Personality dimensions, resilience, and depression during COVID-19 pandemic: A one-year longitudinal study.

BACKGROUND: The onset of the COVID-19 pandemic has brought to light a significant surge in depression across diverse populations. While a considerable body of research has linked this upswing to lockdowns and restrictive measures, it is crucial to recognize that lockdowns alone cannot fully elucidate the observed increase in mental health disorders, given the vast array of individual psychological responses. OBJECTIVE: This study aims to test e whether personality dimensions (Extroversion, Neuroticism, and Psychoticism) and resilience play a role in shielding individuals from developing depression during the COVID-19 pandemic, as observed in a sample of Brazilian adults. METHODS: This research employed a one-year longitudinal naturalistic study involving the general population. It utilized a web-based questionnaire administered in three waves during the COVID-19 pandemic: April 2020, September 2020, and May 2021. The research protocol contains the Patient Health Questionnaire-9 - PHQ-9, the Connor-Davidson Resilience Scale - CD-RISC, and the Eysenck Personality Questionnaire Revised-Abbreviated - EPQR-A. RESULTS: Our study encompassed 455 participants, of which 35.6 % met the criteria for depression in the first wave, and this figure decreased to 18.5 % in the second and third waves (p = 0.001). Resilience levels in the non-depressed group (consistently exhibited higher means across all three waves when compared to the depressed group (first wave: x¯= 27.98; second wave: x¯= 37.26; third wave: x¯= 36.67; p = 0.001). Furthermore, resilience exhibited an overall protective effect against depression in all waves (PR = 0.93, p = 0.000). Neuroticism and Psychoticism emerged as predictors of depression across all waves (PR = 1.346; p = 0.0001 and PR = 1.157; p = 0.030), while the Extroversion dimension showed no significant effect. CONCLUSION: The decline in depression rates during the first year of the COVID-19 pandemic was influenced by levels of resilience, which acted as a protective factor against the development of depressive symptoms. Notably, Neuroticism and Psychoticism predicted the risk of developing depressive symptoms. Implications for practical intervention in future crisis scenarios suggest the need for public health policy programs featuring personalized interventions that prioritize enhancing resilience.

Lifestyle and quality of life in children and adolescents during the covid-19 social distancing period

Abstract Objective To evaluate the lifestyle and quality of life in Brazilian children and adolescents during the COVID-19 social distancing period in 2020. Methods This cross-sectional study evaluated children and adolescents (2-18 years of age) and their parents, who voluntarily participated in an online survey. Snowball sampling was used to recruit participants during the first 6 months of the pandemic. A questionnaire was used to characterize the study population. The PedsQL 4.0 and the EUROHIS-QOL 8-item index were used to assess the quality of life (QoL) in children/adolescents and parents, respectively. Data were analyzed using SPSS 18.0 statistical program through the ANOVA with post hoc Bonferroni analysis, student's t test, and the generalized estimating equation. Results Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p <0.001), which was associated with a decline in PedSQL4.0 scores (from 75.7 ± 2.6 to 71.3 ± 13.7, p <0.001). Unhealthy eating habits increased from 11% to 34% and were associated with worse QoL scores compared with improved or unchanged eating habits during the pandemic (69.7 ± 13.3 vs 72.80 ± 13.4 vs 76.4 ± 12.6; p <0.001). Poor sleep quality increased from 9% to 31.7% and was associated with worse QoL scores compared to improved or unchanged sleep quality during the pandemic (67.3 ± 13.1 vs 74.5 ± 13.1 vs 76.8 ± 12.2; p <0.05). Physical exercise was associated with better PedSQL4.0 scores (77.5 ± 12.3 vs 72.5 ± 14.4; p <0.001). Children aged 2-4y old had the best QoLscores. Conclusions Pandemic-related social distancing promoted significant lifestyle changes in children and adolescents, increasing screen time, reducing physical activity, and worsening food and sleep quality, which resulted in worse QoL scores.

Serum cytokine variations among inpatients with major depression, bipolar disorder, and schizophrenia versus healthy controls: a prospective 'true-to-life' study.

