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Lovato I, Simonelli A, Visentin S, Priante E, Baraldi E, Sacchi C. Prenatal environment and developmental trajectories: the intrauterine growth restriction. Minerva Pediatr (Torino) 2023; 75:62-74. [PMID: 35708036 DOI: 10.23736/s2724-5276.22.06949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prenatal environment is of fundamental importance for the fetus, as the fetus is particularly susceptible to environmental influences while in utero, and several prenatal adversities may constitute a risk factor for fetal growth and child development. Intrauterine growth restriction (IUGR) refers to a pregnancy complication involving the inadequate growth of the fetus in utero, with potential programming consequences on the children's brain-behavior development. In this narrative review we will discuss the most recent literature about IUGR children, including their development and their relationship with the prenatal and postnatal environment. In particular, as an attempt to an adaptive response to intrauterine changes, the brain development of IUGR fetuses follows abnormal developmental pathways, which likely has cascade effects on the future neurodevelopmental outcomes of the children. Cognitive and motor functions are in fact impaired, as well as IUGR children present, across studies, poor socio-emotional abilities and a greater risk for internalizing and externalizing behavior problems. The current work also highlights how the postnatal environment, and in particular parental care, has an important role in IUGR development, acting as a protective factor, or otherwise increasing their constitutional vulnerabilities. Overall, this narrative review has important implications for clinical practice, suggesting the need for long-term follow-up care with IUGR children and strategies supporting parent-child interactions as well.
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Affiliation(s)
- Irene Lovato
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Silvia Visentin
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Elena Priante
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Chiara Sacchi
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy -
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Sacchi C, Marino C, Nosarti C, Vieno A, Visentin S, Simonelli A. Association of Intrauterine Growth Restriction and Small for Gestational Age Status With Childhood Cognitive Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:772-781. [PMID: 32453414 PMCID: PMC7251506 DOI: 10.1001/jamapediatrics.2020.1097] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE The magnitude of the association of intrauterine growth restriction (IUGR) and small for gestational age (SGA) status with cognitive outcomes in preterm and term-born children has not been established. OBJECTIVE To examine cognitive outcomes of preterm and term-born children who had IUGR and were SGA compared with children who were appropriate for gestational age (AGA) during the first 12 years of life. DATA SOURCES For this systematic review and meta-analysis, the Scopus, PubMed, Web of Science, Science Direct, PsycInfo, and ERIC databases were searched for English-language, peer-reviewed literature published between January 1, 2000, and February 20, 2020. The following Medical Subject Heading terms for IUGR and SGA and cognitive outcomes were used: intrauterine growth restriction, intrauterine growth retardation, small for gestational age AND neurodevelopment, neurodevelopmental outcome, developmental outcomes, and cognitive development. STUDY SELECTION Inclusion criteria were assessment of cognitive outcomes (full-scale IQ or a cognitive subscale), inclusion of an AGA group as comparison group, and inclusion of gestational age at birth and completion of cognitive assessment up to 12 years of age. DATA EXTRACTION AND SYNTHESIS The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Data were double screened for full-text articles, and a subset were independently coded by 2 authors. Standardized mean differences (SMDs) and odd ratios from individual studies were pooled by applying random-effects models. MAIN OUTCOMES AND MEASURES Cognitive outcomes, defined as mental, cognitive, or IQ scores, estimated with standardized practitioner-based cognitive tests or as borderline intellectual impairment (BII), defined as mental, cognitive, or IQ scores at least 1 SD below the mean cognitive score. RESULTS In this study of 89 samples from 60 studies including 52 822 children, children who had IUGR and were SGA had significantly poorer cognitive outcomes (eg, cognitive scores and BII) than children with AGA in childhood. For cognitive scores, associations are consistent for preterm (SMD, -0.27; 95% CI, -0.38 to -0.17) and term-born children (SMD, -0.39; 95% CI, -0.50 to -0.28), with higher effect sizes reported for term-born IUGR and AGA group comparisons (SMD, -0.58; 95% CI, -0.82 to -0.35). Analyses on BII revealed a significantly increased risk in the preterm children who had IUGR and were SGA (odds ratio, 1.57; 95% CI, 1.40-1.77) compared with the children with AGA. CONCLUSIONS AND RELEVANCE Growth vulnerabilities assessed antenatally (IUGR) and at the time of birth (SGA) are significantly associated with lower childhood cognitive outcomes in preterm and term-born children compared with children with AGA. These findings highlight the need to develop interventions that boost cognitive functions in these high-risk groups.
