Lithium response in bipolar disorder is associated with focal adhesion and PI3K-Akt networks: a multi-omics replication study.

Lithium is the gold standard treatment for bipolar disorder (BD). However, its mechanism of action is incompletely understood, and prediction of treatment outcomes is limited. In our previous multi-omics study of the Pharmacogenomics of Bipolar Disorder (PGBD) sample combining transcriptomic and genomic data, we found that focal adhesion, the extracellular matrix (ECM), and PI3K-Akt signaling networks were associated with response to lithium. In this study, we replicated the results of our previous study using network propagation methods in a genome-wide association study of an independent sample of 2039 patients from the International Consortium on Lithium Genetics (ConLiGen) study. We identified functional enrichment in focal adhesion and PI3K-Akt pathways, but we did not find an association with the ECM pathway. Our results suggest that deficits in the neuronal growth cone and PI3K-Akt signaling, but not in ECM proteins, may influence response to lithium in BD.

Lithium Response in Bipolar Disorder is Associated with Focal Adhesion and PI3K-Akt Networks: A Multi-omics Replication Study.

Lithium is the gold standard treatment for bipolar disorder (BD). However, its mechanism of action is incompletely understood, and prediction of treatment outcomes is limited. In our previous multi-omics study of the Pharmacogenomics of Bipolar Disorder (PGBD) sample combining transcriptomic and genomic data, we found that focal adhesion, the extracellular matrix (ECM), and PI3K-Akt signaling networks were associated with response to lithium. In this study, we replicated the results of our previous study using network propagation methods in a genome-wide association study of an independent sample of 2,039 patients from the International Consortium on Lithium Genetics (ConLiGen) study. We identified functional enrichment in focal adhesion and PI3K-Akt pathways, but we did not find an association with the ECM pathway. Our results suggest that deficits in the neuronal growth cone and PI3K-Akt signaling, but not in ECM proteins, may influence response to lithium in BD.

General hospital specialists' attitudes toward psychiatry: a cross-sectional survey in seven countries.

OBJECTIVE: Psychiatric comorbidities are common in physical illness and significantly affect health outcomes. Attitudes of general hospital doctors toward psychiatry are important as they influence referral patterns and quality of care. Little is known about these attitudes and their cultural correlates. The aim of this study was to identify attitudes toward psychiatry among general hospital specialists in relation to culture of the practice setting and other clinician factors (gender, age, seniority and specialty). METHODS: A cross-sectional, descriptive study was carried out in seven countries (New Zealand, China, Sri Lanka, Russia, Israel, Brazil, the Netherlands). Data were collected from senior medical staff of various disciplines using an updated version of Mayou and Smith's (1986) self-administered questionnaire. RESULTS: A total of 889 hospital doctors participated. While favourable attitudes toward both psychiatric consultation and management were endorsed by a majority, significant differences were also observed between countries. Subgroup differences were mostly confined to gender, acuity of practice setting and specialty. For example, female doctors in Russia (χ2=7.7, p=0.0056), China (χ2=9.2, p=0.0025) and the Netherlands (χ2=5.7, p=0.0174) endorsed more positive attitudes compared with their male counterparts, but this gender effect was not replicated in the total sample. Chronic care specialists were overall more inclined to manage patients' emotional problems compared with those working in acute care (χ2=70.8, p (adjusted)<0.0001), a significant finding seen also in individual countries (China, New Zealand, the Netherlands, Russia). Physicians were more favourably disposed toward psychiatry compared with other specialists, especially surgeons, in all countries except Israel. CONCLUSIONS: This study adds to evidence for the association of medical attitudes with individual clinician factors and demonstrates that the influence of these factors varies by country. Understanding these issues may help to overcome barriers and improve quality of care provided to general hospital patients.

