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1.
Br J Psychiatry ; : 1-3, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33040746

RESUMO

SUMMARY: We propose that discussions of benzodiazepines in the current psychiatric literature have become negatively biased and have strayed from the scientific evidence base. We advocate returning to the evidence in discussing benzodiazepines and adhering to clear definitions and conceptual rigour in commentary about them.

3.
Transl Psychiatry ; 10(1): 298, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839438

RESUMO

Bipolar disorder is often comorbid with anxiety, which is itself associated with poorer clinical outcomes, including suicide. A better etiologic understanding of this comorbidity could inform diagnosis and treatment. The present study aims to test whether comorbid anxiety in bipolar disorder reflects shared genetic risk factors. We also sought to assess the contribution of genetic risk for anxiety to suicide attempts in bipolar disorder. Polygenic risk scores (PRS) were calculated from published genome-wide association studies of samples of controls and cases with anxiety (n = 83,566) or bipolar disorder (n = 51,710), then scored in independent target samples (total n = 3369) of individuals with bipolar disorder who reported or denied lifetime anxiety disorders or suicidal attempts in research interviews. Participants were recruited from clinical and nonclinical settings and genotyped for common genetic variants. The results show that polygenic risk for anxiety was associated with comorbid anxiety disorders and suicide attempts in bipolar disorder, while polygenic risk for bipolar disorder was not associated with any of these variables. Our findings point out that comorbid anxiety disorders in bipolar disorder reflect a dual burden of bipolar and anxiety-related genes; the latter may also contribute to suicide attempts. Clinical care that recognizes and addresses this dual burden may help improve outcomes in people living with comorbid bipolar and anxiety disorders.

9.
Trends Psychiatry Psychother ; 42(1): 92-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130308

RESUMO

OBJECTIVE: To conduct a systematic review of literature on use and efficacy of cognitive-behavioral therapy (CBT) for treatment of treatment-resistant depression in adults and adolescents. METHODS: We performed a systematic review according to the Prisma Guidelines of literature indexed on the PubMed, SciELO, Psychiatry Online, Scopus, PsycArticles, Science Direct and the Journal of Medical Case Reports databases. Randomized controlled trials, open studies and case reports were included in the review. RESULTS: The searches returned a total of 1,580 articles, published from 1985 to 2017. After applying the inclusion criteria, 17 articles were selected, their complete texts were read and 8 were included in this review. Four of these studies were randomized controlled trials with adults, one of which covered a post-study follow-up period; two were randomized controlled trials with adolescents, one of which presented follow-up data; one was an open study; and one was a case report. The studies provide good quality and robust evidence on the topic addressed. CONCLUSIONS: A combination of CBT with pharmacotherapy for treatment-resistant patients shows a decrease in depressive symptoms. CBT can be an effective type of therapy for adults and adolescents with treatment-resistant depression.

10.
Trends psychiatry psychother. (Impr.) ; 42(1): 92-101, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1099400

RESUMO

Abstract Objective To conduct a systematic review of literature on use and efficacy of cognitive-behavioral therapy (CBT) for treatment of treatment-resistant depression in adults and adolescents. Methods We performed a systematic review according to the Prisma Guidelines of literature indexed on the PubMed, SciELO, Psychiatry Online, Scopus, PsycArticles, Science Direct and the Journal of Medical Case Reports databases. Randomized controlled trials, open studies and case reports were included in the review. Results The searches returned a total of 1,580 articles, published from 1985 to 2017. After applying the inclusion criteria, 17 articles were selected, their complete texts were read and 8 were included in this review. Four of these studies were randomized controlled trials with adults, one of which covered a post-study follow-up period; two were randomized controlled trials with adolescents, one of which presented follow-up data; one was an open study; and one was a case report. The studies provide good quality and robust evidence on the topic addressed. Conclusions A combination of CBT with pharmacotherapy for treatment-resistant patients shows a decrease in depressive symptoms. CBT can be an effective type of therapy for adults and adolescents with treatment-resistant depression.


