Revista Brasileira de Psiquiatria最新文献

Objective: To examine changes in plasma brain-derived neurotrophic factor (BDNF) levels in patients undergoing electroconvulsive therapy or magnetic seizure therapy, as well as any early or late variations in BDNF. Specific changes related to each technique were also evaluated.

Methods: We measured plasma BDNF before and throughout treatment in adult patients (18 to 65 years old) diagnosed with treatment-resistant depression who underwent convulsive therapy (electroconvulsive therapy or magnetic seizure therapy) in the ElectroMagnetic Convulsive therapy for DEpression (EMCODE) project.

Results: We enrolled 31 participants (mean age = 38.4 years, SD = 11.88), of whom 14 (45.16%) underwent electroconvulsive therapy and 17 (54.84%) underwent magnetic seizure therapy. Notable improvements in depressive symptoms were observed in both groups, with no significant differences between them (p = 0.1046). However, no significant changes in plasma BDNF levels were observed for either technique pre- or post-treatment (mean difference = -93.01 pg/mL, 95%CI 545.88-359.86) or over time (coefficient = -67.95, standard error = 37.75, p = 0.072).

Conclusions: The findings suggest that no significant changes occurred in plasma BDNF levels following convulsive therapy, which challenges the notion that BDNF is a biomarker for treatment-resistant depression.

Objective: Depression is a common and debilitating disorder affecting millions of people. First-line treatments fail to achieve remission in approximately one-third of patients, highlighting a critical need for treatment. Transcranial direct current stimulation (tDCS) has emerged as a novel treatment for depression. Therefore, the aim of this review was to provide a comprehensive overview of the last decade of tDCS trials for depression and to suggest future research directions.

Methods: To synthesize studies from the past decade, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) of tDCS for depression.

Results: A total of 21 RCTs were included, showing a moderate effect of active tDCS compared to placebo. We also provided a description of study designs, stimulation parameters, and patient characteristics. We then proposed possible strategies to improve clinical efficacy and reduce outcome variability, including 1) optimization/personalization of tDCS through spatial and temporal target localization, 2) optimized methodological strategies, including home-based, accelerated tDCS protocols and novel study designs, and 3) investigation of the patient profile to identify characteristics that may predict treatment response.

Conclusion: tDCS shows promise as a treatment for depression, but variability in study parameters and outcomes underscores the need for further optimization. Refinement and standardization of protocols may improve its efficacy.

Objective: To examine the effect of nutritional counseling therapy (NCT) combined with transcranial direct current stimulation (tDCS) on binge eating disorder (BED) symptoms.

Methods: Forty women with BED were randomly allocated (2:2:2 ratio) to one of the following groups: active tDCS (a-tDCS), NCT, sham tDCS (s-tDCS) with NCT, and a-tDCS with NCT. Home-based tDCS was applied to the dorsolateral prefrontal cortex for 28 sessions.

Results: A mixed analysis of variance (ANOVA) showed no main effect between groups nor a time × group interaction. However, a significant main effect was found for time on the primary outcome Binge Eating Scale (BES) (p = 0.001; eta2p = 0.325), which tended to decrease during treatment and follow-up. A significant main effect was found for the secondary outcome short-interval intracortical inhibition (SICI) (p = 0.02; eta2p = 0.112), a measure of inhibitory function, which increased from baseline to the final period in the a-tDCS group, without significant differences between groups.

Conclusion: Combined NCT and tDCS did not have a synergistic effect on BED symptoms. Nevertheless, the data from this pilot study should help plan future larger-scale studies investigating the effects of tDCS and behavioral interventions in the promising area of BED treatment.

Objective: Cannabis is the most widely used substance in Brazil. This study examined subtypes of individuals who use cannabis based on usage characteristics and correlates with use of other substances and harms.

Methods: Data are from the São Paulo Megacity Mental Health Survey (n=5,037). Latent class analysis (LCA) was performed considering age of onset, use frequency, tobacco consumption, heavy episodic drinking (HED), alcohol use disorder (AUD), and substance use disorder. Logistic regression assessed class correlates, and a further analysis compared sociodemographic, health, and behavioral indicators.

Results: A four-class model was optimal for 496 individuals. The Polydrug class (26.2%) and the Former class (5.9%) showed earlier onset and highest frequency of cannabis use, with strongest harm associations. The Polydrug class had higher odds of other drug use (OR = 3.0), tobacco use (OR = 2.5), HED (OR = 1.8), and AUD (OR = 1.5), compared to lighter-use groups. About 30% of those who use cannabis are at increased risk for negative outcomes, particularly those with early, frequent, and polydrug use patterns.

Conclusion: Brazil's public health should prioritize targeted prevention of the risks associated with early and frequent cannabis and polydrug use. Addressing this at-risk group is essential for harm reduction and a health-focused approach.

Objective: To evaluate the effectiveness of online group cognitive behavioral therapy (CBT) based on the CAMALEO TOC manual in the treatment of adolescents with obsessive-compulsive disorder (OCD).

Methods: This is a quasi-experimental study with a single-group pretest-posttest intervention. Over a 12-week period, 11 adolescents aged 11 to 17 years with OCD participated in weekly online group CBT sessions based on the CAMALEO TOC manual. We used several assessment tools, including the Children's Yale-Brown Obsessive-Compulsive Scale to assess the severity of OCD symptoms, the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated to measure family accommodation, the Children's Depression Inventory to assess depression symptoms, the Revised Children's Manifest Anxiety Scale to assess anxiety, and the Multidimensional Students' Life Satisfaction Scale to measure satisfaction with life.

Results: OCD symptoms decreased significantly (d = -1.55) after online group CBT, and a strong effect size (d = -1.03) was found for family accommodation. After controlling for variables (e.g., engagement in psychotherapeutic treatment, medication use, or psychiatric comorbidities), no significant differences were found for OCD symptoms and family accommodation scores. In addition, there was insufficient evidence to support the effectiveness of online group CBT in reducing symptoms of depression or anxiety or improving overall quality of life.

Conclusion: Our study demonstrates the feasibility of short-term online group CBT as an effective therapeutic approach for adolescents with OCD.

Objective: To investigate the associations of symptoms of attention deficit hyperactivity disorder (ADHD) with binge eating spectrum conditions (BESC) (binge eating disorder [BED], bulimia nervosa [BN], and recurrent binge eating [RBE]), psychiatric and somatic comorbidity, and healthcare utilization in a representative sample of a Brazilian city.

Methods: A household survey of 2,297 adult residents of the city of Rio de Janeiro was conducted. The Adult Self-Rating Scale Screener (ASRS-6) was used to assess ADHD symptoms. BESC was assessed using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) and confirmed by telephone interview. Standardized questionnaires were used to assess psychiatric comorbidity. Closed-ended questions investigated somatic comorbidity and healthcare utilization.

Results: ADHD symptoms were highly associated with BESC (BED: OR = 13.2, 95%CI 4.3-40.6; BN: OR = 27.5, 95%CI 5.9-128.7; RBE: OR = 5.8, 95%CI 2.9-11.4). However, with further adjustment for psychiatric comorbidity (depression, anxiety, alcohol use, and impulsivity), the ORs were no longer significant. Healthcare resource utilization was significantly higher in participants with ADHD and BESC but lost significance after controlling for psychiatric comorbidity.

Conclusion: ADHD was associated with an increased prevalence of BESC and greater healthcare utilization. Nonetheless, there was an essential interplay among psychiatric comorbidity in the associations of ADHD and BESC.

Objective: The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles.

Methods: An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility.

Results: Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger's coefficient of 0.49 was found, indicating an acceptable level of scalability.

Conclusion: The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed.