Objective: To investigate the trajectory of positive attributes from childhood to early adulthood and how these trajectories might be modified by environmental factors. Methods: We enrolled 2,511 participants aged 6 to 14 years from a large prospective school-based community cohort of Brazilian children and adolescents, 45% of whom were girls. They were assessed and followed for up to 3 years (with 80% retention) or 6 years (with 71% retention). Positive attributes were assessed by using the Youth Strength Inventory (YSI). A composite measure using several indicators was used to assess childhood exposure to threats and deprivations. Results: The trajectories of YSI scores were nonlinear for male and female participants, being high in childhood, decreasing in adolescence, and being high again in early adulthood. Exposure to threat and deprivation presented a negative linear association with YSI over time. Furthermore, exposure to threat and deprivation early in life, but not later, presented an additional effect on decreasing positive attributes during the life course. Conclusion: Our findings provide new evidence on the trajectories of positive attributes in children and adolescents and show how early life adversity affects not only mental disorders but also positive aspects of mental health. Objective factors Methods 2511 2 511 2,51 1 schoolbased school based 45 girls 80 retention 71 retention. . YSI. (YSI) deprivations Results adolescence time Furthermore later course Conclusion health 251 51 2,5 4 8 7 (YSI 25 5 2,

Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde – 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings. Objectives PHQ9 PHQ (PHQ-9 stateoftheart state art Methods 201 Pesquisa 2019, , 2019) 90846 90 846 90,84 citizens structure Summed meanbased mean based PHQ- theorybased models Finally percentiles score) population Results sex itemlevel level reliable mean. . mean) Conclusion tools settings (PHQ- 20 9084 84 90,8 (PHQ 2 908 8 90,

Objectives: To re-evaluate a sample of older adults enrolled in a randomized controlled trial of lithium for amnestic mild cognitive impairment (MCI) after 11 to 15 years, re-assessing their current (or last available) global cognitive and functional state. Methods: We recalled all former participants of the Lithium-MCI trial conducted by our group between 2009 and 2012 to perform a single-blinded, cross-sectional evaluation of their global clinical state to compare the long-term outcome of those who received lithium vs. those who received placebo. Results: Of the original sample (n=61), we were able to reach 36 participants (59% of retention), of whom 22 had previously received lithium (61% of the recall sample) and 14 (39%) had received placebo. Since 30.5% of the recalled sample was deceased, psychometric data were collected only for 69.5% of the participants. We found statistically significant differences in current mean Mini Mental State Examination score according to previous treatment group (25.5 [SD, 5.3] vs. 18.3 [SD, 10.9], p = 0.04). The lithium group also had better performance in the phonemic Verbal Fluency Test than the control group (34.4 [SD, 14.4] vs. 11.6 [SD, 10.10], p < 0.001). Differences in these measures also had large effect sizes, as shown by Cohen’s d values of 0.92 and 1.78, respectively. Conclusion: This data set suggests that older adults with amnestic MCI who had been treated with lithium during a previous randomized controlled trial had a better long-term global cognitive outcome than those from a matched sample who did not receive the intervention. Objectives reevaluate re evaluate (MCI 1 years reassessing assessing or available Methods LithiumMCI Lithium 200 201 singleblinded, singleblinded single blinded, blinded single-blinded crosssectional cross sectional longterm long term vs placebo Results n=61, n61 n n=61 , 61 (n=61) 3 59% 59 (59 retention, retention retention) 2 61% (61 39% 39 (39% 305 30 5 30.5 deceased 695 69 69.5 25.5 255 25 (25. SD, SD [SD 5.3 53 183 18 18. 10.9, 109 10.9 10 9 10.9] 0.04. 004 0.04 . 0 04 0.04) 34.4 344 34 4 (34. 14.4 144 116 6 11. 10.10, 1010 10.10 10.10] 0.001. 0001 0.001 001 0.001) sizes Cohens Cohen s 092 92 0.9 178 78 1.78 respectively Conclusion intervention 20 n6 n=6 (n=61 (5 (6 (39 30. 69. 25. (25 5. 10. 00 0.0 34. (34 14. 101 10.1 000 0.00 09 0. 17 7 1.7 n= (n=6 ( (3 (2 1. (n= (n

SUMMARY OBJECTIVE: It is not uncommon for medical residents to deal with critically ill patients who frequently show several ethical and human dilemmas, highlighting the need for a consultation with ethical specialists. The objective of this article is to present a description of a Brazilian Ethics Consultation group designed to attend psychiatry residents. METHODS: This article reports a case of a critically ill patient with Borderline Personality Disorder with multiple intervention failures and several ethical conflicts who was seen by a resident and supported by an ethics consultation group. RESULTS: When medical residents and medical staff face severe and unusual ethical dilemmas, they might feel unprepared and have ones’ mental health impaired. Thus, this article reports a successful ethics consultation and discusses its development in other academic institutions. CONCLUSION: Medical educators and staff from academic hospitals should pay attention to the needs of the medical residents. The development and support of ethics consultation groups must be provided to fulfill the need of those residents who face serious ethical and human dilemmas.

Este trabalho é um relato de experiência do primeiro ano de funcionamento do Grupo de Apoio ao Primeiranista (GAP). O GAP é um grupo desenvolvido por alunos de Medicina de uma universidade privada do Estado de São Paulo, apoiado por sua direção, com o intuito de amparar e humanizar a recepção aos ingressantes. O início das atividades do GAP ocorreu em 2013 com base nos conceitos de tutoria/mentoring, aplicado por outras escolas médicas brasileiras. Nas reuniões semanais do GAP, os participantes (alunos do primeiro ano) e mentores (acadêmicos veteranos e uma psicóloga institucional) discutiam temas como resiliência, compaixão, humildade e respeito. Durante as reuniões, notou-se uma problemática extensa em relação ao trote universitário, referido pelos primeiranistas como o pior problema enfrentado na universidade. Na sequência dos encontros, o grupo direcionou suas ações para reduzir o trote na universidade. O GAP, apesar de estar em seu primeiro ano de funcionamento, mostrou ter eficácia relevante, podendo ser um modelo a ser implementado em outras universidades.

This paper reports the experience of the first year of the Freshman Support Group (GAP). GAP was developed by a group of medical students at a private university in the state of Sao Paulo, supported by their coordinators, with the aim of supporting and humanizing the reception of new first-year students. GAP opened in 2013 founded on the concepts of mentoring applied at other Brazilian medical schools. GAP held weekly meetings in which participants (first year medical students), and mentors (both senior students and a psychologist), discussed topics such as resilience, compassion, humility, and respect. During the meetings the students voiced much concern about university hazing; cited as the worst problem faced at university. Following these meetings, the group directed its actions toward reducing hazing at the university. GAP, although only in its first year of operation, proved to be effective and could serve as a model for implementation at other universities.