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

{"title":"Transcranial magnetic stimulation and transcranial direct current stimulation in psychiatric disorders in children and adolescents: an umbrella review of meta-analyses of clinical trials.","authors":"Jônatas Magalhães Santos, Lívia Vita Rodrigues, Pedro Henrique Rodrigues da Silva, Lais Boralli Razza, Paul E Croarkin, Andre Russowsky Brunoni","doi":"10.47626/1516-4446-2025-4219","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4219","url":null,"abstract":"<p><strong>Objective: </strong>Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), shows promise for psychiatric disorders in adults, but evidence in children and adolescents remains limited. The objective of this review is to evaluate the efficacy and safety of NIBS in treating psychiatric disorders in children and adolescents.</p><p><strong>Methods: </strong>An umbrella review with a pre-registered PROSPERO protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30th, 2023. PICO strategy guided study selection. Study quality was assessed using AMSTAR-2, and evidence certainty was rated with GRADE-pro.</p><p><strong>Results: </strong>Of 757 records screened, five meta-analyses, including 49 clinical trials and 2105 participants after excluding overlaped samples met inclusion criteria: four evaluating rTMS for depression and one assessing tDCS for ADHD. Among the four meta-analyses evaluating rTMS for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients (Cao et al.) for formal evaluation. Cao et al. (low quality) reported significant improvement in depressive symptoms two (MD=4.68/GRADE=low) and four (MD=5.53/GRADE=low) weeks post-rTMS, with a positive response rate (OR=3.99/GRADE=very low) and minimal adverse effects. Sun et al. (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on L-DLPFC (SMD=1.63/GRADE=low), 1 Hz stimulation on R-DLPFC (SMD=1.22/GRADE=high), and remission rates (RR=1.35/GRADE=moderate). Furthermore, the discontinuation rate was low, without serious adverse events related. Brauer et al. (low quality) reported symptom improvement in ADHD with tDCS (SMD=0.363/GRADE=very low).</p><p><strong>Conclusion: </strong>NIBS appears safe and effective to treat psychiatric disorders in children and adolescents but requires further high-quality RCTs for clinical validation.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194444","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":"Comparison of Optical Coherence Tomography Findings in Patients with Major Depression and Bipolar Affective Disorder in Remission.","authors":"Seda Kiraz, Gülce Gökgöz Özışık","doi":"10.47626/1516-4446-2025-4295","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4295","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to examine the peripapillary retinal nerve fiber layer thickness (RNFL), macular thickness (MAC), ganglion cell layer thickness (GCL), and inner plexiform layer thickness (IPL) determined by Optic Coherence Tomography (OCT) in the euthymic bipolar disorder (BD) and recurrent major depression (MD) in remission period, to compare with healthy control group (CG).</p><p><strong>Method: </strong>51 patients with BD, 50 patients with MD, and 52 CG were included. Complete ophthalmologic examinations were performed on the three groups and right eye was included. OCT findings were analyzed between groups.</p><p><strong>Results: </strong>There was no significant difference between the groups in terms of age, gender, smoking, RNFL and IPL measurements. MAC central and inner temporal (IT) measurements of the CG were significantly higher than the measurements of the MD and BD groups (all p<0.05), but no difference between the MAC central measurements of the MD and BD groups (p=0.084). MAC IT measurements of the MD group were also significantly higher than the measurements of the BD group (p=0.046). MAC inner inferior (II) measurements of the CG were significantly higher than the measurements of the MD and BD groups (p=0.003, p<0.001, respectively), but no difference between the MAC II measurements of the MD and BD groups (p=0.141). GCL IT measurements of the CG were significantly higher than the measurements of the MD and BD groups (p=0.049, p=0.044).</p><p><strong>Conclusions: </strong>The differences between MD and BD may reflect the unique characteristics of each disorder. These data need to be confirmed by studies on retinal structure and function in larger patient populations with longer follow-up.