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Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates
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Diniz, Elton

; Fonseca, Lais

; Rocha, Deyvis

; Trevizol, Alisson

; Cerqueira, Raphael

; Ortiz, Bruno

; Brunoni, André R.

; Bressan, Rodrigo

; Correll, Christoph U.

; Gadelha, Ary

Brazilian Journal of Psychiatry

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Out 2023, Volume 45 Nº 5 Páginas 448 - 458

Resumo: En | Texto: En | PDF: En

Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033.

https://doi.org/10.47626/1516-4446-2023-3126

Trayectorias del dolor en sujetos con afección post-covid-19: estudio prospectivo y transversal con evaluación presencial
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Kubota, Gabriel T

; Soares, Felipe HC

; da Fonseca, Alessandra S

; dos Santos-Rosa, Talita

; da Silva, Valquiria A

; Gouveia, Gisele R

; Faria, Viviane G

; da Cunha, Pedro HM

; Brunoni, André R

; Teixeira, Manoel J

; de Andrade, Daniel C

Revista de la Sociedad Española del Dolor

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Abr 2023, Volume 30 Nº 2 Páginas 131 - 145

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT Background: New-onset chronic pain has been acknowledged as part of the post-COVID-19 condition. However, available fine-grained data about its clinical phenotype, trajectories and main associated characteristics remain scarce. We described the distinct temporal evolutions of post-COVID-19 pain and their epidemiological and phenotypical features. Methods: A prospective cross-sectional study enrolled post-COVID-19 condition patients (i.e. who had persisting COVID-19-related symptoms over 30 days since their first positive laboratory test), whose COVID-19 diagnosis had been supported by RT-PCR of oral/nasopharyngeal swab or serology. They underwent in-person evaluations with a structured interview, pain and quality-of-life-related questionnaires and thorough physical examination. Chronic pain (CP) and probable neuropathic pain (NP) were defined according to IASP criteria. Results: The present study included 226 individuals, 177 (78.3 %) of whom presented over 3 months since their first COVID-19 symptom. New-onset pain occurred in 170 (75.2 %) participants and was chronic in 116 (68.2 %). A chronic course was associated with COVID-19-related hospitalization, new-onset fatigue, lower cognitive performance, motor and thermal sensory deficits, mood and sleep impairments and overall lower quality-of-life levels. Probable NP occurred in only 7.6 % new-onset pain patients, and was associated with pain chronification, new-onset fatigue, motor and thermal sensory deficits, mechanical allodynia and lower rates of SARS-CoV-2 vaccination. Previous CP was reported by 86 (38.1 %) individuals and had aggravated after the infection in 66 (76.7 %) of them, which was associated with orthostatic hypotension. Conclusions: Post-COVID pain phenomena follow different paths, which are associated with specific clinical and epidemiological features, and possibly distinct underlying mechanisms, prognostic and therapeutic implications. Significance: COVID-19-related pain usually follows a chronic course and is non-neuropathic. Its possible courses and phenotypes are associated with distinct clinical and epidemiological features. This suggests differing underlying mechnisms, which may have significant prognostic and therapeutic implications.

RESUMEN Antecedentes: El dolor crónico de nueva aparición se considera que forma parte de la condición o afección post-COVID-19. Sin embargo, los datos detallados existentes sobre el fenotipo clínico, las trayectorias y las principales características asociadas siguen siendo escasos. Describimos las distintas evoluciones temporales del dolor post-COVID-19 y sus rasgos epidemiológicos y fenotípicos. Métodos: Estudio prospectivo y transversal de pacientes con afección post-COVID-19 (es decir, con síntomas persistentes relacionados con la COVID-19 durante 30 días desde la primera prueba positiva de laboratorio) cuyo diagnóstico de COVID-19 estuviera basado en la RT-PCR de un frotis oral/nasofaríngeo o una serología. Se sometieron a evaluaciones presenciales mediante una entrevista estructurada, cuestionarios de dolor y calidad de vida y una exploración física exhaustiva. El dolor crónico (DC) y el dolor neuropático (DN) probablemente se definieron conforme a los criterios IASP. Resultados: El presente estudio incluyó 226 individuos, 177 (78,3 %) de los cuales se presentaron pasados más de 3 meses desde el primer síntoma de COVID-19. Tenían dolor de nueva aparición 170 (75,2 %) de los participantes y dolor crónico 116 (68,2 %). El curso crónico se asociaba a hospitalización por COVID-19, fatiga de nueva aparición, menor rendimiento cognitivo, déficits motores y sensitivos térmicos, alteraciones del ánimo y el sueño, y niveles generalmente inferiores de calidad de vida. El DN probable afectaba a solo el 7,6 % de los pacientes con dolor de nueva aparición y se asociaba a cronificación del dolor, fatiga de nueva aparición, déficits motores y de sensación térmica, alodinia mecánica y tasas menores de vacunación frente al SARS-CoV-2. Referían DC previo 86 (38,1 %) individuos, y este había empeorado tras la infección en 66 (76,7 %) de ellos, lo que se asociaba a hipotensión ortostática. Conclusiones: Los fenómenos dolorosos post-COVID siguen diferentes trayectorias que se asocian a rasgos clínicos y epidemiológicos específicos, y posiblemente a distintos mecanismos de base y diferentes implicaciones pronósticas y terapéuticas. Significado: El dolor relacionado con la COVID-19 sigue normalmente un curso crónico y no es neuropático. Los posibles cursos y fenotipos se asocian a rasgos clínicos y epidemiológicos distintos. Esto sugiere que los mecanismos de base difieren, lo que podría tener implicaciones pronósticas y terapéuticas importantes.