Resumo Objetivos Realizar uma revisão sistemática sobre o uso da terapia cognitivo-comportamental (TCC) e sua eficácia no tratamento da depressão resistente ao tratamento em adultos e adolescentes. Métodos Realizamos uma revisão sistemática utilizando os critérios do Prisma Guidelines, nos seguintes bancos de dados: PubMed, SciELO, Psychiatry Online, Scopus, PsycArticles, Science Direct e Journal of Medical Case Reports. Estudos controlados randomizados, estudos abertos e relatos de casos foram incluídos neste estudo. Resultados A pesquisa retornou um total de 1.580 artigos, publicados de 1985 até 2017. Após aplicarmos os critérios de inclusão, 17 artigos foram selecionados, seus textos completos foram lidos e 8 foram incluídos nesta revisão. Do total, quatro eram estudos controlados randomizados com adultos, tendo um incluído um período de seguimento pós-estudo; dois eram estudos controlados randomizados com adolescentes, tendo um apresentado dados de seguimento; um era um estudo aberto; e o último era um relato de caso. Os estudos apresentaram boa qualidade e evidências robustas sobre o tópico abordado. Conclusões A combinação de TCC com tratamento medicamentoso para pacientes resistentes ao tratamento mostra uma diminuição dos sintomas depressivos. A TCC pode ser um tipo eficaz de terapia para adultos e adolescentes com depressão resistente ao tratamento.

12.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 63-67, Jan.-Feb. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1055364

RESUMO

Objective: To determine whether people with a Sardinian genetic background who live in the megacities of South America have a higher frequency of hypomania than residents of Sardinia. Methods: A community survey of Sardinian immigrants was carried out in four Brazilian metropoles (n=218) and Buenos Aires (n=306). The results were compared with those of a study involving a similar methodology (Mood Disorder Questionnaire [MDQ] as a screening tool) conducted in seven Italian regions, including a sub-sample from Sardinia. Results: There was a higher prevalence of lifetime hypomania among Sardinians living in the Brazilian metropoles than among those living in Sardinia. This result was also consistent with Sardinian immigrants in Buenos Aires. After stratification by sex and age, the lifetime prevalence of MDQ scores ≥ 8 among Sardinians in South-American megacities and Sardinia was 8.6% vs. 2.9%, respectively (p < 0.0001). Conclusions: The higher frequency of hypomania in migrant populations appears to favor an evolutionary view in which mood disorders may be a maladaptive aspect of a genetic background with adaptive characteristics.


Assuntos
Humanos , Masculino , Feminino , Adulto , Migrantes/psicologia , Transtorno Bipolar/epidemiologia , Argentina/epidemiologia , Brasil/epidemiologia , Comparação Transcultural , Prevalência , Inquéritos e Questionários , Fatores de Risco , Cidades/epidemiologia , Distribuição por Sexo , Distribuição por Idade , Itália/etnologia
13.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 33-39, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1055365

RESUMO

Objective: To evaluate body dissatisfaction and distorted body self-image in women with prolactinoma. Methods: Body dissatisfaction and distorted body self-image were evaluated in 80 women with prolactinoma. All patients were in menacme, 34% had normal body mass index (BMI), and 66% were overweight. Most patients (56.2%) had normal prolactin (PRL) levels and no hyperprolactinemia symptoms (52.5%). The Body Shape Questionnaire (BSQ) was used to assess the patients' dissatisfaction with and concern about their physical form, and the Stunkard Figure Rating Scale (FRS) was used to assess body dissatisfaction and distorted body self-image. The patients were divided according to PRL level (normal vs. elevated) and the presence or absence of prolactinoma symptoms. Results: The normal and elevated PRL groups had similar incidences of body dissatisfaction and distorted body self-image. However, symptomatic patients reported a higher incidence of dissatisfaction than asymptomatic patients. Distorted body self-image was less common among symptomatic patients. Conclusion: Symptomatic patients showed higher body dissatisfaction, but lower body self-image distortion. The presence of symptoms may have been responsible for increased body awareness. The perception of body shape could have triggered feelings of dissatisfaction compared to an ideal lean body. Therefore, a distorted body self-image might not necessarily result in body dissatisfaction in women with prolactinomas.


Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Neoplasias Hipofisárias/psicologia , Hiperprolactinemia/psicologia , Prolactinoma/psicologia , Transtornos Dismórficos Corporais/psicologia , Neoplasias Hipofisárias/sangue , Prolactina/sangue , Escalas de Graduação Psiquiátrica , Valores de Referência , Imagem Corporal/psicologia , Hiperprolactinemia/tratamento farmacológico , Hiperprolactinemia/sangue , Prolactinoma/sangue , Índice de Massa Corporal , Inquéritos e Questionários , Estatísticas não Paramétricas , Agonistas de Dopamina/uso terapêutico , Pessoa de Meia-Idade
14.
Braz J Psychiatry ; 42(4): 420-430, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32074230

RESUMO

Panic disorder (PD) pathophysiology is very heterogeneous, and the discrimination of distinct subtypes could be very useful. A subtype based on respiratory symptoms is known to constitute a specific subgroup. However, evidence to support the respiratory subtype (RS) as a distinct subgroup of PD with a well-defined phenotype remains controversial. Studies have focused on characterization of the RS based on symptoms and response to CO2. In this line, we described clinical and biological aspects focused on symptomatology and CO2 challenge tests in PD RS. The main symptoms that characterize RS are dyspnea (shortness of breath) and a choking sensation. Moreover, patients with the RS tended to be more responsive to CO2 challenge tests, which triggered more panic attacks in this subgroup. Future studies should focus on discriminating respiratory-related clusters and exploring psychophysiological and neuroimaging outcomes in order to provide robust evidence to confirm RS as a distinct subtype of PD.


Assuntos
Dióxido de Carbono/sangue , Hiperventilação/fisiopatologia , Transtorno de Pânico/fisiopatologia , Ventilação Pulmonar/fisiologia , Dispneia/etiologia , Humanos , Hiperventilação/diagnóstico , Hiperventilação/psicologia , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Psicopatologia , Psicofisiologia
15.
Braz J Psychiatry ; 42(1): 63-67, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31269095

RESUMO

OBJECTIVE: To determine whether people with a Sardinian genetic background who live in the megacities of South America have a higher frequency of hypomania than residents of Sardinia. METHODS: A community survey of Sardinian immigrants was carried out in four Brazilian metropoles (n=218) and Buenos Aires (n=306). The results were compared with those of a study involving a similar methodology (Mood Disorder Questionnaire [MDQ] as a screening tool) conducted in seven Italian regions, including a sub-sample from Sardinia. RESULTS: There was a higher prevalence of lifetime hypomania among Sardinians living in the Brazilian metropoles than among those living in Sardinia. This result was also consistent with Sardinian immigrants in Buenos Aires. After stratification by sex and age, the lifetime prevalence of MDQ scores ≥ 8 among Sardinians in South-American megacities and Sardinia was 8.6% vs. 2.9%, respectively (p < 0.0001). CONCLUSIONS: The higher frequency of hypomania in migrant populations appears to favor an evolutionary view in which mood disorders may be a maladaptive aspect of a genetic background with adaptive characteristics.


Assuntos
Transtorno Bipolar/epidemiologia , Migrantes/psicologia , Adulto , Distribuição por Idade , Argentina/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Comparação Transcultural , Feminino , Humanos , Itália/etnologia , Masculino , Prevalência , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários
16.
Braz J Psychiatry ; 42(1): 33-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31314867

RESUMO

OBJECTIVE: To evaluate body dissatisfaction and distorted body self-image in women with prolactinoma. METHODS: Body dissatisfaction and distorted body self-image were evaluated in 80 women with prolactinoma. All patients were in menacme, 34% had normal body mass index (BMI), and 66% were overweight. Most patients (56.2%) had normal prolactin (PRL) levels and no hyperprolactinemia symptoms (52.5%). The Body Shape Questionnaire (BSQ) was used to assess the patients' dissatisfaction with and concern about their physical form, and the Stunkard Figure Rating Scale (FRS) was used to assess body dissatisfaction and distorted body self-image. The patients were divided according to PRL level (normal vs. elevated) and the presence or absence of prolactinoma symptoms. RESULTS: The normal and elevated PRL groups had similar incidences of body dissatisfaction and distorted body self-image. However, symptomatic patients reported a higher incidence of dissatisfaction than asymptomatic patients. Distorted body self-image was less common among symptomatic patients. CONCLUSION: Symptomatic patients showed higher body dissatisfaction, but lower body self-image distortion. The presence of symptoms may have been responsible for increased body awareness. The perception of body shape could have triggered feelings of dissatisfaction compared to an ideal lean body. Therefore, a distorted body self-image might not necessarily result in body dissatisfaction in women with prolactinomas.


