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Teles ALS, Baldaçara L, da Silva AG, Leite VDS, Benito ALP, Ribeiro FV. Interfaces between oncology and psychiatry. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S129. [PMID: 38865548 PMCID: PMC11164258 DOI: 10.1590/1806-9282.2024s129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/26/2023] [Indexed: 06/14/2024]
Affiliation(s)
| | - Leonardo Baldaçara
- Universidade Federal do Tocantins – Palmas (TO), Brazil
- Brazilian Psychiatric Association – Rio de Janeiro (RJ), Brazil
| | - Antônio Geraldo da Silva
- Brazilian Psychiatric Association – Rio de Janeiro (RJ), Brazil
- Universidade Federal de Minas Gerais – Belo Horizonte (MG), Brazil
| | - Verônica da Silveira Leite
- Universidade Federal do Tocantins – Palmas (TO), Brazil
- Brazilian Psychiatric Association – Rio de Janeiro (RJ), Brazil
| | - Ana Lucia Paya Benito
- Brazilian Psychiatric Association – Rio de Janeiro (RJ), Brazil
- Brazilian Society of Psycho-oncology – São Paulo (SP), Brazil
| | - Flávio Veloso Ribeiro
- Universidade Federal do Tocantins – Palmas (TO), Brazil
- Brazilian Psychiatric Association – Rio de Janeiro (RJ), Brazil
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2
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Witt K, McGill K, Leckning B, Hill NT, Davies BM, Robinson J, Carter G. Global prevalence of psychiatric in- and out-patient treatment following hospital-presenting self-harm: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102295. [PMID: 37965430 PMCID: PMC10641155 DOI: 10.1016/j.eclinm.2023.102295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Hospital-treated self-harm is common, costly, and strongly associated with suicide. Whilst effective psychosocial interventions exist, little is known about what key factors might modify the clinical decision to refer an individual to psychiatric in- and/or out-patient treatment following an episode of hospital-treated self-harm. Methods We searched five electronic databases (CENTRAL, CDSR, MEDLINE, Embase, and PsycINFO) until 3 January 2023 for studies reporting data on either the proportion of patients and/or events that receive a referral and/or discharge to psychiatric in- and/or outpatient treatment after an episode of hospital-treated self-harm. Pooled weighted prevalence estimates were calculated using the random effects model with the Freedman-Tukey double arcsine adjustment in R, version 4.0.5. We also investigated whether several study-level and macro-level factors explained variability for these outcomes using random-effects meta-regression. The protocol of this review was pre-registered with PROSPERO (CRD42021261531). Findings 189 publications, representing 131 unique studies, which reported data on 243,953 individual participants who had engaged in a total of 174,359 episodes of self-harm were included. Samples were drawn from 44 different countries. According to World Bank classifications, most (83.7%) samples were from high income countries. Across the age range, one-quarter of persons were referred for inpatient psychiatric care and, of these, around one-fifth received treatment. Just over one-third were referred to outpatient psychiatric care, whilst around half of those referred received at least one treatment session across the age range. Event rate estimates were generally of a lower magnitude. Subgroup analyses found that older adults (mean sample age: ≥60 years) may be less likely than young people (mean sample age: ≤25 years) and adults (mean sample age: >25 years to <60 years) to be referred for outpatient psychiatric care following self-harm. More recent studies were associated with a small increase in the proportion of presentations (events) that were referred to, and received, psychiatric outpatient treatment. No macro-level factor explained between-study heterogeneity. Interpretation There is considerable scope for improvement in the allocation and provision of both in- and out-patient psychiatric care following hospital-presenting self-harm, particularly considering that the period after discharge from general hospitals represents the peak risk period for repeat self-harm and suicide. Given the marked between-study heterogeneity, the basis for allocation of aftercare treatment is therefore not yet known and should be further studied. Funding There was no specific funding for this review.
