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Rocha Neto HG, Lessa JLM, Koiller LM, Pereira AM, Gomes BMDS, Veloso Filho CL, Casado Telleria CH, Cavalcanti MT, Telles-Correia D. Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study. Front Psychiatry 2024; 15:1303007. [PMID: 38686124 PMCID: PMC11056870 DOI: 10.3389/fpsyt.2024.1303007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 05/02/2024] Open
Abstract
Objective Our objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario. Methods Psychiatry residents applied the diagnostic criteria of the ICD-10 as a "diagnostic test" to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212. Results Seventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart-Maxwell test did not indicate a significant opinion change (χ2 = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ2 = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency. Conclusion Applying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias. Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.
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Affiliation(s)
- Helio G Rocha Neto
- Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa (PhD CAML), Lisbon, Portugal
| | - José Luiz Martins Lessa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luisa Mendez Koiller
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Amanda Machado Pereira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Carlos Linhares Veloso Filho
- Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Carlos Henrique Casado Telleria
- Medicine Faculty, Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maria T Cavalcanti
- Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Medicine Faculty, Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Diogo Telles-Correia
- Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa (PhD CAML), Lisbon, Portugal
- Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Martins-Martinho J, Ponte A, Dourado E, Khmelinskii N, Barreira SC, Cruz-Machado AR, Macieira C, Teixeira V, Rodrigues AM, Telles-Correia D, Fonseca JE, Ponte C. Anxiety and depression in patients with giant cell arteritis. Rheumatol Adv Pract 2024; 8:rkae013. [PMID: 38384323 PMCID: PMC10879746 DOI: 10.1093/rap/rkae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives To compare the prevalence of anxiety and depression in patients with GCA with that in the general population, using the Hospital Anxiety and Depression Scale (HADS), and to identify independent predictors of these psychiatric manifestations in patients with GCA. Methods We conducted a cross-sectional study including all patients diagnosed with GCA followed during 1 year in a vasculitis outpatient clinic. The HADS and 36-item Short Form (SF-36) questionnaires were prospectively collected. Patients' HADS results were compared with an age- and gender-matched control group. HADS anxiety (HADS-A) and HADS depression (HADS-D) scores between 8 and 10 defined possible anxiety and depression and ≥11 defined probable anxiety and depression, respectively. Results We included 72 patients and 288 controls. Compared with controls, patients with GCA had a statistically significant higher prevalence of HADS-A ≥8 (48.6% vs 26.4%), HADS-A ≥11 (30.6% vs 12.2%) and HADS-D ≥11 (33.3% vs 18.1%). GCA was an independent predictor of HADS-A ≥8 [odds ratio (OR) 3.3 (95% CI 1.9, 5.9)], HADS-A ≥11 [OR 3.8 (95% CI 2.0, 7.4)] and HADS-D ≥11 [OR 2.6 (95% CI 1.4, 4.7)]. Among patients with GCA, a negative correlation was observed between HADS-A/D and SF-36 mental health scores (r = -0.780 and r = -0.742, respectively). Glucocorticoid therapy was a predictor of HADS-A ≥8 [OR 10.4 (95% CI 1.2, 94.2)] and older age of HADS-D ≥8 [OR 1.2 (95% CI 1.1, 1.3)] and HADS-D ≥11 [OR 1.1 (95% CI 1.0, 1.2)]. Conclusions Compared with the general population, patients with GCA have a higher prevalence of anxiety and depression and GCA is an independent predictor of these symptoms. Glucocorticoid treatment and older age are predictors of anxiety and depression, respectively, in patients with GCA.
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Affiliation(s)
- Joana Martins-Martinho
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - André Ponte
- Psychiatry Department, Hospital Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
- Egas Moniz Health Alliance, Aveiro, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia C Barreira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana R Cruz-Machado
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Vítor Teixeira
- Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana M Rodrigues
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Telles-Correia
- Psychiatry Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João E Fonseca
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Mattei G, Krysta K, Clerici M, Colmegna F, Korostiy V, Karlović D, Krzystanek M, Lemmens GMD, Geerts PJ, Novais F, Peitl V, Santambrogio J, Georgescu D, Telles-Correia D. Impact of the CoViD-19 pandemic on consultation-liaison activity: changes in everyday clinical practice and work-related factors associated with the psychiatrist's need for seeking help. Eur Psychiatry 2023:1-22. [PMID: 37881840 DOI: 10.1192/j.eurpsy.2023.2456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Affiliation(s)
- Giorgio Mattei
- Association for Research in Psychiatry - 41051 Via Castello 21/a, Castelnuovo Rangone, Modena, Italy.
| | - Krzysztof Krysta
- Department of Rehabilitation Psychiatry, Medical University of Silesia, Katowice,
| | - Massimo Clerici
- Full Professor of Psychiatry, Department of Medicine and Surgery, University of Milano-Bicocca, Head of Department of Mental Health and Addiction (DSMD), ASST Monza,
| | - Fabrizia Colmegna
- Head of the Consultation-Liaison Psychiatry Service of Department of Mental Health and Addiction (DSMD), ASST Monza,
| | - Vladimir Korostiy
- Medical Director of University Clinic Professor of Department of Psychiatry, Narcology and Medical Psychology, Kharkiv National Medical
| | - Dalibor Karlović
- Department of psychiatry, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia.
| | - Marek Krzystanek
- Department of Rehabilitation Psychiatry, Medical University of Silesia, Katowice,
| | - Gilbert M D Lemmens
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin - Psychiatry, Ghent University,
| | | | | | - Vjekoslav Peitl
- Department of psychiatry, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia.
| | - Jacopo Santambrogio
- Department of Medicine and Surgery, University of Milano-Bicocca; Adele Bonolis AS.FRA. Foundation, Vedano al Lambro (MB), Italy; Presidio Corberi, ASST Brianza, Limbiate (MB),
| | - Dan Georgescu
- Department of Consultation-Liaison Psychiatry, Old Age Psychiatry and Neurodevelopmental Psychiatry, Psychiatric Services Aargau, 5210Windisch, Switzerland;
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Telles-Correia D. The operational paradigm in psychiatry: How valid is it? J Eval Clin Pract 2023. [PMID: 37859515 DOI: 10.1111/jep.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND One of the criticisms of the operational/diagnostic criteria, generalised since DSM-III, has been that they were shaped solely to achieve the best inter-peer reliability with no considerations for validity. This does not fully reflect reality since throughout the development of the criteria, there was an effort to define and fulfil some validity requirements. However, despite several attempts to create alternative diagnostic systems, there is still a widespread misunderstanding of the epistemological foundations that support this paradigm. METHODS In this article, we intend to analyse the epistemological context in which the operational criteria (OC) emerged and some of the validation processes they have undergone since their conception. RESULTS On the epistemological basis of these operational criteria (OC) the influence of Hempel has been widely discussed. However, the group from St. Louis and, also the DSM-III editors, never openly acknowledged his role and his contribution and revealed other influences such as other medical specialties (that used and validated several OC in the diagnosis of their diseases). On the other hand, contrary to what has often been mentioned there has been a continuous attempt to validate the OC since their conception. In the implementation and development of the operational paradigm, a more instrumental trend was followed, focused on utility, but with successive attempts to achieve realistic validity by searching for biological or psychological causality. The methodologies were initially expert-driven and gradually more data-driven and included some variables external to the construct itself, such as familial aggregation, diagnostic consistency over time, prognostic and other psychometric measures.
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Affiliation(s)
- Diogo Telles-Correia
- Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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5
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Gabriel FC, de Melo DO, Stein AT, Fontes-Mota GCH, Dos Santos IB, Rodrigues CDS, Rodrigues MC, Ribeiro TB, Fráguas R, Florez ID, Telles-Correia D, Ribeiro E. Factors associated with higher quality of clinical practice guidelines and their recommendations for the pharmacological treatment of depression: a systematic review. BMJ Open 2023; 13:e067390. [PMID: 36997251 PMCID: PMC10069276 DOI: 10.1136/bmjopen-2022-067390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the quality of clinical practice guidelines (CPGs) for the pharmacological treatment of depression along with their recommendations and factors associated with higher quality. DESIGN We conducted a systematic review that included CPGs for the pharmacological treatment of depression in adults. DATA SOURCES We searched for publications from 1 January 2011 to 31 December 2021, in MEDLINE, Cochrane Library, Embase, PsycINFO, BVS and 12 other databases and guideline repositories. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included CPGs containing recommendations for the pharmacological treatment of depression in adults at outpatient care setting, regardless of whether it met the U.S. National Academy of Medicine criteria, or not. If a CPG included recommendations for both children and adults, they were considered. No language restriction was applied. DATA EXTRACTION AND SYNTHESIS Data extraction was also conducted independently and in duplicate, a process that was validated in a previous project. The quality of the CPGs and their recommendations were assessed by three independent reviewers using Appraisal of Guidelines for Research and Evaluation (AGREE II) and Appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX). A CPG was considered to be of high quality if AGREE II Domain 3 was ≥60%; while their recommendations were considered high if AGREE-REX Domain 1 was ≥60%. RESULTS Seventeen out of 63 (27%) CPGs were classified as high quality, while 7 (11.1%) had high-quality recommendations. The factors associated with higher-scoring CPGs and recommendations in the multiple linear regression analyses were 'Handling of conflicts of interest', 'Multiprofessional team' and 'Type of institution'. 'Inclusion of patient representative in the team' was also associated with higher-quality recommendations. CONCLUSIONS The involvement of professionals from diverse backgrounds, the handling of conflicts of interest, and the inclusion of patients' perspectives should be prioritised by developers aiming for high-quality CPGs for the treatment of depression.
