Decrease in cognitive performance and increase of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with higher doses of antipsychotics in women with schizophrenia: a cross-sectional study.

BACKGROUND: We explored the relationship between symptoms, cognitive performance, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) (three markers of inflammation), and antipsychotic dose (in chlorpromazine units) in male and female patients with schizophrenia. METHODS: We conducted a cross-sectional analysis in patients with schizophrenia of the complete blood count and the results of neuropsychological testing, using the Welch t-test to compare groups and the Pearson test for correlations. RESULTS: We found that the NLR and the PLR are higher among women with schizophrenia when compared with men. In women, the NLR and the PLR correlate positively with antipsychotic drug dose and inversely with a working memory test (Direct Digit Span). Higher doses of antipsychotics are associated with worse working and semantic memory and mental flexibility in the women in our sample. CONCLUSION: Higher doses of antipsychotics were associated with worse working and semantic memory and mental flexibility in women with schizophrenia. No such correlations were present in men, suggesting that, in female patients, cognitive performance deteriorates as the antipsychotic dose is increased, a finding that could be mediated by inflammatory mechanisms, given the demonstrated relationship to biomarkers of inflammation - e.g., the NLR and the PLR. TRIAL REGISTRATION: NCT03788759 (ClinicalTrials.gov).

Homeopathy for Major Depressive Disorder: Protocol for N-of-1 Studies.

BACKGROUND: N-of-1 studies allow the formal assessment of a patient's treatment. A single participant receives different interventions the same number of times in a crossover, double-blind, randomized design. Using this methodology, we will investigate the effectiveness and safety of a standardized homeopathy protocol in treating 10 cases of major depression. METHODS: The method is described below: Design: crossover double-blind placebo-controlled randomized N-of-1 studies, with at most 28 weeks of duration per participant. PARTICIPANTS: women and men at age over 18 years with a diagnosis of a major depressive episode given by a psychiatrist, who have presented a therapeutic response, i.e., a reduction ≥50% of the baseline depressive symptoms, self-assessed by the Beck Depression Inventory - Second Edition (BDI-II), and sustained for at least 4 weeks during an open homeopathic treatment following the protocol of the sixth edition of the Organon, with or without concomitant use of psychotropic drugs. INTERVENTIONS: individualized homeopathy following the same protocol, one globule of the fifty-millesimal potency diluted in 20 mL of 30% alcohol; placebo - 20 mL of 30% alcohol, in the same posology as homeopathy. Crossover study: the participant will go through three consecutive treatment blocks, with two random and masked treatment periods (A or B), corresponding to homeopathy or placebo. Treatment periods will have 2, 4, and 8 weeks in the first, second, and third blocks, respectively. A clinically significant worsening (characterized by an augmentation in BDI-II inclusion score ≥30%) will result in the termination of study participation and resumption of the open treatment. PRIMARY MEASURE: progression of the depressive symptoms, self-assessed by the participant using the BDI-II scale at weeks 0, 2, 4, 8, 12, 16, 20, 24, 28 and analyzed throughout the study concerning homeopathy and placebo partitions. Secondary measures: score of the Clinical Global Impression Scale; mental and physical health scores assessed by the 12-Item Short-Form Health Survey; participant's blind preference for treatment A or B at each block; clinical worsening; and adverse events. DATA ANALYSIS: the participant, assistant physician, evaluator, and statistician will remain blinded for the study treatments until the completion of data analysis of each study. We will follow a 10-step procedure for analyzing N-of-1 observational data of each participant and conduct a meta-analysis of the combined results. DISCUSSION: We understand that each N-de-1 study will be a chapter with its teachings in a book of ten, allowing a broader view of the effectiveness of the homeopathy protocol of the sixth edition of the Organon in treating depression.Einzelpatienten- oder "n = 1"-Studien ermöglichen die formelle Beurteilung der Behandlung eines Patienten. Bei einem einzigen Teilnehmer werden verschiedene Maßnahmen in gleicher Zahl in einem doppelblinden, randomisierten Crossover-Design angewendet. Mit dieser Methode untersuchen wir die Wirksamkeit und Sicherheit eines standardisierten Homöopathie-Protokolls zur Behandlung von Major Depression in zehn Fällen.Aufbau der Studie: Doppelblinde, placebokontrollierte, randomisierte Einzelpatienten- oder "n = 1"-Studie von maximal 28 Wochen Dauer pro Teilnehmer. Teilnehmer: Frauen und Männer ab 18 Jahren mit durch einen Psychiater diagnostizierter Episode einer Major Depression und mit mindestens vier Wochen lang anhaltendem therapeutischem Ansprechen (in Form einer Reduktion der depressiven Symptome um ≥50% gegenüber Baseline laut Selbstbeurteilung mit dem Beck Depression Inventar, zweite Ausgabe [BDI-II]) unter einer offenen homöopathischen Behandlung gemäß dem Protokoll der sechsten Auflage des Organon, mit oder ohne gleichzeitige Anwendung von Psychopharmaka. Interventionen: Individualisierte Homöopathie gemäß demselben Protokoll, ein Globulus der Quinquaginta-Millesimal-Potenz, verdünnt in 20 mL 30%igem Alkohol; Placebo in Form von 20 mL 30%igem Alkohol, nach demselben Dosierungsschema wie die Homöopathie. Crossover-Studie: Der Teilnehmer durchläuft in zwei randomisierten und maskierten Behandlungszeiträumen (A oder B), die Homöopathie oder Placebo enstprechen, je drei aufeinanderfolgende Behandlungsblöcke. Innerhalb der Behandlungszeiträume umfassen der erste, zweite und dritte Block je zwei, vier beziehungsweise acht Wochen. Eine klinisch bedeutsame Verschlechterung (gekennzeichnet durch einen Anstieg des BDI-II-Scores um ≥30% gegenüber der Aufnahme) führt zum Abbruch der Studienteilnahme und zur Wiederaufnahme der offenen Behandlung. Primäre Messgröße: Verlauf der depressiven Symptome laut Selbstbeurteilung des Teilnehmers mit der BDI-II-Skala in Woche 0, 2, 4, 8, 12, 16, 20, 24, 28 und Auswertung im Verlauf der Studie nach Homöopathie-und Placebo-Abschnitten. Sekundäre Messgrößen: Score auf der Clinical Global Impression Scale; Scores für psychische und physische Gesundheit laut 12-Item Short-Form Health Survey; verblindete Teilnehmerpräferenz für Behandlung A oder B in jedem Block; klinische Ver-schlechterung und unerwünschte Ereignisse. Datenauswertung: Der Teilnehmer, behandelnde Arzt, Auswertende und Statistiker bleiben im Hinblick auf die Stu-dienbehandlungen verblindet, bis die Datenauswertung jeder Studie abgeschlossen ist. Wir werden in einem 10-schrittigen Vorgehen die "n = 1"-Beobachtungsdaten der einzelnen Teilnehmer auswerten und eine Metaanalyse der zusammengeführten Ergebnissee durchführen.Unserer Auffassung nach wird jede einzelne "n = 1"-Studie ein Kapitel mit eigenen Lehren innerhalb eines zehnteiligen Buches sein, welches eine umfassende Darstellung der Wirksamkeit des Homöopathie-Protokolls der sechsten Ausgabe des Organon zur Behandlung von Depressionen ermöglicht.

