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Douglas KM, Sperry SH, Dean OM, Fries GR, Gomes FA, Pavón JJ, Morton E, Mitchell RHB, Van Rheenen TE, Verdolini N, Xu N, Hosang GM, Huber RS. Supporting career development for early- and mid-career professionals working in the bipolar disorder field: Key initiatives to be implemented by the International Society for Bipolar Disorders Early- and Mid-Career Committee. Bipolar Disord 2024. [PMID: 38622803 DOI: 10.1111/bdi.13416] [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: 04/17/2024]
Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Olivia M Dean
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Gabriel R Fries
- Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Joanna Jiménez Pavón
- Mood Disorder Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tamsyn E Van Rheenen
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
| | - Norma Verdolini
- Department of Mental Health, Local Health Unit Umbria 1, Mental Health Center of Perugia, Perugia, Italy
| | - Ni Xu
- Peking University Sixth Hospital, Beijing, China
- Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Rebekah S Huber
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Rosenblat JD, Meshkat S, Doyle Z, Kaczmarek E, Brudner RM, Kratiuk K, Mansur RB, Schulz-Quach C, Sethi R, Abate A, Ali S, Bawks J, Blainey MG, Brietzke E, Cronin V, Danilewitz J, Dhawan S, Di Fonzo A, Di Fonzo M, Drzadzewski P, Dunlop W, Fiszter H, Gomes FA, Grewal S, Leon-Carlyle M, McCallum M, Mofidi N, Offman H, Riva-Cambrin J, Schmidt J, Smolkin M, Quinn JM, Zumrova A, Marlborough M, McIntyre RS. Psilocybin-assisted psychotherapy for treatment resistant depression: A randomized clinical trial evaluating repeated doses of psilocybin. Med 2024; 5:190-200.e5. [PMID: 38359838 DOI: 10.1016/j.medj.2024.01.005] [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: 12/01/2023] [Revised: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Psilocybin-assisted psychotherapy (PAP) has been associated with antidepressant effects. Trials to date have typically excluded participants with complex presentations. Our aim was to determine the feasibility of PAP in a complex population, including high levels of treatment resistance in major depressive and bipolar disorder and patients with baseline suicidality and significant comorbidity. We also evaluated flexible repeated doses over a 6-month period. METHODS Adults with treatment-resistant depression as part of major depressive or bipolar II disorder without psychosis or a substance use disorder were eligible to participate. Subjects were randomized to immediate treatment or waitlist control, with all eventually receiving PAP. Participants had one, two, or three psilocybin sessions with a fixed dose of 25 mg. Each dose was accompanied by preparation and integration psychotherapy sessions. Acceptability, safety, tolerability, and efficacy were evaluated (this study was registered at ClinicalTrials.gov: NCT05029466). FINDINGS Participants were randomized to immediate treatment (n = 16) or delayed treatment (n = 14). 29/30 were retained to the week-2 primary endpoint. Adverse events were transient, with no serious adverse events. Greater reductions in depression severity as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) were observed in the immediate treatment arm compared to the waitlist period arm with a large hedge's g effect size of 1.07 (p < 0.01). Repeated doses were associated with further reductions in MADRS scores compared to baseline. CONCLUSIONS PAP was feasible in complex patients with preliminary antidepressant efficacy and adequate safety and tolerability. Repeated doses were associated with greater reductions in depression severity. FUNDING This work was funded by Brain and Cognition Discovery Foundation (BCDF), Usona, and Braxia Scientific.
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Affiliation(s)
- Joshua D Rosenblat
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Shakila Meshkat
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Zoe Doyle
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Erica Kaczmarek
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Ryan M Brudner
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | | | | | | | | | - Shaun Ali
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Jordan Bawks
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Marc G Blainey
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Elisa Brietzke
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; Queens University, Kingston, Ontario, Canada
| | - Victoria Cronin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Jessica Danilewitz
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Shalini Dhawan
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Anthony Di Fonzo
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Melissa Di Fonzo
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Pawel Drzadzewski
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - William Dunlop
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Hajnalka Fiszter
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Fabiano A Gomes
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Smrita Grewal
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Marisa Leon-Carlyle
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Marilyn McCallum
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Niki Mofidi
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Hilary Offman
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Jeremy Riva-Cambrin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Joel Schmidt
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Mark Smolkin
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Joan M Quinn
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Andrea Zumrova
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Michelle Marlborough
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada
| | - Roger S McIntyre
- Braxia Health, Canadian Rapid Treatment Centre of Excellence (CRTCE), Braxia Scientific, Mississauga, ON, Canada; University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
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Gomes FA, Huber RS, Sperry SH, Van Rheenen TE. Fostering networking opportunities and creating a community of early and mid-career clinicians and researchers within the International Society for Bipolar Disorders. Bipolar Disord 2024; 26:186-187. [PMID: 38302731 DOI: 10.1111/bdi.13410] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Rebekah S Huber
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Centre for Mental Health and Brain Sciences, Faculty of Health Arts and Design, Swinburne University, Melbourne, Australia
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Koning E, Grigolon RB, Breda V, Gomes FA, Zucatti KP, Teixeira PP, Colpani V, Gerchman F, Brietzke E. The effect of lifestyle interventions on depressive symptom severity in individuals with type-2 diabetes: A meta-analysis of randomized controlled trials. J Psychosom Res 2023; 173:111445. [PMID: 37579705 DOI: 10.1016/j.jpsychores.2023.111445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a severe metabolic condition which is commonly comorbid with depression. Lifestyle factors are involved in the pathophysiology of both conditions; however, the role of lifestyle interventions remains unclear. OBJECTIVE The objective of this study is to systematically review the literature on randomized controlled trials evaluating the effect of lifestyle interventions on depressive scores in patients with T2DM. METHODS A systematic search was conducted in computerized databases before October 2022. A random-effects model was used to investigate the effect of lifestyle interventions on depression scores and meta-regression was conducted to assess the influence of age and disease onset. RESULTS Six trials met the eligibility criteria for inclusion. A statistically significant reduction in depression scores was found for groups receiving lifestyle interventions compared to controls (SMD = -0.49 [95%CI -0.89 to -0.08]; p = 0.0269]). Interventions increased in efficacy with the age of the participants but no significant correlation was found with years since disease onset. Participants in a control group receiving a less intense lifestyle intervention demonstrated improved depression scores when compared to those who received standard care or no intervention at all. Trial design and outcome measurement tools were heterogeneous between studies and limited data on antidepressant use was available which may introduce bias into the results. CONCLUSION Lifestyle interventions were effective at improving depressive symptom severity in patients with T2DM.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.
| | | | - Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Fabiano A Gomes
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Kelly P Zucatti
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Paula P Teixeira
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Veronica Colpani
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Fernando Gerchman
- Programa de Pós-graduação emCiências Médicas: Endocrinologia, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil; Serviço de Endocrinologia e Metabologia do Hospital de Clínicas de PortoAlegre, Porto Alegre, RS, Brasil; Faculdade de Medicina, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brasil
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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Koning E, McDonald A, Bambokian A, Gomes FA, Vorstman J, Berk M, Fabe J, McIntyre RS, Milev R, Mansur RB, Brietzke E. The concept of "metabolic jet lag" in the pathophysiology of bipolar disorder: implications for research and clinical care. CNS Spectr 2023; 28:571-580. [PMID: 36503605 DOI: 10.1017/s1092852922001195] [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] [Indexed: 12/14/2022]
Abstract
Bipolar disorder (BD) is a potentially chronic mental disorder marked by recurrent depressive and manic episodes, circadian rhythm disruption, and changes in energetic metabolism. "Metabolic jet lag" refers to a state of shift in circadian patterns of energy homeostasis, affecting neuroendocrine, immune, and adipose tissue function, expressed through behavioral changes such as irregularities in sleep and appetite. Risk factors include genetic variation, mitochondrial dysfunction, lifestyle factors, poor gut microbiome health and abnormalities in hunger, satiety, and hedonistic function. Evidence suggests metabolic jet lag is a core component of BD pathophysiology, as individuals with BD frequently exhibit irregular eating rhythms and circadian desynchronization of their energetic metabolism, which is associated with unfavorable clinical outcomes. Although current diagnostic criteria lack any assessment of eating rhythms, technological advancements including mobile phone applications and ecological momentary assessment allow for the reliable tracking of biological rhythms. Overall, methodological refinement of metabolic jet lag assessment will increase knowledge in this field and stimulate the development of interventions targeting metabolic rhythms, such as time-restricted eating.
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Affiliation(s)
- Elena Koning
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alexandra McDonald
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Alexander Bambokian
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jacob Vorstman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Jennifer Fabe
- Department of Neurology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, The Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roumen Milev
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, ON, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry and Pharmacology, University of Toronto, The Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Elisa Brietzke
- Centre for Neurosciences Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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Sperry SH, Douglas KM, Dean OM, Fries GR, Gomes FA, Hosang GM, Morton E, Sandorffy B, Van Rheenen TE, Xu N, Huber RS. Barriers to and facilitators of success for early and Mid-Career professionals focused on bipolar disorder: A global needs survey by the International Society for Bipolar Disorders. Bipolar Disord 2023; 25:379-390. [PMID: 37391923 DOI: 10.1111/bdi.13365] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
INTRODUCTION The International Society for Bipolar Disorders created the Early Mid-Career Committee (EMCC) to support career development of the next generation of researchers and clinicians specializing in bipolar disorder (BD). To develop new infrastructure and initiatives, the EMCC completed a Needs Survey of the current limitations and gaps that restrict recruitment and retention of researchers and clinicians focused on BD. METHODS The EMCC Needs Survey was developed through an iterative process, relying on literature and content expertise of workgroup members. The survey included 8 domains: navigating transitional career stages, creating and fostering mentorship, research activities, raising academic profile, clinical-research balance, networking and collaboration, community engagement, work-life balance. The final survey was deployed from May to August 2022 and was available in English, Spanish, Portuguese, Italian, and Chinese. RESULTS Three hundred participants across six continents completed the Needs Survey. Half of the participants self-identified as belonging to an underrepresented group in health-related sciences (i.e., from certain gender, racial, ethnic, cultural, or disadvantaged backgrounds including individuals with disabilities). Quantitative results and qualitative content analysis revealed key barriers to pursuing a research career focused on BD with unique challenges specific to scientific writing and grant funding. Participants highlighted mentorship as a key facilitator of success in research and clinical work. CONCLUSION The results of the Needs Survey are a call to action to support early- and midcareer professionals pursuing a career in BD. Interventions required to address the identified barriers will take coordination, creativity, and resources to develop, implement, and encourage uptake but will have long-lasting benefits for research, clinical practice, and ultimately those affected by BD.
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Affiliation(s)
- Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Olivia M Dean
- Deakin University and Barwon Health, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Gabriel R Fries
- Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, UK
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Canada
| | - Bronya Sandorffy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Ni Xu
- Peking University Sixth Hospital, Beijing, China
- Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Rebekah S Huber
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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Gomes FA, Dumay H, Fagen J, Palma N, Milev R, Brietzke E. Does the Ranking Matter? A Retrospective Cohort Study Investigating the Impact of the 2018 CANMAT and ISBD Guidelines for the Management of Patients with Bipolar Disorder Treatment Recommendations for Acute Mania on Rehospitalization Rates. Can J Psychiatry 2023; 68:605-612. [PMID: 37551100 PMCID: PMC10411363 DOI: 10.1177/07067437231156235] [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] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE There is limited data about the impact of mood disorders treatment guidelines on clinical outcomes. The objective of this study was to investigate the impact of prescribers' adherence to the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) treatment guidelines recommendations on the readmission rates of patients hospitalized for mania. METHOD A retrospective cohort of all individuals admitted due to acute mania to Kingston General Hospital, Kingston, ON, from January 2018 to July 2021 was included in this study. Patient variables and data regarding index admission and subsequent hospitalizations were extracted from medical records up to December 31, 2021. Treatment regimens were classified as first-line, second-line, noncompliant, or no treatment. We explored the associations between treatment regimens and the risk of readmissions using univariate, multivariate, and survival analysis. RESULTS We identified 211 hospitalizations related to 165 patients. The mean time-to-readmission was 211.8 days (standard deviation [SD] = 247.1); the 30-day rehospitalization rate was 13.7%, and any rehospitalization rate was 40.3%. Compared to no treatment, only first-line treatments were associated with a statistically significant decreased risk of 30-day readmission (odds ratio [OR] = 0.209; 95% CI, 0.058 to 0.670). The risk of any readmission was reduced by first-line (OR = 0.387; 95% CI, 0.173 to 0.848) and noncompliant regimens (OR = 0.414; 95% CI, 0.174 to 0.982) compared to no treatment. On survival analysis, no treatment group was associated with shorter time-to-readmission (log-rank test, p = 0.014) and increased risk of readmission (hazard ratio = 2.27; 95% CI, 1.30 to 3.96) when compared to first-line medications. CONCLUSIONS Treatment with first-line medications was associated with lower 30-day rehospitalization rates and longer time-to-readmission. Physicians' adherence to treatments with higher-ranked evidence for efficacy, safety, and tolerability may improve bipolar disorder outcomes.
