Trends in Psychiatry and Psychotherapy最新文献

Objective: Medical students are a population at increased risk for anxiety due to their demanding schedule and concerns about potential stigmatization, which often discourage them from seeking help. It has been reported that the coronavirus disease (COVID-19) pandemic worsened this issue by restricting social interaction and mobility. An innovative method has been developed to address this problem, known as the asynchronous Digital Cognitive Education Gadjah Mada Anxiety Intervention for Medical Students (DCE GAMA-AIMS). Compared to traditional therapy, this modality can be accessed independently without the guidance of a therapist. The objective of this study was to compare the effectiveness of DCE GAMA-AIMS compared to therapist-guided brief cognitive behavioral therapy (bCBT) for reducing anxiety scores.

Methods: A non-blinded randomized clinical trial (RCT) was conducted with 66 medical students. The participants were equally divided into two groups, an intervention and a control group. The intervention group was given DCE GAMA-AIMS, while guided bCBT was administered to the controls. The data obtained were analyzed using independent t tests and analysis of variance (ANOVA).

Results: The application had a significant effect, reducing anxiety scores from the 2nd week (M Taylor Manifest Anxiety Scale [TMAS] = 18) to the 8th week (M TMAS = 13). A faster and more significant improvement was observed in the intervention group from the 1st to the 2nd week compared to the controls, who began to improve in the 4th week. Furthermore, the intervention group had larger effect size (1.32) compared to the control (0.79) from the 1st to 8th weeks.

Conclusion: Asynchronous DCE GAMA-AIMS and guided bCBT both reduced TMAS scores in medical students with anxiety, but DCE GAMA-AIMS yielded a larger effect size.

Objective: The internet has become an important element in people's lives. The increasing use of smartphones and other electronic devices has promoted an increase in digital interactions, resulting in significant problems in the field of mental health. However, one of the implications of excessive internet use is impaired sleep quality, especially among users who use the internet before bed.

Methods: We searched the PubMed, Web of Science and PsycINFO databases to identify articles that addressed the association between excessive internet use and sleep quality. Studies in which participants had a previous diagnosis of insomnia or used psychoactive substances were excluded.

Results: The initial search resulted in a total of 3269 articles, 25 of which met the inclusion criteria. The results suggested an association between excessive internet use and sleep quality.

Conclusion: Excessive internet use significantly compromises sleep quality, directly affecting users' mental and physical health. This study highlights the importance of strategies that promote digital education to raise awareness about the risks of excessive use of screens. Systematic review registration: PROSPERO, CRD 42024610542.

Objectives: We investigated relationships between the triarchic model of psychopathy, coping styles, and externalizing and internalizing symptoms, and verified the mediating effect of coping styles.

Methods: Participants were 957 adults who answered the Triarchic Psychopathy Measure (TriPM), the Inventory of Depression and Anxiety Symptoms Expanded Version (IDAS-II), and the Crime and Analogous Behavior Scale (CAB).

Results: Data were analyzed using four path analyses to test our hypotheses, indicating each triarchic trait is differently associated with psychological symptoms and coping styles. We also observed preferences for some coping styles affecting the association between triarchic traits and psychological symptoms.

Conclusion: Our findings suggest that coping styles only affect the interaction between boldness and distress, as well as between boldness and fear, indicating that specific coping strategies can account for variations in distress and fear linked to boldness.

Objective: Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the Short Multidimensional Inventory on Lifestyle Evaluation (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students.

Methods: Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis (EFA) to obtain the most parsimonious, interpretable, and good-fitting model.

Results: The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r = 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the Patient Health Questionnaire (PHQ-9) (Spearman's r = -0.517), and Generalized Anxiety Disorder Questionnaire (GAD-7) (Spearman's r = -0.356), two validated instruments to screen for depression and anxiety, respectively.

Conclusion: Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

Introduction: Clozapine is the only antipsychotic with proven superior efficacy for treatment-resistant schizophrenia. However, global utilization rates remain suboptimal due to concerns about hematological side effects. This study aimed to investigate hematological abnormalities among clozapine users at a large community center in the Brazilian countryside.

Methods: This study adopts a real-world approach and was conducted based on a retrospectively analyzed complete blood counts from clozapine users in Goiás, Brazil. We describe the total number and percentage of participants presenting blood dyscrasias. Logistic regression models, using Stata v.18, were employed to evaluate whether sex or age were associated with the presentation of neutropenia.

