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

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Risk gambling in Brazil: National Prevalence and Structural Correlates from the Third Brazilian National Alcohol and Drugs Survey (LENAD III). 巴西的风险赌博:第三次巴西全国酒精和毒品调查(LENAD III)的全国流行率和结构相关性。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-09-05 DOI: 10.47626/1516-4446-2026-4920
Clarice Sandi Madruga, Katia Isicawa de Sousa, Daniel Spritzer, André Constantino Miguel, Hermano Tavares, Thiago Henrique Roza, Rodrigo Pereira Pio, Martha Canfield, Felix Kessler, Quirino Cordeiro, Ronaldo Ramos Laranjeira
{"title":"Risk gambling in Brazil: National Prevalence and Structural Correlates from the Third Brazilian National Alcohol and Drugs Survey (LENAD III).","authors":"Clarice Sandi Madruga, Katia Isicawa de Sousa, Daniel Spritzer, André Constantino Miguel, Hermano Tavares, Thiago Henrique Roza, Rodrigo Pereira Pio, Martha Canfield, Felix Kessler, Quirino Cordeiro, Ronaldo Ramos Laranjeira","doi":"10.47626/1516-4446-2026-4920","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4920","url":null,"abstract":"<p><p>The rapid expansion of online gambling in Brazil has outpaced the consolidation of regulatory safeguards, raising concerns about gambling-related harm at the population level. The Third Brazilian National Alcohol and Drugs Survey (BNADS/LENAD III) investigated gambling participation and risk gambling, providing nationally representative estimates of the magnitude of the problem and identifying vulnerable groups to inform public policy. LENAD III is a survey conducted in Brazil in 2022-2023 with 16,608 individuals aged 14 years and older. Gambling participation and risk were assessed using the Problem Gambling Severity Index (PGSI). Weighted prevalence estimates and multivariable logistic regression models were used to examine associations between structural, sociodemographic, behavioural factors, and risk gambling. Past-year gambling was reported by 17.6% of the population. Overall, 6.6% fell within the PGSI risk spectrum, while 2.8% were classified as moderate- or high-risk. Risk gambling was substantially more frequent among online gamblers. In multivariable models, online gambling remained the strongest correlate of gambling-related harm. Risk gambling in Brazil is substantial and disproportionately concentrated in online betting. Regulatory responses should prioritize structural measures that address product design, advertising exposure, and access control. Strengthening enforcement and aligning regulation with public health principles are urgent priorities.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901855","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}
引用次数: 0
Risk of schizophrenia in the offspring of mothers with diabetes during pregnancy: systematic review and meta-analysis. 妊娠期糖尿病母亲的后代患精神分裂症的风险:系统回顾和荟萃分析
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-08-22 DOI: 10.47626/1516-4446-2026-5019
Marianna Zanette Molha, Ana Julia de Magalhães Pina, Beatriz Yukie Filosi, Beatriz Fernandes Lima, Carlos Antonio Negrato
{"title":"Risk of schizophrenia in the offspring of mothers with diabetes during pregnancy: systematic review and meta-analysis.","authors":"Marianna Zanette Molha, Ana Julia de Magalhães Pina, Beatriz Yukie Filosi, Beatriz Fernandes Lima, Carlos Antonio Negrato","doi":"10.47626/1516-4446-2026-5019","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-5019","url":null,"abstract":"<p><strong>Objectives: </strong>Hyperglycemia during pregnancy is related to adverse obstetric, neonatal, and long-term health outcomes for both mothers and the offspring. This study aimed to conduct a systematic review and meta-analysis of the global literature evaluating the association between maternal diabetes (DM) during pregnancy and the incidence of schizophrenia in the offspring.</p><p><strong>Methods: </strong>Following PRISMA guidelines and registered in PROSPERO (CRD42024545505), a comprehensive search was conducted across major databases up to November 2024. Three retrospective cohort studies, including 2,603,889 individuals, met the inclusion criteria.</p><p><strong>Results: </strong>Three studies were included in the quantitative synthesis. Meta-analysis of hazard ratios showed that maternal DM during pregnancy was associated with an increased risk of schizophrenia in the offspring (HR = 1.58; 95% CI: 1.22-2.03; P = 0.0004), with no heterogeneity (I² = 0%). Analysis based on odds ratios showed a similar trend but did not reach statistical significance (OR = 2.15; 95% CI: 0.13-34.69; P = 0.59).</p><p><strong>Conclusion: </strong>Maternal DM during pregnancy may be associated with an increased risk of schizophrenia in the offspring. Although maternal hyperglycemia may influence fetal neurodevelopment through inflammatory and metabolic mechanisms, the observational nature and limited number of included studies preclude causal inference, and these findings should be interpreted with caution.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805390","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}