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Affiliation(s)
- Fabiano A. Gomes
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | | | - Julia Fagen
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Natalie Palma
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Providence Care Hospital, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
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Gomes FA, Soleas EK, Kcomt A, Duffy A, Milev R, Post RM, Bauer M, Brietzke E. Practices, knowledge, and attitudes about lithium treatment: Results of online surveys completed by clinicians and lithium-treated patients. J Psychiatr Res 2023; 164:335-343. [PMID: 37393799 DOI: 10.1016/j.jpsychires.2023.06.005] [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: 12/14/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Lithium remains the gold-standard medication for acute and prophylactic treatment of bipolar disorder. Understanding clinicians' practices and patients' experiences, knowledge and attitudes about lithium may improve its clinical use. METHODS Online anonymous surveys collected information about clinician's practices and level of confidence in managing lithium and patients' experiences with lithium treatment and information received about benefits and side effects. Knowledge and attitudes regarding lithium were assessed with the Lithium Knowledge Test (LKT) and the Lithium Attitudes Questionnaire (LAQ). RESULTS Among 201 clinicians, 64.2% endorsed often treating patients with lithium and reported high levels of confidence in assessing and managing lithium. Practices concerning clinical indications, drug titration, and serum levels were guideline-concordant, but compliance with monitoring recommendations was less frequent. Practitioners were interested in receiving more education about lithium. The patients' survey recruited 219 participants with 70.3% being current lithium users. Most patients (68%) found lithium helpful and 71% reported experiencing any kind of side effect. Most responders did not receive information about side effects or other benefits of lithium. Patients with higher scores on the LKT were more likely to have positive attitudes about lithium. LIMITATIONS Cross-sectional design with predominantly English-speaking participants from Brazil and North America. CONCLUSIONS There is a discrepancy between guidelines, clinician confidence and knowledge of lithium use and practice. A deeper understanding of how to monitor, prevent and manage long-term side effects and which patients are most likely to benefit from lithium may narrow the gap between knowledge and use.
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Affiliation(s)
- Fabiano A Gomes
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Eleftherios K Soleas
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Andrew Kcomt
- Mood Disorders Association of Ontario, ON, Canada
| | - Anne Duffy
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Providence Care Hospital, Kingston, On, Canada
| | | | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
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Breda V, Cerqueira RO, Ceolin G, Koning E, Fabe J, McDonald A, Gomes FA, Brietzke E. Is there a place for dietetic interventions in adult ADHD? Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110613. [PMID: 35964708 DOI: 10.1016/j.pnpbp.2022.110613] [Citation(s) in RCA: 2] [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: 04/13/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Current treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults are limited by lack of response and side effects in about one third of the individuals. Changes towards a healthier lifestyle could have a positive impact beyond the relief of specific symptoms. However, it is not clear if nutritional interventions influence mental health and cognition. The objective of this study was to summarize the available literature addressing the impact of different diets in ADHD. The most promising dietetic approaches in ADHD are diets considered to be healthy (Mediterranean-type; DASH) and the Few-Foods Diet for children. Studies should take into account the presence of multiple confounders, biases associated with difficulties in blinding participants and researchers, and search for possible mechanisms of action, so we can have better evidence to guide clinical mental care of adults with ADHD.
