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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

Treatment of food addiction: preliminary results
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Oliveira, Edgar Luis Lima de

; Lacroix, Emilie

; Stravogiannis, Andrea Lorena Costa

; Vasques, Maria de Fátima

; Durante, Cristiane Ruiz

; Duran, Érica Panzani

; Pereira, Daniela

; Cabral, Janice Rico

; Tavares, Hermano

Archives of Clinical Psychiatry (São Paulo)

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oct 2020, Volume 47 N. 5 Pages 163 - 164

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0101-60830000000256 186 downloads

Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury
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Medeiros, Gustavo C.

; Seger-Jacob, Liliana

; Garreto, Anna K.

; Kim, Hyoun S.

; Coccaro, Emil F.

; Tavares, Hermano

Brazilian Journal of Psychiatry

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aug 2019, Volume 41 N. 4 Pages 303 - 309

Abstract: En | Text: En | PDF: En

Objective: To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. Methods: We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI. Results: The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa. Conclusions: Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.

https://doi.org/10.1590/1516-4446-2018-0149 1355 downloads

Sexual compulsivity, anxiety, depression, and sexual risk behavior among treatment-seeking men in São Paulo, Brazil
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Scanavino, Marco D.T.

; Ventuneac, Ana

; Abdo, Carmita H.N.

; Tavares, Hermano

; Amaral, Maria L.S.

; Messina, Bruna

; Reis, Sirlene C.

; Martins, João P.L.B.

; Parsons, Jeffrey T.

Brazilian Journal of Psychiatry

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dec 2018, Volume 40 N. 4 Pages 424 - 431

Abstract: En | Text: En | PDF: En

Objective: There is a lack of studies on negative mood states and sexual risk behavior in men of all sexual orientations who seek treatment for excessive sexual behavior (ESB). We aim to examine sexual compulsivity (SC), anxiety, depression, and sexual risk behavior in a treatment-seeking sample of men and controls. Methods: We enrolled 88 (37 [42%] gay or bisexual and 51 [58%] heterosexual) ESB outpatients and 64 controls. Assessments included the Sexual Compulsivity Scale (SCS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and sexual risk behaviors. Results: Compared to controls, ESB outpatients showed increased SC, anxiety, and depression, which were correlated. Regarding sex with casual partners, ESB outpatients reported more sexual intercourse, a greater number of partners, more anal intercourse, and unprotected anal intercourse. Anxiety, depression, and SC were associated with protected vaginal intercourse with a main partner, whereas they were associated with unprotected anal intercourse with a casual partner. Depression was associated with unprotected vaginal intercourse with a casual partner. Condomless anal intercourse was predicted by SC and was also reported by the heterosexual ESB outpatients (36%). Conclusion: The data contribute to the field by providing information on men of all sexual orientations who are searching for mental healthcare. The connections among these psychopathological factors and sexual risk behavior have implications for public health, clinicians, and research.

https://doi.org/10.1590/1516-4446-2017-2476 2394 downloads

Comorbid addictive behaviors in disordered gamblers with psychosis
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Kim, Hyoun S.

; Cassetta, Briana D.

; Hodgins, David C.

; McGrath, Daniel S.

; Tomfohr-Madsen, Lianne M.

; Tavares, Hermano

Brazilian Journal of Psychiatry

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dec 2018, Volume 40 N. 4 Pages 441 - 443

Abstract: En | Text: En | PDF: En

Objective: While it has been shown that disordered gamblers with psychosis are at increased risk for comorbid psychopathology, it is unclear whether this dual-diagnosis population is also at greater risk of problematic engagement with comorbid addictive behaviors. Methods: We tested for association between disordered gambling with psychosis and comorbid addictive behaviors in a sample of 349 treatment-seeking disordered gamblers. Results: Twenty-five (7.2%) disordered gamblers met criteria for psychosis. Disordered gamblers with psychosis were no more likely to meet diagnostic criteria for current alcohol/substance use disorder than disordered gamblers without psychosis. However, this dual-disorder population reported greater misuse of shopping, food bingeing, caffeine, and prescription drugs. When controlling for multiple comparisons, binge eating was the only addictive behavior to remain significant. Conclusion: Given these findings, a comprehensive assessment of addictive behaviors – specifically food bingeing – in this population may be warranted.

https://doi.org/10.1590/1516-4446-2017-2307 992 downloads

Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis
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Costa, Ana M.

; Medeiros, Gustavo C.

