Trends in Psychiatry and Psychotherapy最新文献

Objectives: Stressful events can impact the incidence of psychiatric disorders and, therefore, psychiatric drug use. However, it is not clear whether psychiatric drug use is stable or not across the Brazilian population over time. The aim of this study was to investigate trends in psychiatric drug sales in Brazil over the years, using sales data from private-sector pharmacies as a proxy for psychiatric drug consumption.

Methods: This is a non-interventional pharmacoepidemiological study using routinely collected health data from 2015 to 2021. The primary outcome was the amount of psychiatric drugs sold, corresponding to an individual or entity purchase recorded in the national system.

Results: We found an overall annual increase in psychiatric drug sales in the last few years (Z = -2748·7, p = 2·2 x 10-16). Antidepressants and antipsychotics are by far the top seller psychiatric drugs. The south and southeast regions of Brazil and the state of Pará simultaneously show high levels of psychiatric drug sales, COVID-19 confirmed cases, and per capita income. We have raised hypotheses that might help explain the variations in psychiatric drug consumption. We provide evidence of a growing psychiatric drug sale over the years, likely reflecting an increase in psychiatric disorders or symptoms.

Conclusion: The trend reported here indicates an association between increased psychiatric drug sales and recent socioeconomic and health crises, including the COVID-19 pandemic, but causality cannot be established. This is possibly just the beginning of a major nationwide challenge that deserves attention going forward so that effective measures are implemented.

Objective: Over the last decades, gaming has become a popular way to spend time and connect with people worldwide, engaging millions of users. Literature has shown that games and competition in gaming are closely linked to physiological stress responses. The aim of this systematic review was to determine if cognitive virtual games are also linked with stress responses and to investigate this interplay.

Methods: Following the PRISMA protocol, five databases were used, including EMBASE, PubMed, PsycInfo, SCOPUS and Web of Science. The PICO strategy was employed to formulate the research question. The search was performed by three independent investigators using a predefined protocol registered on the PROSPERO database (CRD42022384921).

Findings: Following these procedures, 30 eligible empirical studies were considered for the review, which included 39 cognitive games, because some studies used more than one game in their research. Fourteen of the selected studies showed significantly increased cortisol levels after playing virtual cognitive games, twelve studies reported a decrease in cortisol levels while the remaining four showed both, increase and decrease cortisol depending on variables such as gender differences, age or type of game. This highlights the complex relationship between virtual cognitive games and cortisol modulation.

Conclusion: Our results provided a comprehensive view of the intricate interplay between virtual cognitive games and cortisol dynamics, acknowledging both the potential stress-inducing and stress-alleviating effects of gaming. The implications of these findings go beyond entertainment, emphasizing the need for a nuanced understanding of the psychophysiological mechanisms involved.

Online gambling has emerged as a significant public health challenge, with multiple psychological and contextual factors contributing to the development and maintenance of gambling behavior. This narrative brief review aims to discuss the pathways model, a theoretical framework that categorizes distinct etiological profiles of individuals with problem gambling. The model offers insights for more personalized therapeutic interventions by identifying specific characteristics and vulnerability factors associated with each profile. The paper further explores the structural and situational characteristics of different gambling modalities, highlighting how specific design features contribute to their heightened addictive potential. Clinical implications are presented, focusing on the need for individualized treatment plans adapted to each gambler profile. Future directions are discussed, particularly the importance of tailoring interventions to the Brazilian mental health care context, considering its public health structure and the demand for capacity-building among professionals. The review highlights the relevance of integrating assessment, early identification, and targeted interventions as key strategies to mitigate the negative consequences of online gambling and to improve health outcomes.

Introduction: Several major cities face public health challenges related to Open Drug Scenes (ODS), where illicit drugs are used and sold openly in public spaces. Despite the growing public and political attention attracted by ODS, quantitative studies exploring the profile of people who use drugs (PWUD) within ODS are lacking. This study aimed to: i) examine the profile of PWUD within ODS in three metropolitan cities of Brazil, and ii) explore potential profile factors associated with willingness to change and healthcare utilisation among PWUD within ODS.

Methods: Cross-sectional survey using time-location sampling method interviewed 489 PWUD at ODS across three Brazilian cities during 2021-22. Latent class analyses to identify homogeneous classes of PWUD based on ODS attendance patterns. Multinomial logistic regression models examined factors associated with willingness to change across profile classes.

Results: Two PWUD profiles in ODS were identified: Chronically Excluded (61.0%) and Self Excluded (39.0%). Both showed high levels of willingness to change, and it was associated with physical health problems. Among the CE group, willingness increased with welfare benefits, emergency care for drug intoxication, and SUD treatment.

Conclusion: This study offers new insights into PWUD profiles in Brazil's ODS, showing high willingness to change across both profiles despite varying levels of social exclusion. The association between willingness to change and healthcare use underscores the need for brief interventions and improved referrals to specialised treatment within primary care services. To respond to the ODS challenge public policies must integrate social and healthcare models.

The medical field has historically resisted uncertainty, often delaying the integration of new scientific evidence into clinical practice-sometimes by nearly two decades. This inertia reflects deep-rooted cultural and epistemological barriers that also impede the adoption of innovations such as Artificial Intelligence (AI). Yet, the call for more rigorous decision-making in medicine is not new. In the 18th century, Pierre-Simon Laplace emphasized the value of probability theory in clinical reasoning, a view later echoed by William Osler, who famously described medicine as "the science of uncertainty and the art of probability." These early insights gained traction through the work of Sir Austin Bradford Hill and Archibald Cochrane, whose contributions laid the groundwork for Evidence-Based Practice (EBP). In the 1990s, Gordon Guyatt formally introduced Evidence-Based Medicine (EBM), advocating for clinical decisions grounded in empirical data, professional expertise, and patient values. In this evolving landscape, basic statistical literacy is no longer sufficient. In this context, cultivating probabilistic reasoning and statistical thinking has become essential to support ethically sound and evidence-aligned decisions to guide a meaningful transformation in both clinical training and practice.