Desafios e potencialidades na implantação de uma experiência de matriciamento em saúde mental na atenção primária / Challenges and potentialities of implementing an experience of a mental health matrix support in primary health care / Retos y potencialidades en la implantación de una experiencia en salud mental en atención primaria

Introdução: A assistência à saúde mental no Brasil passou por avanços com a Reforma Psiquiátrica, introduzindo-se novas práticas e aperfeiçoando-se estratégias na Rede de Atenção Psicossocial, como a Atenção Primária à Saúde. Nesta nova realidade, o matriciamento destaca-se como um novo modo de produzir os cuidados compartilhados entre a equipe especializada e a equipe da Estratégia Saúde da Família (ESF). Entretanto, ainda se encontram dificuldades em implementar suas ações. Objetivo: Descrever os desafios e potencialidades na implantação de uma metodologia proposta para o matriciamento em Saúde Mental na Atenção Primária. Métodos: Trata-se de estudo qualitativo, cuja população foi composta de cinco médicos participantes de uma intervenção de implantação do matriciamento em dois Centros de Saúde da Família, sendo três médicos da ESF e dois que atuavam como matriciadores. Para a coleta de dados, incluíram-se: observação sistemática, entrevista não estruturada, entrevistas grupais e pesquisa documental. Realizou-se pré-teste com um médico da ESF e, após esta fase, realizaram-se cinco entrevistas individuais e três grupais, sendo um grupo com médicos da ESF, outro com os matriciadores e um com os cinco médicos. Para a análise dos dados, utilizou-se análise temática de Minayo. Resultados: Com base na análise temática, emergiram das falas dos entrevistados quatro categorias de análise: "definição de matriciamento", "como implantar e desenvolver o matriciamento", "vantagens e potencialidades do matriciamento" e "dificuldades para o processo". Conclusões: O matriciamento em saúde mental é uma ferramenta extremamente útil e precisa ser amplamente expandida no atual cenário da saúde. Neste estudo, a percepção das vantagens e a motivação para realizar as ações pelos entrevistados demonstram como esta é uma estratégia de exequível implementação e passível de multiplicação.