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Affiliation(s)
- Franciele Cordeiro Gabriel
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | - Airton Tetelbom Stein
- Departamento de Saúde Pública, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
- Hospital Conceição, Porto Alegre, Brazil
| | | | | | | | | | - Tatiane Bomfim Ribeiro
- Departamento de Epidemiologia, Escola de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Renério Fráguas
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (IPq-HC-FM-USP), Divisão de Psiquiatria e Psicologia Hospital Universitário (HU), Laboratório de Investigações Médicas - 21 (LIM 21) FM, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan D Florez
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, University of Antioquia, Medellín, Colombia
- Clínica Las Américas, AUNA, Medellín, Colombia
| | - Diogo Telles-Correia
- Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Eliane Ribeiro
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
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Rocha Neto HG, Silva Filho OCD, Cavalcanti MT, Telles-Correia D. Digital psychopathology: a not yet explored frontier in mental status examination. Braz J Psychiatry 2022; 44:215-216. [PMID: 35588510 PMCID: PMC9041968 DOI: 10.1590/1516-4446-2021-2395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Helio G Rocha Neto
- Programa Doutoral do Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Programa de Pós-Graduação em Psiquiatria e Saúde Mental, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Orli Carvalho da Silva Filho
- Programa de Pós-Graduação em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, RJ, Brazil
| | - Maria Tavares Cavalcanti
- Faculdade de Medicina Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde,Faculdade de Medicina Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, UFRJ
- Programa de Pós-Graduação em Psiquiatria e Saúde Mental, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Diogo Telles-Correia
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Rojnic Kuzman M, Slade M, Puschner B, Scanferla E, Bajic Z, Courtet P, Samochowiec J, Arango C, Vahip S, Taube M, Falkai P, Dom G, Izakova L, Carpiniello B, Bellani M, Fiorillo A, Skugarevsky O, Mihaljevic-Peles A, Telles-Correia D, Novais F, Mohr P, Wancata J, Hultén M, Chkonia E, Balazs J, Beezhold J, Lien L, Mihajlovic G, Delic M, Stoppe G, Racetovic G, Babic D, Mazaliauskiene R, Cozman D, Hjerrild S, Chihai J, Flannery W, Melartin T, Maruta N, Soghoyan A, Gorwood P. Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries. Eur Psychiatry 2022; 65:e75. [DOI: 10.1192/j.eurpsy.2022.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe.
Methods
We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice.
Results
SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style.
Conclusions
The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.
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Rocha Neto HG, Sinem TB, Koiller LM, Pereira AM, de Souza Gomes BM, Veloso Filho CL, Cavalcanti MT, Telles-Correia D. Intra-rater Kappa Accuracy of Prototype and ICD-10 Operational Criteria-Based Diagnoses for Mental Disorders: A Brief Report of a Cross-Sectional Study in an Outpatient Setting. Front Psychiatry 2022; 13:793743. [PMID: 35308869 PMCID: PMC8924129 DOI: 10.3389/fpsyt.2022.793743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of "operational criteria" is a solution for low reliability, contrasting with a prototypical classification that is used in clinics. We aim to measure the reliability of prototypical and ICD-10 diagnoses. METHODS This is a retrospective study, with a convenience sample of subjects treated in a university clinic. Residents reviewed their diagnosis using ICD-10 criteria, and Cohen's kappa statistic was performed on operational and prototype diagnoses. RESULTS Three out of 30 residents participated, reviewing 146 subjects under their care. Diagnoses were grouped in eight classes: organic (diagnoses from F00 to F09), substance disorders (F10-F19), schizophrenia spectrum disorders (F20-F29), bipolar affective disorder (F30, F31, F34.0, F38.1), depression (F32, F33), anxiety-related disorders (F40-F49), personality disorders (F60-F69), and neurodevelopmental disorders (F70-F99). Overall, agreement was high [K = 0.77, 95% confidence interval (CI) = 0.69-0.85], with a lower agreement related to personality disorders (K = 0.58, 95% CI = 0.38-0.76) and higher with schizophrenia spectrum disorders (K = 0.91, 95% CI = 0.82-0.99). DISCUSSION Use of ICD-10 criteria did not significantly increase the number of diagnoses. It changed few diagnoses, implying that operational criteria were irrelevant to clinical opinion. This suggests that reliability among interviewers is more related to information gathering than diagnostic definitions. Also, it suggests an incorporation of diagnostic criteria according to training, which then became part of the clinician's prototypes. Residents should be trained in the use of diagnostic categories, but presence/absence checking is not needed to achieve operational compatible diagnoses.
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Affiliation(s)
- Helio G Rocha Neto
- Programa de Pós Graduação em Psiquiatria e Saúde Mental - PROPSAM, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa - CAMLPHD, Lisbon, Portugal
| | - Tomas Boldrini Sinem
- Medicine Faculty, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luisa Mendez Koiller
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amanda Machado Pereira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carlos Linhares Veloso Filho
- Programa de Pós Graduação em Psiquiatria e Saúde Mental - PROPSAM, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria T Cavalcanti
- Programa de Pós Graduação em Psiquiatria e Saúde Mental - PROPSAM, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Medicine Faculty, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diogo Telles-Correia
- Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa - CAMLPHD, Lisbon, Portugal.,Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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9
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Novais F, Ganança L, Barbosa M, Telles-Correia D. Communication skills in psychiatry for undergraduate students: A scoping review. Front Psychiatry 2022; 13:972703. [PMID: 36032255 PMCID: PMC9402997 DOI: 10.3389/fpsyt.2022.972703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Communication skills are paramount in all areas of medicine but particularly in psychiatry due to the challenges posed by mental health patients and the essential role of communication from diagnosis to treatment. Despite the prevalence of psychiatric disorders in different medical specialties, particularly in primary care settings, communication skills in psychiatry and their training are not well studied and are often not included in the undergraduate medical curriculum. Our paper explores the relevance of teaching communication competencies in psychiatry for undergraduate medical students. Our work focused on reviewing the methods for teaching communication skills to undergraduate students in Psychiatry. Eleven studies were selected to be included in this review. We found considerable heterogeneity among methods for teaching communication skills but also some common elements such as the use of simulated patients and providing feedback. This review has identified two models: the Calgary-Cambridge interview model and the Kolb cycle-based model. However, most studies still lack a theoretical background model. We believe that the inclusion of communication skills training in medical curricula is fundamental to teaching medical students general communication skills but also specific training on establishing adequate communication with psychiatric patients. However, more research is needed to determine the best method for training but also regarding its translation to patient care and cost-effectiveness.
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Affiliation(s)
- Filipa Novais
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Santa Maria Hospital, Lisbon, Portugal.,ISAMB - Instituto de Saúde Ambiental - Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Licínia Ganança
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Santa Maria Hospital, Lisbon, Portugal
| | - Miguel Barbosa
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Diogo Telles-Correia
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,ISAMB - Instituto de Saúde Ambiental - Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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10
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Novais F, Cordeiro C, Câmara Pestana P, Côrte-Real B, Reynolds Sousa T, Delerue Matos A, Telles-Correia D. [The Impact of COVID-19 in Older People in Portugal: Results from the Survey of Health, Ageing and Retirement (SHARE)]. ACTA MEDICA PORT 2021; 34:761-766. [PMID: 34986084 DOI: 10.20344/amp.16209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In March 2020, the World Health Organization declared COVID-19 as a pandemic, and Portugal reported its initial cases. In this study, we aimed to determine the impact of COVID-19 on Portuguese individuals aged over 60 years old. MATERIAL AND METHODS We performed a cross-sectional study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE 8: COVID-19 Survey). We selected a sample of 1080 noninstitutional Portuguese individuals aged ≥ 60 years. RESULTS The study sample consisted of 605 (56%) women and 475 (44%) men, with a mean age of 70 ± 9.1 years. In total, 80% of the participants experienced higher levels of anxiety, 73% felt more depressed and 30% experienced additional sleep problems comparedto the period before the pandemic. Interestingly, there were no statistically significant differences between the sexes or the two selected age groups (60 - 74 and over 75 years old) regarding the incidence of these changes. Only 23%, of those that were interviewed maintained their walking routines. In addition, only 8% of the participants continued visiting family members as frequently as before. While 8% of the participants were refused some form of medical treatment, 56% claimed that they experienced healthcare delays. However,only 15% of the participants reported that their health status worsened during the pandemic. DISCUSSION The pandemic has had a significant impact on Portuguese individuals aged ≥ 60 years; which is in agreement with the findings of previous international studies. It changed the participants' routines and increased their anxiety and depression levels. Despite the deterioration of healthcare services, most participants did not experience worsening of their health status. CONCLUSION In conclusion, a COVID-19 pandemic had a significant impact on the elderly population, particularly regarding their mental health.