Background: There is increasing evidence of the association between chronic low-grade inflammation and severe mental illness (SMI). The objective of our study was to assess serum cytokine levels (SCLs) at admission and discharge in a true-to-life-setting population of inpatients with major depression (MD), bipolar disorder (BD), and schizophrenia (Sz), as well as of healthy controls. Methods: We considered MD, BD, and Sz to be SMIs. We evaluated 206 inpatients [MD, N = 92; BD, N = 26; mania (Ma), N = 44; Sz, N = 44). Generalized estimating equations were used to analyze variations in SCL [interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17] at hospital admission and discharge. Results of 100 healthy controls were compared with those of SMI patients at both time points. We evaluated patients' improvement during in-hospital treatment in terms of general psychiatric symptoms, global clinical impression, functionality, and manic and depressive symptoms with validated scales. Results: In all, 68.9% of patients completed the study. Overall, SMI inpatients had higher SCL when compared with controls regardless of diagnosis. There was a significant decrease in Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity Scale (CGI-S) scores, and an increase in Global Assessment of Functioning (GAF) scores for all disorders evaluated (p < 0.001), as well as a significant decrease in HDRS-17 scores among MD inpatients (p < 0.001) and in YMRS scores among Ma inpatients (p < 0.001). IL-2 and IL-6 levels decreased significantly between admission and discharge only among MD inpatients (p = 0.002 and p = 0.03, respectively). We found no further statistically significant changes in SCL among the remaining disorders (BD, Ma, and Sz). There was no significant decrease in IFN-γ (p = 0.64), TNF-α (p = 0.87), IL-4 (p = 0.21), IL-10 (p = 0.88), and IL-17 (p = 0.71) levels in any of the evaluated diagnoses. Conclusion: MD inpatients had a decrease in IL-2 and IL-6 levels during hospitalization, which was accompanied by clinical improvement. No associations were found for the remaining SMIs (BD, Ma, and Sz).

The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A): psychometric properties of the Brazilian Portuguese version.

INTRODUCTION: The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A) consists of 24 items for assessment of the three fundamental personality traits (psychoticism, extraversion, and neuroticism) and a validity scale (lie scale). Our objectives were to assess the psychometric properties of a version of this instrument culturally adapted for Brazil. METHOD: 321 participants were recruited using a non-probabilistic method. RESULTS: Internal consistencies ranged from minimally acceptable to respectable, except for the psychoticism domain. Higher neuroticism scores were associated with higher depression and anxiety scores, higher extraversion scores were associated with lower levels of depression symptoms, and higher psychoticism scores were associated with higher levels of depression symptoms. CONCLUSION: Our findings describe sustainable psychometric properties for the Brazilian Portuguese version of EPQR-A.

The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A): psychometric properties of the Brazilian Portuguese version

Abstract Introduction The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A) consists of 24 items for assessment of the three fundamental personality traits (psychoticism, extraversion, and neuroticism) and a validity scale (lie scale). Our objectives were to assess the psychometric properties of a version of this instrument culturally adapted for Brazil. Method 321 participants were recruited using a non-probabilistic method. Results Internal consistencies ranged from minimally acceptable to respectable, except for the psychoticism domain. Higher neuroticism scores were associated with higher depression and anxiety scores, higher extraversion scores were associated with lower levels of depression symptoms, and higher psychoticism scores were associated with higher levels of depression symptoms. Conclusion Our findings describe sustainable psychometric properties for the Brazilian Portuguese version of EPQR-A.

Structural magnetic resonance imaging findings in severe mental disorders adult inpatients: A systematic review.

In severe presentations, major depressive disorder (MDD), schizophrenia (SZ), and bipolar disorder (BD) can be categorized as severe mental disorders (SMD). Our aim is to evaluate structural magnetic resonance imaging and computed tomography findings in adult inpatients diagnosed with SMD and hospitalized at psychiatric wards. PubMed, Embase, PsycInfo, Cochrane Library, and Web of Science were searched up to May 27th, 2021. Articles were screened and extracted by two independent groups, with third-party raters for discrepancies. Quality of evidence was evaluated with the Newcastle-Ottawa Scale. Synthesis was made by qualitative analysis. This study was registered on PROSPERO (CRD42020171718) and followed the PRISMA protocol. 35 studies were included, of which none was considered to likely introduce bias in our analyses. Overlapping areas in MDD, SZ, and Affective Psychosis (AP) patients, that include BD and MDD with psychotic features, are presented in the inferior temporal and cingulate gyri. MDD and SZ had commonly affected areas in the inferior and middle frontal gyri, transverse temporal gyrus, insula, and hippocampus. SZ and AP had commonly affected areas in the temporal pole. Overlapping affected areas among SMD patients are reported, but the heterogeneity of studies' designs and findings are still a limitation for clinically relevant guidelines.

Time series analysis of suicide from a monthly perspective in the south of Brazil: an ecological study.