Introduction: Mental health care in Brazil underwent advances with the Psychiatric Reform, introducing new practices and improving strategies in the Psychosocial Care Network such as Primary Health Care. In this new reality, matrix support stands out as a new way of producing shared care between specialized teams and the Family Health Strategy (FHS) team. However, there are still difficulties in implementing its actions. Objective: To describe the challenges and potentialities in the implementation of a proposed methodology for matrix support in Mental Health in Primary Health Care. Methods: This is a qualitative study, whose population consisted of five physicians participating in an intervention to implement a matrix support in two Family Health Centers, three of which were FHS physicians and two who worked as matrix supporters. For data collection, the following were included: systematic observation, unstructured interview, group interviews and documentary research. A pretest was carried out with a FHS physician and, after this phase, five individual and three group interviews were carried out, one group with physicians from the FHS, another with the matrix supporters and one with the five physicians. For data analysis, the Minayo's thematic analysis was used. Results: Based on the thematic analysis, four categories of analysis emerged from the interviewees' statements: "definition of matrix support," "how to implement and develop matrix support," "advantages and potentialities of matrix support," and "difficulties for the process." Conclusions: Matrix support in mental health is an extremely useful tool and must be widely expanded in the current health scenario. In this study, the perception of the advantages and the motivation to carry out the actions by the interviewees demonstrate how this is a strategy that can be implemented and multiplied.

Introducción: La atención a la salud mental en Brasil avanza con la Reforma Psiquiátrica, introduciendo nuevas prácticas y mejorando estrategias en la Red de Atención Psicosocial, como la Atención Primaria de Salud. En esta nueva realidad, el apoyo matricial se destaca como una nueva forma de producir un cuidado compartido entre el equipo especializado y el equipo de la Estrategia Salud de la Familia (ESF). Sin embargo, aún existen dificultades para implementar sus acciones. Objetivo: Describir los desafíos y potencialidades en la implementación de una propuesta metodológica de apoyo matricial en Salud Mental en Atención Primaria. Métodos: Se trata de un estudio cualitativo, cuya población estuvo constituida por cinco médicos que participaban de una intervención para implementar el apoyo matricial en dos Centros de Salud de la Familia, tres de los cuales eran médicos de la ESF y dos actuaban como ayudantes matriciales. Para la recolección de datos se incluyeron: observación sistemática, entrevista no estructurada, entrevistas grupales e investigación documental. Se realizó un pretest con un médico de la ESF y, después de esta fase, se realizaron cinco entrevistas individuales y tres grupales, una con los médicos de la ESF, otra con los simpatizantes de la matriz y una con los cinco médicos. Para el análisis de los datos se utilizó el análisis temático de Minayo. Resultados: Con base en el análisis temático, surgieron cuatro categorías de análisis de las declaraciones de los entrevistados: "definición de soporte matricial", "cómo implementar y desarrollar el soporte matricial", "ventajas y potencialidades del soporte matricial" y "dificultades para el proceso". Conclusiones: La matriz de apoyo en salud mental es una herramienta de gran utilidad y necesita ser ampliamente expandida en el escenario sanitario actual. En este estudio, la percepción de las ventajas y la motivación para realizar las acciones por parte de los entrevistados demuestran cómo esta es una estrategia que se puede implementar y multiplicar.

α-Lipoic Acid as Adjunctive Treatment for Schizophrenia: A Randomized Double-Blind Study.

BACKGROUND/PURPOSE: There is evidence for low endogenous antioxidant levels and oxidative imbalance in patients with schizophrenia. A previous open-label study with α-lipoic acid (ALA), a potent antioxidant, improved patients' negative and cognitive symptoms and markers of lipid peroxidation. Here we report the results of a randomized double-blind, placebo-controlled study to verify the response of patients with schizophrenia to adjunctive treatment with ALA (100 mg/d) in a 4-month follow-up. METHODS: We conducted a 16-week, double-blind, placebo-controlled study of ALA at 100 mg/d dosages. We compared negative and positive symptoms, cognitive function, extrapyramidal symptoms, body mass index, and oxidative/inflammatory parameters between placebo and control groups. RESULTS: We found no significant improvement in body mass index, cognition, psychopathology, antipsychotic adverse effects, or oxidative stress and inflammation in the experimental group compared with placebo. The whole group of patients improved in several measures, indicating a strong placebo effect in this population. A surprising finding was a significant decrease in red blood cells, white blood cells, and platelets in the group treated with ALA. CONCLUSIONS: The decrease in red blood cells, white blood cells, and platelet counts requires further investigation and attention when prescribing ALA for patients with schizophrenia.