https://doi.org/10.1002/ejp.2094

Distractibility, anxiety, irritability, and agitation symptoms are associated with the severity of depressive and manic symptoms in mixed depression
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Tavares, Diego Freitas

; Suen, Paulo

; Moreno, Doris Hupfeld

; Vieta, Eduard

; Moreno, Ricardo Alberto

; Brunoni, André R.

Brazilian Journal of Psychiatry

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Dez 2022, Volume 44 Nº 6 Páginas 576 - 583

Resumo: En | Texto: En | PDF: En

Objective: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. Methods: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. Results: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. Conclusion: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression. Clinical trial registration: ClinicalTrials.gov (NCT04123301).

https://doi.org/10.47626/1516-4446-2022-2606

Chronic inflammatory diseases, subclinical atherosclerosis, and cardiovascular diseases: Design, objectives, and baseline characteristics of a prospective case-cohort study ‒ ELSA-Brasil
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Bensenor, Isabela M.

; Goulart, Alessandra C.

; Pereira, Alexandre C.

; Brunoni, André R.

; Alencar, Airlane

; Santos, Raul D.

; Bittencourt, Márcio S.

; Telles, Rosa W.

; Machado, Luciana Andrade Carneiro

; Barreto, Sandhi Maria

; de Almeida-Pititto, Bianca

; Janovsky, Carolina Porto Silva

; Sgarbi, José Augusto

; Tebar, William R.

; Meneghini, Vandrize

; Barbosa Junior, Fernando

; Ribeiro, Ana Cristina de Medeiros

; Pasoto, Sandra Gofinet

; Pereira, Rosa Maria R.

; Bonfá, Eloísa

; Sipahi, Aytan M.

; Santos, Itamar de S.

; Lotufo, Paulo A.

Clinics

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2022, Volume 77 elocation 100013

Resumo: En | Texto: En | PDF: En

Abstract Objectives This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein >10 mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with 10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results The high-risk group (n = 2,949; aged 53.6 ± 9.2; 65.5% women) and the ACS (n=1543; 52.2±8.8; 54.1% women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1% vs. 24.8%, p < 0.0001), higher BMI (Kg/m2) (28.1 vs. 26.9, p < 0.0001), higher waist circumference (cm) (93.3 vs. 91, p < 0.0001), higher frequencies of hypertension (40.2% vs. 34.5%, p < 0.0001), diabetes (20.7% vs. 17%, p = 0.003) depression (5.8% vs. 3.9%, p = 0.007) and higher levels of GlycA a new inflammatory marker (p < 0.0001) compared to the ACS. Conclusions The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID.

https://doi.org/10.1016/j.clinsp.2022.100013

Combined effects of theta-burst stimulation with transcranial direct current stimulation of the prefrontal cortex: study protocol of a randomized, double-blinded, sham-controlled trial using 99mTc-ECD SPECT
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Razza, Laís B.

; Buchpiguel, Carlos A.

; De Smet, Stefanie

; Klein, Izio

; Baeken, Chris

; Galhardoni, Ricardo

; Vanderhasselt, Marie-Anne

; Brunoni, André R.