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Affiliation(s)
- Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Raphael O Cerqueira
- Department of Psychiatry, Federal University of São Paulo, Rua Major Maragliano 241, São Paulo, SP 04017-030, Brazil
| | - Gilciane Ceolin
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Rua Delfino Conti, Campus Trindade, Florianópolis, SC 88040-970, Brazil
| | - Elena Koning
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Jennifer Fabe
- McMasters Children's Hospital, Hamilton Health Sciences, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
| | | | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
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10
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Huber RS, Douglas KM, Sperry SH, Gomes FA, Van Rheenen TE, Xu N, Hosang GM. The Early Mid-Career Committee (EMCC) of the International Society for Bipolar Disorders: Aspirations and goals. Bipolar Disord 2022; 24:781-783. [PMID: 36543335 DOI: 10.1111/bdi.13269] [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: 12/24/2022]
Affiliation(s)
- Rebekah S Huber
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Ni Xu
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,NHC Key Laboratory of Mental Health (Peking University), Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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11
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Gomes FA, Brietzke E. Conflicts of interest in invasive brain stimulation research. Braz J Psychiatry 2022; 44:674-677. [PMID: 35878064 PMCID: PMC9851760 DOI: 10.47626/1516-4446-2022-2747] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Fabiano A. Gomes
- Department of Psychiatry and Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry and Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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12
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Affiliation(s)
- Matthew J Gazzellone
- From the Department of Psychiatry, Queen's University, Kingston, Ont., Canada (Gazzellone, Oliver, Groll, Gomes)
| | - Dijana Oliver
- From the Department of Psychiatry, Queen's University, Kingston, Ont., Canada (Gazzellone, Oliver, Groll, Gomes)
| | - Dianne Groll
- From the Department of Psychiatry, Queen's University, Kingston, Ont., Canada (Gazzellone, Oliver, Groll, Gomes)
| | - Fabiano A Gomes
- From the Department of Psychiatry, Queen's University, Kingston, Ont., Canada (Gazzellone, Oliver, Groll, Gomes)
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13
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Ceolin G, Breda V, Koning E, Meyyappan AC, Gomes FA, Moreira JD, Gerchman F, Brietzke E. A Possible Antidepressive Effect of Dietary Interventions: Emergent Findings and Research Challenges. Curr Treat Options Psychiatry 2022; 9:151-162. [PMID: 35496470 PMCID: PMC9034261 DOI: 10.1007/s40501-022-00259-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 02/07/2023]
Abstract
Purpose Despite recent advancements in the treatment of depression, the prevalence of affected individuals continues to grow. The development of new strategies has been required and emerging evidence has linked a possible antidepressant effect with dietary interventions. In this review, we discuss recent findings about the possible antidepressant effect of dietary interventions with an emphasis on the results of randomized controlled trials. Recent findings A high consumption of refined sugars and saturated fat and a low dietary content of fruits and vegetables has been associated with the development of depression. There is evidence supporting a small to moderate beneficial effect of a Mediterranean-type diet in depression. In addition, new dietary protocols are being studied for their use as possible interventions, such as the ketogenic diet, Nordic diet, and plant-based diet. Summary Lifestyle interventions surrounding diet and nutrition are a relatively affordable way to enhance response to treatment and to be employed as an adjunct in mental health care. Most studies, however, are limited by the difficulty in controlling for the placebo effect. Mediterranean-style diets seem to be the most promising as an adjunctive treatment for mood disorders. Larger randomized controlled trials that could assess predictors of response to dietary interventions are needed to establish a clear positive effect of diet and guide clinical care and nutritional recommendations concerning mental health care.
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Affiliation(s)
- Gilciane Ceolin
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, 752 King Street West, Kingston, ON K7L 7X3 Canada.,Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, SC Brazil
| | - Vitor Breda
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, 752 King Street West, Kingston, ON K7L 7X3 Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, ON Canada
| | - Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, 752 King Street West, Kingston, ON K7L 7X3 Canada
| | - Arun Chinna Meyyappan
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, 752 King Street West, Kingston, ON K7L 7X3 Canada
| | - Fabiano A Gomes
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, 752 King Street West, Kingston, ON K7L 7X3 Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, ON Canada
| | - Júlia Dubois Moreira
- Department of Nutrition, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC Brazil
| | - Fernando Gerchman
- Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS Brazil.,Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS Brazil
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, 752 King Street West, Kingston, ON K7L 7X3 Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, ON Canada
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15
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Gomes FA, Brietzke E, Bauer M, Post RM. A call for improving lithium literacy among clinicians and patients. Int J Bipolar Disord 2022; 10:5. [PMID: 35229217 PMCID: PMC8885945 DOI: 10.1186/s40345-022-00250-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fabiano A Gomes
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Robert M Post
- George Washington University School of Medicine, Washington, DC, USA
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16
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Gomes FA, Cerqueira RO, Lee Y, Mansur RB, Kapczinski F, McIntyre RS, Yatham LN, Berk M, Milev R, Brietzke E. What not to use in bipolar disorders: A systematic review of non-recommended treatments in clinical practice guidelines. J Affect Disord 2022; 298:565-576. [PMID: 34758372 DOI: 10.1016/j.jad.2021.11.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPG) are an important tool for implementation of evidence-based clinical care. Despite clinical trials showing lack of efficacy of some agents in bipolar disorder (BD), they are still frequently prescribed in clinical practice. The objective of this study was to systematically review the CPG recommendations on pharmacological interventions with evidence against their use due to lack of efficacy data and/or due to serious safety concerns. METHODS A systematic literature search identified 29 guidelines published by national and international organizations during the 1994-2020 period. Information was extracted regarding how the recommendations framed non-use of treatments in particular clinical situations as well as the actual recommendation in the guideline. RESULTS Twenty-three guidelines (79%) mentioned at least one non-recommended treatment. The terms used to qualify recommendations varied amongst guidelines and included: "not recommended" "no recommendation" and "negative evidence". Lamotrigine, topiramate and gabapentin were commonly cited as non-recommended treatments for mania and most CPG did not recommend monotherapy with antidepressants, aripiprazole, risperidone, and ziprasidone for treatment of acute bipolar depression. Most guidelines made recommendations about lack of efficacy data or potential harm in treatments for BD but there is a significant variation in the way this information is conveyed to the reader. LIMITATIONS Non-recommended treatments were based on their use for BD episodes or maintenance but specific medications may benefit patients when treating comorbid conditions. CONCLUSIONS The absence of a uniform language and recommendations in current guidelines may be an additional complicating factor in the implementation of evidence-based treatments in BD.
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Affiliation(s)
- Fabiano A Gomes
- Neurobiology of Mood Disorders Laboratory, Centre for Neuroscience Studies (CNS), Queen's University, 76 Stuart St., Burr 4., Kingston, ON, Canada; Kingston Health Sciences Centre-KGH Site, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.
