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Baldaçara L, Ismael F, Kawakami D, da Rocha GA, Calfat ELDB, Porto DM, Cavalcante BF, Zaramella BP, Ribeiro FV, Dos Santos RM, Grudtner RR, Tung TC, da Silva AG. Brazilian Psychiatric Association Consensus on the physical structure and ideal team for psychiatric emergencies services. Braz J Psychiatry 2024. [PMID: 38635905 DOI: 10.47626/1516-4446-2024-3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION An integral part of Brazil's public health system, the psychiatric emergency service (PES) has been instrumental in improving qualified support for crisis situations of mental disorders, equitable, universally accessible, and humanized. The purpose of this article is to present a systematic review and consensus about the physical area and facilities, and ideal team qualified for psychiatric emergencies services on both Brazilian settings. METHODS The authors conducted a literature search using electronic databases such as MEDLINE (PubMed), Scielo, the Cochrane Database, and documents from the WHO, the Brazilian Ministry of Health, and others deemed relevant by experts. A total of 6839 manuscripts were found, but only 46 were selected. The analysis of article content summarizes consensus statements using the Delphi method and a series of interactive versions to provide a final report. RESULTS Changes to PES are evaluated considering various experiences and models. The authors highlighted that The Emergency Care Network (ECN) must be coordinated with qualified management, effective implementation of integration of all health equipment's and units. PES must have adequate infrastructure; qualified staff, including a psychiatrist; sufficient consultation and observational spaces; tools and resources for differential diagnosis; training for all staff members; and communication with the health care network to facilitate referrals following patient discharge are all necessary. CONCLUSION These standardized models need to be available to public health managers so that they can guide the installation of new services and adjust the existing ones, always looking for improvement. The authors propose requirements for PES as a model to be passed over.
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Affiliation(s)
- Leonardo Baldaçara
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil
| | - Flávia Ismael
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Universidade de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | - Daniel Kawakami
- Psychiatric Emergency Commission of Brazilian Psychiatric Association. Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gislene Alves da Rocha
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil
| | - Elie Leal de Barros Calfat
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brazil
| | - Deisy Mendes Porto
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Associação Catarinense de Psiquiatria, SC, Brazil
| | | | | | | | | | - Roberta Rossi Grudtner
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Secretaria Estadual da Saúde do Rio Grande do Sul, RS, Brazil
| | - Teng Chei Tung
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antônio Geraldo da Silva
- Psychiatric Emergency Commission of Brazilian Psychiatric Association, Brazil. Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil. Faculdade de Medicina da Universidade do Porto, Portugal
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Baldaçara L, Paschoal AB, Pinto AF, Loureiro FF, Gaiotto LAV, Veiga DDL, Almeida TM, Dos Santos DC, Malloy-Diniz LF, de Mello MF, de Mello AF, Sanches M, Gandarela LM, Bernik MA, Nardi AE, da Silva AG, Uchida RR. Brazilian Psychiatric Association guidelines for the treatment of generalized anxiety disorder (GAD). Pharmacological and Psychotherapy approach. Perspectives. Braz J Psychiatry 2023. [PMID: 37956131 DOI: 10.47626/1516-4446-2023-3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To combine elements of a systematic review and critical review to produce best evidence synthesis for the treatament of GAD. METHOD There was included systematic reviews, metanalysis, and randomized controlled trials. Descriptor used was "generalized anxiety disorder", resulting in 4860 articles and 7 other studies, of which 59 were selected. RESULTS Antidepressants and benzodiazepines are indicated, as well as pregabalin. From, atypical antipsychotics quetiapine has been studied. Cognitive behavior therapy (third wave of behavioral and cognitive therapies) as well as individual CBT proven to be effective. CONCLUSION There is extensive literature on many effective treatments for GAD. The present work summarizes the therapeutic possibilities, emphasizing those available in the Brazil. Further studies are still needed to compare other available medications, to assess psychotherapies in more depth, new treatments and specially to assess the ideal time for maintaining therapy.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil. Associação Brasileira de Psiquiatria, Brazil
| | - Ana Beatriz Paschoal
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Aldo Felipe Pinto
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Fabiano Franca Loureiro
- Department of Mental Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Clinical Neuroscience Research Laboratory, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Diogo de Lacerda Veiga
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Thales Marcon Almeida
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Diogo Cesar Dos Santos
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | - Marsal Sanches
- University of Texas Health Science Center, Houston, TX, USA
| | - Lucas Marques Gandarela
- Programa Ansiedade, Instituto de Psiquiatria, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Márcio Antonini Bernik
- Programa Ansiedade, Instituto de Psiquiatria, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio E Nardi
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Ricardo R Uchida
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
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Mosqueiro BP, Costa MDA, Caribé AC, Oliveira e Oliveira FH, Pizutti L, Zimpel RR, Baldaçara L, da Silva AG, Moreira-Almeida A. Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis. Braz J Psychiatry 2023; 45:506-517. [PMID: 37718460 PMCID: PMC10897776 DOI: 10.47626/1516-4446-2023-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/25/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. METHODS A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. RESULTS The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. CONCLUSION Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.