O luto nos tempos da COVID-19: desafios do cuidado durante a pandemia / Grief in the times of COVID-19:challenges to mental health care during the pandemics / El duelo en los tiempos de COVID-19: desafios para la atención en salud mental durante la pandemia / Le deuil aux temps de la COVID-19: les défis des soins de santé mentale durant la pandémie

Este artigo pretende discutir aspectos universais e peculiares da vivência de luto no contexto da pandemia por COVID-19, a partir da escuta clínica de familiares que perderam seus parentes que se encontravam internados. O trajeto para atingir este objetivo inicia-se com a descrição do espaço de escuta fornecido pelo APEM-COVID no Hospital de Clínicas da Unicamp; segue com uma apresentação sobre o luto na perspectiva de alguns reconhecidos autores e continua discutindo elementos observados no processo de luto inserido numa conjuntura sem precedente na história recente. As falas recortadas dos atendimentos dialogam e desafiam aspectos teóricos, pelo inédito do momento em que se inserem, valorizando a importância do cuidado ofertado e seu potencial de construção de saber.

The present article discusses universal and particular aspects of the mourning process during the COVID-19 pandemic. It is based on clinical listening of families who lost relatives at our inpatient service. First, we describe the type of care offered by the APEM-COVID group at the General Hospital of the University of Campinas. Then we present different theoretical approaches to grieving and finally discuss specific elements of grief noticed during the pandemic. Excerpts extracted from clinical appointments relate to and challenge theoretical aspects, shedding light on the importance of the specific type of care provided to patients and its potential to build knowledge.

Cet article discute quelques aspects universels et particuliers de l'expérience du deuil dans le contexte de la pandémie de COVID-19 à partir de l'écoute clinique de membres de famille de patients internés décédés. En premier lieu, on décrit l'espace d'écoute que le groupe APEM-COVID offre aux patients et à leurs familles à l'Hôpital des Cliniques de l'Université de Campinas. Ensuite, de différentes perspectives sur le deuil d'auteurs renommés sont présentées et pour conclure, on discute les éléments identifiés du deuil lors de ce moment si tragique et sans précédent dans l'histoire mondiale récente. Les discours des proches défient souvent les aspects théoriques dû à l'inédit du moment dans lesquels ils sont insérés, ce qui souligne l'importance des soins offerts et leur potentiel pour la construction du savoir.

El presente artículo pretende discutir aspectos universales y particulares del duelo ocasionado por la pandemia de COVID-19, tomando como punto de partida la escucha clínica de familiares de pacientes que murieron durante la hospitalización. Empezaremos con la descripción del espacio de escucha, ofrecido por el grupo APEM-COVID, en el Hospital de Clínicas de la Universidad de Campinas; enseguida, presentaremos conceptos de duelo en la perspectiva de autores muy reconocidos; y por fin discutiremos los elementos del proceso de duelo durante la presente coyuntura de una pandemia sin precedentes en la historia reciente de la humanidad. Aspectos teóricos son desafiados por la realidad invocada en las palabras de los familiares escuchados y se vuelve evidente la importancia del cuidado ofrecido, así como el potencial de construir conocimiento acerca del duelo durante situaciones extremas.

A historical account of schizophrenia proneness categories from DSM-I to DSM-5 (1952-2013) / Uma revisão histórica das categorias de propensão à esquizofrenia do DSM-I ao DSM-5 (1952-2013) / Un rappel historique des catégories de prédisposition à la schizophrénie du DSM-I au DSM-5 [1952-2013] / Una revisión histórica de las categorías de propensión a la esquizofrenia del DSM-I al DSM-5 [1952-2013]

The history of diagnostic classifications in psychiatry has been recognized as a privileged means of access to the vicissitudes inherent to the configuration of a scientific and professional field, also bringing significant contributions to conceptual history. We have taken as primary sources the five editions of the DSM (1952-2013) to examine the construction of diagnostic categories related to schizophrenia proneness, indicating the scientific and social contexts related to the development of DSM and psychiatry itself. Along this process we highlight the conditions of possibility for the emergence of the Attenuated Psychosis Syndrome, a highly controversial diagnostic proposal, in the elaboration of DSM-5. This proposal ended up being rejected not only on scientific grounds, but also because of feared unintended consequences.

