Cannabinoids to Improve Health-Related Quality of Life in Patients with Neurological or Oncological Disease: A Meta-Analysis.

Background: Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety and depression. Mental well-being is an important subdomain of health-related quality of life (HRQoL). Reducing symptoms and maintaining HRQoL are particularly important in malignant primary brain tumor patients, as treatment options are often noncurative and prognosis remains poor. These patients frequently report unprescribed cannabinoid use, presumably for symptom relieve. As studies on brain tumor patients specifically are lacking, we performed a meta-analysis of the current evidence on cannabinoid efficacy on HRQoL and mental well-being in oncological and neurological patients. Methods: We performed a systematic PubMed, PsychINFO, Embase, and Web of Science search according to PRISMA guidelines on August 2 and 3, 2021. We included randomized controlled trials (RCTs) that assessed the effects of tetrahydrocannabinol (THC) or cannabidiol (CBD) on general HRQoL and mental well-being. Pooled effect sizes were calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane's Risk of Bias tool. Results: We included 17 studies: 4 in oncology and 13 in central nervous system (CNS) disease. Meta-analysis showed no effect of cannabinoids on general HRQoL (g=-0.02 confidence interval [95% CI -0.11 to 0.06]; p=0.57) or mental well-being (g=-0.02 [95% CI -0.16 to 0.13]; p=0.81). Conclusions: RCTs in patients with cancer or CNS disease showed no effect of cannabinoids on HRQoL or mental well-being. However, studies were clinically heterogeneous and since many glioma patients currently frequently use cannabinoids, future studies are necessary to evaluate its value in this specific population.

Cross-cultural adaptation of the Internet Gaming Disorder Scale - Short Form (IGDS9-SF) to the Brazilian context.

INTRODUCTION: The Internet Gaming Disorder Scale - Short Form (IGDS9-SF) assesses the severity, harmful effects and/or consequences of excessive online and offline gaming. Its conciseness and theoretical foundations on current diagnostic criteria of gaming disorders make it a useful resource for clinical and screening settings. OBJECTIVE: To describe the process of cross-cultural adaptation of the IGDS9-SF to the Brazilian context. METHODS: The cross-cultural adaptation involved the steps of independent translation of the instrument, synthesis version, back-translation, pre-test and elaboration of the final version. Content validity assessment was conducted by a multidisciplinary committee of experts and consisted of both a quantitative analysis (calculation of content validity coefficients - CVC) and a qualitative analysis (assessment of the experts' comments and suggestions). The pre-test sample consisted of 30 gamers with variable sociodemographic characteristics. RESULTS: The cross-cultural adaptation of the scale followed the proposed protocol, and the CVC was satisfactory (≥ 0.83) for all the structures and equivalences assessed. Most of the suggestions made by the experts were accepted (mainly adjustments and language standardization). The gamers who participated in the pre-test judged the scale easy to understand and did not suggest changes. DISCUSSION: The Brazilian version of the IGDS9-SF showed adequate content validity and is available for researchers and clinicians, as well as for the investigation of additional psychometric characteristics.

Factors associated with levels of empathy among students and professionals in the health field: a systematic review.

Objective This study aimed to investigate factors associated with empathy and identify instruments used to measure this ability in professionals and students in the health field. Method A systematic review was performed. Searches were conducted on the PsycINFO, PubMed, Web of Science, and Scopus databases using the keywords "empathy" and "health professional". We selected 29 articles published in English, with no restriction imposed regarding the year of publication. Results Based on the findings of the articles selected, sociodemographic factors (female gender, being married, being older, having siblings, and having children) are associated with higher levels of empathy. Professional experience (years of practice) and being on the final years of the course also contributed to higher levels of empathy. Different versions of the Jefferson Scale of Empathy were the most prevalent assessment tools employed in the different studies. Conclusion The articles analyzed describe several factors that influence the level of empathy among health professionals and students. Thus, future studies should take sociodemographic factors into account when evaluating levels of empathy in this population.

Factors associated with levels of empathy among students and professionals in the health field: a systematic review

Abstract Objective This study aimed to investigate factors associated with empathy and identify instruments used to measure this ability in professionals and students in the health field. Method A systematic review was performed. Searches were conducted on the PsycINFO, PubMed, Web of Science, and Scopus databases using the keywords "empathy" and "health professional". We selected 29 articles published in English, with no restriction imposed regarding the year of publication. Results Based on the findings of the articles selected, sociodemographic factors (female gender, being married, being older, having siblings, and having children) are associated with higher levels of empathy. Professional experience (years of practice) and being on the final years of the course also contributed to higher levels of empathy. Different versions of the Jefferson Scale of Empathy were the most prevalent assessment tools employed in the different studies. Conclusion The articles analyzed describe several factors that influence the level of empathy among health professionals and students. Thus, future studies should take sociodemographic factors into account when evaluating levels of empathy in this population.