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Affiliation(s)
- Bruno Paz Mosqueiro
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Marianna de Abreu Costa
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - André C. Caribé
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
- Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Fabrício H.A. Oliveira e Oliveira
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Leandro Pizutti
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Rogério R. Zimpel
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil
- ABP, Rio de Janeiro, RJ, Brazil
| | - Antônio Geraldo da Silva
- ABP, Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina, Santo Domingo, Dominican Republic
| | - Alexander Moreira-Almeida
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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Baldaçara L, Leite VDS, Teles ALS, da Silva AG. Puerperal psychosis: an update. Rev Assoc Med Bras (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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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. Braz J Psychiatry 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Baldaçara L, Pettersen ADG, Leite VDS, Ismael F, Motta CP, Freitas RA, Fasanella NA, Pereira LA, Barros MEL, Barbosa L, Teles ALS, Palhano R, Guimaraes HP, Braga MA, Castaldelli-Maia JM, Bicca C, Gligliotti A, Marques ACPR, da Silva AG. Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication. General management and specific interventions for drugs of abuse. Trends Psychiatry Psychother 2022. [PMID: 36463505 DOI: 10.47626/2237-6089-2022-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To present the Brazilian Psychiatric Association's Consensus for the Management of Acute Intoxication. METHODS A group of experts selected by the Brazilian Psychiatric Association searched for articles in the MEDLINE (by PubMed) and Cochrane Database, limited to human studies and acute intoxication. Groups reviewed these materials for appropriateness to the topic and the quality of the work. To perform a table of agreed recommendations at the end of the systematic review, a survey using the Delphi method was conducted. Three survey rounds were conducted to develop a consensus. RESULTS Support for intoxication may start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For that, the group proposed these orders of assessment: A (airway), B (breathing), C (circulation), D.1. (disability), D.2. (differential diagnosis), D.3. (decontamination), D.4. (drug antidotes), E (enhanced elimination). Then, the group of experts presented specific interventions for the main drugs of abuse. CONCLUSIONS The approach to intoxication with drugs of abuse is complex and requires systematic protocols. The group of experts suggested the adoption of the classic use in welcoming the patient of the A-B-C-D-E technique with constant investigation of this patient until reaching a specific conduct and with the support to remit the picture. The group of experts believes that this document, at this time, can help psychiatric, general, and emergency doctors deal with psychiatric emergency episodes due to acute intoxication.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Associação Brasileira de Psiquiatria, Rio de Janeiro (RJ), Brazil
| | | | | | - Flávia Ismael
- Universidade de São Caetano do Sul, São Caetano do Sul (SP), Brazil
| | - Carolina Pereira Motta
- Centro de Atenção Psicossocial de Porto Nacional (TO), Brazil. Hospital Regional de Porto Nacional (TO), ITPAC, Palmas (TO), Brazil
| | | | | | - Lucas Alves Pereira
- Escola Bahiana de Medicina e Saúde Pública e Universidade Salvador, Salvador, (BA), Brazil
| | - Maria Elisa Lima Barros
- Centro Universitário UniFG, Guanambi (BA), Brazil. CAPS II Beija-Flor, Guanambi, (BA), Brazil
| | - Leonardo Barbosa
- Associação Brasileira de Psiquiatria, Rio de Janeiro, (RJ), Brazil
| | | | - Ruy Palhano
- Associação Brasileira de Psiquiatria, Rio de Janeiro, (RJ), Brazil
| | | | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, (SP), Brazil. Department of Psychiatry, Medical School, University of São Paulo, São Paulo, (SP), Brazil
| | - Carla Bicca
- Associação Brasileira de Psiquiatria, Brazil
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da Silva AG, Baldaçara L. Position statement of the Brazilian Psychiatric Association on the use of cannabis in psychiatric treatment. Braz J Psychiatry 2022; 44:572-573. [PMID: 35870135 PMCID: PMC9851767 DOI: 10.47626/1516-4446-2022-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Antônio Geraldo da Silva
- Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil,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
| | - Leonardo Baldaçara
- Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil,Curso de Medicina, Universidade Federal do Tocantins (UFT), Palmas, Tocantins, Brazil
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Grandi GT, Baldaçara RPDC, Coutinho IHILS, Baldaçara L. Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil. SAO PAULO MED J 2022; 140:642-650. [PMID: 36043667 PMCID: PMC9514867 DOI: 10.1590/1516-3180.2021.0731.r1.14122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.
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Affiliation(s)
| | | | | | - Leonardo Baldaçara
- MD, PhD. Assistant Professor, Health Department of the State of Tocantins, Universidade Federal do Tocantins (UFT), Palmas (TO), Brazil
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Pereira LA, da Silva AG, Hemanny C, de Jesus R, Moromizato M, Vieira T, Souza M, Lima MG, Baldaçara L. Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population. Trends Psychiatry Psychother 2022; 45:e20210310. [PMID: 35129902 PMCID: PMC9991416 DOI: 10.47626/2237-6089-2021-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. METHOD An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. RESULTS In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). CONCLUSION The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.
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Affiliation(s)
- Lucas Alves Pereira
- Centro Universitário UNIFTCSalvadorBABrazil Centro Universitário UNIFTC, Salvador, BA, Brazil.
- Faculdade de MedicinaEscola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazil Faculdade de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
| | - Antônio Geraldo da Silva
- Associação Brasileira de PsiquiatriaRio de JaneiroRJBrazil Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.
- Faculdade de MedicinaUniversidade do PortoConselho Federal de MedicinaPortoPortugal Faculdade de Medicina, Universidade do Porto, Conselho Federal de Medicina, Porto, Portugal.
| | - Curt Hemanny
- Faculdades Integradas PadrãoGuanambiBABrazil Faculdades Integradas Padrão (FIP), Guanambi, BA, Brazil.
| | - Rogério de Jesus
- União Metropolitana de Educação e CulturaLauro de FreirasBABrazil União Metropolitana de Educação e Cultura (UNIME), Lauro de Freiras, BA, Brazil.
| | - Maíra Moromizato
- Hospital Juliano MoreiraSalvadorBABrazil Hospital Juliano Moreira, Salvador, BA, Brazil.
| | - Túlio Vieira
- Hospital Juliano MoreiraSalvadorBABrazil Hospital Juliano Moreira, Salvador, BA, Brazil.
| | - Murilo Souza
- Hospital Juliano MoreiraSalvadorBABrazil Hospital Juliano Moreira, Salvador, BA, Brazil.
| | - Manuela Garcia Lima
- Faculdade de MedicinaEscola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazil Faculdade de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
| | - Leonardo Baldaçara
- Comissão de Emergências PsiquiátricasAssociação Brasileira de PsiquiatriaRio de JaneiroRJBrazil Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.