INTRODUCTION: Suicide is the cause of death of almost 800 thousand people worldwide every year. In Brazil, Rio Grande do Sul is one of the states with the highest suicide rates. This study aimed to assess whether there is a significant monthly time pattern of suicide in Rio Grande do Sul, by gender and age ranges, and whether suicide characteristics in the state are coherent with findings from previous studies. METHODS: All data were collected from official secondary sources maintained by the national Brazilian and Rio Grande do Sul governments, covering a period from 2015 to 2019. Data included suicide deaths and population, divided by gender and age range. Sum totals, frequencies, odds ratios, and time series analyses were performed. RESULTS: From 2015 to 2019, 6,287 people committed suicide in Rio Grande do Sul. Most of them were men and the most prevalent age band was from 50 to 59 years old. Men had higher suicide rates then women in all age ranges (p < 0.001) and in all months of the year, with an approximately 4-fold higher risk of committing suicide when compared to women. Men had a trending peak of suicide in January and December (p < 0.001), whereas women's suicide rates peaked in March and December (p = 0.001). CONCLUSION: There are monthly time trends and seasonal patterns of suicide rates in Rio Grande do Sul, varying by gender and age range. Gender differences occurred mainly in the first three months of the year, and the age pattern was more evident among individuals aged 60 years or older.

Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia.

PURPOSE: To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life. METHODS: Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). RESULTS: Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; rs = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience. CONCLUSION: Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.

Novas perspectivas nas psicoterapias em gays e lésbicas / New perspectives on psychotherapies with gays and lesbians

INTRODUÇÃO: O estigma que gays e lésbicas sofrem configura uma questão de saúde pública. Frequentemente, a procura de psicoterapia por esses pacientes é motivada por fatores relacionados a dificuldades de relacionamento com o meio. Dessa forma, a psicoterapia é uma ferramenta valiosa para mitigar os efeitos deletérios do estresse de minorias e dos novos impactos psicossociais advindos da pandemia. MÉTODO: Foi realizada uma revisão narrativa da literatura indexada em bases de dados utilizando palavras-chaves obtidas a partir de vocabulários controlados e sinônimos. A amostragem foi por conveniência. RESULTADOS: Diferentes modelos de psicoterapias foram adaptados às necessidades das minorias sexuais, como protocolos baseados nas terapias interpessoal, psicodinâmica e cognitivo-comportamental. Os modelos atuais da identidade sexual incorporam conceitos como homonegatividade internalizada e estresse de minorias, com conflitos que podem ser descritos em estágios passíveis de intervenções psicoterápicas específicas. Adicionalmente, a pandemia de COVID-19 pareceu trazer à tona uma série de novos possíveis estressores para indivíduos pertencentes a minorias sexuais, como o isolamento social e o aumento no consumo de álcool. DISCUSSÃO: Diversos modelos de psicoterapia mostram resultados satisfatórios em gays e lésbicas. Os principais fatores relacionados ao êxito terapêutico são a adoção de uma postura não julgadora e em uma aliança terapêutica sólida. CONCLUSÃO: A psicoterapia apresenta-se como um tratamento de notável valor ao atenuar o possível sofrimento psíquico de gays e lésbicas, principalmente diante da intensificação do estresse de minorias durante a pandemia de COVID-19.

INTRODUCTION: The stigma suffered by gays and lesbians is a public health issue. Frequently, the demand of psychotherapy by these patients is motivated by factors related to relationship difficulties with the environment, which makes psychotherapy a valuable instrument to reduce the deleterious effects of minority stress and the new psychosocial impacts resulting from the pandemic. METHOD: A narrative review of literature indexed in databases was conducted using keywords obtained from controlled vocabularies and synonyms. The sampling was by convenience. RESULTS: Different models of psychotherapies have been adapted to the needs of sexual minorities, such as protocols based on interpersonal, psychodynamic and cognitive-behavioral therapies. Current models of sexual identity include concepts such as internalized homonegativity and minority stressors, with conflicts that can be described in stages amenable to specific psychotherapeutic interventions. The pandemic of COVID-19 seemed to bring out a number of new potential stressors for individuals belonging to sexual minorities, for exemple social isolation and increased alcohol consumption. DISCUSSION: Several models of psychotherapy demonstrate satisfactory results in gays and lesbians. The main factors related to therapeutic success are the adoption of a non-judgmental stance and in a solid therapeutic alliance. Minority stress, intensified during the COVID-19 pandemic, contributes to negative mental health outcomes. CONCLUSION: Psychotherapy presents itself as a treatment of notable value in alleviating the psychological suffering of gays and lesbians, especially in the face of intensified minority stress during the COVID-19 pandemic.

