Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)最新文献

{"title":"Optimizing Early Psychosis Care through Family Psychoeducation: A Systematic Review and Meta-Analysis.","authors":"Thiago A Benazzi, Vicente R Arturi, Luis H T da Silva, Daniel P Baldez, Gislaine Baroni, Clarissa S Gama","doi":"10.47626/1516-4446-2025-4613","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4613","url":null,"abstract":"<p><p>Family psychoeducation is a key psychosocial strategy in early psychosis care, but its specific effects for relatives of people with first-episode psychosis (FEP) remain uncertain. We conducted a systematic review and meta-analysis, registered in PROSPERO (CRD42024585814) and following PRISMA, to evaluate clinical and caregiver outcomes. Randomized and nonrandomized trials comparing structured programs with treatment as usual or other interventions were searched in PubMed, Embase, Scopus, and the Cochrane Library to April 2024. Fifteen studies (n=2,271) met criteria. Pooled results showed benefits for patients: lower risk of psychiatric hospitalization (risk ratio 0.64; 95% CI 0.45-0.90) and shorter inpatient stays (standardized mean difference [SMD] -0.29; 95% CI -0.50 to -0.09). Symptoms also improved, with reductions in general psychopathology (SMD -0.45; 95% CI -0.80 to -0.09), positive symptoms (SMD -0.36; 95% CI -0.63 to -0.09), and negative symptoms (SMD -0.32; 95% CI -0.49 to -0.15). Effects on negative symptoms persisted at two-year follow-up. No significant effects emerged for functioning or caregiver burden. Overall, family psychoeducation is a low-cost, feasible intervention that improves clinical outcomes and reduces service utilization in FEP, supporting incorporation into early-intervention programs.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Brazilian Personal Social Capital Scale 10 (brPSCS-10): A Translated and Adapted Version of the Personal Social Capital Scale 8 (PSCS-8) tested in a sample of residents of a flood-affected area.","authors":"Santiago Madeira Diefenthaeler, Augusto Colferai Marcon, Augusto Reginatto, Marina Luiza Hartmann, Alice Cacilhas, Daniel Prates-Baldez, Simone Hauck","doi":"10.47626/1516-4446-2025-4516","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4516","url":null,"abstract":"<p><strong>Objective: </strong>In 2024, a catastrophic flood devastated Brazil's southernmost state, highlighting the need for tools to assess social capital. Yet, validated instruments for the Brazilian context are lacking. This study aimed to translate, culturally adapt, and validate the PSCS-8 for use in a Brazilian population after a climate event.</p><p><strong>Methods: </strong>This validation study used a sample from a longitudinal project assessing the mental health of residents of a flood-affected area. Participants (n=1057) responded to an online survey comprising the brPSCS-10, the PTSD Checklist for DSM-5 (PCL-5), and items on community resilience perception (CRP). The adaptation process involved expanding the scale to 10 items to enhance cultural relevance. Reliability was assessed using Cronbach's alpha, and a confirmatory factor analysis (CFA) tested the original two-factor structure.</p><p><strong>Results: </strong>The brPSCS-10 demonstrated good internal consistency. The scoring model aligned with the original structure showed a good fit in the CFA. Social capital was higher among individuals with higher income and education levels, and associated with lower PTSD symptoms and higher CRP.</p><p><strong>Conclusions: </strong>The brPSCS-10 is a reliable instrument for measuring perceived social capital in Brazilian Portuguese. Its brevity makes it suitable for large-scale surveys in post-disaster and public health research.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brazilian Psychiatric Association Guidelines for pharmacological treatment of Major Depressive Disorder: An overview of systematic reviews and meta-analyses.","authors":"Marcelo Pinheiro Machado Adelino, Julia Diniz Grossi, Marcel Vella Nunes, Ives Cavalcante Passos, André R Brunoni, Antonio Geraldo da Silva, Leonardo Baldaçara, Acioly Luiz Tavares de Lacerda","doi":"10.47626/1516-4446-2026-4911","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4911","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize evidence on pharmacological treatments for major depressive disorder (MDD) to inform updated Brazilian clinical guidelines.</p><p><strong>Methods: </strong>This overview included systematic reviews and meta-analyses published in the last 10 years, identified through MEDLINE, Cochrane Library, and SciELO. Eligible studies involved adults with MDD receiving pharmacological interventions. Risk of bias was assessed using ROBIS, methodological quality using AMSTAR 2, and certainty of evidence using the GRADE approach.