- Universidade Federal do TocantinsPalmasTOBrazil Universidade Federal do Tocantins, Palmas, TO, Brazil.
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12
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Urbanin G, Meira W, Serpa A, Costa DDS, Baldaçara L, da Silva AP, Guatimosim R, Lacerda AM, Oliveira EA, Braule A, Romano-Silva MA, da Silva AG, Malloy-Diniz L, Pappa G, Miranda DM. Social determinants in self-protective behavior: association rule mining study (Preprint). JMIR Public Health Surveill 2021; 8:e34020. [PMID: 35704360 PMCID: PMC9202654 DOI: 10.2196/34020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks. Objective Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil. Methods We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern–mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports. Results The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic. Conclusions Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions. Trial Registration Not applicable.
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Affiliation(s)
- Gabriel Urbanin
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wagner Meira
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Serpa
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Danielle de Souza Costa
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Baldaçara
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Associação Brasileira de Psiquiatria, Brasilia, Brazil
| | - Ana Paula da Silva
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafaela Guatimosim
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Anísio Mendes Lacerda
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Andre Braule
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Romano-Silva
- Centro de Tecnologia em Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio Geraldo da Silva
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Associação Brasileira de Psiquiatria, Brasilia, Brazil
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Leandro Malloy-Diniz
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Associação Brasileira de Psiquiatria, Brasilia, Brazil
- Centro de Tecnologia em Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gisele Pappa
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques Miranda
- Instituto de Saúde Mental Baseada em Evidências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Pediatria, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Centro de Tecnologia em Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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13
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Baldaçara L, Grudtner RR, da S. Leite V, Porto DM, Robis KP, Fidalgo TM, Rocha GA, Diaz AP, Meleiro A, Correa H, Tung TC, Malloy-Diniz L, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention. Braz J Psychiatry 2021; 43:538-549. [PMID: 33331533 PMCID: PMC8555636 DOI: 10.1590/1516-4446-2020-1108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022]
Abstract
This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, 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
| | - Verônica da S. Leite
- Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil
- Secretaria de Saúde do Município 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
| | - Kelly P. Robis
- Departamento de Psiquiatria, Pontifícia Universidade Católica de Minas Gerais (PUC Minas), Belo Horizonte, MG, Brazil
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Gislene A. Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Hospital Universitário Clemente de Faria, Montes Claros, MG, Brazil
| | - Alexandre P. Diaz
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 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
- Departamento de Psiquiatria, 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, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Leandro Malloy-Diniz
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Associação Brasileira de Impulsividade e Patologia Dual, Brasília, DF, Brazil
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Antônio G. da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina (APAL)
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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da Silva AG, Baldaçara L, Cavalcante DA, Fasanella NA, Palha AP. The Impact of Mental Illness Stigma on Psychiatric Emergencies. Front Psychiatry 2020; 11:573. [PMID: 32636773 PMCID: PMC7319091 DOI: 10.3389/fpsyt.2020.00573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Abstract
Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care. Stigma has undesirable consequences in patients with mental disorders. Certain measures can reduce stigma and provide a more dignified way for patients to recover from the crisis. This article aims to discuss the causes of stigma, ways of dealing with it, and achievements that have been made in psychiatric emergency care settings.
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Affiliation(s)
- Antônio Geraldo da Silva
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Asociación Psiquiátrica de América Latina
| | - Leonardo Baldaçara
- Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Asociación Psiquiátrica de América Latina.,Medicine, Universidade Federal do Tocantins, Palmas, Brazil
| | - Daniel A Cavalcante
- Department of Psychiatry, Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,GAPi (Early Psychosis Group), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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17
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Vasconcelos Rocha M, Nery-Fernandes F, Baldaçara L, Parolin Jackowski A, De Castro Quarantini L, Ladeia-Rocha G, De Araujo Neto C, Reis De Oliveira I, Caribé A, Miranda-Scippa Â. Prefrontal gray matter volume in adults bipolar I outpatients is associated with history of suicide attempts? ARCH CLIN PSYCHIAT 2020. [DOI: 10.15761/0101-60830000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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18
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Baldaçara L, Diaz AP, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VDP, Calfat ELB, Ismael F, Périco CAM, Porto DM, Zacharias CEK, Cordeiro Q, da Silva AG, Tung TC. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. ACTA ACUST UNITED AC 2019; 41:324-335. [PMID: 30843960 PMCID: PMC6804299 DOI: 10.1590/1516-4446-2018-0177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/18/2018] [Indexed: 01/07/2023]
Abstract
Objective: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. Methods: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. Conclusion: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation. Systematic review registry number: CRD42017054440.