引用次数: 0
Therapeutic effects of tDCS on cognitive functions in patients diagnosed with autism spectrum disorders: a systematic review and meta-analysis on randomized sham-controlled trials. tDCS对自闭症谱系障碍患者认知功能的治疗效果:随机假对照试验的系统回顾和荟萃分析。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-08-22 DOI: 10.47626/1516-4446-2026-4808
Ping-Wen Huang, Shun-Chin Liang, Cheuk-Kwan Sun, Yu-Shian Cheng, Chia-Min Chen, Kuo-Chuan Hung
{"title":"Therapeutic effects of tDCS on cognitive functions in patients diagnosed with autism spectrum disorders: a systematic review and meta-analysis on randomized sham-controlled trials.","authors":"Ping-Wen Huang, Shun-Chin Liang, Cheuk-Kwan Sun, Yu-Shian Cheng, Chia-Min Chen, Kuo-Chuan Hung","doi":"10.47626/1516-4446-2026-4808","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4808","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aimed at investigating the effectiveness of transcranial direct current stimulation (tDCS) in improving cognitive functions in individuals with autism spectrum disorder (ASD) and evaluating the effects of potential confounders on therapeutic outcomes.</p><p><strong>Methods: </strong>Randomized placebo-controlled trials (RCTs) identified from major databases were reviewed. Continuous data were expressed as effect size based on standardized mean difference (SMD) with 95% confidence intervals.</p><p><strong>Results: </strong>Meta-analysis of thirteen RCTs involving 347 participants diagnosed with ASD (mean age=15.76) revealed significant improvements in social cognition among those receiving tDCS treatment compared to sham controls (SMD=1.14, 95% CI=0.70-1.58, p<0.01, seven studies, n=172). Subgroup analysis showed no significant impact regarding location of anode placement, combination with cognitive/behavioral training, and number of sessions. Our secondary analyses demonstrated significantly greater improvements in processing speed of patients receiving tDCS than their sham controls (SMD=0.50, 95% CI=0.22-0.77, p<0.01, five studies, n=208) but not in attentional function, inhibitory control, and working memory.</p><p><strong>Conclusion: </strong>Our study supported the use of tDCS for improving social cognition and processing speed in individuals with ASD. Nevertheless, the impact of potential confounders on therapeutic outcomes, including treatment duration and target brain region, warrants elucidation by further large-scale investigations.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148836101","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}
引用次数: 0
Spatiotemporal Patterns and Determinants of Suicide in a Brazilian State: An Eleven-Year Ecological Study. 巴西州自杀的时空模式和决定因素:一项为期11年的生态研究。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-08-14 DOI: 10.47626/1516-4446-2026-4870
Maria Carolina Vita Nunes, Jônatas Magalhães Santos, Mirian Matsura Shirassu, Elson Asevedo, Rodolfo Furlan Damiano, Jair de Jesus Mari
{"title":"Spatiotemporal Patterns and Determinants of Suicide in a Brazilian State: An Eleven-Year Ecological Study.","authors":"Maria Carolina Vita Nunes, Jônatas Magalhães Santos, Mirian Matsura Shirassu, Elson Asevedo, Rodolfo Furlan Damiano, Jair de Jesus Mari","doi":"10.47626/1516-4446-2026-4870","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4870","url":null,"abstract":"<p><strong>Objective: </strong>Investigate spatial and temporal distribution of suicide mortality across the Regional Health Care Networks of São Paulo State, Brazil, from 2012 to 2022, evaluating associations with mental health service availability, psychiatric workforce density, and socioeconomic indicators.</p><p><strong>Methods: </strong>Longitudinal retrospective ecological study using annual data from 19 Regional Health Care Networks. Suicide mortality (ICD-10 X60-X84) rates per 100,000 inhabitants were analyzed using descriptive epidemiology, exploratory spatial data analysis, and fixed-effects panel regression models with spatial error specifications and one-year lagged independent variables.</p><p><strong>Results: </strong>Suicide rates increased from 4.8 to 6.3 per 100,000 (32%). Female aged 10-14 years experienced a 332% increase. Spatial clustering revealed persistent high-risk areas in inland regions. In panel regression models (within-R² = 0.53), psychiatrist density in the public health system demonstrated a protective association (β = -0.20, p < 0.05), as did psychiatric bed rates in lagged models (β = -0.01, p < 0.05). Psychosocial Care Centers coverage showed no significant association. GDP per capita was positively associated with suicide rates.</p><p><strong>Conclusions: </strong>Psychiatric workforce availability and acute care capacity emerge as key modifiable factors. Increase among female adolescents and persistent geographic disparities warrant targeted prevention strategies. Findings provide actionable evidence for suicide prevention resource allocation in middle-income settings.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765839","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}
