Trends in Psychiatry and Psychotherapy最新文献

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.

Introduction: Causal inference from observational data remains a significant challenge for scholars and policymakers, particularly in assessing the impact of public health policies where randomization is often infeasible.

Objective: To evaluate the impact of the Yellow September campaign on suicide rates in Brazil using the synthetic control method (SCM).

Methods: A quasi-experimental design was applied using annual suicide rate data from 2000 to 2019. Socioeconomic and demographic variables were obtained from the World Bank and WHO datasets. The SCM was employed to construct a counterfactual scenario simulating suicide rates in the absence of the campaign, using Latin American countries as control units.

Results: The synthetic control model demonstrated a strong alignment between Brazil and its synthetic counterpart in the pre-intervention period. However, post-2015 analysis revealed a 9.2% increase in suicide rates in Brazil compared to the synthetic control. Brazil exhibited a post-/pre-intervention RMSPE ratio of 4.18, the highest among all countries in the donor pool. However, placebo tests indicated that this observed increase was not statistically significant, suggesting the difference may reflect random variation or other factors unrelated to the campaign.

Conclusions: The Yellow September campaign had no statistically significant impact on reducing suicide rates in Brazil. While the observed increase in suicide rates may reflect improved case reporting or contextual influences, these findings underscore the complexity of evaluating mental health policies. Complementary strategies and further research are needed to better understand the campaign's effects and address the multifaceted nature of suicide prevention.

The relationship between physical fitness and mental health is recognized, with evidence suggesting that physical fitness components may offer added protection against mental health issues. However, whether this applies to university students, who commonly experience anxiety and depression, is less clear. This cross-sectional study explores the association of physical fitness with anxiety and depression symptoms in ≥18-year-old students from seven Brazilian universities. Mental health was evaluated using the Diagnostic and statistical manual of mental disorders (DSM-5), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Physical fitness was assessed via handgrip strength, vertical jump, and the 20m Shuttle-Run test, with students classified into low or high fitness based on genderspecific medians. Poisson regression with robust variance was used to analyze the relationship between physical fitness, anxiety, and depression. The sample included 199 students (52.6% women; median age=21). Those scoring above the median in 2 or 3 physical fitness tests had lower rates of depressive symptoms (PR= 0.53; 95%Confidence Interval (CI): 0.33 - 0.84) compared to those with 0 or 1 tests. Higher jump height also corresponded with reduced depression risk (PR=0.65; 95%CI: 0.44-0.97) and lower co-occurrence of depression and anxiety (Adjusted PR = 0.55; 95%CI = 0.31 - 0.99). 2 or 3 tests above the median corresponded to a decreased likelihood of co-ocurrence of anxiety and depressive symptoms (PR= 0.43; 95%CI: 0.26 - 0.71). No significant association was found between physical fitness and anxiety alone. Thus, higher physical fitness was associated with fewer depressive symptoms among university students.

Background: The COVID-19 pandemic has impacted global mental health, affecting mortality from suicide. This study evaluated the impact of COVID-19 on suicide mortality in Brazil from 2000 to 2022.

Methods: Study of temporal events with data of events by suicide of the Mortality Information System (MIS). Mortality were calculated per 100,000 inhabitants. Differences before and during the pandemic were evaluated with the Wilcoxon Signed-Rank Test and Prais-Winsten regression. Interrupted Temporal Series (ITS) analysis was performed.

Results: Between 2000 and 2022, there were 243,143 cases of suicide in Brazil. During the pandemic, the median monthly mortality increased from 0.4 to 0.6 per 100,000 inhabitants, with a trend of an increase of 0.78% per month.

Limitations: Because it is an ecological study, it is not possible to have individual conclusions. Secondary data and population estimates may be inaccurate.

Conclusions: The COVID-19 pandemic has increased suicide mortality in Brazil, highlighting the need for more effective mental health policies.

Introduction: This study represents the first clinical descriptive study on opioid use disorder (OUD) in Brazil.