Global cognitive performance is associated with sleep efficiency measured by polysomnography in patients with Parkinson's disease.

AIM: Sleep disorders can be associated with an increased risk for cognitive decline in patients with Parkinson's disease (PD). The aim of this study was to examine the association between cognitive status and presence of sleep symptoms and sleep disorders in PD patients. METHODS: We evaluated excessive sleepiness, other sleep symptoms, and performed polysomnography and neuropsychological evaluation in 79 patients. They were classified as having normal cognition (PDNC), mild cognitive impairment (PDMCI), or dementia (PDD). RESULTS: There were 29 PDNC, 39 PDMCI, and 11 PDD patients. PDD patients were older, had higher scores on the Unified Parkinson's Disease Rating Scale, and lower Schwab and England Activities of Daily Living scores than PDNC patients. After analysis of the polysomnographic variables, it was also found that PDD patients had a lower sleep efficiency, lower total sleep time, and lower number of sleep state changes than PDNC patients. In a stepwise analysis, defining Mattis Dementia Rating Scale scores as the dependent variable, the results were a model that selected three variables that accounted for 59% of the variation in the Mattis Dementia Rating Scale score: wake time after sleep onset, number of state changes, and schooling. CONCLUSION: We found a significant association between global cognitive performance and wake time after sleep onset and the number of state changes during sleep measured in the polysomnography of PD patients. However, we did not find any other association between sleep disorders or symptoms and cognitive status or cognitive performance of PD patients.

Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised / Rastreio de comprometimento cognitivo em pacientes com doença de Parkinson: validade diagnóstica das versões brasileiras da Montreal Cognitive Assessment e do Addenbrooke's Cognitive Examination-Revised

ABSTRACTObjective The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinson's disease (PD).Method Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests.Results There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others.Conclusion Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.

RESUMOObjetivo O objetivo do estudo foi avaliar a acurácia das versões Brasileiras das escalas: Montreal Cognitive Assessment (MoCA) e Addenbrooke's Cognitive Examination-Revised (ACE-R), no rastreamento de comprometimento cognitivo leve (CCL) e demência em pacientes com doença de Parkinson (DP).Método As duas escalas foram aplicadas a uma amostra de conveniência de 79 pacientes com DP. Os pacientes foram avaliados por um neurologista, um psiquiatra e uma neuropsicóloga que utilizaram a UPDRS, a escala de Hoehn e Yahr, a escala de Schwab e England, a escala de deterioração global, uma entrevista psiquiátrica estruturada, a escala de demência de Mattis e outros testes cognitivos.Resultados 32 pacientes foram diagnosticados com CCL e 17 com demência. A MoCA e o ACE-R foram capazes de discriminar pacientes com demência dos demais.Conclusão As duas escalas se mostraram úteis para rastrear demência, mas não CCL, em pacientes com DP.

Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised.

OBJECTIVE: The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinson's disease (PD). METHOD: Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests. RESULTS: There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others. CONCLUSION: Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.

Increased amygdalar and hippocampal volumes in young adults with social anxiety.

BACKGROUND: Functional neuroimaging studies have consistently shown abnormal limbic activation patterns in socially anxious individuals, but structural data on the amygdala and hippocampus of these patients are scarce. This study explored the existence of structural differences in the whole brain, amygdala, and hippocampus of subjects with clinical and subthreshold social anxiety compared to healthy controls. We hypothesized that there would be volumetric differences across groups, without predicting their direction (i.e. enlargement or reduction). METHODS: Subjects classified as having social anxiety disorder (n = 12), subthreshold social anxiety (n = 12) and healthy controls (n = 14) underwent structural magnetic resonance imaging scans. The amygdala and hippocampus were defined a priori as regions of interest and volumes were calculated by manual tracing. Whole brain volume was calculated using voxel-based morphometry. RESULTS: The bilateral amygdala and left hippocampus were enlarged in socially anxious individuals relative to controls. The volume of the right hippocampus was enlarged in subthreshold social anxiety participants relative to controls. No differences were found across groups in respect to total brain volume. CONCLUSIONS: Our results show amygdalar and hippocampal volume alterations in social anxiety, possibly associated with symptom severity. The time course of such alterations and the cellular and molecular bases of limbic plasticity in social anxiety should be further investigated.