A história das classificações diagnósticas na psiquiatria tem sido reconhecida como meio privilegiado de acesso às vicissitudes inerentes à configuração do campo científico e profissional, além de trazer aportes significativos para a história conceitual. Tomamos como principais fontes primárias as cinco edições do DSM (1952-2013) para examinar a construção de categorias diagnósticas relacionadas à propensão para a esquizofrenia, indicando os contextos sociais e científicos relacionados ao desenvolvimento do DSM e da própria psiquiatria. Nesse processo, destacamos as condições de possibilidade para a emergência da Síndrome Psicótica Atenuada, uma proposta diagnóstica altamente controversa, na preparação do DSM-5. Essa proposta foi rejeitada não somente no plano científico, mas também em razão de temidas consequências indesejadas.

L'histoire des classifications diagnostiques en psychiatrie a été reconnue comme un moyen privilégié d'accès aux vicissitudes inhérentes à la configuration du champ scientifique et professionnel, apportant également des contributions importantes à l'histoire conceptuelle. Comme sources primaires principales, nous avons utilisé les cinq éditions du DSM (1952-2013) pour examiner la construction des catégories diagnostiques liées à la prédisposition à la schizophrénie, en indiquant les contextes scientifiques et sociaux du développement du DSM et de la psychiatrie elle-même. Au cours de ce processus, nous mettons en évidence les conditions de possibilité d'émergence du Syndrome Psychotique Atténué, une proposition diagnostique fortement controversée, dans l'élaboration du DSM-5. Cette proposition a fini par être rejetée, non seulement pour des raisons scientifiques, mais aussi par crainte des conséquences non désirées.

La historia de las clasificaciones diagnósticas en psiquiatría, ha sido reconocida como un medio privilegiado de acceso a las vicisitudes inherentes a la configuración de un campo científico y profesional, además de traer aportes significativos a la historia conceptual. Como recursos primarios, hemos utilizado las cinco ediciones del DSM (1952-2013), para examinar la construcción de categorías de diagnóstico relacionadas a la propensión a la esquizofrenia, indicando los contextos sociales y científicos relacionados al desarrollo del DSM y de la propia psiquiatría. A lo largo del proceso, destacamos las condiciones de posibilidad para el surgimiento del Síndrome de Psicosis Atenuada, una propuesta de diagnóstico altamente controvertida, durante la elaboración del DSM-5. Esta propuesta fue rechazada, no solo por motivos científicos, sino también por las temidas consecuencias indeseadas.

Die Geschichte der diagnostischen Klassifizierungen in der Psychiatrie wird als privilegiertes Mittel des Zuganges zu dem Wandel im Rahmen der Gestaltung eines wissenschaftlichen, beruflichen Gebietes anerkannt und trägt wesentlich zur Begriffsgeschichte bei. Als primäre Quellen wurden die fünf Auflagen des DSM (1952-2013) berücksichtigt, um den Aufbau der diagnostischen Kategorien mit Neigung zur Schizophrenie und den sozialen und wissenschaftlichen Zusammenhang der Entwicklung des DSM und der Psychiatrie zu untersuchen. Dabei heben wir die Möglichkeiten der Notbehandlung für „Attenuated Psychosis Syndrome", eines sehr umstrittenen diagnostischen Vorschlages bei der Vorbereitung des DSM-5, hervor. Dieser Vorschlag wurde nicht nur aus wissenschaftlichen Gründen, sondern auch aufgrund befürchteter, unerwünschter Folgen abgelehnt.

Simplifying the human serum proteome for discriminating patients with bipolar disorder of other psychiatry conditions.