INTRODUCCIÓN: El estigma que sufren gays y lesbianas es un problema de salud pública. A menudo, la demanda de psicoterapia por parte de estos pacientes está motivada por factores relacionados con las dificultades de relación con el entorno, lo que convierte a la psicoterapia en un valioso instrumento para reducir los efectos deletéreos del estrés minoritario y los nuevos impactos psicosociales derivados de la pandemia. MÉTODO: Se realizó una revisión narrativa de la literatura indexada en bases de datos utilizando palabras clave obtenidas de vocabularios controlados y sinónimos. El muestreo fue por conveniencia. RESULTADOS: Se han adaptado diferentes modelos de psicoterapias a las necesidades de las minorías sexuales, como protocolos basados en terapias interpersonales, psicodinámicas y cognitivo-conductuales. Así, la psicoterapia afirmativa emerge como un modelo transteórico asociado a mejores resultados en salud mental que auxilia en la expresión de la identidad sexual de los individuos, aunque no se ajuste a la norma social. La pandemia de COVID-19 pareció generar una serie de nuevos factores estresantes para las personas pertenecientes a minorías sexuales. DISCUSIÓN: Varios modelos de psicoterapia demuestran resultados satisfactorios en gays y lesbianas. Los principales factores relacionados con el éxito terapéutico son la adopción de una postura libre de juicios y en una sólida alianza terapéutica. El estrés de las minorías, intensificado durante la pandemia de COVID-19, contribuye a los resultados negativos de salud mental. CONCLUSIÓN: La psicoterapia se presenta como un tratamiento de notable valor para aliviar el sufrimiento psicológico de gays y lesbianas, especialmente ante el estrés de las minorías intensificado durante la pandemia de COVID-19.

Time series analysis of suicide from a monthly perspective in the south of Brazil: an ecological study

Abstract Introduction: Suicide is the cause of death of almost 800 thousand people worldwide every year. In Brazil, Rio Grande do Sul is one of the states with the highest suicide rates. This study aimed to assess whether there is a significant monthly time pattern of suicide in Rio Grande do Sul, by gender and age ranges, and whether suicide characteristics in the state are coherent with findings from previous studies. Methods: All data were collected from official secondary sources maintained by the national Brazilian and Rio Grande do Sul governments, covering a period from 2015 to 2019. Data included suicide deaths and population, divided by gender and age range. Sum totals, frequencies, odds ratios, and time series analyses were performed. Results: From 2015 to 2019, 6,287 people committed suicide in Rio Grande do Sul. Most of them were men and the most prevalent age band was from 50 to 59 years old. Men had higher suicide rates then women in all age ranges (p < 0.001) and in all months of the year, with an approximately 4-fold higher risk of committing suicide when compared to women. Men had a trending peak of suicide in January and December (p < 0.001), whereas women's suicide rates peaked in March and December (p = 0.001). Conclusion: There are monthly time trends and seasonal patterns of suicide rates in Rio Grande do Sul, varying by gender and age range. Gender differences occurred mainly in the first three months of the year, and the age pattern was more evident among individuals aged 60 years or older.

A implementação de psicoterapia on-line em um programa de residência médica em psiquiatria durante a pandemia de COVID-19 / The implementation of online psychotherapy in a medical residency program in psychiatry during the COVID-19 pandemic

O impacto da pandemia de SARS-CoV2 e as recomendações de reduzir a circulação de pessoas produziu uma série de mudanças no nosso cotidiano. Tratamentos tradicionalmente realizados face-a-face de forma presencial as psicoterapias sofreram forte impacto com riscos de abandono e interrupção. O objetivo deste artigo é apresentar um relato de experiência sobre o processo de implementação de psicoterapia on-line no ambulatório de psicoterapias do Serviço de Psiquiatria de um hospital escola durante a pandemia de SARS-CoV2, exibindo as principais adaptações realizadas nos procedimentos de comunicação, protocolos de atendimento e registros das sessões de psicoterapia. Tendo como foco a garantia da manutenção dos atendimentos durante períodos de distanciamento social foram criadas diretrizes para a realização de psicoterapia on-line com a elaboração de um manual norteador (Material suplementar) de procedimentos para continuidade dos atendimentos dentro dos parâmetros éticos e técnicos estabelecidos pelo serviço. O manual foi elaborado a partir da discussão entre supervisores e residentes, de forma que refletisse a realidade e as demandas comumente atendidas. As adaptações realizadas no ambulatório foram norteadas por quatro grandes objetivos: 1) manutenção e continuidade dos atendimentos; 2) diminuição de barreiras de comunicação entre psicoterapeuta-paciente; 3) manutenção de reuniões on-line e web conferência entre todos os membros da equipe e manutenção dos estudos e; 4) normatização de procedimentos durante as sessões de psicoterapia.(AU)