Trends in Psychiatry and Psychotherapy

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Dez 2021, Volume 43 Nº 4 Páginas 293 - 301

Resumo: En | Texto: En | PDF: En

Abstract Introduction Non-invasive brain stimulation (NIBS) as monotherapy has been increasingly used to enhance the activity of brain networks. However, it is unclear whether a combination of distinct NIBS approaches could enhance prefrontal cortical (PFC) activity. Objective We propose to investigate the combined and standalone effects of two NIBS modalities on the PFC through a working memory task, single photon emission computed tomography (SPECT), and salivary cortisol. We hypothesize that the combined protocol will provoke greater changes in the collected measures compared to the remining protocols. Methods A randomized, double-blind, sham-controlled, full-factorial design will be conducted. The effects of transcranial direct current stimulation (tDCS) and intermittent theta-burst stimulation (iTBS) will be investigated over four different sessions (sham tDCS + sham iTBS, anodal tDCS + sham iTBS, anodal tDCS + active iTBS and sham tDCS + active iTBS) in 30 healthy adult volunteers. A 99mTc-ethylene cysteine dimer (99mTC-ECD) will be administered during the NIBS session and neuroimaging will be acquired within one hour. Salivary cortisol will be collected before and after each session and an n-back working memory task will be applied after the end of each NIBS session. The outcomes will be cerebral perfusion alterations (99mTC-ECD SPECT), accuracy and reaction time in the n-back task, and changes in salivary cortisol level. Conclusion The results from this trial can guide future therapeutic protocols for NIBS treatments stimulating the PFC by demonstrating that the combination of NIBS techniques is feasible, tolerable, and can lead to greater enhancement of PFC activity.

https://doi.org/10.47626/2237-6089-2020-0110

Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials
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Razza, Laís B.

; Afonso dos Santos, Leonardo

; Borrione, Lucas

; Bellini, Helena

; Branco, Luis C.

; Cretaz, Eric

; Duarte, Dante

; Ferrão, Ygor

; Galhardoni, Ricardo

; Quevedo, João

; Simis, Marcel

; Fregni, Felipe

; Correll, Christoph U.

; Padberg, Frank

; Trevizol, Alisson

; Daskalakis, Zafiris J.

; Carvalho, Andre F.

; Solmi, Marco

; Brunoni, André R.

Brazilian Journal of Psychiatry

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Out 2021, Volume 43 Nº 5 Páginas 514 - 524

Resumo: En | Texto: En | PDF: En

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

https://doi.org/10.1590/1516-4446-2020-1169 306 downloads

COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned
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Fukuti, Pedro

; Uchôa, Caroline Louise Mesquita

; Mazzoco, Marina Flaborea

; Cruz, Isabella D'Andrea Garcia da

; Echegaray, Mariana V.F.

; Humes, Eduardo de Castro

; Silveira, Júlia Belizário

; Santi, Talita Di

; Miguel, Euripedes Constantino

; Corchs, Felipe

; Fatori, Daniel

; Campello, Guilherme

; Oliveira, Gabriel M. de

; Argolo, Felipe C.

; Ferreira, Felipe de M.

; Machado, Gustavo

; Argeu, Adriana

; Oliveira, Graça Maria Ramos de

; Serafim, Antônio de Pádua

; Siqueira, Luciana de Lima

; Rossi, Luciane de

; Rios, Izabel Cristina

; Oliveira, Talita Rodrigues de

; Antoniazzi, Leilane C. K.

; Gagliotti, Daniel Augusto Mori

; Abelama Neto, Emílio

; Oliveira Junior, Paulo Novais de

; Correia, Aline Villalobo

; Gonçalves, Luca Schilling

; Tortato, Liana Silva

; Busato, Wagner Machado Moraes

; Guimarães-Fernandes, Flávio

; Alves, Marcos

; Leite Netto, Oswaldo Ferreira

; Schoueri, Patrícia de Campos Lindenberg

; Roque, Márcio de Assis

; Merlin, Silvia Stahl

; Boer, Giovana Cardoso Machado

; Sallet, Paulo Clemente

; Malbergier, André

; Spedo, Mariana Abrahão

; Kamitsuji, Carla Satie

; Faria, Elizabeth de

; Moreira, Moacyr Vergara de Godoy

; Kaufman, Arthur

; Abdo, Carmita

; Scanavino, Marco de Tubino

; Lancman, Selma

; Tavares, Hermano

; Polanczyk, Guilherme

; Brunoni, André R.

; Forlenza, Orestes V.

