Treatment of depression during pregnancy: a protocol for systematic review and meta-analysis.

Introduction: Major Depressive Disorder (MDD) is a chronic, recurrent, and highly prevalent disease that is associated with significant functional disability. During pregnancy, the prevalence of the disease is approximately 20%, with 12% of these, requiring treatment to avoid important negative consequences for the mother-baby binomial. Risk-benefit assessment of the use of antidepressants during pregnancy is mandatory, in addition to knowledge of the long-term effects of prenatal exposure to these drugs in the offspring. In this study, we will perform an updated systematic review and meta-analysis to explore the treatment of depression during pregnancy, along with its effectiveness, safety, and possible harm to women and children. Materials and methods: We will search for publications in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, Scopus, Lilacs, and PsycINFO. The reference lists of the included studies will be manually reviewed to identify potentially relevant studies. There will be no restrictions on language or date of publication. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias (RoB2) instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aimed to ascertain the efficacy and safety of antidepressants in pregnant women and children. Ethics and dissemination: Ethical approval was not required as individual patient data were not collected. Dissemination: Plan to publish a systematic review in an open-access medical journal at the end of the process. Systematic Review Registration: PROSPERO, CRD42023447694.

Knowledge and perceived confidence of Brazilian psychiatrists about eating disorders´ diagnosis and treatment recommendations.

OBJECTIVE: To investigate Brazilian psychiatrists ́ knowledge and perceived confidence, both in diagnosis and in evidence-based treatments for eating disorders (ED). METHODS: In this cross-sectional study, 259 psychiatrists filled out an online form including: sociodemographic data, questions about ED diagnosis and management based on standard guidelines. Descriptive statistics described sample characteristics and levels of ED knowledge and perceived confidence. RESULTS: Sample was composed mainly by women (65,64%), with mean age of 42.86, from the Southeast of Brazil (56,37%), working predominantly in private practice (59,85%), with less than ten years of experience in Psychiatry (51,74%). We found that 33.21% of participants correctly chose diagnostic criteria for anorexia nervosa (AN); 29.73% for bulimia nervosa (BN), and 38.22% for binge eating disorder (BED). Correct answers for therapeutic options were similar in BN and BED (20.8%), being considerably lower for AN (2.7%). Additionally, reported ED training were: 15.1% during medical school; 59.8% during medical residency/postgraduate studies; 58.7% as complementary training. Only 8.89% felt satisfied with their ED training; 50.97% felt confident diagnosing ED and 37.07% in managing ED patients. CONCLUSION: These results demonstrated an important gap in ED knowledge of Brazilian psychiatrists, and its consequences on their confidence and competence in managing ED patients.

Adult ADHD Symptoms in a Large Metropolitan Area From Brazil: Prevalence and Associations with Psychiatric Comorbidity, Bullying, Sexual Abuse, and Quality of Life.

OBJECTIVE: The aim of this study was to investigate the prevalence and psychiatric correlates of symptomatic ADHD in a large metropolitan area of a middle-income country. METHODS: An in-person household survey with randomly selected 2,297 adults aged 19 to 60 from Rio de Janeiro, Brazil, assessed by trained lay interviewers. The Adult Self-Rating Scale Screener (ASRS-6) was used. Chi-square and logistic regression were conducted. RESULTS: ADHD prevalence was 4.59 (95% CI [3.56, 5.44]). Those with ADHD were younger and more often unemployed; they displayed more psychiatric symptoms (depression, anxiety, and alcohol abuse) and a history of bullying and sexual abuse. They also had worse physical health indicators. Findings remained significant when controlling for socioeconomic variables. CONCLUSION: Adults with symptomatic ADHD from a large metropolitan area in Brazil show a pattern of findings consistent with what has been observed in higher-income countries.

Medication Non-adherence in Depression: A Systematic Review and Metanalysis.

OBJECTIVE: Medication non-adherence is frequently reported in patients with major depressive disorder (MDD). The objective of this review is to consolidate data on the prevalence of non-adherence to antidepressant in MDD. METHODS: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the protocol was registered in PROSPERO under the number CRD42021199987. Studies assessing medication adherence in MDD were searched in PubMed/Medline, Embase, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and PsycINFO. The data extraction was performed by two independents authors. Meta-analysis used random effects model and performed a subgroup analysis. RESULTS: From the articles retrieved, eleven studies were considered eligible for the final analysis. Most of them assessed non-adherence by self-report scales, followed by Pharmacy Dispensation Records, Monitoring Events Medication System (MEMS) and blood tests. The pooled proportion of non-adherence was 42% (95% IC 30%-54%), but heterogeneity was very large (I2=99%). CONCLUSION: Data from the selected studies suggests that a high number of individuals with MDD do not adequately take their medication as prescribed. The high heterogenicity of measures used for the assessment of adherence may have impacted the great variability of the results. The results suggest it is necessary that health care professionals should address this issue in order to achieve a better treatment outcome in major depression.