引用次数: 0
Eight hundred and twenty-seven: the invisible crisis of child and adolescent psychiatry in Brazil. 827:巴西儿童和青少年精神病学的无形危机。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-08-14 DOI: 10.47626/1516-4446-2026-4995
Danilo Bastos Bispo Ferreira
{"title":"Eight hundred and twenty-seven: the invisible crisis of child and adolescent psychiatry in Brazil.","authors":"Danilo Bastos Bispo Ferreira","doi":"10.47626/1516-4446-2026-4995","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4995","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764331","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}
引用次数: 0
Response-outcome analysis in gambling disorder. 赌博障碍的反应-结果分析。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-07-30 DOI: 10.47626/1516-4446-2026-4928
Raquel Berg, Letícia A G Croccoli, Hermano Tavares
{"title":"Response-outcome analysis in gambling disorder.","authors":"Raquel Berg, Letícia A G Croccoli, Hermano Tavares","doi":"10.47626/1516-4446-2026-4928","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4928","url":null,"abstract":"<p><strong>Introduction: </strong>Gambling Disorder is characterized by persistent betting despite financial losses and social adversities. Previous studies demonstrated that during short response-outcome analytical tests (ROAT), people with gambling disorder (PGD) presented more random responses and less use of analytical strategies on ROAT with and without a solution.</p><p><strong>Objective: </strong>Evaluate the predisposition of PGD to illusion of control and superstitious behavior in longer ROAT versions.</p><p><strong>Method: </strong>34 PGD to 34 Healthy Controls (HC) are compared, regarding emotional and cognitive responses, and behavioral performance.</p><p><strong>Results: </strong>For the whole sample, perception of control while taking both long ROAT versions was predicted by a positive emotional experience. Particularly for the ROAT version without a solution, perception of control was associated with total attempts at controlling the aversive stimulus for PGD. Compared to HC, PGD found both ROAT versions more emotionally distressing, reported a lower perception of control, and presented more attempts at control in the uncontrollable ROAT version.</p><p><strong>Conclusion: </strong>In comparison to HC, PGD insisted more on useless behaviors in tasks with no rewards and despite emotional discomfort, evidencing a splitting between negative emotions and behavioral response.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633543","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}
引用次数: 0
How psychosis shapes the impact of childhood trauma on social cognition in bipolar disorder: the role of Theory of Mind. 精神病如何塑造双相情感障碍儿童创伤对社会认知的影响:心理理论的作用。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-07-20 DOI: 10.47626/1516-4446-2026-4894
Luisa de Siqueira Rotenberg, Maria Eduarda Carrozzino Boog, Alia Garrudo Guirado, Renata Curvello, Clara Nardini, Milene da Silva Franco, Tais Boeira Biazus, Thuani Campanha, Cristiana Castanho de Almeida Rocca, Beny Lafer
{"title":"How psychosis shapes the impact of childhood trauma on social cognition in bipolar disorder: the role of Theory of Mind.","authors":"Luisa de Siqueira Rotenberg, Maria Eduarda Carrozzino Boog, Alia Garrudo Guirado, Renata Curvello, Clara Nardini, Milene da Silva Franco, Tais Boeira Biazus, Thuani Campanha, Cristiana Castanho de Almeida Rocca, Beny Lafer","doi":"10.47626/1516-4446-2026-4894","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4894","url":null,"abstract":"<p><strong>Objective: </strong>Childhood trauma and psychotic symptoms are prevalent in bipolar disorder (BD) and independently linked to social cognition impairments, particularly Theory of Mind (ToM). However, it remains unclear whether trauma and psychosis exert cumulative effects on ToM performance in BD.</p><p><strong>Methods: </strong>We conducted a cross-sectional study involving 54 euthymic individuals with BD reporting at least moderate childhood trauma (Childhood Trauma Questionnaire; CTQ). Participants completed the Reading the Mind in the Eyes Test (RMET) to assess ToM. Clinical and sociodemographic data were collected. Participants were stratified by lifetime psychotic symptoms for between-group comparisons.