西版简易自杀叙事量表（SNI-38）的因子结构、可靠性和有效性：我们在 2020 年 11 月至 2021 年 10 月期间在巴西社区使用了 SNI-38 匿名在线问卷和自我报告测量方法。参与者是通过社交媒体广告招募的。我们进行了确认性因子分析，以检验 SNI-38 的因子结构。此外，我们还检验了内部一致性，以及与生活压力事件、自杀危机综合征、自杀意念和自杀未遂的收敛效度。SNI-38八因子模型具有良好的模型拟合度（χ2[637] = 7,473.98, p < .001，CFI = .99，TLI = .99，RMSEA = .07，SRMR = .06）；所有项目都在各自的因子上有显著的正负荷（因子负荷≥ .45）。除目标脱离外，所有子量表的信度均为良好或较高。此外，除目标脱离外，所有分量表均与自杀危机综合征、生活压力事件、生前/上月自杀意念和生前自杀未遂呈正相关：这些研究结果为巴西版 SNI-38 的有效性提供了初步支持，它是测量巴西样本自杀叙事的适当而有效的工具。

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引用次数: 0

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