Rimonabant effects on anxiety induced by simulated public speaking in healthy humans: a preliminary report.

OBJECTIVE: We investigated the hypothesis that rimonabant, a cannabinoid antagonist/inverse agonist, would increase anxiety in healthy subjects during a simulation of the public speaking test. METHODS: Participants were randomly allocated to receive oral placebo or 90 mg rimonabant in a double-blind design. Subjective effects were measured by Visual Analogue Mood Scale. Physiological parameters, namely arterial blood pressure and heart rate, also were monitored. RESULTS: Twelve participants received oral placebo and 12 received 90 mg rimonabant. Rimonabant increased self-reported anxiety levels during the anticipatory speech and performance phase compared with placebo. Interestingly, rimonabant did not modulate anxiety prestress and was not associated with sedation, cognitive impairment, discomfort, or blood pressure changes. CONCLUSIONS: Cannabinoid-1 antagonism magnifies the responses to an anxiogenic stimulus without interfering with the prestress phase. These data suggest that the endocannabinoid system may work on-demand to counteract the consequences of anxiogenic stimuli in healthy humans.

[Guidelines of the Brazilian Medical Association for the treatment of social anxiety disorder]. / Diretrizes da Associação Médica Brasileira para o tratamento do transtorno de ansiedade social.

INTRODUCTION: Social anxiety disorder (SAD) is the most common anxiety disorder, usually with no remission, and is commonly associated with significant functional and psychosocial impairment. The Brazilian Medical Association (BMA), with the project named Diretrizes (Guidelines, in English), seeks to develop consensus for the diagnosis and treatment of common diseases. The aim of this article is to present the most important findings of the guidelines on the treatment of SAD, serving as a reference for the general practitioner and specialist. METHOD: The method used was proposed by the BMA. The search was conducted in the databases of MEDLINE (PubMed), Scopus, Web of Science and LILACS, between 1980 and 2010. The strategy used was based on structured questions as PICO (acronym formed by the initials of "patient or population", "intervention, display or exhibition", "control or comparison" and "outcome"). RESULTS: Studies show that the first-line pharmacological treatment for adults and children are serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, whereas cognitive-behavioral therapy is considered the best psychotherapeutic treatment. Moreover, some psychiatric comorbidities were associated with a worse outcome of SAD. CONCLUSIONS: Despite its high prevalence, SAD does not receive adequate attention and treatment. The best choice for the treatment of adults is a combination of cognitive-behavioral psychotherapy with serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors. Other options as benzodiazepines or monoamine oxidase inhibitors must be used as second and third choices, respectively.

Diretrizes da Associação Médica Brasileira para o tratamento do transtorno de ansiedade social / Guidelines of the Brazilian Medical Association for the treatment of social anxiety disorder

INTRODUÇÃO: O transtorno de ansiedade social (TAS) é o transtorno de ansiedade mais comum, freqüentemente sem remissões, sendo comumente associado com importante prejuízo funcional e psicossocial. A Associação Médica Brasileira (AMB), através do "Projeto Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes relativas ao tratamento do TAS, servindo de referência para o médico generalista e especialista. MÉTODO: O método utilizado foi o proposto pela AMB. A busca foi realizada nas bases de dados do MEDLINE (PubMed), Scopus, Web of Science e Lilacs, entre 1980 e 2010. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho"). RESULTADOS: Estudos evidenciam que o tratamento farmacológico de primeira linha para adultos e crianças são os inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina, enquanto que a terapia cognitivo-comportamental é apontada como melhor tratamento psicoterápico. Além disso, algumas comorbidades psiquiátricas foram associadas a uma pior evolução do TAS. CONCLUSÕES: Apesar da alta prevalência, o TAS acaba por não receber a devida atenção e tratamento. A melhor escolha para o tratamento de adultos é a associação psicoterapia cognitivo-comportamental com inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina. Outras opções como benzodiazepínicos ou inibidores da monoamino-oxidase devem ser usados como segunda e terceira opção respectivamente.

