The Effect of Cannabidiol for Restless Legs Syndrome/Willis-Ekbom Disease in Parkinson's Disease Patients with REM Sleep Behavior Disorder: A Post Hoc Exploratory Analysis of Phase 2/3 Clinical Trial.

Background: Cannabidiol (CBD) is one of the main nonpsychoactive components of Cannabis sativa and may represent an alternative treatment for Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) in patients with Parkinson's disease (PD) and REM (Rapid Eye Movement) sleep behavior disorder (RBD). Objective: Our purpose was a post hoc exploratory analysis to evaluate the CBD's efficacy to improve the severity of RLS/WED symptoms in patients with PD and RBD. Methods: A post hoc exploratory analysis of a phase II/III, a parallel, double-blind, placebo-controlled clinical trial was conducted in 18 patients with RLS/WED and PD plus RBD associated. Six patients were randomized to the CBD group in doses of 75-300 mg, and twelve received placebo capsules. They were followed up for 14 weeks. The primary outcome was the severity of RLS/WED by Restless Legs Syndrome Rating Scale of the International Restless Legs Syndrome Study Group (IRLSSG). Results: CBD showed no difference in relationship to placebo for primary and secondary outcomes. Conclusion: CBD showed no reduction in the severity of RLS/WED manifestation in patients with PD and RBD.

Evaluation of the HPA Axis' Response to Pharmacological Challenges in Experimental and Clinical Early-Life Stress-Associated Depression.

Early-life stress (ELS) is associated with a higher risk of psychopathologies in adulthood, such as depression, which may be related to persistent changes in the hypothalamic-pituitary-adrenal (HPA) axis. This study aimed to evaluate the effects of ELS on the functioning of the HPA axis in clinical and experimental situations. Clinically, patients with current depressive episodes, with and without ELS, and healthy controls, composed the sample. Subjects took a capsule containing placebo, fludrocortisone, prednisolone, dexamethasone or spironolactone followed by an assessment of plasma cortisol the morning after. Experimentally, male Wistar rats were submitted to ELS protocol based on variable, unpredictable stressors from postnatal day (PND)1 to PND21. On PND65 animals were behaviorally evaluated through the forced-swimming test (FST). At PND68, pharmacological challenges started, using mifepristone, dexamethasone, spironolactone, or fludrocortisone, and corticosterone levels were determined 3 h after injections. Cortisol response of the patients did not differ significantly from healthy subjects, regardless of their ELS history, and it was lower after fludrocortisone, prednisolone, and dexamethasone compared with placebo, indicating the suppression of plasma cortisol by all these treatments. Animals exposed to ELS presented altered phenotype as indicated by an increased immobility time in the FST when compared with control, but no significant long-lasting effects of ELS were observed on the HPA axis response. Limitations on the way the volunteers were sampled may have contributed to the lack of ELS effects on the HPA axis, pointing out the need for further research to understand these complex phenomena.

LaPICC contra COVID-19: relato de uma experiência de terapia cognitivo-comportamental em grupo online / LaPICC against COVID-19: report of an online group cognitive-behavioral therapy experience / LaPICC contra COVID-19: informe de una experiencia grupal de terapia cognitivo-conductual en línea

A saúde mental da população foi impactada pela pandemia da COVID-19. O artigo relata a experiência do projeto "LaPICC contra COVID-19" que ofertou grupos psicoeducativos durante a pandemia para oportunizar a aprendizagem de estratégias de manejo de ansiedade e de estresse diante da grave crise sanitária. Foi proposta uma intervenção online de Terapia cognitivo-comportamental em grupo, com foco no manejo de ansiedade e de estresse, composta de duas sessões que ocorriam na mesma semana. A intervenção foi realizada por videoconferência, sendo que 34 participantes finalizaram a mesma. O conjunto de dados obtidos sugere a diminuição dos níveis de ansiedade, a aquisição de habilidades de manejo de emoções desagradáveis de sentir e o aumento de comportamentos de autocuidado. O artigo discute os desafios em intervenções de terapia cognitivo-comportamental em grupo online e a responsabilidade social dos profissionais de psicologia no contexto da pandemia