Results: Data from 6,160 complete blood counts from 486 patients taken between 2011 and 2018 were analyzed. Blood dyscrasias were observed in 37.4% of patients, with anemia being the most common (23.6%), followed by thrombocytopenia (9.46%) and eosinophilia (13.7%). Neutropenia occurred in 4.52% of patients, primarily mild (3.9%) and moderate (0.62%), with no cases of agranulocytosis identified.

Discussion: Clozapine users showed a higher prevalence of blood dyscrasias compared to the overall Brazilian population. Most cases of neutropenia were mild and transient. Our results suggest a lower risk of severe neutropenia and emphasize the need to investigate other blood dyscrasias.

The current study presents the case of a young man with intellectual disability related to fetal alcohol syndrome, referred for forensic psychiatric examination of criminal liability following charges of armed robbery, and who was considered not criminally liable. In such cases, it is crucial to perform early diagnosis and rely on educational and developmental services and a supportive home environment to decrease complications such as substance use and criminal involvement.

Aim: To carry out the process of cross-cultural adaptation of the Child Mania Rating Scale - Parent Version (CMRS-P) for the Brazilian context.

Method: Statistical procedures were carried out, based on the analysis of the validity of the internal structure of the scale, as well as its relationship with external variables. 224 parents/guardians of children/adolescents aged between five and 18 years participated in the study. The data collection form included instruments for assessing (hypo)manic symptoms, irritability, inattention, hyperactivity, emotional symptoms and behavioral problems. Data were collected in person, at a public school and at a Psychosocial Care Center, and online (via Google forms). Exploratory and confirmatory factor analyses, measurement invariance analyses, reliability analyzes were performed, as well as convergent and concurrent validity analyses.

Results: The one-dimensional model was investigated, showing satisfactory results, similar to those of the original scale. A reduced version was proposed with the ten most robust items from this study. Validity analyzes based on hypotheses indicated higher scores among those subjects with more clinical problems, such as the previous existence of a psychiatric diagnosis. Statistically significant and positive correlations, of low and moderate magnitudes, were observed with the scores of the other instruments used.

Final considerations: The results indicated that the adapted versions of the CMRS-P (full scale and reduced form) are promising instruments for use in the country.

Introduction: Clinical staging is widely applied in various fields of Medicine. Staging makes it possible to constitute early diagnoses and interventions, improving prognosis and preventing disease progression. In relation to Alcohol Use Disorder (AUD), staging is still an underdeveloped subject in the scientific literature. The treatment of AUD is effective for a minority of patients, requiring more targeted interventions individually. This study aims to propose a staging model for AUD that establishes key factors related to the progression of the disorder.

Method: Non-systematic review of the literature on Pubmed/Medline database focusing on articles about AUD and that present a stratified classification and treatment outcomes for that subpopulation through the progression of the disease.

Results: The model proposed includes stages 0 (latent), I A, I B, II A, II B, III A, III B and IV.

Discussion: This study can be used as a basis for a myriad of other reviews with the aim of validating a staging model in AUD. We recommend a systematic review study to validate the model suggested in this study and correlate clinical aspects with neurobiological aspects and the effectiveness of certain treatments.

Conclusion: This work shows that, based on the stratified classification of response to treatment, it is possible to suggest a staging model for AUD. Furthermore, the stages can be subdivided based on different clinical characteristics, risk factors, prognosis and management.

Introduction: Current disease-specific models for prevention of mental disorders are challenged by the overlap of psychopathology, biological mechanisms, and risk factors. Moreover, mental disorders usually begin during childhood or adolescence, when symptoms fluctuate and are highly non-specific.

Discussion: We propose a staging model that integrates three domains - psychopathology, functional impairment and risk factors-, in which prevention is defined as actions to avoid stage progression, irrespective of diagnosis. Thus, preventive interventions should be broadened to include mental health promotion and strategies of risk reduction performed individually, at any stage, even for non-symptomatic subjects (before current at-risk definitions) currently exposed to risk factors.

Conclusions: The model features three innovations: a focus shift from disease conversion to stage progression, highlights functionality as an independent target, and acknowledgment of risk factors in the staging. The model must be validated before implementation.