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Affiliation(s)
- Leonardo Baldaçara
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil
| | - Alexandre P Diaz
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina (UNISUL), Palhoça, SC, Brazil
| | - Verônica Leite
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil.,Secretaria de Saúde do Município de Palmas, Palmas, TO, Brazil
| | - Lucas A Pereira
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Universidade Salvador (UNIFACS), Salvador, BA, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brazil.,Faculdade de Tecnologia e Ciências (FTC), Salvador, BA, Brazil
| | - Roberto M Dos Santos
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.,Pronto Atendimento em Saúde Mental, João Pessoa, PB, Brazil
| | - Vicente de P Gomes Júnior
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Associação Psiquiátrica do Piauí (APPI), Teresina, PI, Brazil
| | - Elie L B Calfat
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Centro de Atenção Integrada à Saúde Mental, Franco da Rocha, SP, Brazil
| | - Flávia Ismael
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Coordenadoria de Saúde Mental, São Caetano do Sul, SP, Brazil.,Universidade de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | - Cintia A M Périco
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Coordenadoria de Saúde Mental, São Bernardo do Campo, SP, Brazil
| | - Deisy M Porto
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria de Santa Catarina, São José, SC, Brazil.,Coordenação Estadual de Saúde Mental, Florianópolis, SC, Brazil
| | - Carlos E K Zacharias
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil.,Secretaria de Saúde do Município de Sorocaba, São Paulo, SP, Brazil
| | - Quirino Cordeiro
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Coordenação-Geral de Saúde Mental, Álcool e Outras Drogas, Ministério da Saúde, Brazil
| | - Antônio Geraldo da Silva
- Asociación Psiquiátrica de América Latina (APAL)Asociación Psiquiátrica de América Latina (APAL).,ABP, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina, Universidade do Porto/Conselho Federal de Medicina (CFM), Porto, Portugal
| | - Teng C Tung
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Baldaçara L, Ismael F, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VDP, Calfat ELB, Diaz AP, Périco CAM, Porto DM, Zacharias CE, Cordeiro Q, da Silva AG, Tung TC. Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. ACTA ACUST UNITED AC 2018; 41:153-167. [PMID: 30540028 PMCID: PMC6781680 DOI: 10.1590/1516-4446-2018-0163] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022]
Abstract
Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient’s appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number: CRD42017054440.
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Affiliation(s)
- Leonardo Baldaçara
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil
| | - Flávia Ismael
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Coordenadoria de Saúde Mental, São Caetano do Sul, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Universidade de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | - Verônica Leite
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil.,Secretaria de Saúde do Município de Palmas, Palmas, TO, Brazil
| | - Lucas A Pereira
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Tecnologia e Ciências (FTC), Salvador, BA.,Universidade Salvador (UNIFACS), Salvador, BA, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brazil
| | - Roberto M Dos Santos
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.,Pronto Atendimento de Saúde Mental, João Pessoa, PB, Brazil
| | - Vicente de P Gomes Júnior
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Psiquiátrica do Piauí (APPI), Teresina, PI, Brazil
| | - Elie L B Calfat
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Centro de Atenção Integrada à Saúde Mental, Franco da Rocha, SP, Brazil
| | - Alexandre P Diaz
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC, Brazil
| | - Cintia A M Périco
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Coordenadoria de Saúde Mental, São Bernardo do Campo, SP, Brazil
| | - Deisy M Porto
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria de Santa Catarina, São José, SC, Brazil.,Coordenação Estadual de Saúde Mental, Florianópolis, SC, Brazil
| | - Carlos E Zacharias
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil.,Secretaria de Saúde do Município de Sorocaba, Sorocaba, SP, Brazil
| | - Quirino Cordeiro
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Coordenação-Geral de Saúde Mental, Álcool e Outras Drogas, Ministério da Saúde, Brazil
| | - Antônio Geraldo da Silva
- Asociación Psiquiátrica de América Latina (APAL).,ABP, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina, Universidade do Porto/Conselho Federal de Medicina (CFM), Porto, Portugal
| | - Teng C Tung
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Baldaçara L, Baldaçara RPDC. Proportion of doctors who stayed in the state of Tocantins after finishing medical residency: preliminary results from a cross-sectional study. SAO PAULO MED J 2018; 136:59-63. [PMID: 28767990 PMCID: PMC9924169 DOI: 10.1590/1516-3180.2016.0340280117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/28/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Few studies have assessed the impact of medical residencies on the public healthcare system. The aim here was to assess the number of specialists who remained in the state of Tocantins after finishing the medical residency program during the first two years of the first programs (2013 and 2014). DESIGN AND SETTING Cross-sectional and exploratory study conducted at the Federal University of Tocantins in Brazil. METHODS All graduates of medical residency programs in Tocantins, of the years 2013 and 2014, were interviewed by telephone and e-mail between May and July 2014. RESULTS Information was obtained from 37 graduates from medical residency. Seventeen (50.0%) were working in the state public healthcare system and only six (17.6%) in a municipal service in June 2014. Considering only the 24 doctors who had never worked in the state of Tocantins before their residency, it was observed that two who graduated in 2013 (20.0%) and five who graduated in 2014 (35.7%), i.e. seven out of the total number (29.2%), had established their homes in Tocantins. CONCLUSIONS The number of graduates from medical residency who stayed in the state of Tocantins in 2013 and 2014 was small. However, this was related to the absence of other programs for continuation of the specialization. The state healthcare system was primarily responsible for employment of these doctors within public services. On the other hand, hiring by municipal services was extremely low.
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Affiliation(s)
- Leonardo Baldaçara
- MD, PhD. Assistant Professor, Universidade Federal do Tocantins (UFT), Health Department of the State of Tocantins, Palmas (TO), Brazil.