</p><p><strong>Results: </strong>Forty studies were included. In acute treatment, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, mirtazapine, and vortioxetine showed consistent evidence across efficacy and tolerability outcomes. For adjunctive treatment, atypical antipsychotics demonstrated the highest certainty of evidence, with short-term support for benzodiazepines. In treatment-resistant depression, ketamine, esketamine, and atypical antipsychotic augmentation showed moderate certainty for response outcomes. In the maintenance phase, SSRIs and SNRIs were associated with the most consistent evidence for relapse prevention and acceptability.</p><p><strong>Conclusion: </strong>These findings support a hierarchy of pharmacological strategies across different stages of MDD. Although consistent with international guidelines, their implementation should consider local healthcare context and resource availability.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A developmentally based approach to multidimensionality: disentangling unity from diversity in youth psychopathology.","authors":"Lorenna Sena Teixeira Mendes, Natan Pereira Gosmann, Guilherme Vanoni Polanczyk, Luís Augusto Rohde, Giovanni Abrahão Salum","doi":"10.47626/1516-4446-2026-4818","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4818","url":null,"abstract":"<p><strong>Objective: </strong>Prior research on the latent structure of psychopathology has indicated the presence of a multidimensional symptom organization and a higher-order factor. This study aimed to evaluate the reliability and validity of a developmentally informed model to disentangle unity and diversity.</p><p><strong>Methods: </strong>We included 2512 children aged 6-14 years-old. Confirmatory factor analysis examined the validity and reliability of a bifactor model with one general dimension and ten dimensions of psychopathology: fear, somatic, distressful thoughts, low mood, low motivation/energy, inattention-hyperactivity, temper loss, aggression, noncompliance, and low concern for others, based on questions from Child Behavioral Checklist and Strengths and Difficulties Questionnaire. We analyzed the reliability of this model and competing models using omega statistics. External validity was examined using sex, executive functioning, and psychiatric diagnoses.</p><p><strong>Results: </strong>The bifactor model demonstrated good overall fit. Reliability analyses indicated that most reliable variance in total scores was attributable to the general factor, whereas the reliability of specific dimensions was largely contingent on this overarching factor. Specific factors exhibited differential validity in terms of sex, executive function, and psychiatric diagnosis.</p><p><strong>Conclusions: </strong>Reliability indices primarily supported unity, whereas external validation favored diversity. These results encourage the extension of developmentally based models to disentangle unity from diversity.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Patients to Caregivers: Indirect Associations between Social Cognition, Patient Distress, and Caregiver Quality of Life in Schizophrenia.","authors":"Alejandra Caqueo-Urízar, J Francisco Santibáñez-Palma, Sara Fernándes, Dominique Lemus-Bugueño, Laurent Boyer","doi":"10.47626/1516-4446-2026-4813","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4813","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether patients' social cognition (SC) is indirectly associated with caregivers' quality of life (S-CGQoL) through patients' psychological distress (PD), using a cross-sectional structural equation model (SEM).</p><p><strong>Methods: </strong>Cross-sectional study of 175 outpatients with schizophrenia-spectrum disorders and their primary family caregivers, recruited from three public community mental-health centers in Chile. Patients completed the GEOPTE SC subscale and the Kessler-10 (PD); caregivers completed the S-CGQoL-25. A cross-sectional SEM with WLSMV tested the indirect association SC→PD→S-CGQoL, reporting standardized coefficients (STDYX), global fit indices, and R².</p><p><strong>Results: </strong>Poorer SC was strongly associated with higher PD (β ≈ 0.79; p < .001). In turn, higher PD was associated with poorer S-CGQoL across all domains (β = -0.55 to -0.82; all p < .001). Indirect effects of SC on each S-CGQoL domain were significant (all p < .001). Model fit was acceptable (χ²/df ≈ 1.6; RMSEA ≈ 0.05; CFI ≈ 0.91; SRMR ≈ 0.06). The model explained 62% of PD variance and 30%-68% of S-CGQoL variance by domain.</p><p><strong>Conclusions: </strong>Patients' SC difficulties were indirectly associated with poorer caregiver quality of life through increased patient distress. These findings are clinically actionable: brief screening and reduction of distress, alongside social-cognitive rehabilitation, may mitigate family impact.