Background: The following article aims to explore the relationship between Pyromania/Firesetters and Attention Deficit Hyperactivity Disorder (ADHD) in childhood and adolescence.

Method: A systematic literature review was carried out using search engines such as PubMed, PsycINFO, Cochrane, and Sicelo, to find relevant articles. Inclusion criteria included studies that related ADHD and Pyromania/Firesetters, while exclusion criteria included articles not related to the researched variables, articles from other systematic reviews, and articles not related to childhood and/or adolescence.

Results: Of the 71 articles initially identified, five met the eligibility criteria and were included in the analysis, which demonstrated that ADHD and Pyromania/Firesetters are comorbid conditions that can be diagnosed during childhood and/or adolescence. The comorbid relationship was observed to be more prevalent in boys, with an estimated prevalence of approximately 33%. Firesetting behavior was associated with a sixfold increase in the likelihood of boys being diagnosed with ADHD. Moreover, the comorbid relationship between ADHD and Pyromania/Firesetters was linked to conduct disorders and an elevated risk of future delinquent behavior. Mental health professionals should consider investigating firesetting history during the diagnostic assessment of ADHD, as the absence of early diagnosis and treatment increases the risk of adverse social outcomes.

Conclusions: The study concluded that the results demonstrated the comorbid relationship between ADHD and Pyromania/Firesetters in childhood and adolescence, but more research is needed to better understand this relationship.

Introduction: The WHO Caregiver Skills Training (WHO CST) program is designed to train caregivers of children with neurodevelopmental disorders, improving access to interventions in areas where professional resources are scarce. This study assesses the effectiveness of the WHO-CST online program in Brazil, focusing on symptom improvement in children with Autism Spectrum Disorder (ASD).

Methodology: This open clinical trial included 37 caregivers who participated in nine on-line sessions. The primary outcome measured was the decrease in scores on the Autism Treatment Evaluation Checklist (ATEC), along with evaluations of target behaviors, like reduction of disruptive behaviors, improvement in communication, and enhancements in play, and the Clinical Global Impression (CGI) scale.

Results: Of the enrolled participants, 28 caregivers completed the training. The results showed a substantial 14% reduction in baseline ATEC scores (p < 0.01), significant improvements in CGI scores (p < 0.01), and positive changes in 77% of the targeted behaviors after the training.

Conclusion: The WHO CST online program is associated with reduced symptoms of autism in children with neurodevelopmental disorders in Brazil, as shown by this open clinical trial. These findings highlight the value of online interventions in enhancing caregiver capabilities and improving child outcomes in resource-limited settings.

Objectives: The present study aimed to evaluate physical activity (PA) levels in individuals with bipolar disorder. Specifically, it sought to compare these levels across mood states (mania, depression, euthymia).

Methods: A cross-sectional study utilizing both subjective (Simple Physical Activity Questionnaire-SIMPAQ) and objective (accelerometers) measures to assess PA. Symptom severity was assessed using The Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HAM-D). Mood states were detected and assessed using the YMRS and HAM-D scales. One-way ANOVAs were used to compare differences in PA and sedentary behavior (SB) across mood states. Correlates were assessed using the Pearson correlation coefficient.

Results: The sample included 43 individuals, 81.5% female, mean age of 47 years (SD=10.4). Regarding mood states, 17 patients were categorized as euthymic, 11 as manic and 15 as depression. The mania group exhibited the highest PA levels, mean = 206 minutes MVPA/week (SD=146.80), while the depression group was the most sedentary, mean = 428 (SD=224.44) minutes/day. ANOVA revealed significant differences in PA levels among the mood states (mania and depression) in accelerometry MVPA (F = 3.598; p = 0.037; η2p = 0.152) and SIMPAQ MVPA (euthymic, mania, depression) (F = 7.373; p = 0.002; η2p = 0.269).

Conclusion: The mania group demonstrated higher PA levels, whereas the depression group exhibited more SB. These findings highlight distinct PA patterns that may inform clinical management and treatment of bipolar disorder.

Introduction: The nucleus accumbens (NAc) is central to the brain's reward circuitry, mediating motivation and emotional processes. Emerging evidence suggests that structural and functional changes in the NAc, including volume alterations, may contribute to the neuropathology of substance use disorder (SUD). This review evaluates current findings on the association between NAc volumetric changes depicted by magnetic resonance imaging (MRI) and SUD.

Methods: A literature search was conducted in PubMed, EMBASE, BVS, Web of Science, Scopus, Cochrane Library, and PsycINFO. Terms used in searches included Nucleus Accumbens, Mental Disorder, Substance Use Disorder, Drug Addiction, and Magnetic Resonance Imaging (MRI). The main findings from the selected studies were synthesized in a table.

Results: The initial database searches yielded 3686 articles. After screening, duplicate articles, non-English/Spanish/Portuguese articles, animal studies, and studies that did not address SUD were excluded. Additional exclusion criteria included studies involving only familial risk of substance use or abstinence, as well as studies without NAc analysis or structural MRI analysis. 52 cross-sectional studies regarding associations between NAc volumes and SUDs were selected.

Conclusion: The reviewed studies suggest that NAc may play a pivotal role as an associated factor in addiction, with strong associations mainly to cigarette smoking and alcohol use. Other substances show inconsistent findings. Discrepancies in results may reflect differences in study designs, type of volumetric analysis employed, and control over confounding variables. Future studies with multimodal approaches and control of confounding variables are required to strengthen these associations.