| | - Raphael O Cerqueira
- Department of Psychiatry, Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences and Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Psychiatry, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Roumen Milev
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Providence Care Hospital, Kingston, Canada
| | - Elisa Brietzke
- Neurobiology of Mood Disorders Laboratory, Centre for Neuroscience Studies (CNS), Queen's University, 76 Stuart St., Burr 4., Kingston, ON, Canada; Kingston Health Sciences Centre-KGH Site, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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17
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Shaw AAB, Ashby R, Gomes FA, Brietzke E. The importance of countertransference in the clinical care of individuals during acute phases of bipolar disorder. Bipolar Disord 2021; 23:850-851. [PMID: 34216081 DOI: 10.1111/bdi.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/12/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew A B Shaw
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Rachel Ashby
- Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada.,NeuroMood Lab, Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada.,NeuroMood Lab, Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
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18
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Gomes FA. Evolution of Primary Health Care appointments in mainland Portugal in 2020. Eur J Public Health 2021. [PMCID: PMC8574699 DOI: 10.1093/eurpub/ckab164.838] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has had an impact on the Portuguese Health Care System. During the first months of the pandemic, there was a great reduction in the number of health rendering services. (1) The aim of this study is to analyse the evolution of Primary Health Care appointments in mainland Portugal, during the whole year of 2020 and to compare it to the period of 2015-2019. The type of appointment and the number of users will also be characterized. Methods An observational, descriptive-retrospective, longitudinal, quantitative study was performed. ‘Portal da Transparência' was used as the source of free access data about the Portuguese National Health Service. Results The results which are here presented are comparing the year 2020 to the average of 2015-2019. In mainland Portugal, in 2020, there were 7% more Primary Health Care appointments (PHCA). Although there were less PHCA during the first five months of 2020, there was a rise in the number of PHCA since June 2020. In 2020, 59% were distance PHCA, a rise of 113% compared to the average of 2015-2019. There was a fall of 38% on presential PHCA in 2020. The number of presential PHCA was inferior in each month of 2020, in comparison to the homologous month of the average of 2015-2019. The month with less presential PHCA was April 2020 (less 72% than the average of 2015-2019). Regarding domiciliary PHCA, there was a 36% reduction.In mainland Portugal, the number of Primary Health Care users with, at least, one face-to-face or distance PHCA, in 2020 was 6,661,927, 3% less than the average of 2015-2019. Conclusions The transition from presential PHCA to distance PHCA that occurred in 2020 due to the COVID-19 pandemic allowed the follow-up of most of the patients. However, there is a need to assess if distance PHCA are as effective as presential PHCA and which are its effects in communities' health. (1) Vieira A et al. Excesso de mortalidade, mortalidade colateral e resposta dos serviços de saúde em Portugal em tempos de COVID-19 Key messages In 2020, in mainland Portugal, there was an increase on distance Primary Health Care appointments and a decrease on presential ones. Its impact on population’s health should be assessed.
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Affiliation(s)
- FA Gomes
- Public Health Unit, Primary Care Center of Loures-Odivelas, Loures, Portugal
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19
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Brietzke E, Gomes FA, Gerchman F, Freire RCR. Should systematic reviews and meta-analysis include data from preprints? Trends Psychiatry Psychother 2021; 45:e20210324. [PMID: 34551239 PMCID: PMC10164401 DOI: 10.47626/2237-6089-2021-0324] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Elisa Brietzke
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada Department of Psychiatry, Queen’s University School of Medicine, Kingston, ON, Canada.
- Kingston General HospitalKingston Health Science CentreKingstonONCanada Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada.
- Centre for Neuroscience (CNS)Queen’s UniversityKingstonONCanada Centre for Neuroscience (CNS), Queen’s University, Kingston, ON, Canada.
| | - Fabiano A. Gomes
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada Department of Psychiatry, Queen’s University School of Medicine, Kingston, ON, Canada.
- Centre for Neuroscience (CNS)Queen’s UniversityKingstonONCanada Centre for Neuroscience (CNS), Queen’s University, Kingston, ON, Canada.
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Fernando Gerchman
- Divisão de Endocrinologia e MetabolismoHospital de Clínicas de Porto AlegrePorto AlegreRSBrazil Divisão de Endocrinologia e Metabolismo, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
- Programa de Pós-graduação em Ciências MédicasFaculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Rafael C. R. Freire
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada Department of Psychiatry, Queen’s University School of Medicine, Kingston, ON, Canada.
- Kingston General HospitalKingston Health Science CentreKingstonONCanada Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada.
- Centre for Neuroscience (CNS)Queen’s UniversityKingstonONCanada Centre for Neuroscience (CNS), Queen’s University, Kingston, ON, Canada.
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Gomes FA, Milev R, Yatham LN, Berk M, Brietzke E. Why do medications with little or no efficacy continue to be prescribed in the management of patients with bipolar disorder? Bipolar Disord 2021; 23:541-543. [PMID: 34297457 DOI: 10.1111/bdi.13114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Berk
- School of Medicine, Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Geelong, VIC, Australia
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
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21
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Grigolon RB, Trevizol AP, Gerchman F, Bambokian AD, Magee T, McIntyre RS, Gomes FA, Brietzke E, Mansur RB. Is Obesity A Determinant Of Success With Pharmacological Treatment For Depression? A Systematic Review, Meta-Analysis And Meta-Regression. J Affect Disord 2021; 287:54-68. [PMID: 33773359 DOI: 10.1016/j.jad.2021.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/19/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The bidirectional association between Major Depressive Disorder (MDD) and obesity suggests that body mass index (BMI) at the baseline could influence remission rates (RR) with pharmacological treatment. We evaluated the influence of baseline BMI on the chances of remission among patients with MDD administered antidepressants. METHODS Based on the guidelines of the PRISMA statement, we conducted a systematic review on PubMed, Cochrane and Embase databases with subsequent meta-analysis and meta-regression. We included only randomized controlled trials evaluating the efficacy of antidepressants of different classes (monotherapy and combined therapies) that evidenced baseline BMI assessment. We created a model to describe the linear relationship between baseline BMI and RR. RESULTS Our systematic review yielded 70 studies with a total of 9,779 patients in the active group and 7,136 patients in the placebo group. In placebo controlled studies, BMI influenced the RR of patients randomized to active treatment. The RR for antidepressants in monotherapy was higher in normal weight to overweight patients rather than obese patients (33% vs 12%, respectively). Also in monotherapy, the RR is higher when the study is conducted on patients with a lower baseline BMI (p=0.029). For combined therapies, the pooled RR was higher in obese patients rather than in normal weight to overweight patients (75% vs 17%, respectively). LIMITATIONS BMI provides no information about body composition and obesity can be related to several potential confounders that potentially influence RR. CONCLUSION The RR with antidepressant therapy seems to be associated with baseline BMI in patients with MDD, although this simple variable was insufficiently explored so far.