</p><p><strong>Results: </strong>Individuals with a history of psychotic symptoms (n=18) reported significantly higher total CTQ scores (Mean=61.0, SD=15.7) than those without psychotic symptoms (Mean=44.5, SD=13.1; p=0.028) and exhibited significantly lower ToM accuracy (Mean RMET=23.0, SD=4.5 vs. 25.4, SD=3.4; p<0.001, d=0.58).</p><p><strong>Conclusions: </strong>In BD, the co-occurrence of childhood trauma and lifetime psychosis is associated with more pronounced ToM deficits. These results highlight the need for trauma-informed approaches and early cognitive interventions targeting social cognition in individuals with BD and psychosis history.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148538105","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}
引用次数: 0
Differences in behavioral and emotional problems among children aged 1-4 years from two independent cohorts in Montevideo, Uruguay: the 2013 and 2018 ENDIS studies. 乌拉圭蒙得维的亚两个独立队列中1-4岁儿童行为和情绪问题的差异:2013年和2018年ENDIS研究
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-07-20 DOI: 10.47626/1516-4446-2026-4981
Danilo Dias Santana, Carlos Zunino, Marianela Rodriguez Rey, Fernanda Blasina, Joseph Murray, Alicia Matijasevich, Gustavo Alberto Giachetto Larraz
{"title":"Differences in behavioral and emotional problems among children aged 1-4 years from two independent cohorts in Montevideo, Uruguay: the 2013 and 2018 ENDIS studies.","authors":"Danilo Dias Santana, Carlos Zunino, Marianela Rodriguez Rey, Fernanda Blasina, Joseph Murray, Alicia Matijasevich, Gustavo Alberto Giachetto Larraz","doi":"10.47626/1516-4446-2026-4981","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4981","url":null,"abstract":"<p><strong>Objective: </strong>To examine differences in behavioral and emotional problems among children aged 1-4 years using baseline data from two independent Uruguayan cohort studies (2013 and 2018), and to investigate whether differences were explained by socioeconomic, maternal, and child characteristics.</p><p><strong>Methods: </strong>Data from two independent Montevideo cohorts (2013: n=790; 2018: n=743) were analyzed. Behavioral and emotional problems were assessed through maternal report using the Child Behavior Checklist for Ages 1½-5 (CBCL 1½-5). Between-cohort differences were examined using ANCOVA with sequential adjustment for socioeconomic, maternal, and child characteristics.</p><p><strong>Results: </strong>The 2018 cohort showed higher CBCL scores for total problems (mean difference=1.87, Cohen's d=0.10, 95%CI:0.00-0.20, p=0.049) and internalizing problems (mean difference=1.01, d=0.17, 95%CI:0.07-0.27, p=0.001). Externalizing scores showed a non-significant trend (mean difference=0.57, d=0.07, 95%CI:-0.02-0.17, p=0.140). After adjustment, emotionally reactive, anxious/depressed, withdrawn, and aggressive behavior scores remained significantly higher in 2018. Differences were largest among low-income families (CBCL total: adjusted mean difference=5.94, p=0.001; internalizing=2.63, p<0.001), with virtually no difference in the highest income tercile.</p><p><strong>Conclusions: </strong>Effect sizes were small overall, yet higher scores in the 2018 cohort were concentrated in lower-income families, suggesting socioeconomic patterning of behavioral and emotional problems across cohorts.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582102","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}
引用次数: 0
Labor market inclusion of autistic adults in Brazil: bridging functional assessment, clinical practice, and public policy. 巴西自闭症成人的劳动力市场包容性:桥接功能评估、临床实践和公共政策。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-07-13 DOI: 10.47626/1516-4446-2026-4927
Malu J A Macedo, Gabriela H S Guimarães, Karina C Bastos, Alice C M Xavier, Carolina B Dreher
{"title":"Labor market inclusion of autistic adults in Brazil: bridging functional assessment, clinical practice, and public policy.","authors":"Malu J A Macedo, Gabriela H S Guimarães, Karina C Bastos, Alice C M Xavier, Carolina B Dreher","doi":"10.47626/1516-4446-2026-4927","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4927","url":null,"abstract":"<p><p>Autism spectrum disorder (ASD) is increasingly recognized in adulthood, yet unemployment and underemployment remain disproportionately high among autistic adults worldwide. Although Brazil has developed a comprehensive legal framework grounded in the biopsychosocial model of disability, including Law No. 12,764/2012, the Brazilian Inclusion Law (13,146/2015), and employment quota legislation, these advances have not consistently translated into sustainable workplace inclusion. This narrative review critically examines the Brazilian legal framework for