The impact of the SARS-CoV2 pandemic and the recommendations to reduce the movement of people and agglomerations produced a series of changes in our daily lives, changing the way various health services were provided. Treatments traditionally performed face-to-face such as psychotherapies suffered a strong impact with risks of abandonment and interruption. This paper is an experience report about the process online psychotherapy implementation in a Psychiatry School Hospital Service during the SARS-CoV2 pandemic, showing the adaptations in communication procedures, care protocols and records of psychotherapy sessions. With a focus on ensuring the maintenance of care during periods of social distancing, guidelines were created for online psychotherapy based on the preparation of a guiding manual (Supplementary material) of procedures so that care was performed within the parameters ethical and technical established by the service. The manual was created from the discussion between supervisors and residents, so that it reflected the reality and demands commonly met. The adaptations were guided by four major objectives: 1) maintenance and continuity of care, 2) reduction of communication barriers between psychotherapist-patient, 3) maintenance of online meetings and web conferences between all team members and maintenance of studies and 4) standardization of procedures during psychotherapy sessions.(AU)

El impacto de la pandemia de SARS-CoV2 y las recomendaciones para reducir el movimiento de personas ha producido una serie de cambios en nuestra vida cotidiana. Los tratamientos tradicionalmente realizados en psicoterapias presenciales sufrieron un fuerte impacto con riesgos de abandono e interrupción. El propósito de este artículo es presentar un informe de experiencia sobre el proceso de implementación de la psicoterapia online en el ambulatorio de psicoterapia del Servicio de Psiquiatría de un hospital escuela durante la pandemia de SARSCoV2, mostrando las principales adaptaciones realizadas en los procedimientos de comunicación, protocolos asistenciales y registros de sesiones de psicoterapia. Con el foco en asegurar el mantenimiento de la atención durante los períodos de distanciamiento social, se crearon pautas para la realización de la psicoterapia en línea a partir de la elaboración de un manual guía (Material Complementario) de procedimientos para que las exploraciones asistenciales se realizaran dentro de los parámetros éticos y técnicos establecidos por el servicio. Las adaptaciones realizadas en el ambulatorio se basaron en cuatro objetivos principales: 1) mantenimiento y continuidad de la atención; 2) reducción de las barreras de comunicación entre psicoterapeuta-paciente; 3) mantenimiento de reuniones en línea y conferencias web entre todos los miembros del equipo y mantenimiento de estudios y; 4) estandarización de los procedimientos durante las sesiones de psicoterapia.(AU)

Potential predictors of depressive symptoms during the initial stage of the COVID-19 outbreak among Brazilian adults.

BACKGROUND: In early 2020, Sars-Cov-2 was identified in China as a new coronavirus. Due to its transmission, Sars-Cov-2 has spread rapidly across the world. In the early stage of the disease outbreak, psychiatric symptoms have been reported, including depressive symptoms. In this study, we assessed the prevalence of depressive symptoms in quarantine and its association with sociodemographic variables and known protective factors for depression, such as spirituality, social support, resilience, and quality of life. METHODS: A cross-sectional web-based questionnaire was distributed via social media. The instruments consisted of the 8-item EUROHIS-QOL, PHQ-9, Social Support Questionnaire, WHOQoL-SRPB, and CD-RISC. RESULTS: A total of 3,274 participants were included in this study. 23.67% of the participants met the criteria for a depressive episode. Higher age, spirituality, social support, resiliency, and quality of life were associated with less depressive symptoms. Quarantine length; mental health treatment; chronic disease; age; sex; lower levels of spirituality, social support, resilience, quality of life, physical exercise, and education; and unpaid occupation were found to be predictors of depressive symptoms during COVID-19 quarantine. LIMITATIONS: The data are limited to the pandemic initial period, the sample isn't random and the use of self-reported questionnaires are some limitations of our study. CONCLUSIONS: During the initial phase of the COVID-19 outbreak in Brazil, quarantine time, treatment for mental health, chronic illness, lower levels of education, and unpaid occupation were positively associated with depressive symptoms. Age, sex, spirituality, social support, resilience, quality of life, and physical exercise showed a negative relationship with depressive symptoms.

Positive Association Between Therapeutic Alliance and Quality of Life in Psychodynamic Psychotherapy, Cognitive Behavior Therapy, and Interpersonal Therapy: The Patient's Perspective.