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Affiliation(s)
- Filipa Novais
- Departamento de Neurociências e Saúde Mental. Departamento de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa; Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Catarina Cordeiro
- Departamento de Neurociências e Saúde Mental. Departamento de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Pedro Câmara Pestana
- Departamento de Neurociências e Saúde Mental. Departamento de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Beatriz Côrte-Real
- Departamento de Neurociências e Saúde Mental. Departamento de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Teresa Reynolds Sousa
- Departamento de Neurociências e Saúde Mental. Departamento de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Alice Delerue Matos
- Departamento de Sociologia. Instituto de Ciências Sociais da Universidade do Minho. Braga. Portugal
| | - Diogo Telles-Correia
- Departamento de Neurociências e Saúde Mental. Departamento de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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11
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Rema J, Novais F, Telles-Correia D. Precision Psychiatry: Machine learning as a tool to find new pharmacological targets. Curr Top Med Chem 2021; 22:1261-1269. [PMID: 34607546 DOI: 10.2174/1568026621666211004095917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/20/2021] [Accepted: 08/19/2021] [Indexed: 12/18/2022]
Abstract
There is an increasing amount of data arising from neurobehavioral sciences and medical records that cannot be adequately analyzed by traditional research methods. New drugs develop at a slow rate and seem unsatisfactory for the majority of neurobehavioral disorders. Machine learning (ML) techniques, instead, can incorporate psychopathological, computational, cognitive, and neurobiological underpinning knowledge leading to a refinement of detection, diagnosis, prognosis, treatment, research, and support. Machine and deep learning methods are currently used to accelerate the process of discovering new pharmacological targets and drugs. OBJECTIVE The present work reviews current evidence regarding the contribution of machine learning to the discovery of new drug targets. METHODS Scientific articles from PubMed, SCOPUS, EMBASE, and Web of Science Core Collection published until May 2021 were included in this review. RESULTS The most significant areas of research are schizophrenia, depression and anxiety, Alzheimer´s disease, and substance use disorders. ML techniques have pinpointed target gene candidates and pathways, new molecular substances, and several biomarkers regarding psychiatric disorders. Drug repositioning studies using ML have identified multiple drug candidates as promising therapeutic agents. CONCLUSION Next-generation ML techniques and subsequent deep learning may power new findings regarding the discovery of new pharmacological agents by bridging the gap between biological data and chemical drug information.
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Affiliation(s)
- João Rema
- Faculdade de Medicina da Universidade de Lisboa. Portugal
| | - Filipa Novais
- Faculdade de Medicina da Universidade de Lisboa. Portugal
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12
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Novais F, Telles-Correia D. Stigma among Physicians Towards Patients with Mental Health Disorders. ACTA MEDICA PORT 2021; 34:712-713. [PMID: 34477551 DOI: 10.20344/amp.16804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Filipa Novais
- Serviço de Psiquiatria e Saúde Mental. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa; Clínica Universitária de Psiquiatria e Psicologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Diogo Telles-Correia
- Clínica Universitária de Psiquiatria e Psicologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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13
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Novais F, Capela J, Machado S, Murillo-Rodriguez E, Telles-Correia D. Does Dysbiosis Increase the Risk of Developing Schizophrenia? - A Comprehensive Narrative Review. Curr Top Med Chem 2021; 21:976-984. [PMID: 34061001 DOI: 10.2174/1568026621666210521163555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is increasing evidence regarding the influence of the intestinal microbiota on the disease processes of various organs and systems. Dysbiosis, that is, alteration of the composition and function of the microbiota may constitute an important risk factor for the development of mental disorders, namely, schizophrenia. OBJECTIVE This works aims to review current evidence regarding the pathological mechanisms leading from dysbiosis to schizophrenia and in particular the deficit syndrome in schizophrenia. METHODS Scientific articles from PubMed, SCOPUS, EMBASE, and Web of Science Core Collection published between September 2017 and December 2020 were included in this review. RESULTS The commensal intestinal flora plays an important role in neurodevelopment. In the presence of dysbiosis, this maturation gets disturbed, resulting in the modification of brain structures and inflammatory responses at the intestinal, systemic, and Central Nervous System (CNS) levels. These disturbances may be linked to the development of symptoms of the disease. The microbiota exerts its influence on the CNS through several pathways, however, in this paper we focused on the membrane hypothesis and the inflammatory hypothesis. We explored the evidence concerning the use of probiotics, prebiotics, and fecal transplants. CONCLUSION Although there is no consensus regarding the alterations that could constitute a risk factor for schizophrenia, some of the species appear to be more frequently altered, and their relationship with the host is dysregulated in patients at risk and with established schizophrenia, particularly in deficit schizophrenia.
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Affiliation(s)
- Filipa Novais
- Faculdade de Medicina, da Universidade de Lisboa, Lisboa, Portugal
| | - Joana Capela
- Faculdade de Medicina, da Universidade de Lisboa, Lisboa, Portugal
| | - Sergio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Eric Murillo-Rodriguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, Division Ciencias de la Salud, Universidad Anahuac Mayab, Merida, Yucatan, Mexico
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14
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Quiroga C, Barberena JJ, Alcaraz-Silva J, Machado S, Imperatori C, Yadollahpour A, Budde H, Yamamoto T, Telles-Correia D, Murillo-Rodríguez E. The Role of Peroxisome Proliferator-Activated Receptor in Addiction: A Novel Drug Target. Curr Top Med Chem 2021; 21:964-975. [PMID: 34061003 DOI: 10.2174/1568026621666210521165532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022]
Abstract
The peroxisome proliferator activated receptors (PPARs) are a superfamily of well-recognized ligand-binding nuclear receptors comprising three isoforms: PPARα, PPARγ, and PPARβ/δ. In response to endogenous lipid messengers, PPARs trigger the transcription of genes related to a wider spectrum of physiological phenomena, including fatty acid oxidation, inflammation, adipogenesis, among many others. Thus, the importance of PPARs as putative protective therapy in health issues has increased the interest of studying these nuclear receptors, including the management of neurodegenerative disorders, multiple sclerosis, and likely addiction. In recent years, several pieces of evidence from animal models have demonstrated the promising role of PPARs as a critical element for interventions in addictive behaviors by reducing the reinforcing properties of addictive substances such as alcohol. However, there is a lack of data in the scope and has so far been unexplored the function of PPARs in additional drugs such as cannabis, opioids, methamphetamine, or cocaine. A similar scenario has been found for the management of binge-type eating disorders. Thus, here we review recent advances in understanding the relevance of the PPAR controlling addiction.
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Affiliation(s)
- Carla Quiroga
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, Division Ciencias de la Salud, Universidad Anahuac Mayab, Merida, Yucatan, Mexico
| | - Juan José Barberena
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, Division Ciencias de la Salud, Universidad Anahuac Mayab, Merida, Yucatan, Mexico
| | - Jocelyne Alcaraz-Silva
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, Division Ciencias de la Salud, Universidad Anahuac Mayab, Merida, Yucatan, Mexico
| | | | | | - Ali Yadollahpour
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Henning Budde
- Intercontinental Neuroscience Research Group, Mexico
| | | | | | - Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, Division Ciencias de la Salud, Universidad Anahuac Mayab, Merida, Yucatan, Mexico
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15
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Rocha NB, Campos C, Figueiredo JM, Saraiva S, Almeida C, Moreira C, Pereira G, Telles-Correia D, Roberts D. Social cognition and interaction training for recent-onset schizophrenia: A preliminary randomized trial. Early Interv Psychiatry 2021; 15:206-212. [PMID: 32052567 DOI: 10.1111/eip.12944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/06/2019] [Accepted: 01/31/2020] [Indexed: 01/25/2023]
Abstract
Comprehensive social cognition training programs have been effective to improve social cognition in people with chronic schizophrenia, although there is insufficient quality evidence for recent-onset psychosis. The aim of this study was to assess the effects of Social Cognition and Interaction Training (SCIT) in a sample of recent-onset schizophrenia outpatients. Sixteen participants who had their first psychotic episode for less than 2 years were randomly allocated to the SCIT group during 20 weeks (weekly sessions) or to a psychoeducation group and completed baseline and post-training assessment for cognitive biases, social cognition, clinical symptoms and functioning. Permutation-based analysis revealed improvements in overall functioning (P = 0.036) and blame score (P = 0.070) in the SCIT group compared to the psychoeducation intervention, with large effect sizes (d = 1.438 and d = 1.204, respectively). There were also large effect sizes for hostility, emotion recognition, social perception, positive and total symptoms (d = 0.833-1.158). These results suggest that SCIT may be an effective tool to improve attributional biases and functional outcomes in recent-onset schizophrenia outpatients. Future controlled trials with larger sample size and follow-up assessments should be developed to further understand effective intervention outcomes for this population.