PURPOSE: An exploratory analysis using proteomic strategies in blood serum of patients with bipolar disorder (BD), and with other psychiatric conditions such as Schizophrenia (SCZ), can provide a better understanding of this disorder, as well as their discrimination based on their proteomic profile. METHODS: The proteomic profile of blood serum samples obtained from patients with BD using lithium or other drugs (N=14), healthy controls, including non-family (HCNF; N=3) and family (HCF; N=9), patients with schizophrenia (SCZ; N=23), and patients using lithium for other psychiatric conditions (OD; N=4) were compared. Four methods for simplifying the serum samples proteome were evaluated for both removing the most abundant proteins and for enriching those of lower-abundance: protein depletion with acetonitrile (ACN), dithiothreitol (DTT), sequential depletion using DTT and ACN, and protein equalization using commercial ProteoMiner® kit (PM). For proteomic evaluation, 2-D DIGE and nanoLC-MS/MS analysis were employed. RESULTS: PM method was the best strategy for removing proteins of high abundance. Through 2-D DIGE gel image comparison, 37 protein spots were found differentially abundant (p<0.05, Student's t-test), which exhibited ≥2.0-fold change of the average value of normalized spot intensities in the serum of SCZ, BD and OD patients compared to subject controls (HCF and HCNF). From these spots detected, 13 different proteins were identified: ApoA1, ApoE, ApoC3, ApoA4, Samp, SerpinA1, TTR, IgK, Alb, VTN, TR, C4A and C4B. CONCLUSIONS: Proteomic analysis allowed the discrimination of patients with BD from patients with other mental disorders, such as SCZ. The findings in this exploratory study may also contribute for better understanding the pathophysiology of these disorders and finding potential serum biomarkers for these conditions.

Academic performance of students who underwent psychiatric treatment at the students' mental health service of a Brazilian university.

CONTEXT AND OBJECTIVE:: University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students' mental health service (SAPPE) and to compare their academic performance with that of non-patient students. DESIGN AND SETTING:: Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. METHODS:: Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC) and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. RESULTS:: 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1%) and anxiety disorders/phobias (33.2%) were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7%) and bipolar disorder (1.9%) were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025), but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. CONCLUSION:: Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

Academic performance of students who underwent psychiatric treatment at the students' mental health service of a Brazilian university / Desempenho acadêmico de alunos que se submeteram a tratamento psiquiátrico no serviço de saúde mental para estudantes de uma universidade brasileira

ABSTRACT CONTEXT AND OBJECTIVE: University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students’ mental health service (SAPPE) and to compare their academic performance with that of non-patient students. DESIGN AND SETTING: Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. METHODS: Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC) and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. RESULTS: 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1%) and anxiety disorders/phobias (33.2%) were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7%) and bipolar disorder (1.9%) were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025), but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. CONCLUSION: Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

RESUMO CONTEXTO E OBJETIVO: Estudantes universitários geralmente estão na faixa etária típica do início de transtornos mentais que podem afetar seu desempenho acadêmico. Tivemos como objetivos caracterizar os estudantes atendidos por psiquiatras em serviço universitário de saúde mental para alunos (SAPPE) e comparar seu desempenho acadêmico com o de alunos não pacientes. DESENHO E LOCAL: Estudo transversal baseado em revisão de prontuários e levantamento de dados acadêmicos em uma universidade pública brasileira. MÉTODOS: Prontuários de 1.237 estudantes assistidos por psiquiatras do SAPPE entre 2004 e 2011 foram revisados. Seu coeficiente de rendimento (CR) e status acadêmicos em julho de 2015 foram levantados e comparados aos de um grupo de controle com 2.579 alunos não pacientes, pareados por sexo, curso e ano de matrícula. RESULTADOS: 37% dos pacientes tiveram acompanhamento psiquiátrico e 4,5% fizeram tentativas de suicídio prévios ao atendimento pelo serviço. Os diagnósticos mais frequentes foram depressão (39,1%) e transtornos fóbico-ansiosos (33,2%). Transtornos mentais graves, como o psicótico (3,7%) e o bipolar (1,9%), foram menos frequentes. Entre os pacientes dos cursos de graduação, o CR médio foi levemente inferior (0,63; desvio padrão, DP: 0,26; versus 0,64; DP: 0,28; P = 0,025) que o de não pacientes, mas suas taxas de conclusão do curso foram maiores e as de evasão, menores. Na pós-graduação, as taxas de conclusão foram semelhantes, mas pacientes tiveram maior frequência de desligamento por baixo desempenho acadêmico e menor de desistência. CONCLUSÃO: Mesmo incluindo pessoas socialmente vulneráveis e com transtornos mentais graves, o grupo de pacientes teve desempenho acadêmico semelhante e, em alguns aspectos melhor, do que o de não pacientes.

Assessing treatment response to prophylactic lithium use in patients with bipolar disorder / Avaliação da resposta terapêutica ao tratamento de manutenção com lítio em pacientes com transtorno afetivo bipolar

ABSTRACT Objetive To identify potential clinical and epidemiological predictors of long-term response to lithium treatment. Methods A total of 40 adult outpatients followed in an university hospital, with confirmed diagnosis of bipolar disorder and with history of lithium use for at least a six months period, had their response to this medication assessed through the use of a standardized instrument. The ALDA scale is based on retrospective clinical data, in our study assessed through a thoroughly reviewed of the medical charts, and is used to evaluate the clinical improvement with the treatment (Criterion A), corrected by the acknowledgement of possible confounding factors, such as duration of the treatment, compliance and concomitant use of additional medications (Criterion B), in order to estimate the response that can be specifically attributable to lithium. Results Our study found an inverse relation between the number of mood episodes with psychotic symptoms and lithium treatment outcome. Conclusion The results reinforce the hypothesis that lithium seems to be less efficacious in patients with bipolar disorder who present psychotic symptoms.

RESUMO Objetivo Identificar potenciais preditores clínicos e epidemiológicos de resposta terapêutica ao uso prolongado de lítio. Métodos Um total de 40 pacientes adultos em tratamento ambulatorial em um hospital universitário, com diagnóstico confirmado de transtorno afetivo bipolar e história de pelo menos seis meses de uso de lítio, teve sua resposta a essa medicação avaliada com a utilização de um instrumento padronizado. A escala ALDA leva em consideração informações clínicas obtidas de forma retrospectiva, em nosso estudo, por meio de minuciosa revisão dos prontuários médicos, para julgar a melhora clínica obtida com o tratamento (Critério A), corrigida pela identificação de possíveis fatores confundidores, tais como duração do tratamento, adesão e uso concomitante de outras drogas (Critério B), de forma a estimar a resposta que pode ser atribuída especificamente ao uso do lítio. Resultados Nosso estudo encontrou uma relação inversa entre o número de episódios de humor com a presença de sintomas psicóticos e o desfecho no tratamento com lítio. Conclusão Esses resultados reforçam a hipótese de que o lítio parece ser menos eficaz em pacientes com transtorno afetivo bipolar que manifestam sintomas psicóticos.

Values and DSM-5: looking at the debate on attenuated psychosis syndrome.

BACKGROUND: Although values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) received harsh criticism, and was even considered secretive by some authors. Also, it lacked an official discussion of values at play. In this perspective paper we briefly discuss the interplay of some values in the scientific and non-scientific debate around one of the most debated DSM-5 category proposals, the Attenuated Psychosis Syndrome (APS). Then, we point out some ethical consequences of a facts-plus-values perspective in psychiatric classification. DISCUSSION: Different stakeholders participated in the APS-debate and for analytical purposes we divided them into four groups: (i) researchers in the field of high-risk mental states; (ii) the DSM-5 Psychotic Disorders Work Group; (iii) patient, carers and advocacy groups; and (iv) external stakeholders, not related to the previous groups, but which also publicly expressed their opinions about APS inclusion in DSM-5. We found that each group differently stressed the role of values we examined in the APS-debate. These values were ethical, but also epistemic, political, economic and ontological. The prominence given to some values, and the lack of discussion about others, generated divergent positions among stakeholders in the debate. As exemplified by the APS discussion, although medicine is primarily an ethical endeavor, values of different kinds that take part in it also shape to a large extent the profession. Thus, it may be strategic to openly discuss values at play in the elaboration of diagnostic tools and classificatory systems. This task, more than scientifically or politically significant, is ethically important.

Genetic variants associated with response to lithium treatment in bipolar disorder: a genome-wide association study.