; Barros-Filho, Tarcísio Eloy Pessoa de

Clinics

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2021, Volume 76 elocation e2631

Resumo: En | Texto: En | PDF: En

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

https://doi.org/10.6061/clinics/2021/e2631

Psychopathological evaluation and use of the Hospital Anxiety and Depression Scale in a sample of Brazilian patients with post-stroke depression
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Pedroso, Vinicius S. P.

; Vieira, Érica L. M.

; Brunoni, André R.

; Lauterbach, Edward C.

; Teixeira, Antônio L.

Archives of Clinical Psychiatry (São Paulo)

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Dez 2016, Volume 43 Nº 6 Páginas 147 - 150

Resumo: En | Texto: En | PDF: En

Abstract Background: Depression is the most frequent psychiatric complication of stroke and is often undetected or inadequately treated. Objective: This study aimed to characterize psychopathological aspects of Brazilian patients admitted to an acute stroke unit, and to evaluate the performance of the Hospital Anxiety and Depression Scale (HADS) in detecting cases of depression. Methods: This was a cross-sectional study. Sixty consecutive patients admitted to an acute stroke unit were assessed with the National Institutes of Health Stroke Scale, the Modified Rankin Scale, the Functional Independence Measure, the Mini International Neuropsychiatric Interview-Plus, the HADS, the Mini Mental State Examination (MMSE) and the Pathological Laughing and Crying Scale. Results: Prevalence of depression was 26.7%. Patients with post-stroke depression were more likely to present diabetes (p < 0.01) and had greater disability (p < 0.001) and cognitive impairment (p < 0.001) in comparison to non-depressed patients. Depressed patients showed worse performance specifically on tasks of attention/calculation and language of the MMSE. ROC curve analysis of HADS provided a cutoff value of 6 for detecting depression (sensitivity: 83.3%; specificity: 83.3%). The depression subscale of HADS (HADS-D) presented sensitivity of 100% and specificity of 99.17%. Discussion: HADS-D showed good performance in screening for depressive symptoms after acute stroke.

https://doi.org/10.1590/0101-60830000000102 1642 downloads

Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
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Nunes, Maria A.

; Pinheiro, Andréa P.

; Bessel, Marina

; Brunoni, André R.

; Kemp, Andrew H.

; Benseñor, Isabela M.

; Chor, Dora

; Barreto, Sandhi

; Schmidt, Maria I.

Brazilian Journal of Psychiatry

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Jun 2016, Volume 38 Nº 2 Páginas 91 - 97

Resumo: En | Texto: En | PDF: En

Objective: To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Methods: We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. Results: CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). Conclusion: The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.

https://doi.org/10.1590/1516-4446-2015-1714 4412 downloads

10.

Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review
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Shiozawa, Pedro

; Silva, Mailu Enokibara da

; Carvalho, Thais Cristina de

; Cordeiro, Quirino

; Brunoni, André R.

; Fregni, Felipe

Arquivos de Neuro-Psiquiatria

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Jul 2014, Volume 72 Nº 7 Páginas 542 - 547

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O uso de estimulação de nervos cranianos de maneira transcutânea tem sido uma estratégia em desenvolvimento recente. Diferentes estudos apontam para resultados clínicos favoráveis no tratamento de diferentes quadros neuropsiquiátricos. Método: Revisão sistemática da literatura com base nas bibliotecas eletrônicas Medline e Embase, sem restrição de data inicial, até agosto de 2013. Os termos de busca utilizados foram [(1) trigeminal nerve stimulation OR (2) cranial nerve OR (3) trigemin* OR (4) transcutaneous VNS OR (5) transcutaneous cranial nerve stimulation] and (6) mental disorders. Resultados: Incluímos quatro estudos pré-clinicos e cinco estudos clínicos abordando estimulação do nervo trigêmeo. Todos os estudos foram abertos, com pequenas amostras, o que reduz a validade externa dos dados, refletindo a ainda incipiente atuação da técnica, apesar de promissora. Considerando-se a estimulação do nervo vago, três artigos avaliaram aspectos fisiológicos em voluntários saudáveis e um artigo estudou pacientes com epilepsia. Conclusão: As estratégias de estimulação transcutânea de nervos cranianos, apesar de incipiente, tem demonstrado resultados clínicos favoráveis no tratamento de distúrbios neuropsiquiátricos.