Validation of the Brazilian version of the Short Inventory of Grazing (SIG)

Abstract Objective Grazing is a disturbed eating pattern that has been associated with eating disorders and obesity. One of the new measures to investigate this eating behavior is the Short Inventory of Grazing (SIG), a two-item questionnaire that assesses grazing in general and grazing associated with the feeling of loss of control over eating (LOC grazing). However, the psychometric properties of the SIG have not been assessed in the Brazilian population. The present study aimed to cross-culturally adapt and validate a Brazilian version of the SIG. Methods The SIG was adapted to the Brazilian context following international guidelines. Then, 90 undergraduate students completed an online survey including questions from the SIG, the Binge Eating Scale (BES), the Patient Health Questionnaire-9 (PHQ9), the Generalized Anxiety Disorder-7 (GAD7), and a question related to self-reported health status. The internal consistency, test-retest reliability, and convergent validity of the questionnaire were assessed. Results The prevalence rates of at least one weekly episode of grazing in general and LOC grazing were 71.1 and 54.5%, respectively. The internal consistence of the SIG was acceptable (0.81). In addition, SIG scores on both items were positively and significantly associated with BES, GAD7, and PHQ9 scores, and with poorer self-rated health. However, SIG test and retest scores differed significantly. Conclusion Overall, the Brazilian version of the SIG demonstrated adequate psychometric properties. The instrument had adequate internal consistency, with both items exhibiting good convergent validity with related measures.

Obtaining long-term recovery: advances in optimizing treatment outcomes in patients with binge-eating disorder.

INTRODUCTION: Binge-eating disorder (BED) is a complex and disabling eating disorder (ED) associated with considerable burden and impairments in quality of life and physical/mental health. It has been recognized as a formal ED category since 2013, however BED is still underdetected and undertreated. AREAS COVERED: This review summarizes the advances in the understanding of the pathophysiology of BED as well as the evidence on the efficacy of the existing treatments. The authors searched Scopus, PubMed, ClinicalTrials.Gov, and ANZCTR with terms including 'assessment' OR 'treatment' OR 'diagnosis' OR 'mechanisms' AND 'binge eating' OR 'binge-eating disorder' for manuscripts published between January 2013 and April 2023. EXPERT OPINION: Most of the trials on treatments of BED have been in people of high weight with weight loss as an outcome. Nevertheless, less is known about the treatment of this condition in people with body mass index (BMI) within the normal range where weight stabilization may be a more appropriate goal. Moreover, there is a need for an enhanced appreciation of the role of combination treatment to improve overall outcomes. Also, there are important opportunities for future research in understanding the mechanisms of action and effectiveness of BED treatments.

Relationship between psychopathology and binge size in binge eating spectrum disorders.

INTRODUCTION: Food intake during binge eating episodes has been found to be associated with symptoms of depression and anxiety in individuals with eating disorders. OBJECTIVE: To evaluate the association between caloric intake during binge eating episodes (BEE) and psychopathology in individuals with binge eating spectrum disorders (BSD). METHODS: One-hundred and fourteen outpatients diagnosed with bulimia nervosa (BN) and binge eating disorder were sequentially assessed. MINI PLUS was used to assess psychiatric diagnoses. Validated self-report instruments were used to assess general and eating-related psychopathology. The assessment of caloric consumption during BEE was performed through Dietpro Clinical Program. Data analysis was performed with independent Student's t test, effect size (Cohen's d) and Pearson's correlation. RESULTS: Participants with BSD comorbid with a depressive disorder consumed significantly more calories during BEE than those without depression. Furthermore, participants with BSD and higher levels of impulsivity had a greater caloric intake during the episode. Specifically, regarding BN, participants with greater disease severity consumed more calories during the episode than those with less severity. CONCLUSIONS: Overall, depression and high impulsivity were associated with a higher caloric intake during BEE in individuals with BSD. For those with BN, the disease severity was associated with greater caloric consumption during the episode. Our results support the relevance of early identification of psychiatric comorbidities and the implementation of strategies to control mood and impulsivity aiming at a better prognosis in the treatment of BSD.

Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City.

The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old-60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE.

Hyperpalatable Foods Consumption in a Representative Sample of the General Population in Brazil: Differences of Binge and Non-Binge Eating Meals.

The availability of hyper-palatable foods (HPF) increased over the past three decades worldwide, a period when eating disorders (ED) and obesity have become global public health concerns. The present study aimed to assess HPF consumption during binge and non-binge meals in a representative sample of adults with and without ED from a metropolitan city in Brazil. A total of 2297 individuals were interviewed in their homes by trained lay interviewers to assess the presence of binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE). Information on their food consumption in objective and subjective binge eating episodes (OBE and SBE, respectively), as well as in the 24 h food recall were obtained. Individuals from the general population consumed 56% of their total calories from HPF. In non-binge meals, people with BN consumed substantially fewer calories from HPF than BED (63% vs. 48%) and RBE (63% vs. 48%) groups. During OBE, participants consumed an average of 70% of the calories from HPF, with no between-group differences. During SBE, subjects with BN consumed substantially fewer calories from HPF than those with BED (76% vs. 50%). In conclusion, HPF were highly consumed by the Brazilian population. However, there was a greater impact on BED and RBE subjects and during binge eating episodes.

Twenty-year associations between disordered eating behaviors and sociodemographic features in a multiple cross-sectional sample.

BACKGROUND: Disordered eating behaviors (DEB) impact on health and wellbeing worldwide. This study aimed to examine sociodemographic trends in the prevalence of DEB over 20 years in the Australian general population. METHODS: Data were derived from five sequential cross-sectional surveys (1998, 2008, 2009, 2016 and 2017) with population-representative samples of adults and adolescents residing in South Australia (N = 15 075). DEBs investigated were objective binge eating (OBE), strict dieting/fasting, and purging. Sociodemographic data included gender, age, educational level, work and marital status, and residence. RESULTS: OBE prevalence increased significantly. Strict dieting/fasting also increased from 1998 to 2008/9 but remained stable between 2008/9 and 2016/7. Purging prevalence did not change significantly over time. All survey years were associated with a significantly higher odds of OBE, and strict diet/fasting compared to 1998. Lower age, a higher Accessibility Remoteness Index of Australia (ARIA) score, higher body mass index (BMI), higher educational attainment, and not being in a married or de facto relationship were independently associated with greater adjusted odds for endorsing OBE. Younger age, female gender, and higher BMI were also independently associated with greater adjusted odds for endorsing strict dieting/fasting. CONCLUSIONS: The increased prevalence of DEBs in various strata of Australian society has both public health and clinical implications. The results refute the stereotype that eating disorders (EDs) predominantly affect young women. They build impetus for future research on EDs among men and older individuals, with a view to developing tailored public health and clinical interventions for these populations.

Prevalence of sexual dysfunction in depressive and persistent depressive disorders: a systematic review and meta-analysis.

The aim of this study was to estimate the prevalence of sexual dysfunction in depressive disorders in individuals not in pharmacological treatment. For this purpose, we performed a systematic review and meta-analysis using the PRISMA guidelines, and the review was registered in PROSPERO (registration number CRD42020179709). Studies that evaluated sexual function and dysfunction in major depressive disorder (MDD) and persistent depressive disorder (PDD) were identified through searches in PubMed/Medline, Web of Science, PsychINFO, Scopus, and Scielo. Twelve cross-sectional studies were eligible. In women with MDD, the pooled prevalence rates of sexual impairment were: 47.22% (95% CI: 34.86-59.58) for arousal; 65.30% (95% CI: 45.86-84.73) for desire; 36.98% (95% CI: 28.42-45.54) for lubrication; 34.17% (95% CI: 17.87-50.46) for orgasm; and 33.91% (95% CI: 17.48-50.34) for sexual satisfaction. In men, the sexual impairment prevalence rates were: 26.45% (95% CI: 12.26-40.63) for arousal; 40.32% (95% CI: 22.19-58.46) for desire; 32.07% (95% CI: 26.14-37.99) for erection; 35.27% (95% CI: 5.13-65.41) for orgasm; and 23.05% (95% CI: 13.60-32.51) for sexual satisfaction. Overall sexual dysfunction was found in 82.75% of women (95% CI: 74.71-90.78) and 63.26% of men (95% CI: 52.83-73.69). Our results show that various sexual functions are impaired in MDD, making imperative the systematic evaluation of these alterations by clinicians. Future studies should be conducted, especially in PDD, to elucidate the role of these disorders in sexual function.