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Baldaçara L, Araújo C, Assunção I, Silva ID, Jackowski AP. Reduction of prefrontal thickness in military police officers with post-traumatic stress disorder. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Leonardo Baldaçara
- Federal University of São Paulo, Brazil; Federal University of Tocantins, Brazil
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Baldaçara L, Cogo-Moreira H, Parreira BL, Diniz TA, Milhomem JJ, Fernandes CC, Lacerda ALT. Efficacy of topiramate in the treatment of crack cocaine dependence: a double-blind, randomized, placebo-controlled trial. J Clin Psychiatry 2016; 77:398-406. [PMID: 27046312 DOI: 10.4088/jcp.14m09377] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 05/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We performed a double-blind, randomized, placebo-controlled trial to assess the efficacy of topiramate in the treatment of crack cocaine dependence. METHOD Sixty men who were dependent on cocaine (DSM-IV) (exclusive use of crack cocaine) were selected. The subjects were randomly assigned to either a topiramate group (subjects received 50-200 mg of topiramate per day for 12 weeks) or a control group (subjects received placebo). The initial daily treatment dose was 50 mg, and this dose was increased weekly at increments of 25 to 50 mg, based on the subject's tolerability, to a maximum of 200 mg. All of the subjects also participated in motivational interviews and group therapy. The primary outcome measures were detection of benzoylecgonine in the urine, study retention, frequency of cocaine smoking, amount of cocaine use, and mean amount of money spent on cocaine per week. The study was conducted from February 2013 to February 2014. RESULTS Twenty-nine subjects in the topiramate group and 29 subjects in the control group completed the study. Longitudinal assessment revealed that retention was not significant (odds ratio [OR] = 1.072, P = .908) between the 2 groups. Negative results from a urine test for benzoylecgonine (a cocaine metabolite), which is a measure of cocaine abstinence, were more frequently obtained from the topiramate group (OR = 8.687, P < .001). Topiramate reduced the quantity of cocaine used (mean reduction = -3.108 g, P < .001), the frequency of cocaine use (mean = -0.784 times per week, P = .005), and the amount of money spent on cocaine (mean [US dollars] = -$25.38, P = .015; this variable did not achieve statistical significance after Bonferroni correction) compared with the placebo during the 12 weeks (or 84 days) of the assessment. However, the differences in reductions between the 2 groups in the quantity of cocaine used, the frequency of cocaine use, and money spent on cocaine over time (time × group interaction) were present only during the first 4 weeks, and none of these variables by 12 weeks. The studied groups did not differ with regard to secondary end points, such as study dropout and the number of subjects who reported side effects. CONCLUSIONS The present findings indicate that topiramate is effective and safe and thus reinforce previous data suggesting that topiramate is a potentially useful treatment for crack cocaine dependence. However, we found that topiramate is only useful as an adjunctive treatment during the first 4 weeks of the treatment. Future studies with larger samples are needed to confirm these results. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-3vwfjs and UTN: U1111-1131-4443.
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Affiliation(s)
- Leonardo Baldaçara
- Federal University of Tocantins, CUP-Medicina, Av. NS 15 ALC NO 14, 109 Norte, Caixa Postal 114, Palmas-TO, Brazil, CEP 77001-090
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Garriga M, Pacchiarotti I, Kasper S, Zeller SL, Allen MH, Vázquez G, Baldaçara L, San L, McAllister-Williams RH, Fountoulakis KN, Courtet P, Naber D, Chan EW, Fagiolini A, Möller HJ, Grunze H, Llorca PM, Jaffe RL, Yatham LN, Hidalgo-Mazzei D, Passamar M, Messer T, Bernardo M, Vieta E. Assessment and management of agitation in psychiatry: Expert consensus. World J Biol Psychiatry 2016; 17:86-128. [PMID: 26912127 DOI: 10.3109/15622975.2015.1132007] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions. METHODS An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items. RESULTS Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic. CONCLUSIONS Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.
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Affiliation(s)
- Marina Garriga
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
- b Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Isabella Pacchiarotti
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Siegfried Kasper
- c Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | | | - Michael H Allen
- e University of Colorado Depression Center , Denver , CO 80045 , USA
| | - Gustavo Vázquez
- f Research Center for Neuroscience and Neuropsychology, Department of Neuroscience , University of Palermo , Buenos Aires , Argentina
| | | | - Luis San
- h CIBERSAM, Parc Sanitari Sant Joan De Déu , Barcelona , Catalonia , Spain
| | - R Hamish McAllister-Williams
- i Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Konstantinos N Fountoulakis
- j 3rd Department of Psychiatry, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Philippe Courtet
- k Department of Emergency Psychiatry and Post Acute Care , Hôpital Lapeyronie , CHU Montpellier , France
| | - Dieter Naber
- l Department for Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Esther W Chan
- m Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine , the University of Hong Kong , Hong Kong , China
| | - Andrea Fagiolini
- n School of Medicine, Department of Molecular Medicine , University of Siena , Siena , Italy
| | - Hans Jürgen Möller
- o Department of Psychiatry and Psychotherapy , Ludwig Maximilian University , Munich , Germany
| | - Heinz Grunze
- p Paracelsus Medical University , Salzburg , Austria
| | - Pierre Michel Llorca
- q Service De Psychiatrie B , CHU De Clermont-Ferrand , Clermont-Ferrand , France
| | | | - Lakshmi N Yatham
- s Mood Disorders Centre, Department of Psychiatry , University of British Columbia , Vancouver , British Columbia , Canada
| | - Diego Hidalgo-Mazzei
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Marc Passamar
- t Centre Hospitalier Pierre-Jamet, SAUS , Albi , France
| | - Thomas Messer
- u Danuvius Klinik GmbH, Pfaffenhofen an Der Ilm , Germany
| | - Miquel Bernardo
- b Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
| | - Eduard Vieta
- a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain
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Baldaçara L, Silva ÁF, Castro JGD, Santos GDCA. Common psychiatric symptoms among public school teachers in Palmas, Tocantins, Brazil. An observational cross-sectional study. SAO PAULO MED J 2015; 133:435-8. [PMID: 26648433 PMCID: PMC10871806 DOI: 10.1590/1516-3180.2014.8242810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 10/17/2014] [Accepted: 10/28/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Teachers are at great risk of physical and mental stress due to material or psychological difficulties associated with their work. This study aimed to assess the prevalence of common psychiatric symptoms measured on the Self-Reporting Questionnaire (SRQ-20) scale that would suggest a diagnosis of psychiatric disorders among public school teachers in Palmas, Tocantins, Brazil, in 2012. DESIGN AND SETTING Observational cross-sectional study in Palmas, Tocantins, Brazil. METHOD We assessed 110 municipal teachers in the city of Palmas, Tocantins, Brazil. They were selected randomly from a list of employees of the Municipal Education Department of Palmas. All of them answered the SRQ-20 questionnaire after giving their consent. RESULTS Between the years 2008 and 2011, 24 cases of absence from work due to mental disorders were found. We excluded one case and 109 teachers answered the SRQ-20questionnaire. Out of the 109 teachers assessed, 54 had ≥ 7 points on the SRQ-20 scale. This finding suggests that 49.5% of the teachers had symptoms that were sufficient to consider a diagnosis of mental disorder, with the need for treatment. CONCLUSION Our study found that the prevalence of mental disorders among teachers is as high as seen in the literature. Our results suggest that recognition of mental disorders is low and that the current statistics fail to reach the occupational health sector.