Assuntos
Transtornos Dismórficos Corporais/psicologia , Hiperprolactinemia/psicologia , Neoplasias Hipofisárias/psicologia , Prolactinoma/psicologia , Adulto , Imagem Corporal/psicologia , Índice de Massa Corporal , Agonistas de Dopamina/uso terapêutico , Feminino , Humanos , Hiperprolactinemia/sangue , Hiperprolactinemia/tratamento farmacológico , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Prolactina/sangue , Prolactinoma/sangue , Escalas de Graduação Psiquiátrica , Valores de Referência , Estatísticas não Paramétricas , Inquéritos e Questionários , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-31819760

RESUMO

Background: Acute administration of caffeine produces panic attacks in most Panic Disorder (PD) patients, but little is known about chronic caffeine use in these patients. Objective: To assess caffeine use in patients with PD and to ascertain if caffeine consumption is associated with sociodemographic or clinical features. Methods: 65 adults with PD and 66 healthy controls were included in the current study. Their caffeine intake within the previous week was quantified with a questionnaire and compared. Harmful caffeine use was defined as consumption above 400 mg/day of caffeine. We tested for correlations between caffeine intake, demographic and clinical features. Results: Patients consumed significantly more caffeine than controls (P < 0.001). 14% (N = 9) of the PD patients made harmful use of caffeine. The use of caffeine-containing medications was observed in 40% (N = 26) of the PD patients and 6% (N = 4) of controls. Consumption of energy drinks was observed in 11% (N = 7) of PD patients and in none of the healthy subjects. Patients reported sleeping significantly less than controls (P < 0.001). In PD patients, caffeine consumption was not correlated with the presence of panic attacks or comorbidity with depression. The use of benzodiazepines or sedative medications was not correlated with caffeine intake. Conclusion: High caffeine consumption in PD patients could be explained by the development of tolerance with regular use of this substance. Subtypes of sensitive and non-sensitive PD patients could also explain why some of these patients are able to tolerate high doses of caffeine.

20.
Expert Opin Investig Drugs ; 28(12): 1081-1094, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31714807

RESUMO

Introduction: Binge eating disorder (BED) is the most common eating disorder and is frequently associated with psychiatric and medical comorbidities and functional impairment. Although psychological treatments have been the cornerstones of BED treatment, pharmacologic interventions also play an important part of the multimodal management of this condition.Areas covered: This review examines investigational, approved and other pharmacological agents for the treatment of BED. We searched PubMed and clinicaltrials.gov to identify pharmacological interventions for the management of this condition.Expert opinion: BED pharmacological studies have incorporated new drug targets based on our enhanced understanding of the pathophysiology of BED. Neurobiological dysregulation in the reward center and impulse control circuitry and related disturbances in dopamine neurotransmission are among the neurobiological explanations that have been suggested for BED. These mechanisms serve as a pharmacodynamic foundation for the development of new compounds such as lisdexamfetamine (LDX) and dasotraline. Despite these advances, pharmacological trials in BED have numerous challenges that must be overcome. For most compounds studied, larger and more definitive trials is a high priority.


Assuntos
Transtorno da Compulsão Alimentar/tratamento farmacológico , Desenvolvimento de Medicamentos , Drogas em Investigação/administração & dosagem , Animais , Transtorno da Compulsão Alimentar/fisiopatologia , Transtorno da Compulsão Alimentar/psicologia , Dopamina/metabolismo , Drogas em Investigação/farmacologia , Humanos , Recompensa
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