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Affiliation(s)
- Ruth Bartelli Grigolon
- Post-Graduation Program in Psychiatry and Medical Psychology, Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Stimulation and the Mood and Anxiety Ambulatory Services at the Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Fernando Gerchman
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Service of Endocrinology and Metabology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Taylor Magee
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Inpatient Psychiatric Unit, Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Inpatient Psychiatric Unit, Kingston General Hospital, Kingston Health Science Centre, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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22
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Gomes FA, Magalhães PV, Magee T, Brietzke E, Kunz M, Kapczinski F. Clinical correlates of high burden of general medical comorbidities in patients with bipolar disorder. Journal of Affective Disorders Reports 2020. [DOI: 10.1016/j.jadr.2020.100001] [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: 10/23/2022] Open
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Gomes FA, Duarte S, Lopes DG, Moreira A, Pereira MB, Cunha I, Gil MM, Pinto CS. Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.850] [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: 11/14/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019.
Methods
An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables.
Results
In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12).
Conclusions
Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016.
Key messages
Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.
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Affiliation(s)
- F A Gomes
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - S Duarte
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - D G Lopes
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - A Moreira
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - M B Pereira
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - I Cunha
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - M M Gil
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - C S Pinto
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
- Serviços Partilhados do Ministério da Saúde, Lisbon, Portugal
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Gomes FA, Lopes DG, Cunha I, Duarte S, Pereira MB, Moreira A, Gil MM, Esteves H. Do long-term care services meet the minimal requirements for the elderly? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.692] [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: 11/12/2022] Open
Abstract
Abstract
Background
As the percentage of elderly people (aged over 65) is expected to rise, from 16.0% of the population in 2010 to 29.3% in 2060 in Europe, a quality long-term care system is of increasing priority for governments. The aim of this study is to analyse long-term care services (LTCS) in the geographical area of the group of primary healthcare centres of Loures-Odivelas.
Methods
A retrospective, observational, descriptive study comprising data from public health inspections to LTCS between 2015 and 2019. Variables included were the number of residents, nurses, orderly, cooks, kitchen helpers and medical doctors; licensing status, public health inspection results and the presence of air conditioning. Descriptive analysis was performed for all variables.
Results
Between 2015 and 2019, a total of 200 public health inspections were carried out in 106 LTCS. Only 41 (38.7%) LTCS were licensed. The total number of residents was 2,803, 168 (6.0%) of which were bedridden. Concerning the staff ratio, 79 (74.5%) LTCS fulfilled the ratio of nurse to resident of 1:40 and 67 (63.2%) the ratio of orderly to resident of 1:8. On the first inspection, 11 LTCS (10.4%) complied with the minimal requirements for health care, hygiene, food preparation and facilities conditions. After the implementation of corrective measures proposed by the Public Health Unit, the number of LTCS which had complied for the same criteria was 64 (60.4%).
Conclusions
Society needs to adapt to a growing ageing population. LCTS, while part of the solution, still have deficiencies. In this sample, the majority were illegal and lacked the appropriate conditions. Public Health interventions can contribute to improving these services.
Key messages
In an ageing society, long-term care services are essential but the majority lack the appropriate conditions. Public Health intervention is crucial in implementing corrective measures that will result in better conditions for the elderly.
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Affiliation(s)
- F A Gomes
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - D G Lopes
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - I Cunha
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - S Duarte
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - M B Pereira
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - A Moreira
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - M M Gil
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
| | - H Esteves
- Public Health Unit, Group of Primary Healthcare Centres of Loures-Odivelas, Loures, Portugal
- Public Health and Preventive Medicine Institute, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
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Brietzke E, Magee T, Freire RCR, Gomes FA, Milev R. Three insights on psychoneuroimmunology of mood disorders to be taken from the COVID-19 pandemic. Brain Behav Immun Health 2020; 5:100076. [PMID: 32322822 PMCID: PMC7174985 DOI: 10.1016/j.bbih.2020.100076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 12/16/2022] Open
Abstract
In the recent months, the world was taken by surprise by the outbreak of a coronavirus (SARS-CoV-2) pandemic (COVID-19). The COVID-19 pandemic is a unique opportunity to advance the understanding of the association of respiratory viruses with mood disorders and suicide. In this editorial, we explore three insights to the neuropsychoneuroimmunology of mood disorders that could be taken from the COVID-19 pandemic.
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Affiliation(s)
- Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Taylor Magee
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Rafael C R Freire
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
| | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
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Brasileiro RB, Tabosa FBP, Gomes FA, Paula RCM, Feitosa JPA, Maniglia-Ferreira C, Vitoriano MM. Análise do Processo de Degradação do Material Obturador Através da Diminuição da Concentração de Zinco. J Health Scie 2018. [DOI: 10.17921/2447-8938.2017v19n5p96] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Este estudo in vivo teve como objetivo analisar a degradação do material obturador de acordo com a idade de tratamento através do decréscimo da concentração de zinco presente no material obturador. Foram removidos materiais obturadores do interior de canais radiculares que apresentavam indicações de retratamento. O material obturador foi colhido do interior dos canais radiculares com auxílio de limas Hedströem, sem uso de solventes ou brocas. As informações a respeito do tempo de tratamento foram obtidas diretamente com os pacientes. Foram utilizadas 30 amostras com tempos de tratamentos entre 2 e 30 anos. Espectrometria de absorção atômica, EDX e difração de raios-X foram os métodos empregados para identificar e quantificar os elementos químicos e os compostos de zinco. Todas as análises foram executadas em triplicata. Todos os resultados obtidos foram comparados com os dados provenientes de cones novos, e então submetidos à análise estatística, utilizando-se o teste ANOVA (SPSS 12.0). Todas as amostras, para os diferentes períodos de tempo apresentaram decréscimo na concentração de zinco. Após 15 anos de tratamento, os resultados mostraram-se com diferenças estatisticamente significantes de concentração de zinco (p 0,0103). O método utilizado foi apropriado para quantificar a concentração do zinco nas amostras analisadas.Palavras-chave: Canal Radicular. Obturação. Zinco.