Methods: This comparative cross-sectional study involved 314 adult patients at the Addiction Outpatient Clinic of Instituto Perdizes, São Paulo, from April 2023 to August 2024. Data were collected through interviews, using the validated Brazilian Portuguese version of the Addiction Severity Index (ASI-6) and the Structured Clinical Interview for DSM-5 (SCID). Statistical analysis included descriptive statistics, chi-square tests for categorical variables, and the Kruskal-Wallis test for continuous variables.

Results: Patients were evaluated and divided in two groups: OUD group (OUDG) with 45 (14.3%) and non-opioid use disorder group (NOUDG) with 269 (85,87%). In the OUDG, 26.7% were healthcare professionals (p < 0.001; 95%CI 3.34 - 7.92), and there was a high incidence of chronic pain (55.6%) (p < 0.001; 95%CI 2.60 - 4.13). Healthcare utilization was notably higher among OUD patients, with 73.3% attending healthcare services in the past six months (p < 0.001; 95%CI 1.14 - 4.97).

Discussion: Emerging data reveal a growing trend in opioid use in low- and middle-income countries, with Brazil witnessing a notable rise in opioid prescriptions.

Conclusion: Developing effective preventive strategies for OUD is crucial to mitigating its significant public health risks. Chronic pain conditions and healthcare professionals may represent vulnerable groups with an elevated risk of developing OUD.

Objectives: Empathy is crucial in patient-centered care, enabling shared decision-making, better satisfaction, and clinical outcomes. We examined the association between empathy and personality in a sample of medical students from Brazil.

Methods: The sample comprised medical students from the first to sixth year at a private university in Sao Paulo. Empathy was evaluated cross-sectionally using the Interpersonal Reactivity Index. The NEO Five-Factor Inventory was used to assess personality domains. A multivariate linear regression analysis modeled the association between personality and empathy.

Results: The final sample consisted of 227 subjects. The mean age was 24.2 (SD 4.3) years, and the sample was predominately female (75%). Higher levels of Neuroticism (β = 2.11, 95% CI 0.84-3.38, P = 0.001) and Agreeableness (β = 2.50, 95% CI 1.46-3.53, P < 0.001) were associated with higher empathy scores. Extraversion (β = 0.00, 95% CI -1.26-1.26, P = 0.998); Openness to Experience (β = 0.85, 95% CI -0.28-1.98, P = 0.138), and Conscientiousness (β = -0.80, 95% CI -1.95-0.35, P = 0.173) did not show significant associations with empathy scores. Female gender, year in the program, and sociodemographic characteristics did not show significant associations with empathy.

Conclusion: Both Neuroticism and Agreeableness were found to be associated with higher empathy. We review available interventions to enhance empathy and identified potential medical education curricular changes that could foster empathy development.

Objective: This study aimed to investigate the clinical outcomes and mortality risk factors associated with alcohol use disorder (AUD) in hospitalized COVID-19 patients.

Methods: We analyzed a national database containing information on the clinical and sociodemographic aspects of patients hospitalized with severe acute respiratory syndrome between February 2020 and February 2023 in Brazil, including those aged > 18 years with laboratory-confirmed COVID-19. The primary exposure of interest was a history of AUD before admission and the primary outcome was in-hospital mortality.

Results: Among the 2,124,285 patients, 11,433 (0.53 %) had AUD. The in-hospital mortality rate was higher in the patients with AUD (46.2%) than in those without AUD (31.9%). After adjusting for confounding covariates, individuals with AUD had twice the risk of death (Odds Ratio [OR]= 1.94, 95% confidence interval [CI] 1.85-2.03) compared with non-AUD patients. Among individuals with AUD, the covariates independently associated with the primary outcome were age > 60 years, male sex, hospitalization in the Central-West, Northeast and North regions, symptoms of dyspnea and reduced oxygen saturation at admission, presence of comorbidities, and year of admission.

Conclusion: In this population-based study, we found that patients with AUD had twice the risk of fatal outcomes than those without AUD.