BACKGROUND: Lithium is a first-line treatment in bipolar disorder, but individual response is variable. Previous studies have suggested that lithium response is a heritable trait. However, no genetic markers of treatment response have been reproducibly identified. METHODS: Here, we report the results of a genome-wide association study of lithium response in 2563 patients collected by 22 participating sites from the International Consortium on Lithium Genetics (ConLiGen). Data from common single nucleotide polymorphisms (SNPs) were tested for association with categorical and continuous ratings of lithium response. Lithium response was measured using a well established scale (Alda scale). Genotyped SNPs were used to generate data at more than 6 million sites, using standard genomic imputation methods. Traits were regressed against genotype dosage. Results were combined across two batches by meta-analysis. FINDINGS: A single locus of four linked SNPs on chromosome 21 met genome-wide significance criteria for association with lithium response (rs79663003, p=1·37 × 10(-8); rs78015114, p=1·31 × 10(-8); rs74795342, p=3·31 × 10(-9); and rs75222709, p=3·50 × 10(-9)). In an independent, prospective study of 73 patients treated with lithium monotherapy for a period of up to 2 years, carriers of the response-associated alleles had a significantly lower rate of relapse than carriers of the alternate alleles (p=0·03268, hazard ratio 3·8, 95% CI 1·1-13·0). INTERPRETATION: The response-associated region contains two genes for long, non-coding RNAs (lncRNAs), AL157359.3 and AL157359.4. LncRNAs are increasingly appreciated as important regulators of gene expression, particularly in the CNS. Confirmed biomarkers of lithium response would constitute an important step forward in the clinical management of bipolar disorder. Further studies are needed to establish the biological context and potential clinical utility of these findings. FUNDING: Deutsche Forschungsgemeinschaft, National Institute of Mental Health Intramural Research Program.

Valores conflitantes na produção do DSM-5: o “caso” da síndrome psicótica atenuada / Conflicting values in the production of DSM-5: the “case” of the attenuated psychotic syndrome / Conflit de valeurs dans la production de DSM-5: le “cas” du syndrome psychotique atténué / Valores en conflicto en la producción de DSM-5: el “caso” del síndrome de la psicosis atenuada

O debate sobre a possível inclusão da síndrome psicótica atenuada como diagnóstico oficial no DSM-5 foi atravessado por diversos valores em torno dos quais argumentadores a favor ou contra a criação dessa nova categoria se dividiram. As defesas de tais valores geraram posições divergentes, mas igualmente legítimas e bem fundamentadas, e trouxeram consigo questionamentos importantes para o cenário potencialmente inovador da psiquiatria preventiva contemporânea. Entre eles, a preocupação ética com o sofrimento, os riscos associados às ações de prevenção e a importância do papel dos valores na formulação de categorias diagnósticas e na própria prática psiquiátrica.

The discussion on the possible inclusion of Attenuated Psychosis Syndrome as an official diagnosis of the DSM-5 was permeated by different values, which underpinned the division between those who argued in favor and those who were against the creation of that new category. The prominence given to certain values generated divergent positions, but which were equally legitimate and well grounded, and which brought up significant questions regarding the potentially innovative scenario of contemporary preventive psychiatry. The ethical preoccupation with suffering, the risks associated with preventive actions and the importance of the role of values in the formulation of diagnostic categories and in psychiatric practice were some of the key issues raised by that debate.

La discussion sur la possible inclusion du Syndrome Psychotique Atténué comme diagnostique officiel dans le DSM-5 a été traversée par diverses valeurs, autour desquelles les argumentateurs, en faveur ou à l’opposé de la création de cette catégorie, se sont séparés. Les soutenances de telles valeurs ont suscité des positions divergentes, mais aussi légitimes et bien fondées, qui ont conduit à des questionnements importants pour le cadre potentiellement novateur de la psychiatrie préventive contemporaine. Parmi ces valeurs, il existe la préoccupation éthique par rapport à la souffrance, les risques associés aux actions de prévention, l’importance du rôle des valeurs dans la formulation des catégories diagnostiques, ainsi que dans la pratique psychiatrique.

El debate sobre la posible inclusión del síndrome de psicosis atenuada como un diagnóstico oficial en el DSM-5 fue atravesado por numerosos valores, que dividieron a los que estaban a favor o en contra de la creación de esta nueva categoría. Las defensas de tales valores generaron posturas divergentes, pero igualmente legítimas y con fundamento, y trajeron consigo puntos de discusión importantes para el escenario potencialmente innovador de la psiquiatría preventiva contemporánea, incluyendo la preocupación ética por el sufrimiento, los riesgos asociados a la prevención y la importancia del papel de los valores en la formulación de las categorías diagnósticas y en la propia práctica psiquiátrica.