BACKGROUND: The therapeutic alliance (TA) is considered a common psychotherapeutic factor associated with positive results in psychotherapies. There are no studies relating the TA with quality of life (Qol). OBJECTIVES: Our objective was to evaluate whether there is an association between the TA and Qol across three different psychotherapies. METHODS: A cross-sectional study, which included outpatients undergoing individual psychotherapeutic treatment was conducted. When analyzing the total sample, the correlation of the TA with Qol domains did not present statistical significance. When considering only the sample of patients who were undergoing treatment in psychodynamic psychotherapy (PP), there was a statistically significant association between the TA and the psychological domain of Qol (p < 0.05). When using a regression model for adjusting for confounding factors, the association between psychological domain with the TA on the PP patients sample lost significance (p = 0.221). DISCUSSION: These findings suggest that the TA seems to be more strongly related to better QoL in PP.

Brain-derived neurotrophic factor (BDNF) and inflammatory markers: Perspectives for the management of depression.

BACKGROUND: Mood disorders, including major depressive disorder, are among the main causes of disability and early mortality and constitute an important public health problem. Despite the search for a neurobiological explanation for these disorders, diagnosis and treatment are still based on subjective symptoms and psychometric assessments. Biomarkers, used as indicators of normal biological and pathological processes or pharmacological responses to a clinical intervention, may be useful in improving the current classification of psychiatric disorders, which can help understand the role of biological information in diagnosis, prognosis, and assessment of responses to intervention. OBJECTIVES: This review aims to analyze the existing literature on Brain-Derived Neurotrophic Factor (BDNF) and inflammatory markers related to depression and to assess the advances and perspectives of their applicability in the diagnosis, prognosis, and assessment of responses to intervention in order to understand the importance of these biomarkers for the management of depression. RESULTS: Evidence shows that BDNF is an important biomarker for the pathogenesis of depression; reduced levels are linked to reduced synaptic plasticity and neuronal atrophy, while elevated levels are associated with survival and neuronal differentiation, which is compatible with the neurogenic hypothesis of depression. Although the use of this biomarker is not yet established, literature shows that the concentration of BDNF is a useful measure for the differentiation between healthy and depressed individuals. Based on the inflammatory theory of depression, studies have found higher levels of inflammation in depressed individuals when compared to healthy ones, as well as an association between chronic inflammation and depressive symptoms. Studies have also found anti-inflammatory agents with anti-depressant effects. Markers such as IL-6, IL-1ß, TNFα, and C-reactive protein (CRP) are potential markers of depression, but the role of cytokines in human brain activity is still insufficiently established. CONCLUSIONS: Despite the large number of potential biological markers not yet fully established in the pathophysiology of depression, which is a challenge for psychobiology, it is clear that the concentrations of these substances are altered in psychiatric diagnoses related to the disease activity. Thus, although more research is needed, the current body of knowledge on biomarkers allows us to predict their use in the management of depression.

Propriedades psicométricas do protocolo de sistema diagnóstico Operationalization of Psychodynamic Diagnosis 2 (OPD-2) em pacientes com transtorno mental grave em psicoterapia / Psychometric properties of the Operationalization of Psychodynamic Diagnosis 2 (OPD-2) diagnostic system protocol in patients with severe mental disorder undergoing psychotherapy

INTRODUCTION: In order to expand the descriptive classification of symptoms in mental disorders, and to bring empirical consistency to psychodynamic/psychoanalytic models, a multiaxial instrument called Operationalized Psychodynamic Diagnosis (OPD-2) has been developed, allowing psychotherapy research to encompass the complexity of the relationships between conditions and factors that determine the phenomena of mental pathologies, from a psychodynamic point of view. METHODOLOGY: Longitudinal naturalistic study with 80 outpatients with severe mental disorders, who were treated with a) psychodynamic psychotherapy, b) interpersonal psychotherapy and c) cognitive behavioral psychotherapy. All patients were interviewed at baseline and after six months, according to OPD-2's criteria. They all also completed two self-report measures (WHOQOL-BREF and SCL-90R) to evaluate symptoms and quality of life at each assessment point. RESULTS: According to OPD-2's axis I, better personal resources, psychosocial support, and introspective capacity significantly correlated with fewer symptoms in the BDI's and SCL-90's measures. Also, symptoms' reduction and quality of life's domains significantly correlated with items that assessed OPD-2's "desire for care versus autarchy" and "identity" conflicts. There was also a significant correlation between all items that evaluate structural functioning according to OPD-2 and the SCL-90R's psychotic index. Regarding predictive validity analysis, we observed mean differences in the structural functioning of patients with a history of suicide attempt and previous history of hospitalization. DISCUSSION: results support that OPD-2's criteria significantly correlates with data from validated self-report measures. When administered by trained raters, OPD-2 displayed good quality in assessing patients' conflicts and structural issues. This evidence suggests that the Brazilian version of OPD-2 is a valid and reliable instrument in evaluating psychodynamic properties and can be a useful tool within the clinical and research contexts. (AU)