The population mental health was impacted by the COVID-19 pandemic. The article reports the experience of the "LaPICC against COVID-19" project, which offered psychoeducational groups during the pandemic to provide opportunities for learning about anxiety and stress management strategies, it is in the face of a serious health crisis. An online group cognitive-behavioral therapy intervention was proposed, focusing on the management of anxiety and stress, consisting of 2 sessions in the same week. The intervention was carried out by videoconference, and 34 participants completed it. The data obtained suggests a decrease in anxiety levels, the acquisition of skills to manage unpleasant emotions and an increase in self-care behaviors. The article discusses the challenges in online group cognitive-behavioral therapy interventions and the social responsibility of psychology professionals in the context of the pandemic

La salud mental de la población se vio afectada por la pandemia del COVID-19. El artículo relata la experiencia del proyecto "LaPICC contra COVID-19", que ofreció grupos psicoeducativos durante la pandemia para brindar oportunidades de aprendizaje sobre estrategias de manejo de la ansiedad y el estrés ante una grave crisis de salud. Se propuso una intervención de terapia cognitivo-conductual grupal en línea, centrada en el manejo de la ansiedad y el estrés, que estaba compuesta por 2 sesiones, que se realizaban en la misma semana. La intervención se realizó por videoconferencia y la completaron 34 participantes. Los datos obtenidos sugieren una disminución de los niveles de ansiedad, la adquisición de habilidades para el manejo de emociones desagradables y un aumento de las conductas de autocuidado. El artículo analiza los desafíos en las intervenciones de terapia cognitivo-conductual grupal en línea y la responsabilidad social de los profesionales de la psicología en el contexto de la pandemia

Transtorno bipolar: uma revisão dos aspectos conceituais e clínicos / Bipolar disorder: a review of conceptual and clinical aspects

Esta revisão tem o objetivo de introduzir aspectos históricos, epidemiológicos e etiológicos do transtorno bipolar, além de apresentar a caracterização e curso da doença e algumas questões relativas ao diagnóstico, tratamento e prognóstico. O Transtorno Bipolar (TB) é caracterizado por graves alterações de humor, que envolvem períodos de humor elevado e de depressão intercalados por períodos de remissão. O transtorno se diferencia em dois tipos principais: o Tipo I, em que ocorrem episódios de mania, e o Tipo II, em que a elevação do humor é mais branda e breve, caracterizando episódios de hipomania. O conceito de espectro bipolar amplia a classificação do TB, incluindo padrões clínicos e genéticos. O TB é uma doença comum, que atinge cerca de 30 milhões de pessoas no mundo, afetando homens e mulheres de modo diferente. As causas do TB incluem uma interação de fatores genéticos e ambientais, distinguindo-o como um transtorno complexo e multideterminado. O diagnóstico segundo os critérios do DSM-5 envolve a identificação de sintomas de mania ou hipomania e da avaliação do curso longitudinal da doença. A depressão é geralmente o quadro mais comum e persistente entre os pacientes bipolares. Embora não existam sintomas específicos que distinguem a depressão unipolar da depressão bipolar, foram encontradas características clínicas típicas de cada manifestação (e.g., perfil dos sintomas, história familiar, e curso da doença). O diagnóstico precoce e o tratamento dos episódios agudos de humor melhoram significativamente o prognóstico. O tratamento de primeira escolha é com medicamentos estabilizadores de humor, anticonvulsivantes e antipsicóticos atípicos. A combinação de medicamentos com intervenções psicossociais tem se mostrado efetiva. Não obstante, o uso de antidepressivos em monoterapia não é recomendado. (AU)

