Revista Brasileira de Psiquiatria最新文献

Objective: Due to the uncertainty whether atypical and typical antipsychotics have a stronger association with mortality among older people with schizophrenia, we examined the rates and causes of mortality in older adults with schizophrenia who take atypical or typical antipsychotics.

Methods: In a 5-year prospective multicenter study of patients aged = 55 years with an ICD-10 diagnosis of schizophrenia, we used a multivariable logistic regression model to examine the association between atypical vs. typical antipsychotics and mortality, adjusting for sociodemographic and clinical characteristics.

Results: Of 313 older adults with schizophrenia, the 5-year all-cause mortality rates in patients who took atypical (n=192) and typical (n=167) antipsychotics were 36.4% and 24.3%, respectively. Following adjustment, no significant differences were found in all-cause mortality (AOR = 1.56; 95%CI 0.75-3.27; p = 0.24) or causes of mortality (all p > 0.05) between medication groups. Atypical antipsychotics were significantly associated with lower overall mortality in the subpopulation with baseline Mini Mental State Examination scores < 24 (AOR = 0.24; 95%CI 0.07-0.84; p = 0.025).

Conclusion: Although atypical antipsychotics may not be associated with lower odds of overall mortality than typical antipsychotics in older people with schizophrenia, they might be associated with lower mortality among those with substantial cognitive impairment.

Objective: There has been a call for neuroscientific studies of spiritual experiences due to their global prevalence, significant impact, and importance for understanding the mind-brain problem. Mediumship is a spiritual experience where individuals claim to communicate with or be influenced by deceased persons or non-material entities. We assessed whether mediums carry specific genetic alterations.

Methods: We selected highly gifted mediums (n=54) with over 10 years of experience who engaged in mediumistic work for no material gain, performed whole-exome sequencing of these individuals, and compared its findings to those of first-degree relatives who claimed no mediumship (n=53).

Results: We identified 15,669 variants exclusively found in mediums, likely to impact the function of 7,269 genes. Thirty-three of these genes were altered in at least one-third of all mediums but in none of their relatives. The inflammatory pathway was the most frequently affected (43.9%), with the translocation of zeta-chain associated protein kinase 70 kDa (ZAP-70) to the immunological synapse being particularly prominent.

Conclusion: This is the first exome-wide investigation of genes possibly related to mediumistic experiences. We identified gene variants that were present in mediums but not in their non-medium first-degree relatives. These genes emerge as possible candidates for further investigations of the biological underpinnings that allow spiritual experiences such as mediumship.

Objective: Major depressive disorder is heterogeneous. While transcranial direct current stimulation (tDCS) is an effective treatment, its impact on symptoms remains underexplored. This ancillary study investigated the effects of home-use tDCS on depression symptom clusters.

Methods: Data were used from the Portable Transcranial Electrical Stimulation and Internet-Based Behavioral Therapy for Major Depression Study (PSYLECT) study, in which 210 depressed patients were randomized to active (n=137) or sham tDCS (n=73) for 6 weeks. Items from the Hamilton Depression Rating Scale were grouped into symptom clusters using hierarchical clustering. Treatment effects were analyzed with mixed regressions. An alternative clustering solution was also evaluated using a larger sample.

Results: Four clusters were identified: emotional, sleep, psychomotor, and psychosomatic symptoms. None showed significant group differences (sleep: p = 0.058, Cohen's d = 0.36, emotional: p = 0.976, d = -0.01, psychosomatic: p = 0.157, d = 0.27, psychomotor: p = 0.944, d = 0.01). The alternative clustering solution produced a similar sleep cluster, where tDCS led to significant reductions (p = 0.033, d = 0.41), but no differences were observed in other clusters (emotional: p = 0.707, d = 0.07, atypical: p = 0.537, d = 0.12).

Conclusion: The association between tDCS and sleep improvement warrants further study. tDCS may be more effective for specific symptom clusters.

Objective: To evaluate whether attitudes toward drug use, as well as decision-making, communication, and alcohol resistance skills, act as predictors of alcohol use and binge drinking initiation among Brazilian students, considering sex differences.

Methods: In a longitudinal sample of 1,103 seventh-grade students from 15 Brazilian public schools, we explored if attitudes toward drug use and decision-making, communication, and alcohol resistance skills at baseline predicted alcohol outcomes 9 months later.