labor inclusion of autistic adults, the limitations of current functional assessment instruments, particularly the Brazilian Functionality Index (IF-Br), and the implementation of reasonable accommodations from an International Classification of Functioning, Disability and Health (ICF) perspective, drawing on international policy experiences for comparison. Results indicate that Brazilian policy remains predominantly oriented toward quota-based hiring, with functional assessment instruments that inadequately capture context-dependent difficulties-such as sensory processing, executive functioning, and implicit social demands-particularly among individuals requiring level 1 support. This mismatch between formal inclusion and workplace accessibility may generate a self-reinforcing cycle of psychological distress, reduced occupational performance, and job loss. International models combining legal protections with individualized functional assessment and structured workplace support demonstrate more sustainable outcomes. The findings underscore the strategic role of psychiatrists in bridging clinical evaluation and public policy through workplace-oriented functional assessments and concrete recommendations for reasonable accommodations. Improving labor inclusion for autistic adults in Brazil depends less on new legislation and more on refining clinical and evaluative practices capable of translating formal rights into meaningful, sustainable occupational participation.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439886","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}
引用次数: 0
Metabolic effects of long-term Aripiprazole use in patients with schizophrenia and first-episode psychosis: A systematic review. 长期使用阿立哌唑对精神分裂症和首发精神病患者的代谢影响:一项系统综述。
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) Pub Date : 2026-07-13 DOI: 10.47626/1516-4446-2026-4803
Gustavo Vieira, Mahmood Balogun, Mateus Alessi, Izidione Miozzo, Vitória Freitas, Anna Laura Larcipretti, Milena Almeida, Paulo Sérgio Diniz, Andrea Lezana
{"title":"Metabolic effects of long-term Aripiprazole use in patients with schizophrenia and first-episode psychosis: A systematic review.","authors":"Gustavo Vieira, Mahmood Balogun, Mateus Alessi, Izidione Miozzo, Vitória Freitas, Anna Laura Larcipretti, Milena Almeida, Paulo Sérgio Diniz, Andrea Lezana","doi":"10.47626/1516-4446-2026-4803","DOIUrl":"https://doi.org/10.47626/1516-4446-2026-4803","url":null,"abstract":"<p><strong>Objective: </strong>Schizophrenia and first-episode psychosis often require long-term antipsychotic treatment, making metabolic adverse effects an important clinical concern. This study evaluated the long-term metabolic effects of aripiprazole compared with other antipsychotics.</p><p><strong>Methods: </strong>This systematic review analyzed randomized controlled trials with at least one year of follow-up and was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The protocol was prospectively registered in PROSPERO (CRD4202563245). Two authors independently conducted a systematic search in MEDLINE/PubMed, Embase, and Cochrane databases from inception to December 2024. Adult patients with schizophrenia spectrum disorders or first-episode psychosis were included. Primary outcomes were weight, body mass index, and cholesterol. Two authors independently assessed the risk of bias in the included randomized clinical trials using the Cochrane Risk of Bias 2 tool, with any discrepancies resolved by a third reviewer.</p><p><strong>Results: </strong>Long-term aripiprazole treatment was associated with comparable metabolic changes, including increases in body weight, BMI, and lipid parameters. However, head-to-head comparisons did not demonstrate a consistent pattern of greater metabolic worsening with aripiprazole relative to other antipsychotics. Some studies reported no statistically significant between-group differences in weight, BMI, or cholesterol, while others described numerically lower frequencies of selected metabolic adverse events with aripiprazole. Nevertheless, statistical testing and reporting of confidence intervals were inconsistent across studies, limiting firm comparative conclusions.</p><p><strong>Conclusions: </strong>These findings suggest that aripiprazole may have a comparably favorable metabolic profile for selected outcomes during chronic treatment; however, increases in weight, BMI, and lipid parameters were observed in some studies. Further long-term studies with standardized metabolic outcome reporting are warranted to clarify its comparative effects across broader clinical populations.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440304","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}
引用次数: 0
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