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Affiliation(s)
- Katrina Witt
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Katie McGill
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Local Health District, Waratah, New South Wales, Australia
| | - Bernard Leckning
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Nicole T.M. Hill
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | | | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
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Baldaçara L, Leite VDS, Teles ALS, da Silva AG. Puerperal psychosis: an update. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S125. [PMID: 37556644 PMCID: PMC10411698 DOI: 10.1590/1806-9282.2023s125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/18/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Leonardo Baldaçara
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Universidade Federal do Tocantins – Palmas (TO), Brazil
| | - Verônica da Silveira Leite
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Universidade Federal do Tocantins – Palmas (TO), Brazil
| | - Ana Luiza Silva Teles
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Centro Universitário de Brasília – Brasília (DF), Brazil
| | - Antônio Geraldo da Silva
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Universidade Federal de Minas Gerais – Belo Horizonte (MG), Brazil
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4
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Baldaçara L, Ramos A, Castaldelli-Maia JM. Managing drug-induced psychosis. Int Rev Psychiatry 2023; 35:496-502. [PMID: 38299647 DOI: 10.1080/09540261.2023.2261544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 02/02/2024]
Abstract
Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is expected to resolve after a 30-day period of sobriety, however, individuals with this condition are more likely to develop severe drug addiction. Compared to primary psychosis, participants with drug-induced psychosis exhibit poorer family history of psychotic diseases, higher insight, fewer positive and negative symptoms, more depressive symptoms, and greater anxiety. Substance-induced psychosis is strongly associated with the emergence of bipolar illness or schizophrenia spectrum disorder, with an increased chance of developing schizophrenia at a younger age. Episodes of self-harm after substance-induced psychosis are strongly linked to an elevated likelihood of developing schizophrenia or bipolar disorder. Effective treatment involves ruling out emergencies, investigating underlying causes, and addressing acute intoxication and withdrawal. Management includes dynamic assessment, intervention, and vigilant monitoring in cases of suicidal behaviour. Antipsychotics may be used for short term, with gradual discontinuation when a person is in a stable condition. Relapse prevention strategies, both medication and non-medication-based, are crucial in long-term management. Conversion rates to schizophrenia or bipolar disorder can be as high as one in three individuals, with cannabis users and those with early-onset substance abuse at the highest risk.
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Affiliation(s)
- Leonardo Baldaçara
- Federal University of Tocantins, Palmas, Brazil
- Directory Board, Brazilian Psychiatric Association, Rio de Janeiro, Brazil
| | - Artur Ramos
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - João Maurício Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
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5
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Baldaçara L, Weber CAT, Gorender M, Grudtner RR, Peu S, Teles ALS, Passos IC, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 3. Suicide prevention hotlines. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:54-61. [PMID: 35809251 PMCID: PMC9976911 DOI: 10.47626/1516-4446-2022-2536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022]
Abstract
Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness.