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Affiliation(s)
- Leonardo Baldaçara
- PhD. Professor, Medicine Program and Master´s Health Science Program, Universidade Federal do Tocantins (UFT), Palmas, Tocantins, Brazil
| | - Álvaro Ferreira Silva
- MSc. Researcher, Master's Health Science Program, Universidade Federal do Tocantins (UFT), Palmas, Tocantins, Brazil
| | - José Gerley Díaz Castro
- PhD. Professor, Master's Health Science Program, Universidade Federal do Tocantins (UFT), Palmas, Tocantins, Brazil
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Barcelos AC, Trein AM, Sousa GS, Fleury Neto L, Baldaçara L. Efeitos cardiotóxicos resultantes da interação da risperidona com diuréticos tiazídicos. J bras psiquiatr 2014. [DOI: 10.1590/0047-2085000000048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Antipsicóticos atípicos têm sua ação em doses que podem produzir efeitos colaterais importantes. A risperidona é o antipsicótico atípico de nova geração mais utilizado na atualidade e seu uso está associado a tratamento de esquizofrenia, transtornos psicóticos, episódios de mania e nos distúrbios de comportamento, entre outros. Os efeitos adversos mais importantes estão relacionados ao sistema nervoso central e autônomo, sistema endócrino e sistema cardiovascular. Neste último, pode haver efeitos inotrópicos negativos e alterações no eletrocardiograma, como prolongamento do intervalo QT, podendo causar taquicardia e arritmias. Relatamos um caso de um homem de 48 anos com história de delírio persecutório após ser ameaçado no trabalho, que estava sendo tratado com risperidona e paroxetina. Por não haver melhora, suas doses foram aumentadas e o paciente apresentou alargamento do intervalo QTc, com diminuição da amplitude da onda T e aumento da onda U, e hipocalemia. Além disso, o paciente era hipertenso e estava em uso de hidroclorotiazida. A risperidona tem o potencial de bloquear o componente rápido do canal cardíaco de potássio e isso prolonga o processo de repolarização dos ventrículos, podendo causar torsade de pointes, morte súbita e arritmias. Já a hidroclorotiazida causa hipocalemia, provocando alterações na contração e relaxamento do miocárdio. Houve interação medicamentosa grave entre duas drogas com potencial arritmogênico, o que levou às alterações no eletrocardiograma e produziu sintomas danosos ao paciente. A troca do antipsicótico atípico para um típico e da hidroclorotiazida por um diurético que não causa hipocalemia trouxe melhoras ao paciente.
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Baldaçara L, Diniz TA, Parreira BL, Milhomem JJ, Almeida LJCD, Fernandes CC. Could disulfiram be a new treatment for crack cocaine dependence?: a pilot study. Braz J Psychiatry 2013; 35:97-8. [PMID: 23567610 DOI: 10.1016/j.rbp.2012.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Baldaçara L, Ferreira JR, Filho LCPS, Venturini RR, Coutinho OMVC, Camarço WC, Fernandes CC, Júnior EV. Behavior disorder after encephalitis caused by dengue. J Neuropsychiatry Clin Neurosci 2013; 25:E44. [PMID: 23487229 DOI: 10.1176/appi.neuropsych.12020040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Borgio JGF, Baldaçara L, Moraes WDS, Lacerda ALT, Montaño MB, Jackowski AP, Tufik S, Ramos LR, Bressan RA. Hippocampal volume and CDR-SB can predict conversion to dementia in MCI patients. Arq Neuropsiquiatr 2013; 70:839-42. [PMID: 23175194 DOI: 10.1590/s0004-282x2012001100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/03/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the combination of two factors: clinical dementia rating sum of boxes scores (CDR-SB) and hippocampal volume (HV) as predictors of conversion from mild cognitive impairment (MCI) to dementia. METHODS Twenty-eight individuals (9 normal and 19 with MCI) were classified according to their CDR sum of boxes scores into 3 groups. RESULTS The hippocampal volume was significantly lower in the high-risk group and in those who developed dementia after two years. The rate of conversion was crescent among the three groups. CONCLUSION We were proposed an additional measurement of the hippocampal volume which may be helpful in the prognosis. However, we noted that the CDR-SB is a method as efficient as neuroimaging to predict dementia with the advantage of being a procedure for low cost and easy implementation, more consistent with public policy.
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Baldaçara RPDC, Fernandes MDFM, Baldaçara L, Aun WT, de Mello JF, Pires MC. Prevalence of allergen sensitization, most important allergens and factors associated with atopy in children. SAO PAULO MED J 2013; 131:301-8. [PMID: 24310798 PMCID: PMC10876323 DOI: 10.1590/1516-3180.2013.1315502] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 12/26/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Knowledge of the profile of allergen sensitization among children is important for planning preventive measures. The objective of this study was to assess the prevalence and profile of sensitization to inhaled allergens and food among children and adolescents in an outpatient population in the city of Palmas. DESIGN AND SETTING Cross-sectional study at outpatient clinics in Palmas, Tocantins, Brazil. METHODS Ninety-four patients aged 1-15 years who were attending two pediatric outpatient clinics were selected between September and November 2008. All of the subjects underwent clinical interviews and skin prick tests. RESULTS A positive skin prick test was observed in 76.6% of the participants (72.3% for inhalants and 28.9% for food allergens). The most frequent allergens were Dermatophagoides pteronyssinus (34%), cat epithelium (28.7%), dog epithelium (21.3%), Dermatophagoides farinae (19.1%), Blomia tropicalis (18.1%), cow's milk (9.6%) and grasses (9.6%). A positive skin prick test correlated with a history of atopic disease (odds ratio, OR = 5.833; P = 0.002), a family history of atopic disease (OR = 8.400; P < 0.001), maternal asthma (OR = 8.077; P = 0.048), pet exposure (OR = 3.600; P = 0.012) and cesarean delivery (OR = 3.367; P = 0.019). CONCLUSION Dermatophagoides pteronyssinus was the most frequent aeroallergen and cow's milk was the most prevalent food allergen. There was a positive correlation between a positive skin prick test and several factors, such as a family history of atopic disease, maternal asthma, pet exposure and cesarean delivery.