Remote consultation with people with eating disorders during the COVID-19 pandemic / Consulta remota a las personas con trastornos alimenticios durante la pandemia de COVID-19 / Consulta remota a pessoas com transtornos alimentares durante a pandemia de COVID-19

ABSTRACT Objectives: to analyze subjective experiences related to adaptation to remote care by users with eating disorders during the COVID-19 pandemic. Methods: a descriptive study with a qualitative approach conducted with users of an eating disorders outpatient clinic. A semi-structured remote interview was applied using the Google Meet application. The data were submitted to lexical analysis using ALCESTE software and discussed in the light of scientific evidence. Results: the remote appointment is a positive strategy but not a substitute for the face-to-face modality. The research cited financial savings, closer contact with professionals, and flexibility of service schedules as advantages. It pointed out the difficulty in clinical evaluation concerning weight, vital signs, and poor mastery of technology as limitations. Final Considerations: the study induces discussion about the systematization of remote care, which, during the COVID-19 pandemic, were responsible for providing a greater sense of support to people with eating disorders.

RESUMEN Objetivos: analizar experiencias subjetivas relacionadas a la adaptación a la atención remota por usuarios con trastornos alimenticios durante la pandemia de COVID-19. Métodos: estudio descriptivo de abordaje cualitativo realizado con usuarios de un ambulatorio especializado en trastornos alimenticios. Fue aplicada una entrevista semiestructurada remota, utilizándose el aplicativo Google Meet. Los datos fueron sometidos al análisis lexical mediante software ALCESTE y discutidos a la luz de las evidencias científicas. Resultados: la consulta remota es una estrategia positiva, pero no substitutiva de la presencial. Ventajas como economía financiera, mayor contacto con los profesionales y flexibilización de horarios de atenciones fueron citadas. Dificultad de evaluación clínica en relación al peso, signos vitales y poco dominio de tecnología fueron apuntados como limitaciones. Consideraciones Finales: el estudio induce la discusión sobre sistematización de atenciones remotas, las cuales, durante la pandemia de COVID-19, fueron responsables por fornecer mayor sensación de soporte a personas con trastornos alimenticios.

RESUMO Objetivos: analisar as experiências subjetivas relacionadas à adaptação ao atendimento remoto por usuários com transtornos alimentares durante a pandemia de COVID-19. Métodos: estudo descritivo de abordagem qualitativa realizado com usuários de um ambulatório especializado em transtornos alimentares. Foi aplicada uma entrevista semiestruturada remota, utilizando-se o aplicativo Google Meet. Os dados foram submetidos à análise lexical por meio do software ALCESTE e discutidos à luz das evidências científicas. Resultados: a consulta remota é uma estratégia positiva, mas não substitutiva da modalidade presencial. Vantagens como economia financeira, maior contato com os profissionais e flexibilização de horários de atendimentos foram citadas. Dificuldade de avaliação clínica em relação ao peso, sinais vitais e pouco domínio da tecnologia foram apontados como limitações. Considerações Finais: o estudo induz a discussão sobre sistematização dos atendimentos remotos, os quais, durante a pandemia de COVID-19, foram responsáveis por fornecer maior sensação de suporte às pessoas com transtornos alimentares.

Impairment of Sexual Desire in Treatment-Resistant Depression: Prevalence and Correlates.

Objective: To assess sexual desire in patients with treatment-resistant depression (TRD).Methods: Baseline data were analyzed from an ongoing cohort study at an outpatient clinic specializing in TRD treatment in Brazil. The cohort comprised consecutive patients with the diagnosis of TRD who sought treatment at this center between November 2015 and January 2021. The Hamilton Depression Rating Scale (HDRS) genital symptoms item (item 14) was used as a proxy to assess sexual desire.Results: Sixty-five participants with TRD were included. There was sexual desire impairment in 67.7% of patients. Men (87.5%) were more affected than women (61.2%), and this difference was statistically significant (P = .05). Depression severity was associated with greater complaints of this aspect of sexual function (P < .01).Conclusions: Participants with TRD had a high prevalence of sexual desire impairment, which was associated with greater depressive symptom severity and male sex. The findings suggest that health care professionals should systematically assess sexual desire in patients with TRD in daily clinical practice. Further longitudinal studies are needed in larger samples using specific instruments for assessing sexual dysfunction and comparing TRD and non-TRD populations.

Remote consultation with people with eating disorders during the COVID-19 pandemic.

