Functional and structural neuroimaging in premenstrual dysphoric disorder: A systematic review.

This systematic review aimed to summarize the most recent data on changes in brain structure and function in premenstrual dysphoric disorder (PMDD) as well as elucidate the possible correlations between these findings and symptom severity. Articles published in PubMed, EMBASE, ScienceDirect, PsycInfo, Web of Science, and Scopus from inception until April 2023 were systematically reviewed according to the PICO framework: population (women with PMDD), intervention (neuroimaging study), control (healthy subjects), and outcome (neuroimaging changes). In total, 1026 individuals were included from controlled (n = 22) and non-controlled (n = 2) trials. Among them, 608 had PMDD, and 418 were healthy controls. Different neuroimaging methods were addressed, such as task-based functional magnetic resonance imaging (MRI), resting-state functional MRI, proton magnetic resonance spectroscopy, diffusion tensor imaging, proton emission tomography, and structural MRI. Despite the absence of consensual results, several brain structures have been implicated in PMDD, including the prefrontal cortex, amygdala, hippocampus, insula, basal ganglia, and cerebellum. In addition, some brain changes are related to the intensity of symptoms and phases of the menstrual cycle, such as the correlation between depressive symptoms and increased serotonin transporter binding potential in the midbrain during the luteal phase.

Psychotherapy training in Brazil: Experiences of psychiatric trainees and early career psychiatrists.

Understanding and skills in psychotherapy are fundamental aspects of clinical psychiatry practice. Learning about psychotherapy during the training of psychiatrists offers solid opportunities for developing high standards of psychiatric practice and providing better outcomes for patients. However, little is known about the extent that psychotherapy training is available to psychiatrists in America. This study aimed to analyze the status of psychotherapy training in Brazil through the experiences of early-career psychiatrists. This is a cross-sectional survey conducted between July and November 2021. A 16-item questionnaire was used to investigate: the quality of psychotherapy training; the organizational aspects of psychotherapy training; and satisfaction with training in psychotherapy. The majority of participants reported having mandatory training in psychotherapy, mainly in cognitive-behavioral therapy and psychodynamic therapy. However, only had some practical experience with psychotherapy training. This study highlights the frequent use of psychotherapy training among Brazilian early career psychiatrists. The consensus on the necessity of mandatory psychotherapy training underscores its importance in shaping psychiatric practice. While participants express satisfaction with psychotherapy supervision, the financial burden for advanced training raises concerns. These findings advocate for the improvement of the quality of psychotherapy training in Brazil.

Are physicians aging well? Subjective successful aging, happiness, optimism, and resilience in a sample of Brazilian aging doctors

Background and objectives: The elderly physician population is increasing worldwide. Data on how doctors have aged are scarce. The purpose of this study is to evaluate subjective successful aging (SSA) and its correlations with resilience, happiness, and optimism in a sample of older physicians.MethodsA cross-sectional study was carried out with physicians over 65, through face-to-face interviews. All the volunteers answered the following: Self-rate successful aging; CD-RISC 10; Subjective Happiness Scale; LOT-R; SF-36; and a socio-demographic questionnaire.ResultsThe mean of self-rate successful aging in SSA was 8.65 (92.3% over or equal to 7), and significant and positive correlations were found between resilience (r = 0.33) and happiness (r = 0.68). No correlation was found between age subset (young-old x old) or physical limitations and evaluation of SSA.ConclusionPhysicians evaluated aging as successful regardless of health and limitations. SSA had a positive correlation with resilience and happiness. (AU)

Left frontal pole repetitive transcranial magnetic stimulation reduces cigarette cue-reactivity in correlation with verbal memory performance.

BACKGROUND: Although left frontal pole (LFP) repetitive transcranial magnetic stimulation (rTMS) has been recently investigated for the treatment of different substance use disorders, there is no current evidence that it can effectively influence craving or clinical outcomes in smokers. A single session of 1 Hz rTMS over LFP is proposed to explore short-term effects of this protocol in tobacco use disorder. METHODS: A pilot randomized trial compared 1 Hz rTMS of the LFP (n = 12) and primary motor cortex (n = 12) in a high-craving, severe nicotine dependence population (9 females, 15 males). A cigarette cue-reactivity paradigm with smoking-related and neutral visual stimuli was used for primary outcome measures. Chronic craving, dependence severity, impulsivity and cognitive measures were also obtained. RESULTS: Compared to baseline, LFP rTMS significantly reduced cue-reactivity to both smoking-related and neutral cue types, while no change occurred in the motor cortex group. Reactivity to affectively neutral pictures was significantly reduced in the LFP vs. motor cortex analysis. There was one robust correlation between verbal memory recall score and reduction of neutral cue-reactivity. CONCLUSIONS: LFP 1 Hz rTMS significantly reduced cigarette cue-reactivity. Association of change in cue-reactivity with verbal memory performance suggests a relationship between craving experiences and declarative memory systems that seems relevant to rTMS effects.

Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review

Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review.