Results: Lower levels of resistance skills (i.e., ORboys = 0.29; 95%CI 0.12-0.70) and positive attitudes toward drugs (i.e., ORgirls: = 1.41; 95%CI 1.02-1.94) were predictors of alcohol use onset and binge drinking, independently of sex. Decision-making predicted binge drinking initiation, but only for girls (OR = 0.73; 95%CI 0.59-0.91). Negative attitudes toward drugs were a risk factor for alcohol use initiation, but only for boys (OR = 0.78; 95%CI 0.64-0.95).

Conclusion: Our findings highlight the importance of understanding the predictors of alcohol initiation in adolescents, to inform which key components preventive programs should address in their activities to achieve the expected preventive outcomes.

Objective: To explore the association of 75 candidate genes previously reported in subjects with anxiety symptoms (AS) and depressive symptoms (DS) with such symptomatology in a Mexican cohort.

Methods: The sample included 2,012 individuals from the Mexican Genomic Database for Addiction Research (MxGDAR/Encodat) cohort: 198 with AS, 266 with DS, 66 with both anxiety and depressive symptoms (ADS), and 1,482 healthy controls. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) screening questionnaire was used to evaluate lifetime AS and DS. The sample was genotyped with the commercial microarray PsychArray BeadChip. We identified 707 single nucleotide polymorphisms (SNPs) of 75 genes previously associated with AS and DS. The PLINK logistic regression approach was performed to analyze the association between these SNPs and AS, DS, and ADS.

Results: The analysis identified significant associations of LAMA SNP rs2437092 (p = 3.89 × 10(-5)) and MYO1H SNP rs11066591 (p = 4.06 × 10(-5)) with anxiety and depressive symptoms. Additionally, MBD5 SNPs rs7578002 and rs1234428 were associated with DS (p = 7.9 × 10(-6) and p = 1.94 × 10(-5), respectively). However, after adjustment for age, sex, and the three genetic principal components, only the associations of rs7578002 and rs1234428 with DS remained (p = 5.85 × 10(-5) and p = 8.15 × 10(-5), respectively).

Conclusions: Our study replicated the association between MBD5 and DS. The MBD5 protein is involved in gene silencing, suggesting its potential implication in the development of DS in the Mexican population.

Objective: The practice of using drugs to modulate experiences is a well-documented phenomenon worldwide, particularly among men who have sex with men (MSM). This study aims to describe patterns of drug combinations used by Brazilian MSM, embracing a detailed examination of the Brazilian context, which may inspire research elsewhere while enriching the global panorama on MSM drug use. By focusing on Brazilian MSM, the study sheds light on specific drug use combinations, which may help in the development of effective, culturally sensitive public health strategies.

Methods: This investigation was conducted within the Latin American MSM Internet Survey, a pioneer online study addressing psychosocial and sexual health of MSM in the region. Conducted from January to May 2018, the survey garnered responses from over 18,139 Brazilian MSM. Using exploratory factor analysis through maximum likelihood estimation, the study identified distinct sub-groups of drug users among 15,499 participants after exclusion due to discrepant responses (Kaiser-Meyer-Olkin measure = 0.94 and Bartlett's test = 0.01), indicating adequate sampling and suitability for factor analysis across all substances.

Results: The factor analysis revealed four primary drug combination groups among participants: Group One (Heavy Drug Users), Group Two (Party Drug Users), Group Three (Conservative Users), and Group Four (Classic Chemsex Users). Each group represents unique drug use patterns and preferences, from the use of potent stimulants to more socially accepted substances like tobacco and cannabis. Notably, Group One, identified as "heavy" drugs users, used particularly risky substances, including mephedrone, crack, crystal meth, heroin, and other synthetic stimulants.

Conclusion: The findings reveal diverse and complex drug use patterns among MSM in Brazil. Understanding these patterns is essential for developing targeted interventions and support mechanisms for various sub-groups among MSM. Future research should focus on the health outcomes associated with these patterns and the social and psychological contexts of drug use.

Objective: Depressive symptoms during the perinatal period 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.

Methods: Thirty-four 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) by gas chromatography-mass spectrometry (GC-MS).

Results: No differences in SCFA concentrations were observed between groups (p > 0.05). However, postpartum women with moderate to severe symptoms (MS group) had a significant increase in Enterobacteriaceae abundance compared to women with mild or absent symptoms (AM group) (p < 0.05). The Bifidobacterium genus increased significantly in both groups over time (p < 0.05). The MS 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 using microbiome-targeted approaches is needed to understand the broader implications for maternal health.