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Affiliation(s)
- Nuno Barbosa Rocha
- Neurocognition Group
- LabRP, Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, Portugal
| | - Carlos Campos
- Neurocognition Group
- LabRP, Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, Portugal
| | | | | | | | | | | | | | - David Roberts
- Department of Psychiatry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
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16
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Sá Filho AS, Cheniaux E, de Paula CC, Murillo-Rodriguez E, Teixeira D, Monteiro D, Cid L, Yamamoto T, Telles-Correia D, Imperatori C, Budde H, Machado S. Exercise is medicine: a new perspective for health promotion in bipolar disorder. Expert Rev Neurother 2020; 20:1099-1107. [PMID: 32762382 DOI: 10.1080/14737175.2020.1807329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Similar effects in reducing the symptoms of the mood disorder are reported in the literature compared the action of drugs and aerobic exercise sessions, demonstrating the potential of exercise in the control and mood stabilization. Therefore, there are many reasons to believe that the increased cardiorespiratory fitness (VO2max) can be an important means of protection and a reducing potential of physical and mental damage in bipolar disorders (BD). This review will highlight the current pattern of response of exercise on the pathophysiology of BD, relating the possible mechanisms, and hypotheses based on exercises. AREAS COVERED The mechanism of monoaminergic action and its relationship with exercise, role of physical conditioning and increased VO2Max on neurotrophin release, and new perspectives on long-term exercise will be reviewed. EXPERT OPINION The adaptations to training, although little explored in the context of BD, can induce the expression of substances that co-regulate several processes related to the pathophysiology of BD. Furthermore, high intensity interval training (HIIT) can also be adjusted to improve the physical fitness and health in patients with BD. Future research is needed to adopt a training strategy that is both time efficient and adequate for the population in question.
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Affiliation(s)
- Alberto Souza Sá Filho
- Department of Physical Education, Paulista University (UNIP) , São Paulo, Brazil.,Department of Physical Education, University Center of Anápolis (Unievangélica) , Anápolis, Brazil
| | - Elie Cheniaux
- School of Medical Sciences, State University of Rio De Janeiro (UERJ) , Rio De Janeiro, Brazil.,Institute of Psychiatry, Federal University of Rio De Janeiro , Rio De Janeiro, Brazil
| | - Carolina Cavalcante de Paula
- Department of Cellular, Tissue and Developmental Biology, The Institute of Biomedical Science, The University of São Paulo (ICB/USP) , São Paulo, Brazil
| | - Eric Murillo-Rodriguez
- International Neuroscience Research Group , Yucatan, México.,Laboratorio De Neurociencias Moleculares E Integrativas, Escuela De Medicina, División Ciencias De La Salud, Universidad Anáhuac Mayab , Mérida, Mexico
| | - Diogo Teixeira
- International Neuroscience Research Group , Yucatan, México.,Faculty of Physical Education and Sport, ULHT , Lisbon, Portugal
| | - Diogo Monteiro
- International Neuroscience Research Group , Yucatan, México.,Research Centre in Sports, Health and Human Development, CIDESD , Rio Maior, Portugal.,Sport Science School of Rio Maior, Polytechnique Institute of Santarém , Rio Maior, Portugal
| | - Luis Cid
- International Neuroscience Research Group , Yucatan, México.,Research Centre in Sports, Health and Human Development, CIDESD , Rio Maior, Portugal.,Sport Science School of Rio Maior, Polytechnique Institute of Santarém , Rio Maior, Portugal
| | - Tetsuya Yamamoto
- International Neuroscience Research Group , Yucatan, México.,Graduate School of Technology, Industrial and Social Sciences, Tokushima University , Tokushima, Japan
| | - Diogo Telles-Correia
- International Neuroscience Research Group , Yucatan, México.,Clínica Universitária De Psicologia E Psiquiatria, Faculdade De Medicina, Universidade De Lisboa , Lisbon, Portugal.,Departamento De Psiquiatria, Faculdade De Medicina, Universidade De Lisboa , Lisbon, Portugal
| | - Claudio Imperatori
- International Neuroscience Research Group , Yucatan, México.,Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190 , Rome, Italy
| | - Henning Budde
- International Neuroscience Research Group , Yucatan, México.,Faculty of Human Sciences, Medical School Hamburg, University of Applied Science and Medical University , Hamburg, Germany
| | - Sergio Machado
- Institute of Psychiatry, Federal University of Rio De Janeiro , Rio De Janeiro, Brazil.,International Neuroscience Research Group , Yucatan, México.,Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado De Oliveira University (UNIVERSO) , Niterói, Brazil.,Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados , RJ, Brazil
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17
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Murillo-Rodríguez E, Budde H, Veras AB, Rocha NB, Telles-Correia D, Monteiro D, Cid L, Yamamoto T, Machado S, Torterolo P. The Endocannabinoid System May Modulate Sleep Disorders in Aging. Curr Neuropharmacol 2020; 18:97-108. [PMID: 31368874 PMCID: PMC7324886 DOI: 10.2174/1570159x17666190801155922] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
Aging is an inevitable process that involves changes across life in multiple neurochemical, neuroanatomical, hormonal systems, and many others. In addition, these biological modifications lead to an increase in age-related sickness such as cardiovascular diseases, osteoporosis, neurodegenerative disorders, and sleep disturbances, among others that affect activities of daily life. Demographic projections have demonstrated that aging will increase its worldwide rate in the coming years. The research on chronic diseases of the elderly is important to gain insights into this growing global burden. Novel therapeutic approaches aimed for treatment of age-related pathologies have included the endocannabinoid system as an effective tool since this biological system shows beneficial effects in preclinical models. However, and despite these advances, little has been addressed in the arena of the endocannabinoid system as an option for treating sleep disorders in aging since experimental evidence suggests that some elements of the endocannabinoid system modulate the sleep-wake cycle. This article addresses this less-studied field, focusing on the likely perspective of the implication of the endocannabinoid system in the regulation of sleep problems reported in the aged. We conclude that beneficial effects regarding the putative efficacy of the endocannabinoid system as therapeutic tools in aging is either inconclusive or still missing.
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Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, México
- Intercontinental Neuroscience Research Group
| | - Henning Budde
- Intercontinental Neuroscience Research Group
- Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - André Barciela Veras
- Intercontinental Neuroscience Research Group
- Dom Bosco Catholic University, Campo Grande, Mato Grosso do Sul, Brazil
| | - Nuno Barbosa Rocha
- Intercontinental Neuroscience Research Group
- School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Diogo Telles-Correia
- Intercontinental Neuroscience Research Group
- University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Diogo Monteiro
- Intercontinental Neuroscience Research Group
- Sport Science School of Rio Maior-Polytechnic Institute of Santarém, Rio Maior, Portugal
- Research Center in Sport, Health and Human Development-CIDESD, Vila Real, Portugal
| | - Luis Cid
- Intercontinental Neuroscience Research Group
- Sport Science School of Rio Maior-Polytechnic Institute of Santarém, Rio Maior, Portugal
- Research Center in Sport, Health and Human Development-CIDESD, Vila Real, Portugal
| | - Tetsuya Yamamoto
- Intercontinental Neuroscience Research Group
- Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói, Brazil
| | - Pablo Torterolo
- Intercontinental Neuroscience Research Group
- Laboratorio de Neurobiología del Sueño, Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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18
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Murillo-Rodríguez E, Arankowsky-Sandoval G, Barros JA, Rocha NB, Yamamoto T, Machado S, Budde H, Telles-Correia D, Monteiro D, Cid L, Veras AB. Sleep and Neurochemical Modulation by DZNep and GSK-J1: Potential Link With Histone Methylation Status. Front Neurosci 2019; 13:237. [PMID: 30930741 PMCID: PMC6428769 DOI: 10.3389/fnins.2019.00237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/27/2019] [Indexed: 12/24/2022] Open
Abstract
Histone methylation/demethylation plays an important modulatory role in chromatin restructuring, RNA transcription and is essential for controlling a plethora of biological processes. Due to many human diseases have been related to histone methylation/demethylation, several compounds such as 3-deazaneplanocin A (DZNep) or 3-((6-(4,5-Dihydro-1H-benzo[d]azepin-3(2H)-yl)-2-(pyridin-2-yl)pyrimidin-4-yl)amino)propanoic acid; N-[2-(2-pyridinyl)-6-(1,2,4,5-tetrahydro-3H-3-benzazepin-3-yl)-4-pyrimidinyl]-β-Alanine (GSK-J1), have been designed to inhibit histone methylase or suppress histone demethylase, respectively. In the present study, we investigated the effects on the sleep-wake cycle and sleep-related neurochemical levels after systemic injections of DZNep or GSK-J1 given during the light or dark phase in rats. DZNep dose-dependently (0.1, 1.0, or 10 mg/kg, i.p.) prolonged wakefulness (W) duration while decreased slow wave sleep (SWS) and rapid eye movement sleep (REMS) time spent during the lights-on period with no changes observed in dark phase. In opposite direction, GSK-J1 (0.1, 1.0, or 10 mg/kg, i.p.) injected at the beginning of the lights-on period induced no statistical changes in W, SWS, or REMS whereas if administered at darkness, we found a diminution in W and an enhancement in SWS and REMS. Finally, brain microdialysis experiments in freely moving animals were used to evaluate the effects of DZNep or GSK-J1 treatments on contents of sleep-related neurochemicals. The results showed that DZNep boosted extracellular levels of dopamine, norepinephrine, epinephrine, serotonin, adenosine, and acetylcholine if injected at the beginning of the lights-on period whereas GSK-J1 exerted similar outcomes but when administered at darkness. In summary, DZNep and GSK-J1 may control the sleep-wake cycle and sleep-related neurochemicals through histone methylation/demethylation activity.