Bioética e psiquiatria: escassez de literatura recente no Brasil / Bioethics and psychiatry: paucity of recent literature in Brazil / Bioética y psiquiatría: escasez de literatura reciente en Brasil

Resumo A fim de analisar a produção científica sobre bioética e psiquiatria no Brasil publicada nos últimos dez anos, realizou-se revisão integrativa da literatura disponível em bases de dados, utilizando descritores e operadores de pesquisa para relacionar os termos "ética or bioética or ética médica and psiquiatria". O processo de busca dos estudos culminou em seleção de treze artigos, dos quais apenas dois foram elegíveis para a revisão integrativa de acordo com os critérios de inclusão. A pesquisa mostrou que apenas os temas da espiritualidade e da pedofilia foram abordados nos estudos analisados, ambos com metodologia de revisão de literatura. Apesar de os campos de bioética e psiquiatria terem grande relevância na contemporaneidade, há escassez de trabalhos científicos no Brasil sobre o tema, pouco explorado e incentivado.

Abstract Our integrative literature review sought to analyze the scientific production on bioethics and psychiatry published in Brazil in the last ten years. Bibliographic search used descriptors and search operators to relates the terms " ética or bioética or ética médica and psiquiatria, " resulting in thirteen articles selected, of which only two were eligible for review according to the inclusion criteria. Results show that only spirituality and pedophilia were themes addressed by the analyzed studies, both literature reviews. Despite the contemporary relevancy of bioethics and psychiatry, research on these themes is little explored and encouraged in Brazil.

Resumen Con el fin de analizar la producción científica sobre bioética y psiquiatría en Brasil publicada en los últimos diez años, se realizó una revisión integradora de la literatura disponible en bases de datos, utilizando descriptores y operadores de investigación para relacionar los términos "ética or bioética or ética médica and psiquiatría". La búsqueda culminó con la selección de trece artículos, de los cuales solo dos fueron elegibles para la revisión integradora según los criterios de inclusión. Los resultados mostraron que solo se abordaron los temas de espiritualidad y pedofilia en los estudios analizados, ambos siguieron la metodología de revisión de literatura. Aunque la bioética y la psiquiatría tienen gran relevancia en la contemporaneidad, los estudios científicos en Brasil sobre el tema son escasos, poco explorados y fomentados.

Transtornos de ansiedade: histórico, aspectos clínicos e classificações atuais / Anxiety disorders: history, clinical features, and current classifications

Objetivos: contribuir para a compreensão do desenvolvimento histórico do conceito de ansiedade, das classificações dos transtornos ansiosos e suas manifestações clínicas, bem como para a atualização sobre o processo de avaliação diagnóstica. Métodos: todas as edições das classificações da Organização Mundial de Saúde (OMS) - CID e da Associação Psiquiátrica Americana (APA) - DSM foram examinadas, além de livros-texto de referência de psiquiatria clínica, de publicações sobre a história e a evolução desses diagnósticos e de publicações produzidas pelas equipes responsáveis pela revisão das classificações atuais. Resultados: entende-se por ansiedade um estado afetivo normal, como um sintoma ou um termo para nomear um grupo de transtornos mentais. Nas primeiras e subsequentes edições das classificações da OMS e da APA, entre 1948 e 1975, os quadros ansiosos faziam parte do grupo das psiconeurose/neuroses. A partir do DSM-III (1980), o grupo das neuroses foi fragmentado em diversos outros, entre os quais os transtornos de ansiedade, o que foi seguido pela CID-10 (1992), apesar de alguma distinção na composição dos subtipos. Para as últimas versões, houve um empenho de compatibilização entre as duas, contudo restaram diferenças: o DSM-5 (2013) adota critérios diagnósticos; a CID-11 (2019) utiliza descrições clínicas e diretrizes diagnósticas, além de abordagens dimensionais para alguns transtornos. Conclusão: ocorreram modificações nas classificações psiquiátricas atuais, no grupo dos transtornos de ansiedade, que precisam ser disseminadas e agregadas a estratégias de formação e qualificação profissionais, incrementando habilidades diagnósticas e permitindo uma comunicação mais uniforme e precisa na prática clínica.