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194378","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":"Charcot's Bicentennial Legacy: Bridging Hysteria, Neuroscience, and Neurohumanities.","authors":"Marleide de Mota Gomes, Antonio Egidio Nardi","doi":"10.47626/1516-4446-2025-4389","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4389","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194382","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":"Early Psychosis Care in Brazil: A Comparative Study of a Specialized University Center and Community-Based Services.","authors":"Pâmela Pilar, July Gomes, Ary Gadelha, Cristiano Noto","doi":"10.47626/1516-4446-2025-4230","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4230","url":null,"abstract":"<p><strong>Objective: </strong>To compare early intervention (EI) strategies for psychosis between community-based Psychosocial Care Centers (CAPS) and a specialized university service (GAPi) in Brazil, assessing EI fidelity, recovery-oriented practices (ROP), and professional stigma.</p><p><strong>Methods: </strong>The FEPS-FS, RSA-R, and a stigma questionnaire evaluated EI fidelity, ROP, and stigma. Data from both services were analyzed to examine correlations.</p><p><strong>Results: </strong>GAPi demonstrated greater adherence to EI strategies, whereas CAPS scored higher in ROP. Though demonstrating lower overall EI fidelity, CAPS already incorporated several EI components. No significant differences in stigma levels were observed. Higher ROP correlated with fewer negative stereotypes, while greater EI adherence correlated with fewer positive stereotypes.</p><p><strong>Conclusions: </strong>The findings highlight the complementary strengths of both service models. Although improving EI fidelity in CAPS is a priority, their existing community-based structure and recovery orientation offer a strong platform for expanding these services. An integrated approach combining specialized EI strategies with robust ROP may optimize outcomes and reduce stigma.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194367","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":"Global temporal and regional trends in cannabis use among medical students: A systematic review and meta-analysis.","authors":"Eduardo Karpovisch, Gabriel Grando Alves, Vicente Fichbein Folgierini, Luiza Elizabete Braun, Ighor Miron Porto, Mauricio Scopel Hoffmann, João Pedro Gonçalves Pacheco","doi":"10.47626/1516-4446-2025-4286","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4286","url":null,"abstract":"<p><strong>Objective: </strong>Given the interest in the potential effects of cannabis on medical students, this study aims to establish the prevalence of recreational use within this population.</p><p><strong>Methods: </strong>We searched MEDLINE, LILACS, PubMed, Embase, PsycINFO/PsycArticles/APA Books), and SciELO for observational studies published before June 9, 2025, that reported cannabis use prevalence among medical students. We conducted subgroup analyses based on gender, study cycle, school type, decade of publication, and world region. Data were pooled using a random-effects model.</p><p><strong>Results: </strong>Our search identified 109 studies meeting the inclusion criteria, published between 1971 and 2025, encompassing data from 62,444 participants from 32 countries. Lifetime prevalence was 29.2%, past year 20.5%, past month 9.2%, and past week 5.1%. Global prevalence declined from 38.4% in the 1970s (95% CI 19.2-57.7) to 18.1% in the 2000s (95% CI 13.6-23.8), increased to 30.4% in the 2020s (95% CI 19.2-41.6), driven by trends in Latin America, Asia, and Africa. The lowest prevalence was in Asia (11.5%, 95% CI 07.1-15.8) and the highest in Anglo-Saxon America (59.7%, 95% CI 53.1-66.3).</p><p><strong>Conclusions: </strong>Cannabis use is prevalent among medical students, with increasing trends and regional variations. Targeted interventions are needed to raise awareness of associated risks.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194333","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":"Acute Suicidal Behavior Following Ayahuasca Ingestion in a Clinical Trial Setting: A Case Report.","authors":"José Augusto S Reis, Giordano N Rossi, Anna Beatriz V Zacharias, Jaime E C Hallak, Rafael G Dos Santos","doi":"10.47626/1516-4446-2025-4354","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4354","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194340","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":"Real-world use of classic and non-classic psychedelics in Hispanic/Latino adults with Obsessive-Compulsive Disorder: International findings from the LATINO Study.","authors":"David S Mathai, Jill O Robinson, Kevin Wagner, Logan Neitzke-Spruill, Dayan Berrones, Jacey L Anderberg, Renee M Frederick, Vanessa Zavala Cruz, Josselyn S Muñoz, Carolyn I Rodriguez, Lynnette A Averill, James J Crowley, Eric A Storch, Amy L McGuire","doi":"10.47626/1516-4446-2025-4316","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4316","url":null,"abstract":"<p><strong>Objective: </strong>Despite growing research on the potential mental health benefits of psychedelics, there has been limited study of these drugs in populations with obsessive-compulsive disorder (OCD) and with Hispanic and Latin American (H/L) ancestry.