Cartografia das pesquisas avaliativas de serviços de saúde mental no Brasil (2004-2013) / Mapping of inquiries in mental health care in Brazil (2004-2013)

Este trabalho tem como objetivo mapear as pesquisas avaliativas de serviços de saúde mental, produzidas no Brasil nos últimos dez anos, a partir de levantamento em bases de dados de dissertações e teses acadêmicas e de artigos científicos. Foram analisadas 68 dissertações e teses e 103 artigos. A produção das dissertações e teses se concentra em instituições nos estados de São Paulo e do Rio de Janeiro, e estas se originam principalmente de programas de pós-graduação em Saúde Coletiva e em Enfermagem. Os artigos se referem a serviços localizados em número restrito de municípios das regiões Sul e Sudeste do país, principalmente do Rio Grande do Sul e de São Paulo, havendo poucos estudos de abrangência nacional. No conjunto da produção, os serviços mais avaliados são os Centros de Atenção Psicossocial, seguidos pela Atenção Básica em Saúde. Os sujeitos de pesquisa mais frequentes são os trabalhadores de saúde mental, e em segundo lugar, os usuários. A maioria dos trabalhos usa metodologia qualitativa. Conclui-se que as pesquisas avaliativas vêm se concentrando em abordagens pouco diversificadas do processo da reforma da saúde mental, e que estas não têm abrangência suficiente para fornecer, proximamente, elementos para prover indicadores básicos nacionais de saúde mental...

This work aims to map the research on public mental health services evaluation carried out in Brazil in the last 10 years. We searched electronic databases for dissertations, theses and academic papers. We selected 68 dissertations and theses, and 103 articles. Most of dissertations and theses were produced by Public Health and Nursing graduate programs in the states of São Paulo and Rio de Janeiro. The articles refer to services located in a restricted number of municipalities in the South and Southeast regions of the country, mainly in Rio Grande do Sul and São Paulo, with few nationwide studies. Throughout the production, the Psychosocial Community Centers, followed by Primary Health Care, are the most frequently evaluated services. Mental health workers, followed by service-users were the main source of information in the studies. Most work uses qualitative methodology. We conclude that, taken as a whole, evaluative researches in Brazil have focused on a few approaches to the process of mental health care reform, and that they are not comprehensive enough to provide information on national mental health indicators...

Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report / Eletroconvulsoterapia e anticoagulação após tromboembolismo pulmonar: relato de caso

Introduction Electroconvulsive therapy (ECT) is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE) is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods Case report and literature review. Results A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. Conclusion The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks. .

Introdução A eletroconvulsoterapia (ECT) é considerada o tratamento mais eficaz para catatonia independente da causa base. Rigidez e imobilidade são comumente observadas e podem levar a diversas complicações clínicas, das quais o tromboembolismo pulmonar (TEP) é a mais grave. A melhora rápida da condição psiquiátrica de base no TEP associado à catatonia é fundamental, uma vez que a imobilidade favorece a ocorrência de novos eventos tromboembólicos e suas complicações. Nesse cenário, a indicação de ECT deve ser considerada, pesando-se riscos e benefícios, visando-se à rápida resolução do quadro catatônico. Métodos Relato de caso e revisão da literatura. Resultados Paciente de 66 anos estava internada em enfermaria de psiquiatria com quadro catatônico devido a episódio depressivo quando apresentou TEP bilateral, necessitando de medidas de suporte ventilatório e, posteriormente, de anticoagulação plena com enoxaparina. Embora clinicamente estável, apresentava-se ainda gravemente deprimida após ensaio com antidepressivos. Foi indicada ECT apesar de manter-se terapia de anticoagulação concomitante. Após cinco sessões de ECT, o humor da paciente apresentou significativa melhora e ela já andava e comia espontaneamente. Não houve complicações relacionadas ao TEP ou à anticoagulação com enoxaparina. Após a oitava sessão, evoluiu com hipomania, manejada com ajustes da medicação oral. A paciente recebeu alta hospitalar completamente eutímica. Conclusão O caso apresentado oferece evidência adicional em favor da segurança da ECT concomitante à anticoagulação plena após TEP, mostrando que, com precauções adequadas, os benefícios na ECT ...