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Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Mexico.,Intercontinental Neuroscience Research Group, Mérida, Mexico
| | - Gloria Arankowsky-Sandoval
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi" Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Jorge Aparecido Barros
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Post-graduation Program of Psychology of Health, NACNeuro, Dom Bosco Catholic University, Campo Grande, Mato Grosso del Sur, Brazil
| | - Nuno Barbosa Rocha
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Tetsuya Yamamoto
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói, Brazil
| | - Henning Budde
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Diogo Telles-Correia
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Diogo Monteiro
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Sport Science School of Rio Maior- Polytechnic Institute of Santarém, Rio Maior, Portugal.,Research Center in Sport, Health and Human Development-CIDESD, Vila Real, Portugal
| | - Luis Cid
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Sport Science School of Rio Maior- Polytechnic Institute of Santarém, Rio Maior, Portugal.,Research Center in Sport, Health and Human Development-CIDESD, Vila Real, Portugal
| | - André Barciela Veras
- Intercontinental Neuroscience Research Group, Mérida, Mexico.,Post-graduation Program of Psychology of Health, NACNeuro, Dom Bosco Catholic University, Campo Grande, Mato Grosso del Sur, Brazil
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19
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Ferreira MF, Castanheira L, Sebastião AM, Telles-Correia D. Depression Assessment in Clinical Trials and Pre-clinical Tests: A Critical Review. Curr Top Med Chem 2019; 18:1677-1703. [PMID: 30430942 DOI: 10.2174/1568026618666181115095920] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022]
Abstract
Depression is deeply rooted in human behavior. The development of new antidepressants demands the creation of animal models to investigate new drugs, which potentially could work as antidepressants. The aim of this review is to discuss the different ways of assessing depression in clinical research, including clinical trials, and the different animal behavioral tests used to study depression and test the efficacy of antidepressants in pre-clinical studies. In clinical practice, a categorical classification, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD) can be used for diagnosis, through the use of structured and semi-structured interviews. On the other hand, depression can also be assessed using a dimensional approach, through self- or clinicianrated questionnaires. Regarding the assessment of the efficacy of antidepressants in animal models, several tests are routinely used, namely the Forced Swim Test, the Modified Forced Swim Test, the Tail Suspension Test and the Sucrose Preference Test. These tests are informative, providing that the following rules are taken into account: 1) more than one test is used, with coherent results; 2) secondary drug effects, the most frequent being putative changes in motor activity, are taken into account and properly controlled with specific tests run concomitantly; 3) each test and specific protocol is validated with data from at least a gold standard antidepressant drug. We herein briefly discuss the potential and limitations of each of those tests.
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Affiliation(s)
- Miguel F Ferreira
- Instituto de Medicina Molecular JoAo Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Lígia Castanheira
- Departamento de Psiquiatria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,Clínica Universitária de Psicologia e Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana M Sebastião
- Instituto de Medicina Molecular JoAo Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Diogo Telles-Correia
- Departamento de Psiquiatria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,Clínica Universitária de Psicologia e Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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20
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Queirós T, Coelho F, Linhares L, Telles-Correia D. [Schizophrenia: What Non-Psychiatrist Physicians Need to Know]. ACTA MEDICA PORT 2019; 32:70-77. [PMID: 30753806 DOI: 10.20344/amp.10768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/29/2018] [Indexed: 11/20/2022]
Abstract
Schizophrenia is a disabling and severe mental illness that affects all social classes and racial and ethnic groups, spreading across every part of the world. It's more frequent in males and it usually manifests itself in late adolescence or early adulthood and its early detection by all clinicians is important so that there is a proper referral to specialized psychiatric care. This article intends to update the knowledge regarding the diagnosis, treatment and prognosis of schizophrenia, with an emphasis on the warning signs for a timely referral to psychiatric evaluation. We conducted a literature search across through articles available in databases of scientific articles but also in scientific and technical books specialized in the field of schizophrenia. The clinical presentation of this illness is heterogeneous and complex, with a typical evolution based on several episodes of acute decompensation requiring hospitalization. The diagnosis of schizophrenia relies on some key symptoms, and the various international diagnostic criteria vary in relation to the temporal window with productive symptomatology required to establish a diagnosis. The prognosis is variable, not always deteriorating and is all the better when the treatment is started as early as possible. Treatment requires a multidisciplinary approach and is based primarily on antipsychotic drugs. This medication although very effective for the typical symptoms of this illness, entails some adverse effects with medical consequences that are important in the clinical practice of all doctors of other specialties.
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Affiliation(s)
- Tiago Queirós
- Serviço de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Filipa Coelho
- Serviço de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Ludgero Linhares
- Serviço de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Diogo Telles-Correia
- Serviço de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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21
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Stoyanov D, Telles-Correia D, Cuthbert BN. The Research Domain Criteria (RDoC) and the historical roots of psychopathology: A viewpoint. Eur Psychiatry 2019; 57:58-60. [PMID: 30677549 DOI: 10.1016/j.eurpsy.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Abstract
In this article we aim at conceptual reconstruction of the historical background behind RDoC project. It incorporates some elements that have not heretofore been included in frameworks for psychopathology research. At the same time, however, RDoC - like any approach to mental illness - must grapple with longstanding challenges in addressing issues about the roles and relationships of mind, brain, and patients' reports in considering the nature of disorder. In this respect, the historical roots of psychopathology remain as relevant as ever.
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Affiliation(s)
- Drozdstoy Stoyanov
- Department of Psychiatry and Medical Psychology, Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bulgaria.
| | - Diogo Telles-Correia
- University of Lisbon, Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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22
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Castanheira L, Silva C, Cheniaux E, Telles-Correia D. Neuroimaging Correlates of Depression-Implications to Clinical Practice. Front Psychiatry 2019; 10:703. [PMID: 31632306 PMCID: PMC6779851 DOI: 10.3389/fpsyt.2019.00703] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/30/2019] [Indexed: 12/31/2022] Open
Abstract
The growth of the literature about neuroimaging of major depressive disorder (MDD) over the last several decades has contributed to the progress in recognizing precise brain areas, networks, and neurotransmitter processes related to depression. However, there are still doubts about the etiology and pathophysiology of depression that need answering. The authors did a nonsystematic review of the literature using PubMed database, with the following search terms: "major depressive disorder," "neuroimaging," "functional imaging," "magnetic resonance imaging," "functional magnetic resonance imaging," and "structural imaging," being selected the significant articles published on the topic. Anterior cingulate cortex, hippocampus, orbitomedial prefrontal cortex, amygdala basal ganglia, and the cerebellum were the main affected areas across the selected studies. These areas respond to particular neurotransmitter systems, neurochemicals, hormones, and other signal proteins; even more, the evidence supports a distorted frontolimbic mood regulatory pathway in MDD patients. Despite the positive findings, translation to treatment of MDD remains illusory. In conclusion, this article aims to be a critical review of the neuroimaging correlates of depression in clinical research with the purpose to improve clinical practice.
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Affiliation(s)
- Lígia Castanheira
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Clínica Universitária de Psicologia e Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Silva
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Elie Cheniaux
- Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ) & Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM/UERJ), Rio de Janeiro, Brazil
| | - Diogo Telles-Correia
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Clínica Universitária de Psicologia e Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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23
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Castanheira L, Ferreira MF, Sebastião AM, Telles-Correia D. Anxiety Assessment in Pre-clinical Tests and in Clinical Trials: A Critical Review. Curr Top Med Chem 2018; 18:1656-1676. [DOI: 10.2174/1568026618666181115102518] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022]
Abstract
The identification of anxious symptoms is crucial to diagnose anxiety disorders, as well as to
monitor their treatment in clinical practice and research. The aim of this review is to discuss the different
ways of assessing anxiety in clinical research, including clinical trials, and the different kinds of
animal behavioral tests used to study anxiety and test the efficacy of anxiolytics in pre-clinical studies.
In clinical practice, a categorical classification (such as the Diagnostic and Statistical Manual of Mental
Disorders and the International Statistical Classification of Diseases and Related Health Problems)
distinguishes the cases of the disease versus non-disease. Some structured and semi-structured
interviews can be used to arrive at these diagnoses. On the other hand, anxiety can also be assessed
using a dimensional approach, through self-report or hetero-evaluation questionnaires. Regarding the
assessment of anxiety in animals, several behavioral tests are described and evaluated, namely the
Social Interaction Test, Elevated Plus Maze and Open Field Test. Under a critical view, these two
approaches are presented and discussed, in order to improve the outcome of research in this field.
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Affiliation(s)
- Lígia Castanheira
- Clínica Universitaria de Psicologia e Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel F. Ferreira
- Instituto de Medicina Molecular Joao Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana M. Sebastião
- Instituto de Medicina Molecular Joao Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Diogo Telles-Correia
- Clínica Universitaria de Psicologia e Psiquiatria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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24
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Telles-Correia D. Mental disorder: Are we moving away from distress and disability? J Eval Clin Pract 2018; 24:973-977. [PMID: 29327512 DOI: 10.1111/jep.12871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/02/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Abstract
The first time that formally a definition of mental disorder was presented was in DSM-III. This resulted from a complex conceptual analysis carried out by Spitzer, chair of the committee on nomenclature and statistics. The criteria of harm (distress-disability) arise as main defining characteristics for mental illness, being added that "there is an inference" that there is a dysfunction. The distress-disability model was later developed by Wakefield. This author argued that in a medical or psychiatric disorder there had to be a dysfunctional component (value free) and another one of harm (value laden). In this article, we intend to review the emergence and evolution of the definition of mental disorder and the importance that the criteria of distress and disability always had in this definition. This happened until the advent of DSM-5 when these criteria came to play a secondary role.