; Redden, Sarah

; Grant, Jon E.

; Tavares, Hermano

; Seger, Liliana

Brazilian Journal of Psychiatry

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sep 2018, Volume 40 N. 3 Pages 316 - 319

Abstract: En | Text: En | PDF: En

Objectives: To evaluate the efficacy of a group therapy based on cognitive-behavioral techniques customized for intermittent explosive disorder (IED). The current report presents the preliminary results of a clinical trial comparing pre- and post-intervention scores in different anger dimensions. Methods: The studied sample consisted of 84 treatment-seeking subjects. The mean (standard deviation) age was 43.0 (11.9) years, and 78% were male. The therapeutic group program consisted of 15 weekly sessions plus three maintenance sessions. The sessions lasted approximately 90 minutes each. Results: No differences were found in demographic profile and pre-treatment status between subjects who completed treatment (n=59) and dropouts (n=25). Comparison of State-Trait Anger Expression Scale (STAXI) scores pre- and post-treatment showed statistically significant changes in all anger scales and subscales of the questionnaire. Conclusion: This preliminary report is a significant addition to currently scarce clinical data. Our findings provide further evidence that structured cognitive-behavioral group therapy, with a focus on anger management and cognitive coping, may be a promising approach to the treatment of IED.

https://doi.org/10.1590/1516-4446-2017-2262 2619 downloads

Impairments of kleptomania: what are they?
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Kim, Hyoun S.

; Christianini, Aparecida Rangon

; Hodgins, David C.

; Tavares, Hermano

Brazilian Journal of Psychiatry

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sep 2017, Volume 39 N. 3 Pages 279 - 280

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-4446-2017-2218 2003 downloads

Development and validation of the Gambling Follow-up Scale, Self-Report version: an outcome measure in the treatment of pathological gambling
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Galetti, Ana M.

; Tavares, Hermano

Brazilian Journal of Psychiatry

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mar 2017, Volume 39 N. 1 Pages 36 - 44

Abstract: En | Text: En | PDF: En

Objective: To validate the Gambling Follow-up Scale, Self-Report version (GFS-SR), a 10-item scale designed to assess gambling frequency, time and money spent on gambling, gambling craving, debts, emotional distress, family relationships, autonomy, and frequency of and satisfaction with leisure activities in individuals diagnosed with gambling disorder according to the DSM-5 criteria. Methods: One hundred and twenty treatment-seeking gamblers were evaluated, 84 of whom proceeded to treatment. Fifty-two relatives provided collateral informant reports at baseline. Six months later, the 50 patients who completed the program were reassessed. Results: The GFS-SR showed good inter-rater agreement and internal consistency. Factor analysis presented a three-factor solution: gambling behavior (factor 1); social life (factor 2); and personal hardship (factor 3). There was a high degree of convergence between GFS-SR scores and those of reference scales. The GFS-SR scores showed excellent sensitivity to change (factor 1), predictive validity for treatment response (factor 2), and ability to distinguish recovered from unrecovered patients after treatment (factor 3). A cutoff score of 33 was found to have 87% sensitivity and 80% specificity for gambling recovery. Conclusion: The GFS-SR is well suited to providing reliable follow-up of gamblers under treatment and assessing the efficacy of their treatment.

https://doi.org/10.1590/1516-4446-2016-1911 1445 downloads

10.

A cross-cultural study of gambling disorder: a comparison between women from Brazil and the United States
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Medeiros, Gustavo C.

; Leppink, Eric W.

; Redden, Sarah A.

; Yaemi, Ana

; Mariani, Mirella

; Tavares, Hermano

; Grant, Jon E.

Brazilian Journal of Psychiatry

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mar 2016, Volume 38 N. 1 Pages 53 - 57