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Affiliation(s)
- Chiara Sacchi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Claudia Marino
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Chiara Nosarti
- Centre for the Developing Brain, King's College London School of Bioengineering & Imaging Sciences, London, United Kingdom,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alessio Vieno
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Silvia Visentin
- Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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Schmidt LA, Saigal S. Assessing Cognitive Outcomes in Studies of Extreme Prematurity. Pediatrics 2020; 145:peds.2019-3359. [PMID: 31924687 DOI: 10.1542/peds.2019-3359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Saroj Saigal
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
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4
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Lev-Ari L, Bachner-Melman R, Zohar AH, Ebstein R, Mankuta D. Weight gain, feeding and eating in the first year of life of babies of smoking and non-smoking mothers. Early Hum Dev 2019; 140:104889. [PMID: 31670174 DOI: 10.1016/j.earlhumdev.2019.104889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 01/02/2023]
Abstract
Babies of mothers who smoke during pregnancy tend to be born underweight but are at risk for pediatric obesity. Maternal feeding practices, maternal disordered eating, and child temperament were assessed as potential mediators of early weight gain in babies of smoking and non-smoking mothers. The BMIs of babies of 88 smoking and 107 non-smoking mothers were recorded at birth and reported one year later. Mothers self-reported on disordered eating and child feeding practices, and on their infants' temperament. Babies of smoking mothers had lower BMI at birth but not at age one. For babies of non-smoking but not for those of smoking mothers, BMI at birth predicted BMI at age one. Smoking mothers' disordered eating and pressure for children to eat predicted their babies' BMI at age one. In the non-smoking group only, there were significant correlations between babies' temperamental difficulties and babies' BMI at age one. In contrast to non-smoking mothers, smoking mothers tend to pressure their babies to eat, and not to feed them in response to their distress. This interim picture may provide insight into the transition of the children of smoking mothers from underweight newborns to children classified as overweight.
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Affiliation(s)
- Lilac Lev-Ari
- Clinical Psychology Program, School of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel.
| | - Rachel Bachner-Melman
- Clinical Psychology Program, School of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel; School of Social work, Hebrew University of Jerusalem, Mt Scopus, Jerusalem, Israel
| | - Ada H Zohar
- Clinical Psychology Program, School of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Richard Ebstein
- China Center for Behavior Economics & Finance & Southwestern University of Finance & Economics
| | - David Mankuta
- Obstetrics and Gynecology, Hadassah University Medical Center, Jerusalem, Israel
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Mansur RB, Cunha GR, Asevedo E, Zugman A, Rios AC, Salum GA, Pan PM, Gadelha A, Levandowski ML, Belangero SI, Manfro GG, Stertz L, Kauer-Sant'anna M, Miguel EC, Bressan RA, Mari JJ, Grassi-Oliveira R, Brietzke E. Perinatal complications, lipid peroxidation, and mental health problems in a large community pediatric sample. Eur Child Adolesc Psychiatry 2017; 26:521-529. [PMID: 27785581 DOI: 10.1007/s00787-016-0914-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/21/2016] [Indexed: 01/21/2023]
Abstract
Replicated evidence indicates that perinatal complications are associated with increased markers of oxidative stress and with mental health problems in children. However, there are fewer reports on the impact of perinatal complications in later phases of development. We aimed to investigate the estimated effects of perinatal complications on levels of lipid peroxidation and on psychopathology in children and adolescents. The study is part of the High Risk Cohort Study for Psychiatric Disorders; the population was composed by 554 students, 6-14 years of age. Serum levels of malondialdehyde, a product of lipid peroxidation, were measured by the TBARS method. A household interview with parents and caregivers was conducted and included inquiries about perinatal history, the Child Behavior Checklist (CBCL), and parent's evaluation, using the Mini International Psychiatric Interview (MINI). We created a cumulative risk index, conceptualized as each individual's cumulative exposure to perinatal complications. Results indicate that perinatal complications were associated with higher levels of TBARS. After adjusting for age, gender, socio-economic status, CBCL total problems score, parental psychopathology, and childhood maltreatment, children exposed to 3 or more perinatal complications had an 26.9% (95% CI 9.9%, 46.6%) increase in TBARS levels, relative to the unexposed group. Exploratory mediation analysis indicated that TBARS levels partially mediated the association between perinatal complications and externalizing problems. In conclusion, an adverse intrauterine and/or early life environment, as proxied by the cumulative exposure to perinatal complications, was independently associated with higher levels of lipid peroxidation in children and adolescents.