Objectives: to contribute to the understanding of the historical development of the concept of anxiety, the classifications of anxiety disorders and their clinical manifestations, as well as to update on the diagnostic evaluation process. Methods: all editions of the classifications of the World Health Organization (WHO) - ICD and the American Psychiatric Association (APA) - DSM were examined, in addition to reference textbooks on clinical psychiatry, publications on the history and evolution of these diagnoses, and scientific articles produced by the teams responsible for reviewing the current classifications. Results: anxiety is understood as a normal affective state, as a symptom, or as a term to name a group of mental disorders. In the first and subsequent editions of the WHO and APA classifications, between 1948 and 1975, anxiety disorders were part of the psychoneuroses/neuroses group. As of DSM-III (1980) onwards, the neuroses group was fragmented into several others, including anxiety disorders, which was followed by ICD-10 (1992), despite some different choices of subtypes. For the latest versions, there was a compatibility effort between them. However, differences remained: DSM-5 (2013) adopts diagnostic criteria; ICD-11 (2019) uses clinical description and diagnostic guidelines, in addition to dimensional approaches for some disorders. Conclusion: modifications have occurred in current psychiatric classifications, in the group of anxiety disorders, which need to be disseminated and added to professional training and qualification strategies, increasing diagnostic skills and providing for more uniform and accurate communication in clinical practice.

Prevalence and factors associated with depression in people living with HIV/AIDS in a Brazilian metropolitan region.

The frequent association between mental disorders and HIV infection may be related to several risk factors. The present study aims to determine the prevalence of depression and its associated factors in people living with HIV/AIDS (PLWHA) who attended four outpatient clinics in Fortaleza, Brazil, between September 2014 and April 2015. In addition to the Mini International Neuropsychiatric Interview questionnaire, which was used to identify the prevalence of depressive disorder, the researchers applied a sociodemographic questionnaire, and the Hamilton Depression Scale to classify the severity of depression. In all, 257 participants were included in the analyses. The overall lifetime prevalence of depression was identified to be 29.2% (19.5% in men and 44.9% in women). The prevalence of a current depressive episode was 18.7%. Mild, moderate, and severe depression was identified in 2.1%, 12.5%, and 85.4%, respectively. The factors related to depression were: gender, marital status, income, educational level, current employment status, and family history of depression. This study highlights the importance of lifetime depression as a disorder of high prevalence in PLWHA, and associated with risk factors that are difficult or impossible to be modified. Early diagnosis and treatment of depression may improve quality of life in PLWHA.

Desigualdade da mortalidade por suicídio entre as macrorregiões de saúde do estado do Ceará, Brasil, 2012-2016 / Inequality of suicide mortality among health macro-regions in the state of Ceará, Brazil, 2012-2016

Objetivo: descrever as características e taxas de mortalidade por suicídio no estado do Ceará e suas macrorregiões. Método: estudo descritivo, compreendendo o período de 2012-2016. Resultados e conclusão: a maioria dos casos ocorreu no sexo masculino, entre não casados, em domicílio, por enforcamento, na macrorregião de Fortaleza. A taxa no Ceará foi de 5,1/100.000. As macrorregiões do Sertão Central, Sobral e Cariri apresentam maiores taxas. Taxas mais elevadas ocorreram no interior do estado, onde, habitualmente, há menor acesso a serviços especializados, sendo a participação da atenção primária de grande importância no enfrentamento desse agravo.

Objective: to describe the characteristics and rates of mortality by suicide in the state of Ceará and its macro-regions. Method: a descriptive study covering the period 2012-2016. Results and conclusion: most cases occurred in males, among unmarried people, at home, by hanging, in the macro-region of Fortaleza. The rate in Ceará was 5.1/100.000 thousand. The macro-regions of Sertão Central, Sobral, and Cariri have higher rates of cases. Higher rates occurred in areas in the interior of the state, where there is usually less access to specialized services, and the participation of primary care is of great importance in dealing with this problem.

Qualidade de vida de pacientes esquizofrenicos

O autores apresentam contribuicoes de varios estudiosos na discussao do conceito de qualidade de vida (QV) e listam as dimensoes que compoem o modelo de consenso que emergiu dessa discussao. Relacionam o emprego da QV como variavel em diversos campos de investigacao cientifica, particularmente na area da saude e da medicina clinica. Fazem uma revisao da literatura, sobre seu uso, em estudos com pacientes esquizofrenicos. Por fim, mencionam algumas questoes ainda pendentes a respeito das afericoes de QV. Concluem ressaltando a importancia e a necessidade de investigacoes com QV, sugerindo que seja empregada como parametro de apreciacao da qualidade da prestacao dos servicos de saude mental no Brasil, e que os profissionais da area da saude a adotem como mais um elemento na avaliacao de seus pacientes.