OBJECTIVES: to analyze subjective experiences related to adaptation to remote care by users with eating disorders during the COVID-19 pandemic. METHODS: a descriptive study with a qualitative approach conducted with users of an eating disorders outpatient clinic. A semi-structured remote interview was applied using the Google Meet application. The data were submitted to lexical analysis using ALCESTE software and discussed in the light of scientific evidence. RESULTS: the remote appointment is a positive strategy but not a substitute for the face-to-face modality. The research cited financial savings, closer contact with professionals, and flexibility of service schedules as advantages. It pointed out the difficulty in clinical evaluation concerning weight, vital signs, and poor mastery of technology as limitations. FINAL CONSIDERATIONS: the study induces discussion about the systematization of remote care, which, during the COVID-19 pandemic, were responsible for providing a greater sense of support to people with eating disorders.

Validation of the Brazilian version of the Short Inventory of Grazing (SIG).

BACKGROUND: Grazing is a disturbed eating pattern that has been associated with eating disorders and obesity. One of the new measures to investigate this eating behavior is the Short Inventory of Grazing (SIG), a two-item questionnaire that assesses grazing in general and grazing associated with the feeling of loss of control over eating (LOC grazing). However, the psychometric properties of SIG have not been assessed in the Brazilian population. OBJECTIVE: The present study aimed to cross-culturally adapt and validate the Brazilian version of SIG. METHODS: SIG was adapted to the Brazilian context following international guidelines. Then, 90 undergraduate students completed an online survey including questions from the SIG, the Binge Eating Scale (BES), the Patient Health Questionnaire-9 (PHQ9), the Generalized Anxiety Disorder-7 (GAD7), and questions related to self-reported health status. The internal consistency, test-retest reliability, and the convergent validity of the questionnaire were assessed. RESULTS: The prevalence of at least one weekly episode of grazing in general and LOC grazing was 71.1% and 54.5%, respectively. The internal consistence of the SIG was acceptable (0.81). In addition, SIG scores on both items were positively and significantly associated with BES, GAD7, and PHQ9 scores, and with poorer self-rated health. However, SIG scores on the test and retest differed significantly. CONCLUSION: Overall, the Brazilian version of SIG demonstrated adequate psychometric properties. The instrument had an adequate internal consistency, with both items exhibiting good convergent validity with related measures.

Patients and physician's self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study / Autoavaliação de pacientes e médicos em relação à estabilidade clínica em transtornos mentais graves: um estudo transversal

OBJECTIVE: This study explores the relationship between patients' self-assessment and physicians' evaluation regarding clinical stability. METHODS: This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient's physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician's global clinical impression over the six previous months. The patients' self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients' self-evaluation was considered as our standard. RESULTS: The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians' evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. CONCLUSION: The data analysis confirms our hypothesis that the self- -assessment made by patients with SMD was accurate regarding their health condition, and that the self- -assessment made by patients who considered themselves stable agree with the physicians' evaluation.

OBJETIVO: Este estudo explora a relação entre a autoavaliação dos pacientes e a avaliação dos médicos quanto à estabilidade clínica. MÉTODOS: Trata-se de um estudo transversal realizado no ambulatório do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) em uma ampla amostra de pacientes (1.447), dos quais 67,9% eram portadores de transtornos mentais graves (TMG). Coletamos informações por meio de um questionário estruturado desenvolvido para esse fim, preenchido pelo médico assistente. A estabilidade clínica foi avaliada por meio de cinco critérios de instabilidade psiquiátrica e pela impressão clínica global do médico, nos seis meses anteriores. A autoavaliação dos pacientes baseou-se em uma pergunta sobre como eles avaliavam seu estado de saúde: estável/melhor, pior, não sabe. Para as análises, a autoavaliação dos pacientes foi considerada como nosso padrão. RESULTADOS: A amostra foi composta por 824 (57%) mulheres, com idade média de 49 anos. Os diagnósticos mais prevalentes na categoria TMG corresponderam a 937 pacientes, dos quais 846 (90,3%) se avaliaram como estáveis/melhores. As avaliações dos médicos concordaram mais com pacientes portadores de transtorno bipolar e menos com esquizofrênicos em relação à estabilidade. Quanto aos pacientes com transtorno depressivo, os médicos concordaram mais com eles em relação à instabilidade. CONCLUSÃO: A análise dos dados confirma nossa hipótese de que a autoavaliação feita por pacientes com TMG foi precisa quanto à sua condição de saúde e que a autoavaliação feita por pacientes que se consideravam estáveis concorda com a avaliação dos médicos.