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Affiliation(s)
- Rodrigo B Mansur
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil. .,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. .,Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.
| | - Graccielle R Cunha
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elson Asevedo
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - André Zugman
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Adiel C Rios
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Giovanni A Salum
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro M Pan
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Mateus L Levandowski
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Síntia I Belangero
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gisele G Manfro
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Stertz
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Sciences, Center for Translational Psychiatry, The University of Texas Health Science Center at Houston, Houston, USA
| | - Márcia Kauer-Sant'anna
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eurípedes C Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Department of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jair J Mari
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rodrigo Grassi-Oliveira
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Elisa Brietzke
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil.,PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental Statem, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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6
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Momany AM, Kamradt JM, Ullsperger JM, Elmore AL, Nigg JT, Nikolas MA. Sex moderates the impact of birth weight on child externalizing psychopathology. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:244-256. [PMID: 27868421 PMCID: PMC5305621 DOI: 10.1037/abn0000238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Low birth weight (LBW) has consistently been associated with childhood attention deficit/hyperactivity disorder (ADHD), and a similar association has been found for childhood externalizing disorders, such as oppositional defiant disorder (ODD) and conduct disorder (CD), albeit to a lesser degree. Although the association between LBW and these disorders has been robustly replicated, few studies have adequately controlled for confounding variables, such as parental age at birth and prenatal tobacco use, examined the specificity of the risk of LBW for ADHD symptoms, or investigated potential nonlinear (i.e., quadratic) effects of birth weight (BW). Additionally, the extent to which LBW confers risk for these disorders depending on childhood sex has rarely been examined. The current study examined associations between BW and ADHD, ODD, and CD symptom dimensions as well as the extent to which such associations are moderated by child sex, while also controlling for confounding variables. Significant interactions between sex and BW emerged across all analyses predicting ADHD and externalizing psychopathology, such that associations were stronger in males relative to females. Results remained when controlling for a number of confounds, including parental age, prenatal tobacco use, comorbid psychopathology, as well as other indicators of maternal and child health during the pre- and perinatal period. Both linear and quadratic associations emerged between BW and both hyperactivity and CD symptoms, whereas BW predicted inattention and ODD symptoms in a linear fashion. Future research should continue to investigate the impact of BW on ADHD and externalizing psychopathology, in particular, the biological mechanisms underlying this association. (PsycINFO Database Record
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Affiliation(s)
- Allison M Momany
- Department of Psychological and Brain Sciences, University of Iowa
| | - Jaclyn M Kamradt
- Department of Psychological and Brain Sciences, University of Iowa
| | | | - Alexis L Elmore
- Department of Psychological and Brain Sciences, University of Iowa
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health and Sciences University
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa
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Mansur RB, Cunha GR, Asevedo E, Zugman A, Rizzo LB, Grassi-Oliveira R, Levandowski ML, Gadelha A, Pan PM, Teixeira AL, McIntyre RS, Mari JJ, Rohde LA, Miguel EC, Bressan RA, Brietzke E. Association of serum interleukin-6 with mental health problems in children exposed to perinatal complications and social disadvantage. Psychoneuroendocrinology 2016; 71:94-101. [PMID: 27258821 DOI: 10.1016/j.psyneuen.2016.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/18/2016] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Abstract
There is consistent evidence that inflammation is involved in mental disorders pathogenesis. Herein, using data from the High Risk Cohort Study for Psychiatric Disorders, we investigated the relationship between parental mood disorders (PMD), environmental factors, serum interleukin-6 (IL6) and mental health problems in children aged 6-12. We measured the serum levels of IL6 in 567 children. Information related to socio-demographic characteristics, mental health problems and multiple risk factors, as well as parent's psychiatric diagnosis, was captured. We evaluated two groups of environmental risk factors (i.e. perinatal complications and social disadvantage) using a cumulative risk model. Results showed that higher serum levels of IL6 were associated with PMD (RR=1.072, p=0.001), perinatal complications (RR=1.022, p=0.013) and social disadvantage (RR=1.024, p=0.021). There was an interaction between PMD and social disadvantage (RR=1.141, p=0.021), as the effect of PMD on IL6 was significantly higher in children exposed to higher levels of social disadvantage. Moreover, there was a positive correlation between IL6 and mental health problems (RR=1.099, p=0.026), which was moderated by exposure to perinatal complications or social disadvantage (RR=1.273, p=0.015 and RR=1.179, p=0.048, respectively). In conclusions, there is evidence of a differential inflammatory activation in children with PMD and exposure to environmental risk factors, when compared to matched peers. Systemic inflammation may be involved in the pathway linking familial risk and mental health problems.
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Affiliation(s)
- Rodrigo B Mansur
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
| | - Graccielle R Cunha
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elson Asevedo
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - André Zugman
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Lucas B Rizzo
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Psychiatry, University of Tuebingen, Tuebingen, Germany
| | - Rodrigo Grassi-Oliveira
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mateus L Levandowski
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Pedro M Pan
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Antônio L Teixeira
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Interdisciplinary Laboratory of Medical Investigation, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Jair J Mari
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Luís A Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eurípedes C Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Department of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elisa Brietzke
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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