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Affiliation(s)
| | - Maria de Fátima Marcelos Fernandes
- MD, MSc. Head of the Diagnostic and Therapeutic Division, Department of Allergy and Immunology, Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil.
| | - Leonardo Baldaçara
- MD, PhD. Associate Professor in the Department of Medicine, Universidade Federal do Tocantins (UFT), Palmas, Tocantins, Brazil.
| | - Wilson Tartuce Aun
- MD. Head of the Immunology Section, Department of Allergy and Immunology, Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil.
| | - João Ferreira de Mello
- MD, PhD. Director of the Department of Allergy and Immunology, Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil.
| | - Mario Cesar Pires
- MD, PhD. Head of the Diagnostic and Therapeutic Division, Department of Dermatology, Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil.
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Baldaçara L, Borgio JGF, Araújo C, Nery-Fernandes F, Lacerda ALT, Moraes WADS, Montaño MBMM, Rocha M, Quarantini LC, Schoedl A, Pupo M, Mello MF, Andreoli SB, Miranda-Scippa A, Ramos LR, Mari JJ, Bressan RA, Jackowski AP. Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder. Dement Neuropsychol 2012; 6:203-211. [PMID: 29213799 PMCID: PMC5619331 DOI: 10.1590/s1980-57642012dn06040003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.
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Affiliation(s)
- Leonardo Baldaçara
- Federal University of São Paulo, SP, Brazil.,Federal University of Tocantins, TO, Brazil
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Baldaçara L, Borgio JGF, Moraes WADS, Lacerda ALT, Montaño MBMM, Tufik S, Bressan RA, Ramos LR, Jackowski AP. Cerebellar volume in patients with dementia. ACTA ACUST UNITED AC 2012; 33:122-9. [PMID: 21829904 DOI: 10.1590/s1516-44462011000200006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 09/24/2010] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this study was to examine the cerebellar volume of subjects at different stages of Alzheimer's disease and to investigate whether volume reductions in this structure are related to cognitive decline. METHOD Ninety-six subjects from an epidemiological study were submitted to a magnetic resonance imaging scan and evaluated using the Mini-Mental State Examination and the Functional Activities Questionnaire. Subjects were divided into five groups according to the Clinical Dementia Rating scale. Twenty-six subjects from the original group who had no dementia diagnosis at baseline were re-evaluated for the onset of dementia after two years. RESULTS The volumes of the cerebellar hemispheres, posterior cerebellar lobe, vermis and temporal lobe were found to be reduced as a function of the severity of the disease. There were significant positive correlations between the volume of the temporal lobe and cerebellum and the language, attention, and total scores in the Mini-Mental State Examination and the Functional Activities Questionnaire. A logistic regression analysis demonstrated that reduced temporal lobe, posterior cerebellar lobe and vermal volume at baseline is a risk factor for the onset of dementia. CONCLUSION This is the first study demonstrating that reduced cerebellar volume is already apparent at the predementia stage. The results of this study support the involvement of the cerebellum in the progression of dementia. Whereas the cerebellum might not be directly associated with the origin of Alzheimer's disease, it may provide useful information related to its prognosis.
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Affiliation(s)
- Leonardo Baldaçara
- Laboratório Interdisciplinar de Neurociências Clínicas, Department of Psychiatry, Universidade Federal de São Paulo, Brazil.
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Baldaçara L, Diniz T, Parreira B, Milhomem J, Baldaçara R. Organic mental disorder after pneumococcal meningoencephalitis with autism-like symptoms. Braz J Psychiatry 2011; 33:410-1. [PMID: 22189932 DOI: 10.1590/s1516-44462011000400016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baldaçara L, Jackowski AP, Schoedl A, Pupo M, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample. J Psychiatr Res 2011; 45:1627-33. [PMID: 21824628 DOI: 10.1016/j.jpsychires.2011.07.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. In this context, the current study evaluated whether cerebellar volume is associated with PTSD. METHODS Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of São Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis. RESULTS PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. In PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01). CONCLUSION The cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development.
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Affiliation(s)
- Leonardo Baldaçara
- Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), Brazil.
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Baldaçara L, Nery-Fernandes F, Rocha M, Quarantini LC, Rocha GGL, Guimarães JL, Araújo C, Oliveira I, Miranda-Scippa A, Jackowski A. Is cerebellar volume related to bipolar disorder? J Affect Disord 2011; 135:305-9. [PMID: 21783257 DOI: 10.1016/j.jad.2011.06.059] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 06/29/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent data suggest that cerebellum influences emotion modulation in humans. The findings of cerebellar abnormalities in bipolar disorder (BD) are especially intriguing given the link between the cerebellum emotional and behavioral regulation. The purpose of this study was to evaluate cerebellar volume in patients with euthymic BD type I compared to controls. Moreover, we investigated the possible relationship between cerebellar volume and suicidal behavior. METHODS Forty-patients with euthymic BD type I, 20 with and 20 without history of suicide attempt, and 22 healthy controls underwent an MRI scan. The participants were interviewed using the Structured Clinical Interview with the DSM-IV axis I (SCID-I), the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS) and the Barratt Impulsiveness Scale (BIS-11). RESULTS Groups were age, gender and years of schooling-matched. The left cerebellum (p=0.02), right cerebellum (p=0.02) and vermis (p<0.01) were significantly smaller in the BD group; however, there were no volumetric differences between the BD subjects with and without suicidal attempt. There was no correlation between cerebellar measurements and clinical variables. LIMITATIONS The main strength is that our sample consisted of patients with euthymic BD type I without any comorbidities, however, these results cannot establish causality as the cross-sectional nature of the study. CONCLUSIONS Our findings suggest that the reduction in cerebellar volumes observed in BD type I might be a trait-related characteristic of this disorder. Additional studies with larger samples and subtypes of this heterogeneous disorder are warranted to determine the possible specificity of this cerebellar finding.