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Affiliation(s)
- Leonardo Baldaçara
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Universidade Federal do Tocantins, Palmas, TO, Brazil
| | - César Augusto Trinta Weber
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Centro de Estudos José de Barros Falcão, Porto Alegre, RS, Brazil
| | - Miriam Gorender
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Roberta R. Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Hospital Psiquiátrico São Pedro, Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandra Peu
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Centro Universitário de Brasília, Brasília, DF, Brazil
| | | | - Ives Cavalcante Passos
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - João Quevedo
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas, Houston, TX, USA
| | - Antônio Geraldo da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina (APAL)
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Programa de Pós-Graduação em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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6
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Baldaçara L. Editorial: Current challenges and evidence-based medicine in psychiatric emergencies. Front Psychiatry 2023; 14:1145280. [PMID: 36937733 PMCID: PMC10014996 DOI: 10.3389/fpsyt.2023.1145280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 03/05/2023] Open
Affiliation(s)
- Leonardo Baldaçara
- Medicine, Federal University of Tocantins, Palmas, Tocantins, Brazil
- Board of Directors, Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil
- *Correspondence: Leonardo Baldaçara
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Implicações para homens do afastamento do(a) filho(a) devido medida protetiva de urgência. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao03427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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8
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Duarte D, El-Hagrassy MM, Couto T, Gurgel W, Frey BN, Kapczinski F, Corrêa H. Physician suicide demographics and the COVID-19 pandemic. BRAZILIAN JOURNAL OF PSYCHIATRY 2022; 44:124-135. [PMID: 35081210 PMCID: PMC9041957 DOI: 10.1590/1516-4446-2021-1865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2023]
Abstract
Objective: Methods: Results: Conclusions:
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Affiliation(s)
| | | | | | | | - Benicio N. Frey
- McMaster University, Canada; St. Joseph’s Healthcare Hamilton, Canada
| | - Flavio Kapczinski
- McMaster University, Canada; Universidade Federal do Rio Grande do Sul, Brazil
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9
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Shirzad F, Gholamzad S, Shafiee M, Shariat SV. Development of a pre-hospital emergencies protocol for the management of suicidal patients in Iran. BMC Emerg Med 2021; 21:47. [PMID: 33853531 PMCID: PMC8048184 DOI: 10.1186/s12873-021-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation. Method We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks. Results The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered. Conclusion A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shakiba Gholamzad
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Shafiee
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychological Health research institute (PHRI), Iran University of Medical Science, Tehran, Iran. .,School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran.
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10
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Baldaçara L, da Silva AG, Pereira LA, Malloy-Diniz L, Tung TC. The Management of Psychiatric Emergencies in Situations of Public Calamity. Front Psychiatry 2021; 12:556792. [PMID: 33643085 PMCID: PMC7905390 DOI: 10.3389/fpsyt.2021.556792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
The prevalence of mental health problems in the general population during a public calamity is high. In calamities, the number of patients who present with mental disorder outbreaks or crises may increase, but the necessary support systems to help them may be impaired if they have not been planned for. Although there are several models for addressing psychiatric emergencies, the general rules are the same, especially when it comes to making these services easily available to the affected population. In this article, we seek to review and present recommendations for the management of psychiatric emergencies in situations of public calamity, including disasters, physical and medical catastrophes, epidemics, and pandemics.
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Affiliation(s)
- Leonardo Baldaçara
- Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Medicine, Universidade Federal do Tocantins, Palmas, Brazil
| | - Antônio Geraldo da Silva
- Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Lucas Alves Pereira
- Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Departamento de Psiquiatria, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Leandro Malloy-Diniz
- Mental Health Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Psychology Department, Universidade FUMEC, Belo Horizonte, Brazil
| | - Teng Chei Tung
- Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Universidade de São Paulo, São Paulo, Brazil
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11
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Baldaçara L, Rocha GA, Leite VDS, Porto DM, Grudtner RR, Diaz AP, Meleiro A, Correa H, Tung TC, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. ACTA ACUST UNITED AC 2020; 43:525-537. [PMID: 33111773 PMCID: PMC8555650 DOI: 10.1590/1516-4446-2020-0994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/21/2020] [Indexed: 12/28/2022]
Abstract
Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Gislene A Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil.,Serviço Especializado em Reabilitação em Deficiência Intelectual, Associação de Pais e Amigos dos Excepcionais, Montes Claros, MG, Brazil
| | - Verônica da S Leite
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria Municipal de Saúde de Palmas, Palmas, TO, Brazil
| | - Deisy M Porto
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Catarinense de Psiquiatria, Florianópolis, SC, Brazil
| | - Roberta R Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Núcleo de Dor e Neuromodulação, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Secretaria Estadual da Saúde, Porto Alegre, RS, Brazil
| | - Alexandre P Diaz
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Humberto Correa
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Teng C Tung
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.,Serviços de Pronto Socorro e Interconsultas, IPq, HCFMUSP, São Paulo, SP, Brazil
| | - João Quevedo
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Antônio G da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Asociación Psiquiátrica de América Latina (APAL)
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