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Affiliation(s)
- Diogo Telles-Correia
- Faculty of Medicine, University of Lisbon, Psychiatry Department, Avª Egas Moniz, Portugal
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25
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Moreira de Sousa J, Moreira CA, Telles-Correia D. Anxiety, Depression and Academic Performance: A Study Amongst Portuguese Medical Students Versus Non-Medical Students. ACTA MEDICA PORT 2018; 31:454-462. [PMID: 30332368 DOI: 10.20344/amp.9996] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of the study is to assess the prevalence of anxiety and depressive symptoms in Portuguese medical students compared to students of other faculties, and the possible impact those symptoms have on academic performance. MATERIAL AND METHODS A cross-sectional study was conducted in a sample of 750 students: 512 medical students and 238 nonmedical students. All students anonymously completed a socio-demographic survey and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed using the chi-square test, Mann-Whitney test, Spearman correlation coefficient or Kruskal-Wallis test. RESULTS We found a prevalence of 21.5% (n = 161) for anxiety symptoms and 3.7% (n = 28) for depressive symptoms. Being a medical student was more significantly associated with symptoms of anxiety (p = 0.034) compared with other students. Depressive symptoms were slightly associated with poor academic performance (p < 0.01). A percentage of 59.6% (n = 96) of students with anxiety symptoms and 46.4% (n = 13) of students with depressive symptoms did not seek medical or psychological care at that time. DISCUSSION Medical students in this sample seem to have more symptoms of anxiety, possibly explained by a higher number of female students in that sample. Depressive symptoms could be associated with poor academic performance in both groups, but an evident correlation was not established. CONCLUSION Considering the high levels of anxiety symptoms, the possible impact of depressive symptoms in academic performance and the lack of psychiatric or psychological follow-up reported in this study, it is urgent to develop adequate means of support to improve students' well-being and mental health.
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Affiliation(s)
| | - Cátia A Moreira
- Schizophrenia Clinic. Hospital Júlio de Matos. Lisbon Psychiatric Hospital Center. Lisbon. Portugal
| | - Diogo Telles-Correia
- University Clinic of Psychiatry and Medical Psychology. Faculty of Medicine. University of Lisbon. Lisbon. Portugal
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26
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Abstract
A problem underlying the mind brain gap is the complex integration among the disciplines involved in it: neurosciences, clinical psychiatry and psychology, and philosophy of science. Research in neurosciences and clinical psychiatry requires a positioning in relation to some conceptual/philosophical aspects. These are related to the models of interrelationship of the brain and the mind, to explanatory approaches in psychiatry, and to conceptual issues such as dimensionality versus categories, symptoms versus disorders, and neurobiological correlates versus clinical determination of mental disorder. In this article, we try to address some of these issues that, if taken into account, could reduce the gap between psychiatrists and neuroscientists and turn the research in this area more profitable.
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Affiliation(s)
- Diogo Telles-Correia
- Psychiatry Department, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
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27
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Arantes-Gonçalves F, Gama Marques J, Telles-Correia D. Bleuler's Psychopathological Perspective on Schizophrenia Delusions: Towards New Tools in Psychotherapy Treatment. Front Psychiatry 2018; 9:306. [PMID: 30065668 PMCID: PMC6056670 DOI: 10.3389/fpsyt.2018.00306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/19/2018] [Indexed: 11/13/2022] Open
Abstract
The authors begin by addressing the historical evolution of the delusion concept and its different approaches, focusing afterwards mainly on the work of Bleuler, who stressed the proximity between delusions and the emotional life of patients with schizophrenia. I Therefore, the present work intends to review the main aspects of the theory of delusion formation in schizophrenia according to Bleuler's psychopathological perspective. For that purpose, first the role of delusions in the psychopathology of schizophrenia is explored in a close relation with the Bleuler's fundamental symptoms (Alogia, Autism, Ambivalence, and Affect Blunting) nowadays known as negative symptoms. Then, persecutory, grandiosity and sexual delusions in schizophrenia are described according to the tension between logic and affects, as well as, internal conflict, schizoid features, and auto-erotism as key psychopathological pathways. Thus, with this subjective perspective, it is intended to highlight Bleuler's psychopathological contribution to the affective and meaningful causality of delusions in schizophrenia. The former might be useful in the integration with other psychopathological phenomena (hallucinations and negative symptoms) and new forms of research and therapeutic approaches in this disorder that are complementary with the contemporary tendencies in psychopathology.
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Affiliation(s)
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Consulta de Esquizofrenia Resistente, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Diogo Telles-Correia
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
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28
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Abstract
In this article the authors intend to review in an intelligible and comprehensive way the historical roots of Formal Thought Disorders. Early descriptions of thought disorders date back to the XIX century with Esquirol, but it was in the first half of the XX century that several authors introduced the main features of the actual concept of Formal Thought Disorders. Emil Kraepelin described akataphasia (inability to find the appropriate expression for a thought) in patients with dementia praecox (a term that some years later was replaced by schizophrenia). Bleuler and Kretschmer also identified in schizophrenic patients a generalized "loosening of associations" and Carl Schneider described several Formal Thought Disorders such as derailment, fusion, omission, suspension and driveling. At the end of the XX century Nancy Andreasen studied the classical descriptions regarding Formal Thought Disorders, reclassified them and also introduced a scale to assess them. Although the specificity of these symptoms in schizophrenia and psychosis has been a source of controversy among the different authors, the importance given to their presence in these mental disorders is universal. We defend that it is crucial that these historical and conceptual elements are grasped in order to assess Formal Thought Disorders for clinical and research purposes.
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Affiliation(s)
- Joana Jerónimo
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.,Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Tiago Queirós
- Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Elie Cheniaux
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diogo Telles-Correia
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.,Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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29
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Abstract
There are several reasons why a definition for mental disorder is essential. Among these are not only reasons linked to psychiatry itself as a science (nosology, research) but also to ethical, legal, and financial issues. The first formal definition of mental disorder resulted from a deep conceptual analysis led by Robert Spitzer. It emerged to address several challenges that psychiatry faced at the time, namely to serve as the starting point for an atheoretical and evidence-based classification of mental disorders, to justify the removal of homosexuality from classifications, and to counter the arguments of antipsychiatry. This definition has been updated, with some conceptual changes that make it depart from the main assumptions of Spitzer's original definition. In this article, we intend to review the factors that substantiated the emergence of the first formal definition of mental disorder that based all its later versions.
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Affiliation(s)
- Diogo Telles-Correia
- Clinica Universitaria de Psiquiatria e Psicologia, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Sérgio Saraiva
- Clinica Universitaria de Psiquiatria e Psicologia, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Gonçalves
- Faculty of Social and Human Sciences, IFILNOVA, Universidade Nova de Lisboa, Lisbon, Portugal
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30
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Telles-Correia D, Barbosa-Rocha N, Gama-Marques J, Moreira AL, Alves-Moreira C, Saraiva S, Antunes F, Almeida C, Machado S, Haddock G. Validation of the Portuguese version of the Psychotic Symptom Rating Scales (PSYRATS). Actas Esp Psiquiatr 2017; 45:56-61. [PMID: 28353290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Abstract
The Psychotic Symptom Rating Scales (PSYRATS) is a clinical assessment tool that focuses on the detailed measurement of delusions and hallucinations in patients with psychosis. The goal of this study was to examine the psychometric properties of the Portuguese version of the PSYRATS. A sample of 92 outpatients suffering from schizophrenia or schizoaffective disorders and presenting persistent psychotic symptoms was assessed using the PSYRATS and the Positive and Negative Syndrome Scale (PANSS). Good inter-rater reliability, test-retest reliability, concurrent validity and internal consistency were found. Factor analysis of the auditory hallucinations scale items disclosed a four-factor solution: emotion characteristics and disruption factor (factor 1), a physical characteristics factor (factor 2), a control characteristics factor (factor 3) and a cognitive attribution factor (factor 4). Regarding the delusions scale items, a two-factor solution was found: cognitive interpretation and disruption factor (factor 1) and an emotional characteristics (factor 2). The Portuguese version of the PSYRATS partially replicates previously published results in other countries.
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Affiliation(s)
- Diogo Telles-Correia
- University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisboa, Portugal Santa Maria Hospital, Department of Psychiatry, Lisboa, Portugal
| | | | - João Gama-Marques
- University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisboa, Portugal Schizophrenia Clinic, Hospital Júlio de Matos, Lisbon Psychiatric Hospital Center, Portugal
| | - Ana L Moreira
- University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Cátia Alves-Moreira
- Schizophrenia Clinic, Hospital Júlio de Matos, Lisbon Psychiatric Hospital Center, Portuga
| | - Sérgio Saraiva
- University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisboa, Portugal Schizophrenia Clinic, Hospital Júlio de Matos, Lisbon Psychiatric Hospital Center, Portugal
| | - Filipa Antunes
- University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisboa, Portugal Santa Maria Hospital, Department of Psychiatry, Lisboa, Portugal
| | - Carolina Almeida
- University Clinic of Psychiatry and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisboa, Portugal Santa Maria Hospital, Department of Psychiatry, Lisboa, Portugal
| | - Sérgio Machado
- Institute of Psichiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Gillian Haddock
- Section for Clinical and Health Psychology, School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
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31
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Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NBF, Machado S. Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity. World J Gastrointest Pharmacol Ther 2017; 8:26-38. [PMID: 28217372 PMCID: PMC5292604 DOI: 10.4292/wjgpt.v8.i1.26] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/02/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.