Hazardous use of alcohol among undergraduate students at a public university

BACKGROUND. The potentially harmful consequences of alcohol use among undergraduates have become a growing concern in recent years. OBJECTIVES. This study aimed to determine the prevalence of hazardous use of alcohol in this population and to identify demographic and psychosocial factors associated with this pattern of consumption. METHODS. This was a cross-sectional study using an anonymous and self-completed questionnaire in the classroom. The questionnaire was administered to 1,290 enrolled male and female students, which comprised a proportional sample of the main areas of knowledge at University of Campinas. The questionnaire produced sociodemographic and psychosocial profiles and the Alcohol Use Disorders Identification Test was used to detect hazardous use of alcohol. RESULTS. The prevalence of hazardous use of alcohol among the study participants was 24%. Male gender, subjective perceived social support in case of difficulties, being sexually active, not dating, having smoked tobacco cigarettes or marijuana, and having used other illicit psychoactive substances were associated with hazardous use of alcohol. DISCUSSION. Variables related to gender, sexuality, affective partnerships, and consumption of other psychoactive substances were associated with hazardous use of alcohol, which was identified in a quarter of the evaluated students, and indicate the need for strategies to prevent and to treat problems.

Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report.

OBJECTIVE: The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the "Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" scale currently used in the Consortium on Lithium Genetics (ConLiGen) study. MATERIALS AND METHODS: Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (κ)] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling. RESULTS: Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (κ = 0.66 and κ = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (ICC1 = 0.71 and ICC2 = 0.75, respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders). CONCLUSIONS: We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study.

Correlation between insight dimensions and cognitive functions in patients with deficit and nondeficit schizophrenia.

Previous studies have shown correlations between poor insight and neurocognitive impairment in schizophrenia. Deficit schizophrenia has been associated with worse cognitive functioning and poorer insight. This study aimed at investigating the relationship between insight dimensions (measured by Schedule for the Assessment of Insight-Expanded Version and its factors) and specific neurocognitive functions (assessed through a battery of neuropsychological tests) considering separately patients with deficit (n=29) and nondeficit schizophrenia (n=44), categorized according to the Schedule for the Deficit Syndrome. We found that working memory correlated positively and significantly with awareness of mental illness in both groups. In nondeficit group, awareness of mental illness correlated additionally with verbal fluency and attention. If confirmed by further studies, these results may have important consequences, such as the need of tailoring differently cognitive rehabilitation for each group.

Defining new guidelines for screening the 22q11.2 deletion based on a clinical and dysmorphologic evaluation of 194 individuals and review of the literature.

The 22q11.2 deletion is the most frequent interstitial deletion in humans and presents a wide phenotypic spectrum, with over 180 clinical manifestations described. Distinct studies have detected frequencies of the deletion ranging from 0 % to 75 %, depending on the studied population and selection criteria adopted. Due to the lack of consensus in this matter, several studies have been conducted aiming to define which patients would be eligible for screening; however, the issue is still up for debate. In order to contribute to the delineation of possible clinical and dysmorphologic guidelines to optimize decision making in the clinical setting, 194 individuals with variable features of the 22q11.2 deletion syndromes (22q11.2DS) were evaluated. Group I, clinical suspicion of 22q11.2DS with palatal anomalies; Group II, clinical suspicion without palatal anomalies; Group III, cardiac malformations associated with the 22q11.2DS; and Group IV, juvenile-onset schizophrenia. Multiplex ligation-dependent probe amplification was used for screening the 22q11.2 deletion, which was detected in 45 patients (23.2 %), distributed as such: Group I, 35/101 (34.7 %); Group II, 4/18 (22.2 %); Group III, 6/52 (11.5 %); and Group IV, 0/23 (0 %). Clinical data were analyzed by frequency distribution and statistically. Based on the present results and on the review of the literature, we propose a set of guidelines for screening patients with distinct manifestations of the 22q11.2DS in order to maximize resources. In addition, we report the dysmorphic features which we found to be statistically correlated with the presence of the 22q11.2DS.