OBJECTIVE: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. METHODS: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). RESULTS: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. CONCLUSION: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Cross-cultural adaptation of the City Birth Trauma Scale for the Brazilian context

Abstract Background Posttraumatic stress disorder consists of a set of symptoms that occurs in response to one or more traumatic events and can occur in postpartum, from traumatic situations related to the birth or to the baby's health in the first days of life. It is important tracking the presence of birth trauma, but there is not available instruments in the Brazilian context for this purpose. Objectives To present the cross-cultural adaptation of City Birth Trauma Scale (BiTS) into Brazilian portuguese. Methods Cross-cultural adaptation involved independent translations, synthesis,back-translation, and submission to the original author's appreciation. After the scale was subjected to face validity, followed by a pilot study with postpartum mothers. Results All steps were performed for the cross-cultural adaptation. Regarding face validity, items evaluated concerning different types of equivalence, presented satisfactory agreement values (≥4.20). Most of the expert's suggestions were followed, being the main ones related to adjustments in prepositions, pronouns and verbal subjects. Pilot study showed that the mothers had been able to understand and respond to the instrument without adjustments. Discussion BiTS's Brazilian version proved to be cross-culturally adapted, ensuring the possibility of intercultural data comparison from the semantic, idiomatic, cultural, and conceptual perspectives. New studies are being conducted to attest its psychometric adequacy.

Relationship between Prolactin, Chronic Kidney Disease, and Cardiovascular Risk.

CKD has a high prevalence worldwide, mainly due to its main etiologies-diabetes and hypertension. It has high cardiovascular morbidity and mortality, with traditional risk factors such as atherosclerosis, hypertension, diabetes, smoking, and left ventricular hypertrophy being common. Nontraditional cardiovascular risk factors, such as anemia, hyperparathyroidism, chronic inflammation, and microalbuminuria, are also well studied. Prolactin is a hormone not only related to lactation but also being considered a uremic toxin by some authors. It accumulates with loss of renal function, and it is associated with cardiovascular outcomes in both normal renal function population and CKD population. The purpose of this narrative review is to raise the main common aspects of CKD, prolactinemia, and cardiovascular risk.

Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review

Objective: The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. Methods: This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. Results: Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. Conclusion: These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.

Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review.

OBJECTIVE: The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. METHODS: This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. RESULTS: Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. CONCLUSION: These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.

Common mental disorders and subjective well-being: Emotional training among medical students based on positive psychology.

INTRODUCTION: The prevalence of common mental disorders among medical students is globally high. However, medical students tend to seek less professional help to treat their mental health issues. Hence, ways have been devised to reduce emotional stress in this population. OBJECTIVE: The current study uses positive psychology techniques to increase subjective well-being (SWB) in order to reduce symptons of common mental disorders (CMD) in medical students (MS). METHODS: The study comprised two groups: intervention group (n = 37) and control group (n = 32). Throughout seven weeks, the intervention group had meetings focused on emotions, mental health of medical students, gratitude, appreciation, optimism, resilience, qualities and virtues. The control group attended conventional medical psychology classes (psychosomatic aspects in clinical illness, for example). RESULTS: The intervention group presented average increase by 2.85 points in the positive emotions scale; average increase by 2.53 points in the satisfaction-with-life scale; and average decrease by 1.79 points in the SRQ-20 scale, when it was compared to the control group. The intervention effect size was moderate. CONCLUSION: Use of techniques to increase SWB may reduce CMD in MS, even if these techniques do not diminish negative emotions.

Use of a Double-Cone Coil in Transcranial Magnetic Stimulation for Depression Treatment.

INTRODUCTION: Approximately 15% of all people will experience a depressive episode throughout their lives, and by 2020, depression will be the second largest cause of disability around the world. Transcranial magnetic stimulation (TMS) has been shown to be an effective option for treating this condition. Devices such as the double-cone coil may bring new insights regarding depression treatment. METHODS: A literature search was performed on PubMed, ScienceDirect, Cochrane, LILACS, and Google Scholar by applying the descriptors "depression" AND "transcranial magnetic stimulation" AND "double cone-coil." RESULTS: Six studies were considered eligible (three clinical trials, two case series, and one isolated case report). All of them described treatments with transcranial magnetic stimulation by double-cone coil (DC-TMS) at 10 Hz over the dorsomedial prefrontal cortex, achieving response and remission rates of 40-52.4% and 34.7-47.6%, respectively. Two clinical trials investigated both intermittent theta-burst stimulation and 10 Hz TMS, suggesting a slight advantage of the latter. They also found no additional gains by combining both techniques. CONCLUSION: Despite the small number of controlled clinical trials and the small sample sizes, which limit the generalization of the obtained results, the collected data provide an optimistic perspective on the effectiveness of using DC-TMS for depression treatment.

Subjective well-being, religiosity and anxiety: a cross-sectional study applied to a sample of Brazilian medical students.

OBJECTIVE: To assess associations between subjective well-being (SWB), religiosity, anxiety and other factors in a sample of Brazilian medical students from a public university in northeastern Brazil. METHODS: The present study followed a cross-sectional, observational, analytical approach. Data were collected by administering a self-applicable questionnaire composed of questions focused on sociodemographic data and based on the Satisfaction With Life Scale (SWL), Positive Affect and Negative Affect Scale (PANAS), Penn State Worry Questionnaire (PSWQ), and the Duke Religiosity Index (DUREL). RESULTS: The sample comprised 417 medical school students (73.54% of all the enrolled students). The medical students assessed presented a medium level of satisfaction with life, low mean positive emotion levels and high anxiety/uneasiness levels. Surprisingly, lower anxiety and intrinsic religiosity (IR) scores were associated with higher scores in the two SWB parameters (positive emotions and satisfaction with life). Furthermore, the factors leisure activities, good sleep quality, financial support, age, and gender were associated with the highest SWB scores (with emotional and cognitive components, or with only one of these two components). CONCLUSIONS: Data in the current study corroborated the negative association between SWB and anxiety; however, in opposition to the literature, they also evidenced a negative association between SWB and IR. In addition, the present research signaled the need for creating preventive intervention programs to increase SWB through positive psychological techniques and/or to decrease anxiety by applying, for instance, cognitive-behavioral therapy paradigms and/or mindfulness techniques to medical students.