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Gomes FA, Almeida KM, Magalhães PV, Caetano SC, Kauer-Sant'Anna M, Lafer B, Kapczinski F. Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder. Rev Bras Psiquiatr 2013; 35:126-30. [DOI: 10.1590/1516-4446-2011-0768] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/16/2012] [Indexed: 11/22/2022]
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Gomes FA, Kauer-Sant'Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha A, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder. Acta Neuropsychiatr 2010; 22:63-7. [PMID: 25385031 DOI: 10.1111/j.1601-5215.2010.00452.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED Gomes FA, Kauer-Sant'Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha Â, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder. OBJECTIVE There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder. METHODS Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese. RESULTS Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06-3.69, p = 0.03) as likely to have a history of suicide attempt(s). CONCLUSION Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.
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Affiliation(s)
- Fabiano A Gomes
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia Kauer-Sant'Anna
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro V Magalhães
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felice N Jacka
- 2Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
| | - Seetal Dodd
- 2Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
| | - Clarissa S Gama
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Cunha
- 3University Hospital, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Michael Berk
- 2Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
| | - Flávio Kapczinski
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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da Silva Magalhães PV, Gomes FA, Kunz M, Kapczinski F. Birth-cohort and dual diagnosis effects on age-at-onset in Brazilian patients with bipolar I disorder. Acta Psychiatr Scand 2009; 120:492-5. [PMID: 19594482 DOI: 10.1111/j.1600-0447.2009.01426.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Substance use disorders and birth-cohort have been associated with an earlier onset in bipolar disorder (BD). This study aimed at evaluating the inter-relations of these factors in age-at-onset in bipolar illness. METHOD Two-hundred and thirty patients with bipolar I disorder were cross-sectionally evaluated. Patients were categorized into four age groups for analysis. Lifetime comorbidity and age-at-onset were derived from the Structured Clinical Interview for DSM-IV. RESULTS There was a strong linear association between age group and age-at-onset. Lifetime alcohol and drug use disorders were also associated with age-at-onset. Illicit drug and alcohol use disorders and age group remained significant in the multivariate model. No interactions appeared. CONCLUSION Both age group and dual diagnoses had strong and independent impacts on age-at-onset in out-patients with BD. Substance abuse may be partly accountable for earlier symptom onset, but other features of BD in younger generations are still in need to be accounted for.
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Affiliation(s)
- P V da Silva Magalhães
- Bipolar Disorders Program & INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Cunha AB, Andreazza AC, Gomes FA, Frey BN, da Silveira LE, Gonçalves CA, Kapczinski F. Investigation of serum high-sensitive C-reactive protein levels across all mood states in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2008; 258:300-4. [PMID: 18297417 DOI: 10.1007/s00406-007-0797-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 11/06/2007] [Indexed: 12/23/2022]
Abstract
There has been an increasing interest in the role of the immune and inflammatory systems in mood disorders. Mood episodes are associated with changes in acute phase proteins such as high-sensitivity C-reactive protein (hsCRP). The present study investigated serum hsCRP in manic, depressed, and euthymic BD patients as compared to matched healthy controls. Serum hsCRP was assessed using an ultrasensitive assay of particle-enhanced immunoturbidimetric latex agglutination. Serum hsCRP levels were increased in manic BD patients, as compared to euthymic, depressed patients and healthy controls (P < 0.001). These findings add to the notion that changes in the inflammatory system take place during acute episodes of mania.
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Affiliation(s)
- Angelo B Cunha
- Department of Neuropsychiatry, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Faixa de Camobi Km 9, Santa Maria, RS, 97105-900, Brazil
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Kapczinski F, Vieta E, Andreazza AC, Frey BN, Gomes FA, Tramontina J, Kauer-Sant’Anna M, Grassi-Oliveira R, Post RM. Allostatic load in bipolar disorder: Implications for pathophysiology and treatment. Neurosci Biobehav Rev 2008; 32:675-92. [PMID: 18199480 DOI: 10.1016/j.neubiorev.2007.10.005] [Citation(s) in RCA: 306] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Revised: 09/25/2007] [Accepted: 10/28/2007] [Indexed: 12/14/2022]
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Frey BN, Andreazza AC, Kunz M, Gomes FA, Quevedo J, Salvador M, Gonçalves CA, Kapczinski F. Increased oxidative stress and DNA damage in bipolar disorder: a twin-case report. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:283-5. [PMID: 16859818 DOI: 10.1016/j.pnpbp.2006.06.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 06/08/2006] [Accepted: 06/13/2006] [Indexed: 12/28/2022]
Abstract
OBJECTIVE There is an emerging body of data suggesting that oxidative stress may be associated with the pathophysiology of bipolar disorder (BD). In the present study we investigated the oxidative stress profile in two monozygotic twins during a manic episode. METHODS Two monozygotic twins diagnosed as currently manic by the Structured Clinical Interview for DSM-IV were studied. Serum thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD) and catalase (CAT) were measured as parameters of oxidative stress. DNA damage was assessed using the single cell gel electrophoresis technique (Comet Assay). All biochemical measures were conducted at baseline and after a 6-week treatment. RESULTS Bipolar twins had higher TBARS, SOD and DNA damage, and lower CAT than the healthy control. TBARS and SOD were normalized after mood stabilization, whereas CAT and DNA damage remained altered at week 6. CONCLUSIONS These findings support that oxidative stress may play a role in the pathophysiology of BD and that pharmacological treatment may exert antioxidant effects. Studies with larger samples are warranted to further clarify this issue.