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32
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Telles-Correia D, Moreira AL, Gama Marques J, Saraiva S, Moreira CA, Antunes F, Almeida C, Rocha NB. The Proximity between Hallucination and Delusion Dimensions: An Observational, Analytic, Cross-Sectional, Multicentre Study. Front Psychol 2016; 7:1642. [PMID: 27877142 PMCID: PMC5099164 DOI: 10.3389/fpsyg.2016.01642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/06/2016] [Indexed: 11/13/2022] Open
Abstract
In psychiatric classifications, hallucinations (mainly auditory hallucinations) are one of the fundamental criteria for establishing a schizophrenia diagnosis or any of the related psychotic disorder's diagnoses. The conceptual proximity between delusions and hallucinations was maintained until the end of the XIX century, with several supporters during the XX century. Their limits were not yet definitely defined in terms of Descriptive Psychopathology, and much less so in terms of biochemical and anatomical models. In this article we aimed to analyse the dimensions of both hallucinations and delusions in a sample of patients with schizophrenia and schizoaffective disorder. We also intend to find the determinants of the main dimensions of hallucinations. One hundred patients with schizophrenia (80) or schizoaffective disorder (20), 64% males, mean age 39.75, from the outpatient and inpatient units of the Psychiatry Department of Hospital de Santa Maria and the Centro Hospitalar Psiquiátrico de Lisboa were assessed by means of the Psychotic Symptom Rating Scales (PSYRATS) and a structured interview. In this study we designed an empirical based model by means of bivariate Spearman's rank correlation coefficient, and multivariate statistics (linear regression and multiple multivariate linear regression), where the main dimensions of hallucinations are determined by the central dimensions of delusions.
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Affiliation(s)
- Diogo Telles-Correia
- Faculty of Medicine, University Clinic of Psychiatry and Medical Psychology, University of Lisbon Lisbon, Portugal
| | - Ana L Moreira
- Faculty of Medicine, University Clinic of Psychiatry and Medical Psychology, University of Lisbon Lisbon, Portugal
| | - João Gama Marques
- Schizophrenia Clinic, Hospital Júlio de Matos, Lisbon Psychiatric Hospital Center Lisbon, Portugal
| | - Sérgio Saraiva
- Schizophrenia Clinic, Hospital Júlio de Matos, Lisbon Psychiatric Hospital Center Lisbon, Portugal
| | - Cátia A Moreira
- Schizophrenia Clinic, Hospital Júlio de Matos, Lisbon Psychiatric Hospital Center Lisbon, Portugal
| | - Filipa Antunes
- Faculty of Medicine, University Clinic of Psychiatry and Medical Psychology, University of Lisbon Lisbon, Portugal
| | - Carolina Almeida
- Faculty of Medicine, University Clinic of Psychiatry and Medical Psychology, University of Lisbon Lisbon, Portugal
| | - Nuno B Rocha
- School of Health Technologies, Polytechnic Institute of Porto Porto, Portugal
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33
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Affiliation(s)
| | - Daniel Sampaio
- Faculty of Medicine, University of Lisbon Lisbon, Portugal
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Campos C, Rocha NB, Vieira RT, Rocha SA, Telles-Correia D, Paes F, Yuan T, Nardi AE, Arias-Carrión O, Machado S, Caixeta L. Treatment of Cognitive Deficits in Alzheimer's disease: A psychopharmacological review. Psychiatr Danub 2016; 28:2-12. [PMID: 26938815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The growing and aging population has contributed to the increased prevalence of Alzheimer's disease (AD) and other types of dementia in the world. AD is a progressive and degenerative brain disease with an onset characterized by episodic memory impairments, although progressive deficits can be observed in several domains including language, executive functions, attention and working memory. The relationship between cognitive impairments and the topography and progression of brain neuropathology is well established. The pathophysiologic mechanisms and processes that underline the course of cognitive and clinical decline have been the theoretical support for the development of pharmacological treatments for AD. Cholinesterase inhibitors (ChEIs) and N-methyl-D-aspartate (NMDA) antagonists are the main drugs used in the management of global cognitive impairment and several studies also explore the effects of both in specific cognitive measures. Recent research trends also examine the effects of combination therapy using both compounds. This review aims to update practical recommendations for the treatment of global cognitive functioning and specific neurocognitive deficits in AD using ChEIs, NMDA antagonists and combination therapy with both drugs.
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Affiliation(s)
- Carlos Campos
- Polytechnic Institute of Porto, School of Health Technologies, Portugal
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Telles-Correia D, Gama Marques J, Gramaça J, Sampaio D. Stigma and Attitudes towards Psychiatric Patients in Portuguese Medical Students. ACTA MEDICA PORT 2015; 28:715-9. [PMID: 26849755 DOI: 10.20344/amp.6231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/03/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study aims to assess the impact of psychiatric education on attitudes of medical students towards psychiatric patients. MATERIAL AND METHODS A cross-sectional survey of medical students was conducted at the biggest Portuguese medical school. The students completed an anonymous self-report questionnaire, including sociodemographic data, family history of psychiatric illness, and the Community Attitudes toward the Mentally Ill scale. RESULTS Of the 2 178 students, 398 answered the survey, representing 18.2% of the whole medical school. There was a significant improvement in all Community Attitudes toward the Mentally Ill scale dimensions along the medical course. The higher scores were in Restrictiveness subscale (38.01), and the lower scores were for Authoritarianism (36.13). The best improvement along the course was for Authoritarianism (5th year score - 1st year score = 2.03), and the worse was for Benevolence (5th year score - 1st year score = 0.39). The biggest improvement, in all scores, was found at the end of the 3rd year. DISCUSSION The authors propose that the better attitudes found on third year students were due to a very specific anti-stigma module on the theoretical discipline 'Introduction to Mental Health'. After that, this positive effect was lost, with fourth and fifth year medical students showing a worsening of their attitudes. CONCLUSION Our results highlight the importance of anti-stigma specific education modules in order to improve students' attitudes toward mental health. Thus more anti-stigma preventive measures can be taken onward, on preparing the best way possible, the next generation of doctors.
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Affiliation(s)
- Diogo Telles-Correia
- Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Clínica de Psicoses Esquizofrénicas. Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal
| | - João Gramaça
- Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Daniel Sampaio
- Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Telles-Correia D, Mega I. Candidates for liver transplantation with alcoholic liver disease: Psychosocial aspects. World J Gastroenterol 2015; 21:11027-11033. [PMID: 26494959 PMCID: PMC4607902 DOI: 10.3748/wjg.v21.i39.11027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 02/07/2023] Open
Abstract
In Europe, 30% to 50% of liver transplantations are currently due to alcoholic liver disease (ALD). In the United States, this percentage is 17.2%. Post-transplant survival and other predictors of clinical course do not differ significantly from those in other types of transplanted patients, as long as there is no relapse of drinking. However, 20%-25% of these patients lapse or relapse to heavy drinking post-operatively, which has been associated with an increased risk of liver damage and mortality. It is therefore crucial to design specific selection and follow-up strategies aimed at this particular type of patient. Several good and poor prognosis factors that could help to predict a relapse have been suggested, among them the duration of abstinence, social support, a family history of alcoholism, abuse diagnosis versus alcohol dependence, non-acceptance of diagnosis related to alcohol use, presence of severe mental illness, non-adherence in a broad sense, number of years of alcoholism, and daily quantity of alcohol consumption. In this article, we discuss these and other, more controversial factors in selecting ALD patients for liver transplantation. Abstinence should be the main goal after transplantation in an ALD patient. In this article, we review the several definitions of post-transplant relapse, its monitoring and the psychopharmacological and psychotherapeutic treatment.
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Pedro P, Telles-Correia D, Godinho I, Chagas C. Onset of psychosis at age 81? With regard to frontal lobe syndromes. Einstein (Sao Paulo) 2015; 13:615-7. [PMID: 26398362 PMCID: PMC4878641 DOI: 10.1590/s1679-45082015rc3004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.
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Affiliation(s)
- Patrícia Pedro
- Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
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Abstract
Prior to the seventeenth century, the experiences we now name hallucinations were valued within a cultural context, they could bring meaning to the subject or the world. From mid-seventeenth to eighteenth centuries, they acquire a medical quality in mental and organic illnesses. However, the term was only fully integrated in psychiatry by Esquirol in the eighteenth-nineteenth centuries. By then, a controversy begins on whether hallucinations have a perceptual or intellectual origin. Esquirol favors the intellectual origin, describing them as an involuntary exercise of memory and imagination. By the twentieth century, some authors maintain that hallucinations are a form of delusion (Ey), while others describe them as a change in perception (Jaspers, Fish). More integrated perspectives like those proposed by Alonso Fernandez and Luque, highlights the heterogeneity of hallucinations and the multiplicity of their types and causes. The terms pseudohallucination, illusion, and hallucinosis are grafted into the concept of hallucination. Since its introduction the term pseudohallucination has been used with different meanings. The major characteristics that we found associated with pseudohallucinations were "lack of objectivity" and "presence of insight" (differing from hallucinations). Illusions are unanimously taken as distortions of real objects. Hallucinosis, first described in the context of alcohol consumption, is generally considered egodystonic, in which insight is preserved. These and other controversial aspects regarding the evolution of the term hallucination and all its derivative concepts are discussed in this paper.