Abstract: En | Text: En | PDF: En

Objective: To perform a cross-cultural comparison of gambling disorder (GD) in women from Brazil and the United States, two countries with pronounced social and cultural differences. We hoped to produce insight into the impact of cultural influences on the presentation of GD in women, which may be useful for the development of culturally-sensitive interventions. Method: We assessed 681 women with GD: 406 from a Brazilian sample and 275 from a U.S. sample. We assessed demographic and gambling behavior variables in addition to co-occurring psychiatric disorders. Results: Fewer Brazilian participants were Caucasian (73.3 vs. 91.3%; p = 0.022). Also, Brazilian women had lower levels of education (59.9% with high school or less vs. 44.4%; p < 0.001), and were more likely to have a current partner (54.9 vs. 43.4%; p = 0.003). Brazilian gamblers also reported lower urge scores (6.6±4.3 vs. 11.6±2.4; p < 0.001) and higher chasing rates (89.1 vs. 80.0%; p = 0.002). Brazilian gamblers reported higher rates of bingo gambling (19.2 vs. 5.7%; p < 0.001), but lower rates of card game gambling (5.8 vs. 23.1%; p < 0.001). Finally, Brazilian gamblers were more likely to endorse a history of major depressive disorder (36.9 vs. 24.4%; p = 0.001). Conclusions: This study reinforces the need for further general cross-cultural research on GD and particularly for studies investigating how gender mediates these differences. Finally, the differences noted in this analysis suggest that the findings of predominantly Anglo-Saxon cultures may not be generalizable to other world populations.

https://doi.org/10.1590/1516-4446-2015-1718 1862 downloads

11.

Happiness and health in psychiatry: what are their implications?
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Machado, Leonardo

; Tavares, Hermano

; Petribú, Katia

; Zilberman, Mônica

; Torres, Renata Ferraz

; Cantilino, Amaury

Archives of Clinical Psychiatry (São Paulo)

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aug 2015, Volume 42 N. 4 Pages 100 - 110

Abstract: En | Text: En | PDF: En

Background Happiness is a lasting state and is associated with the absence of negative emotions, the presence of positive emotions, life satisfaction, social engagement and objectives in life. Researchers have demonstrated the benefits of happiness in many aspects of life, but few studies have been conducted within psychiatry.Objectives To develop a critical literature review of studies on happiness and health in order to bring some further and useful information to psychiatry updating the article “Happiness: a review” published in 2007 in Revista de Psiquiatria Clínica.Methods Computational searching was undertaken of digital data basis (PubMed and SciELO) using the keywords “happiness” and “health”. One hundred twenty-seven papers published between 2004 and 2014 were found, but only 76 had the keywords in the title or abstract and with this were selected.Results Personality traits, such as self-direction; being married; being involved in physical and leisure activities; higher educational backgrounds and intelligence quotient; religiosity, volunteering and altruism; good physical and mental health; were positively related to happiness.Discussion Analysis of the concept of happiness and its associated emotions may be more complex than describing the symptoms of psychiatric disorders. Despite this, the study of happiness brings several positive implications for psychiatry.

https://doi.org/10.1590/0101-60830000000058 10612 downloads

12.

Impulsive aggression in Brazil: losing opportunities to intervene
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Medeiros, Gustavo C.

; Leppink, Eric

; Seger, Liliana

; Costa, Ana M.

; Bernardo, Carolina

; Tavares, Hermano

Brazilian Journal of Psychiatry

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jun 2015, Volume 37 N. 2 Pages 177 - 178

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-4446-2014-1609 3145 downloads

13.

Telemental health in Brazil: past, present and integration into primary care
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Dias, Rodrigo Da Silva

; Marques, Andrea De Fatima Horvath

; Diniz, Paula Rejane Bezerra

; Silva, Tatiana Araújo Bertilino Da

; Cofiel, Luciana

; Mariani, Mirella Martins De Castro

; Salgado, Christiana Leal

; Oliveira, Ana Emilia Figueiredo De

; Miguel Filho, Euripedes Constantino

; Wen, Chao Lung

; Novaes, Magdala De Araújo

; Tavares, Hermano

Archives of Clinical Psychiatry (São Paulo)

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apr 2015, Volume 42 N. 2 Pages 41 - 44

Abstract: En | Text: En | PDF: En

Background Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research.

https://doi.org/10.1590/0101-60830000000046 3216 downloads

14.

N-acetylcysteine in the treatment of skin-picking disorder
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Silva-Netto, Regina

; Jesus, Gustavo

; Nogueira, Marcelo

; Tavares, Hermano

Brazilian Journal of Psychiatry

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mar 2014, Volume 36 N. 1 Pages 101 - 101

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-4446-2013-1154 5750 downloads

15.

Five cases of sexual addiction under Short-term Psychodynamic Group Psychotherapy
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Scanavino, Marco de Tubino

; Kimura, Cintia Mayumi Sakurai

; Messina, Bruna

; Abdo, Carmita Helena Najjar

; Tavares, Hermano

Archives of Clinical Psychiatry (São Paulo)

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2013, Volume 40 N. 5 Pages 208 - 209

Abstract: En | Text: En | PDF: En

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