INTRODUCTION: Social anxiety disorder (SAD) is the most common anxiety disorder, usually with no remission, and is commonly associated with significant functional and psychosocial impairment. The Brazilian Medical Association (BMA), with the project named Diretrizes (Guidelines, in English), seeks to develop consensus for the diagnosis and treatment of common diseases. The aim of this article is to present the most important findings of the guidelines on the treatment of SAD, serving as a reference for the general practitioner and specialist. METHOD: The method used was proposed by the BMA. The search was conducted in the databases of MEDLINE (PubMed), Scopus, Web of Science and LILACS, between 1980 and 2010. The strategy used was based on structured questions as PICO (acronym formed by the initials of "patient or population", "intervention, display or exhibition", "control or comparison" and "outcome"). RESULTS: Studies show that the first-line pharmacological treatment for adults and children are serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, whereas cognitive-behavioral therapy is considered the best psychotherapeutic treatment. Moreover, some psychiatric comorbidities were associated with a worse outcome of SAD. CONCLUSIONS: Despite its high prevalence, SAD does not receive adequate attention and treatment. The best choice for the treatment of adults is a combination of cognitive-behavioral psychotherapy with serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors. Other options as benzodiazepines or monoamine oxidase inhibitors must be used as second and third choices, respectively.

Increased dopamine transporter density in Parkinson's disease patients with Social Anxiety Disorder.

Social Anxiety Disorder (SAD) is more common among PD patients than in the general population. This association may be explained by psychosocial mechanisms but it is also possible that neurobiological mechanism underlying PD can predispose to SAD. The aim of this study was to investigate a possible dopaminergic mechanism involved in PD patients with SAD, by correlating striatal dopamine transporter binding potential (DAT-BP) with intensity of social anxiety symptoms in PD patients using SPECT with TRODAT-1 as the radiopharmaceutical. Eleven PD patients with generalized SAD and 21 PD patients without SAD were included in this study; groups were matched for age, gender, disease duration and disease severity. SAD diagnosis was determined according to DSM IV criteria assessed with SCID-I and social anxiety symptom severity with the Brief Social Phobia Scale (BSPS). Demographic and clinical data were also collected. DAT-BP was significantly correlated to scores on BSPS for right putamen (r=0.37, p=0.04), left putamen (r=0.43, p=0.02) and left caudate (r=0.39, p=0.03). No significant correlation was found for the right caudate (r=0.23, p=0.21). This finding may reinforce the hypothesis that dopaminergic dysfunction might be implicated in the pathogenesis of social anxiety in PD.

Validity of the PHQ-2 for the screening of major depression in Parkinson's disease: two questions and one important answer.

INTRODUCTION: Depression is the most common psychiatric comorbidity in Parkinson's disease (PD), but is often under-diagnosed and under-recognized. OBJECTIVES: To evaluate and compare the psychometric qualities of the Patient Health Questionnaire (PHQ-2) and the depression item of the Unified Parkinson's Disease Rating Scale (UPDRS). METHOD: Cross-sectional study conducted at a movement disorders outpatient clinic. One hundred ten patients with a diagnosis of PD without dementia were evaluated. A neurologist administered the PHQ-2 and the UPDRS, and the diagnosis of major depression was performed using the structured clinical interview for DSM disorders - clinical version. Two self-rating scales (Zung Self-rating Depression Scale and 15-item Geriatric Depression Scale) were also used. RESULTS: The prevalence of current depression in the sample was 25.5% (n = 28). The scores of the PHQ-2 discriminated between subjects with and without depression, with an area under the receiver operating characteristic curve of 0.90. The sensitivity and specificity for a cut-off score of three were 75% and 89%, respectively. The values for the depression item of the UPDRS were slightly lower. CONCLUSION: The PHQ-2 is a valid tool for screening depression in PD.

Adhesio interthalamica alterations in schizophrenia spectrum disorders: A systematic review and meta-analysis.

Magnetic resonance imaging (MRI) studies have reported a variety of brain abnormalities in association with schizophrenia. These include a higher prevalence of an absent adhesio interthalamica (AI; also known massa intermedia), a gray matter junction that is present between the two thalami in approximately 80% of healthy subjects. In this meta-analytic review, we describe and discuss the main AI MRI findings in schizophrenia spectrum disorders (SSDs) to date. The MEDLINE and ISI Web of Knowledge databases were searched up to December 2010, for studies that used MRI to assess AI in patients with SSD and controls. From fourteen potential reports, eleven were eligible to be part of the current review. These studies included 822 patients with SSD and 718 healthy volunteers. There was a large degree of variability in the MRI methods they employed. Patients with SSD had a higher prevalence of absent AI than healthy volunteers (odds ratio = 1.98; 95% confidence interval 1.33-2.94; p = 0.0008). This association was evident in both male and female SSD subjects, and there was no evidence that the prevalence was related to age or duration of illness. The significance of the absence of an AI for SSD may be clarified by studies in large, longitudinal community-based samples using standardized methods.