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Use Disorder in Brazil: Emerging Patterns, Critical Gaps, and Implications for Public Health Policy - A Systematic Review.","authors":"Mariana Campello de Oliveira, Henrique Alves Bezerra, Cláudia Carneiro de Araújo Palmeira, André Brooking Negrão, André Malbergier, João Maurício Castadelli-Maia","doi":"10.47626/1516-4446-2025-4750","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4750","url":null,"abstract":"<p><strong>Background: </strong>Opioid Use Disorder (OUD) has become a major global public health concern, yet its epidemiological and clinical profile in Brazil remains insufficiently characterized. This systematic review aimed to synthesize the available evidence on OUD in the Brazilian context.</p><p><strong>Methods: </strong>Following a protocol registered in PROSPERO (CRD420250656485), we searched PubMed, BVS/LILACS, Scopus, and Web of Science from inception to April 30, 2025. Studies conducted in Brazil and involving individuals with OUD were eligible. Methodological quality was assessed using standardized critical appraisal tools.</p><p><strong>Results: </strong>Twelve studies met inclusion criteria, with 58% rated as high methodological quality. Most studies reported low absolute numbers of opioid users. Illicit opioid use was rare (<0.5%), whereas non-medical use of prescription opioids was considerably more prevalent. Health care professionals showed a higher risk. No randomized controlled trials (RCTs) were identified.</p><p><strong>Conclusions: </strong>Brazil faces a distinct opioid landscape characterized by low prevalence of illicit opioid use but notable misuse of prescription opioids. The absence of RCTs evaluating treatment effectiveness represents a significant evidence gap. Urgent research is needed to assess the feasibility and effectiveness of Medication for Opioid Use Disorder (MOUD) within the Brazilian health care system (SUS).</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Local Realities and Global Science: Psychiatric Education at 35 Years of Brazil's Sistema Único de Saúde.","authors":"Larissa Junkes, Michael S Duncan, Antonio E Nardi","doi":"10.47626/1516-4446-2025-4754","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4754","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Environment, Academic Stressors, and Institutional Aspects as Determinants of Mental Health Outcomes in Medical Education.","authors":"Clarissa Garcia Custódio, Lilian Cristie de Oliveira, Laura Fernandes Berto, Bianca Besteti Fernandes Damiano, Juliane Piasseschi de Bernardin Gonçalves, Oscarina da Silva Ezequiel, Alessandra Lamas Granero Lucchetti, Lisabeth F DiLalla, Homero Vallada, Euripedes Constantino Miguel, Giancarlo Lucchetti, Rodolfo Furlan Damiano","doi":"10.47626/1516-4446-2025-4509","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4509","url":null,"abstract":"<p><strong>Objective: </strong>Examine associations between learning environment, academic stressors, and mental health among Brazilian medical students across different institutional contexts.</p><p><strong>Methods: </strong>Cross-sectional study of 1,026 medical students from 74 public and private universities. Participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Johns Hopkins Learning Environment Scale (JHLES), and Medical Student Stressor Factor Scale (MSSF). Analyses included group comparisons, multiple regression, random forest modeling, and latent class analysis.</p><p><strong>Results: </strong>Private university students reported significantly better learning environments than public university counterparts (M = 84.6 vs. 81.9, p < 0.001). Quota students, those admitted to universities through affirmative action policies, demonstrated higher depression scores (M = 14.2 vs. 12.8, p = 0.007) and academic stress levels (M = 134.0 vs. 129.1, p = 0.018). Academic stressors demonstrated significant associations with both depressive (β=0.103; p<0.001) and anxiety symptoms (β=0.103; p<0.001), while higher learning environment quality was associated with lower depressive symptom severity (β=-0.105; p=0.043). Latent classes identified high-risk (53.7%), moderate-distress (32.7%), and high-functioning (13.6%) profiles, with affirmative-action students overrepresented in higher-risk classes.</p><p><strong>Conclusion: </strong>Students admitted via affirmative action in public universities face compounded vulnerabilities. Interventions should focus on reducing academic stress and improving learning environments, especially in public institutions serving disadvantaged groups.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Science Is Not Opinion.","authors":"César Augusto Trinta Weber, Antônio Geraldo da Silva","doi":"10.47626/1516-4446-2026-4850","DOIUrl":"10.47626/1516-4446-2026-4850","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol consumption among adolescents with and without ADHD and the interaction with socioemotional competences at age 18- Data from the 2004 Pelotas Birth Cohort.","authors":"Ana Beatriz Bozzini, Jessica M Maruyama, Luciana Tovo-Rodrigues, Iná S Santos, Aluisio J D Barros, Alicia Matijasevich","doi":"10.47626/1516-4446-2025-4592","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4592","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}