</p><p><strong>Methods: </strong>Demographic and clinical assessments were conducted as part of the Latin American Trans-ancestry Initiative for OCD genomics (LATINO) Study in H/L participants with OCD living throughout the Americas. Self-reported data on the prevalence of naturalistic psychedelic use and associated outcomes on OCD symptoms were collected in a subsample of 2,639 adults. Descriptive statistics and regression analyses were used to assess psychedelic use, predictors of use, and predictors of OCD symptom change attributed to psychedelics.</p><p><strong>Results: </strong>Across 11 countries, 9% of respondents reported using psychedelics or related substances for treatment. Most respondents (72%) had received traditionally available treatments for OCD (e.g., psychiatric medication and/or psychotherapy). Psilocybin, LSD, and MDMA were the most used psychedelics. Psychedelic users compared to non-users were more likely to be male, have received non-ERP therapy for OCD, and have a comorbid psychiatric diagnosis. Outcomes of psychedelic use for OCD-related symptoms varied widely by drug and were difficult to predict but were reported as most favorable for \"classic\" serotonergic psychedelics.</p><p><strong>Conclusions: </strong>Real-world evidence suggests that H/L adults are exploring psychedelics as a treatment for OCD, though further work is needed to establish the conditions for safe and effective use in this population. Increased research and practical harm reduction in this area is critical as public interest in psychedelic drugs continues to surge.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194407","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 Real-World Pharmacovigilance study of FAERS Database for Fluvoxamine: Perspectives from Physicians and Pharmacists.","authors":"Weiming Xie, Na Li, Jun Gu, Fei Wang, Liang Liu, Jianhong Wu, Haifeng Wang","doi":"10.47626/1516-4446-2025-4146","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4146","url":null,"abstract":"<p><strong>Background: </strong>Fluvoxamine is a well-established treatment for depressive disorders. However, real-world safety data regarding fluvoxamine remains limited. This study aims to analyze adverse drug events (ADEs) associated with fluvoxamine using the large-scale pharmacovigilance database FAERS, to assess its safety profile.</p><p><strong>Methods: </strong>The FAERS database was used to collect data on ADEs related to fluvoxamine from the first quarter of 2004 to the third quarter of 2024. Disproportionality analyses were performed using the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayes Geometric Mean (EBGM) methods.</p><p><strong>Result: </strong>A total of 355 ADEs reports related to fluvoxamine were identified, spanning 26 different System Organ Classes (SOCs) and 67 preferred terms (PTs). Psychiatric disorders were the most frequently reported ADEs. Notably, signals for reproductive system and breast disorders, cardiac disorders, and eye disorders were stronger but not related to the pharmacological properties of fluvoxamine, thus warranting special clinical attention. Disinhibition showed the highest signal strength in fluvoxamine and requires vigilance. A considerable number of drug interactions were noted, leading to increased antipsychotic drug levels and extrapyramidal symptoms, such as slow speech, drooling, and tardive dyskinesia. Self-harm and suicidal behavior necessitate clinical risk management. Additionally, significant symptoms of serotonin syndrome were observed, including tic, clonus, mydriasis, and myoclonus. Our study also uncovered ADEs not previously documented in product labels, such as Cushing's syndrome, papilloedema, and increased intracranial pressure.</p><p><strong>Conclusion: </strong>This study provides a real-world pharmacovigilance analysis of fluvoxamine. It identifies several rare ADEs and clinically significant symptoms, particularly neuroleptic malignant syndrome and serotonin syndrome. Our study offers important insights for the clinical safety assessment of fluvoxamine.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194344","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":"Uncertainty about our own beliefs: co-occurrence of obsessive and psychotic phenomena.","authors":"Igor Studart, Jônatas Magalhães Santos, Ary Gadelha, André Fernandes, Euripedes Constantino Miguel, Marcelo Q Hoexter","doi":"10.47626/1516-4446-2025-4429","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4429","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194401","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 case report of sertraline-induced agranulocytosis.","authors":"Valentin Scheer, Mahdi Fayad, Claire de la Perriere, Juliette Tennenbaum, Christine le Beller, Nadia Rivet, Charles Ouazana-Vedrines, Marina Sánchez-Rico, Frédéric Limosin, Nicolas Hoertel","doi":"10.47626/1516-4446-2025-4327","DOIUrl":"https://doi.org/10.47626/1516-4446-2025-4327","url":null,"abstract":"","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194364","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}