Psychotic depression in hospitalized patients: Longitudinal outcomes of psychotic vs. nonpsychotic depression among inpatients.

Even though psychotic depression is related to worse outcomes than nonpsychotic depression, there is increasing evidence that this greater severity is not solely explained by the depressive symptoms. We evaluated the socio-demographic and clinical characteristics, as well as the differences in clinical outcomes of psychiatric hospitalization between psychotic and non-psychotic depression. Two-hundred-eighty-eight depressive inpatients were assessed within 72 h after hospitalization and 24 h before discharge. We compared scores of Hamilton Depression Rating Scale 17-items (HDRS-17), Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), and Global Assessment of Functioning (GAF) between psychotic and nonpsychotic patients. Instruments were compared both cross-sectionally - on admission and discharge - and longitudinally. Longitudinal outcomes were corrected for potential confounders (sex, age, age at disease onset, years of study, previous history of mania/hypomania, electroconvulsive therapy in current hospitalization, history of attempted suicide, number of suicide attempts, and previous hospitalizations). One-hundred-thirty-one depressive inpatients (45.4%) presented psychotic features. Both groups showed similar HDRS-17 scores at admission and discharge. However, psychotic patients had worse scores on BPRS, CGI, and GAF at both timepoints. Both groups had similar improvement on HDRS-17 (P = 0.75), CGI (P = 0.5), and GAF (P = 0.84), but psychotic patients had greater improvement on BPRS (P < 0.001). Psychotic inpatients showed worse clinical and functional parameters. Nonetheless, the groups did not differ in depressive symptom severity. These findings reinforce the hypothesis that depressive episode with psychotic features is a more severe form of the disease irrespective of intensity of affective symptomatology.

The Effects of Individual Psychotherapy in BDNF Levels of Patients With Mental Disorders: A Systematic Review.

BACKGROUND: Brain-derived Neurotrophic Factor (BDNF) is considered the main cerebral neurotrophin and is produced in the central neural system and peripherals. Its levels are reduced in patients with several psychiatric disorders, but it is unclear if the response to psychotherapy can alter its concentration. OBJECTIVE: To carry out a systematic review evaluating the effects of individual psychotherapy in BDNF levels in patients with mental disorders. METHODS: The databases PubMed, EMBASE, PsycArticles, SciELO, Web of Science, and CENTRAL; the last search was performed on October 2019 for trials evaluating the effects of individual psychotherapy in BDNF levels in adults with mental disorders. PROSPERO registration: CRD42018108144. RESULTS: Eight of 293 studies were included. A rise in BDNF levels was observed in depressive patients when psychotherapy was combined with medication. Patients with post-traumatic stress disorder (PTSD) who responded to therapy presented a raise in BDNF levels mostly when combined with physical activity. There was a rise in BDNF levels in those who responded to psychotherapy in patients with bulimia, in borderline patients, and in insomniacs. CONCLUSIONS: The BDNF seems to present variations after psychotherapy especially in patients with bulimia, PTSD, insomnia, and borderline. These subjects also have symptom reduction. Thereby, BDNF could be a supplemental tool to analyze the success to psychotherapy. BDNF levels in patients with major depression after therapy are still controversial and the short follow-up of most studies is a limiting factor.

Interpersonal Psychotherapy for Gender Dysphoria in a Transgender Woman.

We present a case of a 32-year-old natal male seeking medical follow-up care, due to gender dysphoria (GD) along with other complaints (depressive symptoms, anxiety, and suicidal ideation). The attending team chose interpersonal psychotherapy (IPT), with a focus on role transition in order to help her. The patient presented a favorable trajectory throughout treatment and demonstrated personal growth one year after treatment. To our knowledge, little was found in the literature on the use of IPT in the treatment of those with GD; we also did not find any other publication or case report using IPT exclusively to treat the problems accompanying role transition. Psychotherapy was not intended to change the gender identity of this individual. However, further studies will be required to explore possible benefits of IPT for GD treatment.