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Affiliation(s)
- Diogo Telles-Correia
- Clinica Universitaria de Psiquiatria e Psicologia, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Telles-Correia D, João Freire M, Mega I, Barreiras D, Cortez Pinto H. Anxiety and Depression Symptoms in Hepatic Encephalopathy: Are They Psychiatric or Organic? Transplant Proc 2015; 47:1005-7. [DOI: 10.1016/j.transproceed.2015.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Telles-Correia D, Barbosa A. Psychopharmacotherapy in Gastrointestinal and Liver Diseases. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Throughout the history of psychopathology, several meanings have been assigned to the term melancholia. The main ones were related to affective disorders (fear and sadness) and abnormal beliefs. At the time of Hippocrates melancholia was regarded mainly in its affective component. Since that time, and until the eighteenth century, authors and opinions have been divided, with both aspects (affective disorders and abnormal beliefs), being valued. Finally, in the eighteenth to nineteenth centuries, with Pinel at its peak, melancholia becomes exclusively a synonym of abnormal beliefs. At the turn of the nineteenth to the twentieth century, the affective component returns as the main aspect characterizing melancholia.
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Affiliation(s)
- Diogo Telles-Correia
- University Clinic of Psychiatry and Psychology, Faculty of Medicine, University of Lisbon , Lisboa, Portugal
| | - João Gama Marques
- University Clinic of Psychiatry and Psychology, Faculty of Medicine, University of Lisbon , Lisboa, Portugal
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Telles-Correia D, Moreira ALR. A psychosomatic approach to severe nausea and vomiting in liver transplant recipients with familial amyloid polyneuropathy: clinical outcome in 10 cases. Prog Transplant 2014; 24:242-6. [PMID: 25193724 DOI: 10.7182/pit2014615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
After transplant, patients with familial amyloid polyneuropathy may manifest several medical and psychiatric symptoms that can be difficult to diagnose and treat. We describe 10 liver transplant candidates with familial amyloid polyneuropathy who had severe somatic signs and symptoms (nausea and vomiting) after transplant. Their physical examinations were performed by physicians from different specialties. Before transplant, the patients' evaluations did not reveal relevant medical or psychiatric symptoms. After transplant, they had severe nausea and vomiting and high scores on the Hospital Anxiety and Depression Scale. A psychopharmacological trial with a selective serotonin reuptake inhibitor plus an antiemetic drug was unsuccessful. Remission was obtained with tricyclic antidepressants and low-dose atypical antipsychotic agents. Previous researchers had concluded that the mental quality of life in patients with familial amyloid polyneuropathy was worse after receiving a liver transplant, unlike other transplant recipients. The 10 cases described in this study are a good example of comorbid physical and mental symptoms occurring after transplant in patients with familial amyloid polyneuropathy. The conclusions of this study have implications for clinical practice, showing how a careful holistic approach in the posttransplant period is relevant in these cases.
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Affiliation(s)
- Diogo Telles-Correia
- Curry Cabral Hospital, Lisbon, Portugal Hospital de Santa Maria, Lisbon, Portugal
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Telles-Correia D, Barbosa A, Mega I, Monteiro E, Barroso E. Quality of Life Following Liver Transplantation in Patients With Familial Amyloid Neuropathy: A Prospective Controlled Study. Psychol Community Health 2014. [DOI: 10.5964/pch.v3i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moreira A, Godinho Pereira M, Telles-Correia D. 705 – Psychotropic drugs and HIV. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sampaio D, Telles-Correia D. [Suicide in the elderly: crucial not to forget!]. ACTA MEDICA PORT 2013; 26:1-2. [PMID: 23697349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 02/19/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Daniel Sampaio
- Serviço de Psiquiatria, Hospital de Santa Maria/Faculdade de Medicina de Lisboa, Lisboa, Portugal
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Telles-Correia D, Barbosa A, Mega I, Monteiro E. Psychosocial predictors of adherence after liver transplant in a single transplant center in Portugal. Prog Transplant 2012; 22:91-4. [PMID: 22489449 DOI: 10.7182/pit2012569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Nonadherence has important implications for morbidity and mortality, reduced quality of life, and increased medical costs after transplant. OBJECTIVE; To investigate which psychiatric and psychosocial factors determine adherence after liver transplant. DESIGN A group of 150 consecutive transplant candidates attending the outpatient clinics of the transplant unit of Hospital de Curry Cabral were studied between January 1,2006, and December 1, 2007. Among these, 84 received a transplant and of those 84, 11 recipients died, 3 received another transplant, and 8 refused to finish the study (62 patients remained). MEASURES Before transplant, prospective recipients were assessed via the Hospital Anxiety and Depression Scale, the NEO Five-Factor Inventory, and the revised Illness Perception Questionnaire. Both before and after transplant, patients were assessed with the Multidimensional Adherence Questionnaire. RESULTS AND CONCLUSIONS Adherence to medication improved significantly from before to after transplant. This kind of adherence after transplant was associated with adherence to medication before transplant and high scores on the personal control dimension of the Illness Perception Questionnaire before transplant. Therefore it might be useful to focus on patients with poor adherence to medication and low scores on the personal control dimension of the Illness Perception Questionnaire before transplant in order to design interventions for them.
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Telles-Correia D. [Alcohol liver disease patients and liver transplantation: a psychosocial approach]. ACTA MEDICA PORT 2011; 24 Suppl 4:835-844. [PMID: 22863491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
One of the most common indications for Liver transplantation is Alcohol Liver Disease (ALD). Transplant recipients with ALD have a similar prognosis in terms of medical evolution and quality of life to those with other liver diseases. ALD is present when alcoholism (alcohol dependence /abuse) or heavy drinking coexists with chronic/acute liver disease. In the present article difficulties in establishing this diagnosis are debated. The main predictors of alcohol intake relapse after transplantation are: pre-transplantation abstinence (> 6m), social support, diagnosis acceptance, history of previous treatments, alcohol abuse VS dependence, Vaillant prognosis factors, good adherence (good prognosis); and family history of alcoholism, psychiatric history (psychosis, personality disorder), duration of alcoholism period, quantity of alcohol /day consumed (bad prognosis). Based in these factors we present a new evaluation scale. Diagnosis of alcohol relapse depends on the criterion used. Relapse rate is 5.6% /year. In the end of this article we discuss the different psychopharmacological and psychological methods used to treat pos-transplantation alcoholism relapse and some ethical aspects related to discrimination of patients with ALD.
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Affiliation(s)
- Diogo Telles-Correia
- Serviço de Psiquiatria, Faculdade de Medicina de Lisboa, Unidade Transplantação, Hospital Curry Cabral, Lisboa, Portugal
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Telles-Correia D, Barbosa A, Mega I, Monteiro E, Barroso E. Mental health and quality of life in alcoholic liver disease patients after liver transplantation: a prospective controlled study. Transplant Proc 2011; 43:184-6. [PMID: 21335183 DOI: 10.1016/j.transproceed.2011.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Alcoholic liver disease (ALD) is one of the most important indications for liver transplantation. Discordant conclusions have been found concerning quality of life and mental health after transplantation in this particular group. The aim of this work was to investigate improvements in mental health and quality of life among transplanted patients for ALD. METHODS We studied 45 consecutive transplant candidates with ALD, attending the outpatient clinics. Among these patients we transplanted 24 with the control candidates remaining in wait for transplantation. RESULTS There was a significant improvement in all mental health and quality of life dimensions among the transplanted ALD group. We also observed a favorable evolution of coping mechanisms (CM) in this group. CONCLUSION There is a favorable adjustment of ALD patients after transplantation as shown in CM evolution, which might explain the improved mental health and quality-of-life dimensions.
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Telles-Correia D, Barbosa A, Mega I, Barroso E, Monteiro E. Psychiatric and psychosocial predictors of medical outcome after liver transplantation: a prospective, single-center study. Transplant Proc 2011; 43:155-7. [PMID: 21335175 DOI: 10.1016/j.transproceed.2010.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recognizing the potential impact of psychiatric and psychosocial factors on liver transplant patient outcomes is essential to apply special follow-up for more vulnerable patients. The aim of this article was to investigate the psychiatric and psychosocial factors predicted medical outcomes of liver transplanted patients. METHODS We studied 150 consecutive transplant candidates, attending our outpatient transplantation clinic, including 84 who had been grafted 11 of whom died and 3 retransplanted. RESULTS We observed that active coping was an important predictor of length of stay after liver transplantation. Neuroticism and social support were important predictors of mortality after liver transplantation. CONCLUSION It may be useful to identify patients with low scores for active coping and for social support and high scores for neuroticism to design special modes of follow-up to improve their medical outcomes.
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Affiliation(s)
- D Telles-Correia
- Psychiatric Approach to Liver Transplanted Patients' Unit of Curry Cabral Hospital's Liver Transplantation Centre, Lisbon, Portugal.
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Telles-Correia D, Barbosa A, Mega I, Monteiro E. Predictors of mental health and quality of life after liver transplantation. Psychother Psychosom 2011; 80:60-1. [PMID: 21088450 DOI: 10.1159/000317539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 06/20/2010] [Indexed: 12/28/2022]
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