We reviewed trigeminal nerve stimulation (TNS) and transcutaneous vagus nerve stimulation (tVNS). All techniques have shown preliminary promising results, although the results are mixed. Method: We performed a systematic review of the Medline and Embase databases, with no constraint to dates, through June 2013. The keywords were [(1) trigeminal nerve stimulation OR (2) cranial nerve OR (3) trigemin* OR (4) transcutaneous VNS OR (5) transcutaneous cranial nerve stimulation] and (6) mental disorders. Results: We included four preclinical and clinical five studies on TNS. All clinical data were based on open-label studies with small samples, which diminished the external validity of the results, thus reflecting the modest impact of TNS in current clinical practice. Of the tVNS clinical trials, three assessed physiological features in healthy volunteers, and one examined patients with epilepsy. Conclusion: TNS and tVNS improve treatment of particular neuropsychiatric disorders such as depression.

https://doi.org/10.1590/0004-282X20140061 9718 downloads Citado 1 vez em SciELO

11.

An ethical discussion of the use of transcranial direct current stimulation for cognitive enhancement in healthy individuals: a fictional case study
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Lapenta, Olivia M.

; Valasek, Claudia A.

; Brunoni, André R.

; Boggio, Paulo S.

Psychology & Neuroscience

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Jun 2014, Volume 7 Nº 2 Páginas 175 - 180

Resumo: En | Texto: En | PDF: En

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique. Because of its low cost, ease of use, safety, and portability, tDCS has been increasingly investigated for therapeutic purposes in neuropsychiatric disorders and in experimental neuropsychological studies with healthy volunteers. These experiments on healthy cognition have shown significant effects on working memory, decision-making, and language. Such promising results have fomented reflections on studying tDCS to enhance or modify normal cognitive function, a concept described by some as "cosmetic" neurology. As the field evolves, discussing whether the use of tDCS in these situations is appropriate is important, including how bioethical principles may help resolve these challenges. In this article, we present some examples of the effects of tDCS on cognition in healthy participants as a starting point for this ethical debate. We envision a futuristic "Brain Boosting" tDCS clinic that specializes in cosmetic neurology and cognitive enhancement. Using the typical cases of a fictitious Dr. Icarus as a discussion starting point, we raise some issues that are both humorous and provocative about the use of tDCS in healthy people. The importance of this work is to ask relatively new questions regarding cosmetic neurology in the field of neuromodulation and discuss the related ethical conflicts.

https://doi.org/10.3922/j.psns.2014.010 3510 downloads

12.

Suicide rates and trends in São Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis
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Bando, Daniel H.

; Brunoni, André R.

; Fernandes, Tiótrefis G.

; Benseñor, Isabela M.

; Lotufo, Paulo A.

Brazilian Journal of Psychiatry

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Out 2012, Volume 34 Nº 3 Páginas 286 - 293

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar as taxas de suicídio e as tendências em São Paulo por gênero, faixa etária e métodos. MÉTODOS: Dados de mortalidade foram coletados a partir de bases de dados da Prefeitura de São Paulo de 1996-2009. A população total foi estimada utilizando dados do Censo Nacional. Utilizamos o programa Joinpoint regression analysis para explorar tendências temporais. Também avaliamos estado civil, etnia, local de nascimento e métodos de suicídio. RESULTADOS: No período, ocorreram 6.002 suicídios, uma taxa de 4,6 por 100.000 habitantes (7,5 em homens e 2,0 em mulheres), a relação masculino-feminino foi cerca de 3,7. Tendências de suicídio para os homens apresentaram uma queda significativa de 5,3% por ano entre 1996 e 2002, e um aumento significativo de 2,5% ao ano a partir de 2002. Mulheres não apresentaram alterações significativas na tendência. Para os homens, os idosos (> 65 anos) tiveram uma redução significativa de 2,3% ao ano, enquanto os homens mais novos (25-44 anos) apresentaram um aumento significativo de 8,6% ao ano a partir de 2004. Mulheres não apresentaram alterações significativas na tendência por faixa etária. Principais métodos de suicídio foram enforcamento e envenenamento, para homens e mulheres respectivamente. Outras análises mostraram um aumento do risco relativo ao suicídio para os solteiros e estrangeiros. CONCLUSÕES: Foram identificadas tendências epidemiológicas específicas do suicídio na cidade de São Paulo que merecem uma investigação mais aprofundada. Grupos de alto risco - como os imigrantes - poderiam se beneficiar com estratégias focalizadas na prevenção do suicídio.

OBJECTIVE: To evaluate suicide rates and trends in São Paulo by sex, age-strata, and methods. METHODS: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide. RESULTS: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (> 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners. CONCLUSIONS: Specific epidemiological trends for suicide in the city of São Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention.

https://doi.org/10.1016/j.rbp.2012.02.001 8669 downloads

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