This review aims to introduce historical, epidemiological and etiological aspects of bipolar disorder, also to present the characterization and course of the disease, as well as some issues related to the diagnosis, treatment and prognosis. Bipolar disorder (BD) is characterized by severe mood disturbances, involving periods of elevated mood and depression intercalated with periods of remission. The disorder is distinguished into two main types: Type I, in which episodes of mania occur; and Type II, in which mood elevation is milder and briefer, characterizing episodes of hypomania. The concept of bipolar spectrum extends the classification of BD, including clinical and genetic patterns. BD is a common disease that strikes about 30 million people worldwide, affecting men and women differently. The causes of BD include the interaction of genetic and environmental factors, distinguishing it as a complex and multidimensional disorder. The diagnosis according to DSM-5 involves the identification of mania or hypomania symptoms and the longitudinal evaluation of the disease course. Depression is usually the most common and persistent condition among bipolar patients. Although there are no specific symptoms that distinguish unipolar depression from bipolar depression, typical clinical features of each manifestation were found (e.g., symptom profile, family history, and disease course). Early diagnosis and the treatment of acute mood episodes significantly improve the prognosis. The first choice treatment involves mood stabilizers, anticonvulsants and atypical antipsychotics. The combination of medication with psychosocial interventions has been proved effective. However, the use of antidepressant monotherapy is not recommended. (AU)

Neuropsychological changes in melancholic and atypical depression: A systematic review.

There is not a consensus as to whether neuropsychological profiling can distinguish depressive subtypes. We aimed to systematically review and critically analyse the literature on cognitive function in patients with melancholic and atypical depression. We searched in databases PubMed, SCOPUS, Web of Knowledge and PsycInfo for papers comparing the neuropsychological performance of melancholic patients (MEL) to non-melancholic depressive patients (NMEL), including atypical depressives, and healthy controls (HC). All studies were scrutinised to determine the main methodological characteristics and particularly possible sources of bias influencing the results reported, using the STROBE statement checklist. We also provide effect size of the results reported for contrasts between MEL; patients and NMEL patients. Seventeen studies were included; most of them demonstrated higher neuropsychological impairments of MEL patients compared to both NMEL patients and HC on tasks requiring memory, executive function, attention and reaction time. Detailed analysis of the methodologies used in the studies revealed significant variability especially regarding the participants' sociodemographic characteristics, clinical characteristics of patients and differences in neuropsychological assessment. These findings suggest that MEL may have a distinct and impaired cognitive performance compared to NMEL depressive patients on tasks involving verbal and visual memory, executive function, sustained attention and span, as well as psychomotor speed, this last especially when cognitive load is increased. Additional studies with adequate control of potentially confounding variables will help to clarify further differences in the neuropsychological functioning of depressive subtypes.

Padrão da atividade locomotora e expressão de EAAC1 e GLT1 no córtex pré-frontal e entorrinal de ratos criados em isolamento a partir do desmame

O estresse por isolamento social aplicado em ratos a partir do desmame e mantido durante o desenvolvimento encefálico tem sido utilizado como um modelo experimental de desordens psiquiátricas como a esquizofrenia. Tem sido demonstrado que o isolamento induz alterações morfológicas, comportamentais (como hiperatividade em um novo ambiente) e neuroquímicas semelhantes àquelas que ocorrem em humanos esquizofrênicos. Evidências sugerem que as sinapses glutamatérgicas sejam o sitio primário das anormalidades que ocorrem na esquizofrenia, sendo as alterações dopaminérgicas secundárias às glutamatérgicas. Nesse sentido, alterações nos mecanismos de regulação desta neurotransmissão pelos transportadores de glutamato podem contribuir para o desenvolvimento e/ou manutenção da esquizofrenia. Neste estudo analisamos o padrão de atividade locomotora e a expressão de transportadores de glutamato (EAAC1 e GLT1) no córtex pré-frontal e córtex entorrinal de ratos criados em isolamento a partir do desmame. Ratos Wistar machos (PND21) foram aleatoriamente alocados em 2 grupos (n=11-12): controle (agrupados, 3 animais/caixa) ou isolados (1 animal/caixa) por 10 semanas. Os animais foram testados no campo aberto (arena) durante 20 min. e registrados: números de cruzamentos (exploração horizontal), número de levantamentos (exploração vertical) e tempo despendido, tanto no centro como na periferia da arena. Os grupos foram comparados utilizando ANOVA ou teste t de Student (significante quando p 0.05)...(AU)

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