A troca de psicoterapeuta e o impacto na condição global de pacientes em ambulatórios de residência em psiquiatria / The change of psychotherapist and the impact on the overall condition of patients in outpatient clinics in psychiatry

O processo de troca de psicoterapeuta durante o tratamento em psicoterapia de orientação analítica, em geral, caracteriza-se por ser prejudicial e até mesmo traumático em boa parte dos casos. Porém, trata-se da realidade assistencial em hospitais universitários, em virtude da necessidade de rodízio de atendimentos pelos médicos residentes em formação psiquiátrica durante seu treinamento em psicoterapia e de psiquiatras realizando especialização em psicoterapia. Este trabalho visa revisar este tema pouco abordado na literatura através da proposição de possíveis cenários de como a troca de terapeuta pode ser encarada pelo paciente, ilustrando com algumas vinhetas clínicas. Concluímos que o tema precisa ser expandido para avaliar o melhor encaminhamento para esse contexto clínico, institucional e socioeconômico, visto não haver consenso teórico e técnico que norteiem a abordagem mais adequada e menos traumática para o paciente.(AU)

The process of changing psychotherapist during treatment in analytically oriented psychotherapy is often harmful and even traumatic in most cases. However, this is the reality of care in university hospitals, due to the need for rotation of care by medical residents in training during their qualification in psychotherapy and psychiatrists performing specialization in psychotherapy. This paper aims to review this little addressed theme in the literature by proposing possible scenarios of how the therapist change can be viewed by the patient, illustrating with some clinical vignettes. We conclude that the theme needs to be expanded to evaluate the best referral to this clinical, institutional and socioeconomic context, since there is no theoretical and technical consensus that guides the most appropriate and least traumatic approach for the patient.(AU)

El proceso de cambio de terapeuta durante el tratamiento en psicoterapia de orientación analítica, en general, se caracteriza por ser perjudicial e, incluso, traumático en gran parte de los casos. Sin embargo, se trata de la realidad asistencial en hospitales universitarios, en virtud de la necesidad de rotación en la atención por parte de los residentes en formación en psicoterapia y psiquiatras que realizan especialización en psicoterapia. Este trabajo busca revisar este tema poco analizado en la literatura a través de la proposición de posibles escenarios de cómo el cambio de terapeuta puede ser tomado por el paciente, ilustrando algunos casos clínicos. Concluimos que el asunto necesita ser ampliado para evaluar cuál sería el mejor camino para este contexto clínico, institucional y socioeconómico, una vez que no hay consenso teórico y técnico que orienten hacia un abordaje más adecuado y menos traumático para el paciente.(AU)

Increased Levels of Brain-Derived Neurotrophic Factor Are Associated With High Intrinsic Religiosity Among Depressed Inpatients.

Recognition of the importance of religion and spirituality in psychiatry is increasing, and several studies have shown a predominantly inverse relationship between religiosity and depression. Brain-derived neurotrophic factor (BDNF) is a widely studied brain neurotrophin responsible for synaptic plasticity, dendritic and neuronal fiber growth, and neuronal survival. The objective of the present study was to evaluate BDNF levels across high and low intrinsic religiosity (IR) in depressed inpatients. Serum BDNF levels were evaluated from 101 depressed inpatients at hospital admission and 91 inpatients at discharge. Religiosity was assessed using a validated version of the Duke University Religion Index. High IR patients had significantly higher serum BDNF at discharge than do low IR (52.0 vs. 41.3 ng/mL, P = 0.02), with a Cohen's d effect size difference of 0.56. High IR patients had a statistically significant increase in BDNF levels from admission to discharge (43.6 ± 22.4 vs. 53.8 ± 20.6 ng/mL, -1.950 (paired t-statistic), P = 0.05). The relationship between IR and BDNF levels (F = 6.199, P = 0.00) was controlled for the effects of depressive symptoms (â€…ß = 2.73, P = 0.00) and psychiatric treatments, including selective serotonin reuptake inhibitors (SSRIs) (ß = 0.17, P = 0.08), serotonin and norepinephrine reuptake inhibitors (SNRIs) (â€…ß = -0.23, P = 0.02), tricyclic antidepressants (TCAs) (â€…ß = -0.17, P = 0.10), lithium (â€…ß = 0.29, P = 0.00), anticonvulsants (â€…ß = 0.22, P = 0.03), antipsychotics (â€…ß = -0.05, P = 0.61), and electroconvulsive therapy (â€…ß = 0.00, P = 0.98). The current findings suggest a potential pathway to help understand the protective effect of religiosity in depressive disorders.