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Affiliation(s)
- Benício N Frey
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2600/Anexo, 90035-003 Porto Alegre, RS, Brazil
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Giraldo P, von Nowaskonski A, Gomes FA, Linhares I, Neves NA, Witkin SS. Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis. Obstet Gynecol 2000; 95:413-6. [PMID: 10711554 DOI: 10.1016/s0029-7844(99)00577-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The asymptomatic carriage of Candida in the vagina of women with a history of recurrent vulvovaginal candidiasis was compared with that of women with no such history. METHODS Vaginal swabs from 50 women with a history of recurrent vulvovaginal candidiasis and 45 women with one or fewer episodes of candidal vaginitis within the past 12 months were evaluated for Candida by wet mount/Gram stain, culture, and polymerase chain reaction (PCR). All women were asymptomatic for at least 30 days. RESULTS Candida was identified in 28 women by PCR, in 14 women by culture, and in 13 women by wet mount/Gram stain. Candida was identified by PCR in a similar proportion of patients with previous recurrent vulvovaginal candidiasis (30%) and in controls (28.8%). However, Candida was identified by culture in more women with previous recurrent vulvovaginal candidiasis (22%) than in controls (6.6%, P = .04); it also was identified by wet mount/Gram stain in more women with recurrent vulvovaginal candidiasis (22%) than in controls (4.4%, P = .01). For the recurrent vulvovaginal candidiasis patients, culture and wet mount/Gram stain had a sensitivity of 66.6% compared with PCR. For the controls, the sensitivity of the two former assays relative to PCR was only 15.3%. CONCLUSION Women with a history of recurrent vulvovaginal candidiasis have more easily detectable Candida in their vagina, even when asymptomatic, than do other women. A relative inefficiency in regulating the proliferation of Candida in the vagina may increase susceptibility to periodic symptomatic recurrences.
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Affiliation(s)
- P Giraldo
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Aiello VD, Gomes FA, Monteiro DC, Marcial MB. [Hearts with double inlet ventricle. Morphological aspects in 20 cases]. Arq Bras Cardiol 1991; 56:19-24. [PMID: 1872704] [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: 12/29/2022] Open
Abstract
PURPOSE The authors intended to verify the most common anatomical presentations of hearts with double inlet ventricle (DIV) and the associated lesions, in order to provide information regarding surgical palliation/correction. MATERIAL AND METHODS Twenty hearts presenting DIV, from pathological collections. The sequential segmental analysis was applied. RESULTS Fourteen cases showed usual atrial arrangement, and six isomeric atria (4 with right isomerism and 2 with left isomerism). "Situs solitus" showed two atrioventricular (AV) valves, and the others a single valve. The main ventricle was morphologically left in 13 cases, right in one and of indeterminate morphology in six. The ventriculoarterial connexion was discordant in 10 cases, concordant in two, of double outlet type in eight (6 from an indeterminate ventricle, one from the main chamber and one from the rudimentary ventricle). Pulmonary obstructive lesions were common in the group with atrial isomerism (67%). AV valve stenosis was present in 4 cases, two of the left valve and two of the right one. Straddling of one AV valve was observed in 5 cases and aortic coarctation in three. The ventricular septal defect was restrictive in two cases, both with double inlet to a dominant left ventricle and a concordant AV connexion (Holmes'heart). CONCLUSION In those with atrial isomerism, the obstructive pulmonary lesions are the dominant feature and require early attention. For the other group, the atriopulmonary anastomosis procedures should take into account peculiarities such as AV valve dysfunctions and aortic coarctation.
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Affiliation(s)
- V D Aiello
- Instituto do Coração do Hospital das Clínicas e Departamento de Patologia da FMUSP, São Paulo
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Monteiro DC, Gomes FA. [Anatomic study of the coronary arteries in transposition of great vessels]. Arq Bras Cardiol 1989; 53:9-13. [PMID: 2619595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors studied 64 hearts presenting transposition of the great arteries, in order to evaluate the pattern of distribution and origin of the main coronary arteries. Regarding the origin in each sinus of Valsalva, there was no significant difference with the data from the literature. It was also evaluated the precise site of origin inside the sinuses, which were divided in three thirds: the medial and those adjacent to the valvar commissures. We observed that, although the coronary ostia took origin from the medial third in more than half of the cases, there was some variation when considering the different patterns of distribution. This observations is relevant, since, when Jatene's procedure is considered, the surgical disinsertion of a coronary artery may put at risk the valvar leaflet, when the ostium is near the commissure.
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Gomes FA, Ruas A, Carvalheiro M, Pereira S. [Clinical aspects of a case of transexualism]. ACTA MEDICA PORT 1981; 3:201-9. [PMID: 7325008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Gomes FA. [Arsenic intoxication]. Rev Bras Gastroenterol 1968; 20:21-2. [PMID: 5708871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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de Azevedo JF, Barreira F, Gil FB, Gomes FA. Calcium absorption by Australorbis glabratus and Physa acuta in constant concentration environment. Rev Inst Med Trop Sao Paulo 1967; 9:419-28. [PMID: 5605319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Gomes FA. [Toxic ornametnal plants]. Rev Bras Med 1967; 24:235-7. [PMID: 5597805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gomes FA. [Effects of fatigue on conduction]. J Med (Oporto) 1966; 59:90-6. [PMID: 4157461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gomes FA. [Psychopathological aspects of strabismus]. Bol Inst Pueric Martagao Gesteira 1965; 22:23-27. [PMID: 5827178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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de Azevedo JF, Gil FB, Gomes FA, Rocha RM, Pinhão RC, Rombert PC, Vieira RA. [Pathogenicity of ancylostomidae studied with radioisotopes. II. Erythrocyte half-life studied with Cr-51]. An Inst Med Trop (Lisb) 1965; 22:25-9. [PMID: 5871713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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de Azevedo JF, Gil FB, Gomes FA, Rocha RM, Pinhão RC, Rombert PC, Vieira RA. [The pathogenicity of ancylostomidae studies with radioisotopes. I. Blood loss in the feces determined with Cr-51]. An Inst Med Trop (Lisb) 1965; 22:15-23. [PMID: 5872020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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de Azevedo JF, Gil FB, Gomes FA, Rocha RM, Pinhão RC, Rombert PC, Vieira RA. [The pathogenicity of ancylostomidae studied with radioisotopes. 3. The absorption of vitamin B 12 (Co-58)]. An Inst Med Trop (Lisb) 1965; 22:31-4. [PMID: 5871715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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