Are cavum septum pellucidum abnormalities more common in schizophrenia spectrum disorders? A systematic review and meta-analysis.

Magnetic resonance imaging (MRI) studies have reported a variety of brain abnormalities in association with schizophrenia. These include a higher incidence of cavum septum pellucidum (CSP), which is consistent with a neurodevelopmental model for this disorder. In this meta-analytic review, we describe and discuss the main CSP MRI findings in schizophrenia spectrum disorders (SSDs) to date. We adopted as keywords cavum and schizophrenia or psychosis, and the inclusion criteria were articles in English, with samples of SSD patients compared to healthy subjects, which used MRI to assess CSP, without time limit. From 18 potential reports, fifteen were eligible to be part of the current review. These studies included 1054 patients with SSD and 866 healthy volunteers. Six out of 15 studies pointed to a higher prevalence of CSP of any size in SSD patients, while five out of 15 showed that subjects with SSD had a greater occurrence of a large CSP than healthy individuals. However, the meta-analysis demonstrated that only the incidence of a large CSP was significantly higher in SSD relative to healthy comparisons (odds ratio=1.59; 95%CI 1.07-2.38; p=0.02). Overall our results suggest that only a large CSP is associated with SSD while a small CSP may be considered a normal neuroanatomical variation. Our review revealed a large degree of variability in the methods employed across the MRI studies published to date, as well as evidence of publication bias. Studies in large, community-based samples with greater standardization of methods should clarify the true significance of CSP in SSD.

Facial affect processing in social anxiety: tasks and stimuli.

Social anxiety (SA) has as its main feature the fear of social situations, being characterized as social phobia or social anxiety disorder when functional impairment emerges as a result of that fear. Although the recognition of the condition has increased in recent years, it is believed that many patients and physicians still take the symptoms of the disorder for personality traits with no need for treatment. There is evidence that people with SA display abnormal patterns of facial emotion processing that could account for the onset and maintenance of the disorder. The objective of this review is to describe, compare, and discuss the methods used to study facial emotion processing in SA with an emphasis on the tasks and stimuli employed. Articles were searched for on online scientific databases. Forty research articles were selected according to the inclusion and exclusion criteria established. The articles were read and information from them was gathered on a comparative table for analysis. Evidence available to date suggests that SA individuals have abnormal patterns of facial information processing characterized by a bias for negative emotions. The results of the articles analyzed have a high degree of concordance, in spite of the variety of tasks and stimuli employed. The similarity between results from non-clinical samples with SA and patients affected by social phobia speaks in favor of the current view that SA occurs as a continuum of severity, rather than a clearly circumscribed nosological entity.

Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions.

BACKGROUND: This study was aimed at assessing the psychometric qualities of the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT-3, AUDIT-4, AUDIT-C, AUDIT-PC, AUDIT-QF, FAST, and Five-Shot) and at comparing them to the 10-item AUDIT and the CAGE in 2 samples of Brazilian adults. METHODS: The validity and internal consistency of the scales were assessed in a sample of 530 subjects attended at an emergency department and at a Psychosocial Care Center for Alcohol and Drugs. The Structured Clinical Interview for DSM-IV was used as the diagnostic comparative measure for the predictive validity assessment. The concurrent validity between the scales was analyzed by means of Pearson's correlation coefficient. RESULTS: The assessment of the predictive validity of the abbreviated versions showed high sensitivity (of 0.78 to 0.96) and specificity (of 0.74 to 0.94) indices, with areas under the curve as elevated as those of the AUDIT (0.89 and 0.92 to screen for abuse and 0.93 and 0.95 in the screening of dependence). The CAGE presented lower indices: 0.81 for abuse and 0.87 for dependence. The analysis of the internal consistency of the AUDIT and its versions exhibited Cronbach's alpha coefficients between 0.83 and 0.94, while the coefficient for the CAGE was 0.78. Significant correlations were found between the 10-item AUDIT and its versions, ranging from 0.91 to 0.99. Again, the results for the CAGE were satisfactory (0.77), although inferior to the other instruments. CONCLUSIONS: The results obtained in this study confirm the validity of the abbreviated versions of the AUDIT for the screening of alcohol use disorders and show that their psychometric properties are as satisfactory as those of the 10-item AUDIT and the CAGE.