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Affiliation(s)
- L Baldaçara
- Universidade Federal Tocantins, Tocantins, Brazil.
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Baldaçara L, Sanches M, Cordeiro DC, Jackowski AP. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Rev Bras Psiquiatr 2011; 33:30-9. [DOI: 10.1590/s1516-44462011000100008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/07/2011] [Indexed: 05/26/2023]
Abstract
OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s) used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or haloperidol alone. The Overt Agitation Severity Scale, Overt Aggression Scale and Ramsay Sedation Scale were applied within 12 hours after the first dosage. RESULTS: All medications produced a calming effect within one hour of administration, but only olanzapine and haloperidol reduced agitation by less than 10 points, and only olanzapine reduced aggression by less than four points in the first hour. After twelve hours, only patients treated with haloperidol plus midazolam had high levels of agitation and aggression and also more side effects. Ziprasidone, olanzapine and haloperidol alone had more stable results for agitation control, while ziprasidone, haloperidol plus promethazine and olanzapine had stable results for aggression control. CONCLUSION: Olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol were effective in controlling agitation and aggression caused by mental illness over 12 hours. Although all the drugs had advantages and disadvantages, haloperidol plus midazolam was associated with the worst results in all the observed parameters.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Brazil; Universidade Federal de São Paulo, Brazil
| | - Marsal Sanches
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; University of Texas, USA
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Baldaçara L, de Souza DN, Canton R, Ratto L. Thyroid traps that every psychiatrist should be aware of. Braz J Psychiatry 2009; 31:288-9. [PMID: 19784501 DOI: 10.1590/s1516-44462009000300022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baldaçara L, Borgio JGF, Lacerda ALTD, Jackowski AP. Cerebellum and psychiatric disorders. Rev Bras Psiquiatr 2008; 30:281-9. [PMID: 18833430 DOI: 10.1590/s1516-44462008000300016] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 05/29/2008] [Indexed: 12/26/2022]
Abstract
OBJECTIVE: The objective of this update article is to report structural and functional neuroimaging studies exploring the potential role of cerebellum in the pathophysiology of psychiatric disorders. METHOD: A non-systematic literature review was conducted by means of Medline using the following terms as a parameter: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" and "attention deficit hyperactivity disorder". The electronic search was done up to April 2008. DISCUSSION: Structural and functional cerebellar abnormalities have been reported in many psychiatric disorders, namely schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, dementia and attention deficit hyperactivity disorder. Structural magnetic resonance imaging studies have reported smaller total cerebellar and vermal volumes in schizophrenia, mood disorders and attention deficit hyperactivity disorder. Functional magnetic resonance imaging studies using cognitive paradigms have shown alterations in cerebellar activity in schizophrenia, anxiety disorders and attention deficit hyperactivity disorder. In dementia, the cerebellum is affected in later stages of the disease. CONCLUSION: Contrasting with early theories, cerebellum appears to play a major role in different brain functions other than balance and motor control, including emotional regulation and cognition. Future studies are clearly needed to further elucidate the role of cerebellum in both normal and pathological behavior, mood regulation, and cognitive functioning.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal de São Paulo, Brazil; Irmandade da Santa Casa de São Paulo, Brazil; Universidade Federal do Tocantins, Brazil
| | | | - Acioly Luiz Tavares de Lacerda
- Universidade Federal de São Paulo, Brazil; Instituto Sinapse de Neurociências Clínicas, Brazil; Centro de Pesquisa e Ensaios Clínicos Sinapse-Bairral, Brazil
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Baldaçara L, de Castro Ferrari MC, Monteiro BF, Uchida RR, Sanches M. Hypomania Induced by Atypical Antipsychotics among Schizophrenic Patients: Report of Three Cases. Pharmacopsychiatry 2007; 40:169-70. [PMID: 17694481 DOI: 10.1055/s-2007-984388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Induction of mania or hypomania related to the use of atypical antipsychotics among patients with no history of mood disorders has been previously reported. We reported the cases of three schizophrenic patients with no previous history of mood disorders (including no history of mania or hypomania episodes) who developed hypomania associated to the use of atypical antipsychotics.
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Amadera GD, Baldaçara L, Gennaro K, Uchida R, Sanches M. [Posttraumatic stress disorder after automatic implantable carvioverter defibrillator]. Rev Bras Psiquiatr 2007; 29:191-2. [PMID: 17639262 DOI: 10.1590/s1516-44462007000200023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Baldaçara L, Nóbrega LPC, Haraguchi F, Lastoria V, Suozzo AC. [Cultural aspects importance in a case with psychomotor agitation]. Braz J Psychiatry 2006; 28:159-60. [PMID: 16810404 DOI: 10.1590/s1516-44462006000200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baldaçara L, Nóbrega LPC, Freirias A, Marques AP, Sanches M. [Schizophrenia and body image distortion: nosological considerations]. Braz J Psychiatry 2005; 27:343-4. [PMID: 16358121 DOI: 10.1590/s1516-44462005000400018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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