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Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde – 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) show similar efficacy as treatments for anxiety, obsessive-compulsive, and stress-related disorders. Hence, comparisons of adverse event rates across medications are an essential component of clinical decision-making. We aimed to compare patterns of adverse events associated with SSRIs and SNRIs in the treatment of children and adults diagnosed with these disorders through a network meta-analysis. We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies, and international registers from inception to 09 September 2022, for randomized controlled trials assessing the efficacy of SSRIs or SNRIs. We analyzed the proportion of participants experiencing at least one adverse event and incidence rates of 17 specific adverse events. We estimated incidence rates and odds ratios through network meta-analysis with random effects and three-level models. We analyzed 799 outcome measures from 80 studies (n = 21 338). Participants in medication groups presented higher rates of adverse events (80.22%, 95% CI 76.13-83.76) when compared to placebo groups (71.21%, 67.00-75.09). Nausea was the most common adverse event (25.71%, CI 23.96-27.54), while weight change was the least common (3.56%, 1.68-7.37). We found higher rates of adverse events of medications over placebo for most medications, except sertraline and fluoxetine. We found significant differences between medications for overall tolerability and for autonomic, gastrointestinal, and sleep-related symptoms. Adverse events are a common reason that patients discontinue SSRIs and SNRIs. Results presented here guide clinical decision-making when clinicians weigh one medication over another. This might improve treatment acceptability and compliance.

Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women’s worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7, 876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women’s brains and provide initial evidence for neuroscience-informed policies for gender equality., 男女間の不平等と脳の性差 --男女間の不平等は脳構造の性差と関連する--. 京都大学プレスリリース. 2023-05-10.

Background: We examined the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between poverty in childhood and MHD is mediated by exposure to stressful life events (SLE). Methods: We used data from a prospective community cohort of young people assessed at baseline (M=9.7 years, SD=1.9), first (M=13.5 years, SD=1.9), and second (M=18.2 years, SD=2.0) follow-ups (N=1,590) in Brazil. Poverty was assessed using a standardized classification. Exposure to 20 different SLE was measured using the Life History instrument. Psychiatric diagnoses were evaluated using the Development and Well-Being Assessment. Latent growth models investigated the association between poverty at baseline and the growth of any MHD, externalizing, and internalizing disorders. Mediation models evaluated whether the association between childhood poverty and MHD in early adulthood was mediated by exposure to SLE. Results: Poverty affected 11.4% of the sample at baseline and was associated with an increased propensity for presenting externalizing disorders in adolescence or early adulthood (standardized estimate=0.27, p=0.016). This association was not significant for any disorder or internalizing disorders. Childhood poverty increased the likelihood of externalizing disorders in early adulthood through higher exposure to SLE (OR=1.07, 95CI% 1.01–1.14). Results were only replicated among females in stratified analyses. Conclusions: Childhood poverty had detrimental consequences on externalizing MHD in adolescence, especially among females. Poverty and SLE are preventable risk factors that need to be tackled to reduce the burden of externalizing disorders in young people.

et al., Human brain structure changes throughout the lifespan. Altered brain growth or rates of decline are implicated in a vast range of psychiatric, developmental and neurodegenerative diseases. In this study, we identified common genetic variants that affect rates of brain growth or atrophy in what is, to our knowledge, the first genome-wide association meta-analysis of changes in brain morphology across the lifespan. Longitudinal magnetic resonance imaging data from 15,640 individuals were used to compute rates of change for 15 brain structures. The most robustly identified genes GPR139, DACH1 and APOE are associated with metabolic processes. We demonstrate global genetic overlap with depression, schizophrenia, cognitive functioning, insomnia, height, body mass index and smoking. Gene set findings implicate both early brain development and neurodegenerative processes in the rates of brain changes. Identifying variants involved in structural brain changes may help to determine biological pathways underlying optimal and dysfunctional brain development and aging., The ENIGMA-Plasticity Working Group is part of the ENIGMA World Aging Center, funded by NIA grants R56 AG058854 and R01 AG058854. The ENIGMA Consortium core funding was supported by NIH Consortium Grant U54 EB020403, supported by a cross-NIH alliance that funds Big Data to Knowledge Centers of Excellence. 1000BRAINS: 1000BRAINS is a population-based cohort based on the Heinz-Nixdorf Recall Study and is supported, in part, by the German National Cohort. We thank the Heinz Nixdorf Foundation (Germany) for their generous support in terms of the Heinz Nixdorf Study. The authors are supported by the Initiative and Networking Fund of the Helmholtz Association (Svenja Caspers) and the European Union’s Horizon 2020 Research and Innovation Programme under grant agreements 785907 (Human Brain Project SGA2; Svenja Caspers, Sven Cichon and Katrin Amunts). This work was further supported by the German Federal Ministry of Education and Research (BMBF) through the Integrated Network IntegraMent (Integrated Understanding of Causes and Mechanisms in Mental Disorders) under the auspices of the e:Med Program (grant 01ZX1314A; Sven Cichon) and by the Swiss National Science Foundation (SNSF, grant 156791; Sven Cichon). The authors acknowledge grants supporting their work from the European Union’s Horizon 2020 Research and Innovation Programme (H2020/2014–2020) under grant agreements 667302 (CoCA), 728018 (Eat2beNICE), 785907 (HBP SGA2) and 772376 (EScORIAL) and the Netherlands ALS Foundation.Additional support is received from the European Community’s Seventh Framework Programme (FP7/2007—2013) under grant agreements n° 602805 (Aggressotype), n° 603016 (MATRICS), n° 602450 (IMAGEMEND) and n° 278948 (TACTICS) and from the European Community’s Horizon 2020 Programme (H2020/2014—2020) under grant agreements n° 643051 (MiND) and n° 667302 (CoCA). FP7 Ideas: the European Research Council (ERC-230374 to D.B.). This work was supported by Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012 and PI19/024), co-financed by ERDF Funds from the European Commission, ‘A way of making Europe’, CIBERSAM; Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds; European Union Seventh Framework Program under grant agreements FP7- HEALTH-2013-2.2.1-2-603196 (Project PSYSCAN) and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement 115916, Project PRISM and grant agreement 777394, Project AIMS-2-TRIALS), Fundación Familia Alonso, Fundación Alicia Koplowitz and Fundación Mutua Madrileña. The Horizon 2020 funded ERC Advanced Grant ‘STRATIFY’ (Brain network based stratification of reinforcement-related disorders) (695313). The FP7 project MATRICS (603016). The research leading to these results also received support from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement 278948 (TACTICS), 602805 (Aggressotype), 603016 (MATRICS) and 602450 (Imagemend) and the Innovation Medicine Initiative grants 115300 (EU-AIMS) and 777394 (AIMS-2-TRIALS).PAFIP: PAFIP was supported by the Instituto de Salud Carlos III (PI14/00639, PI14/00918 and PI17/01056) and Fundación Instituto de Investigación Marqués de Valdecilla (NCT0235832 and NCT025KG Jebsen Stiftelsen and H2020 CoMorMent (847776).34363). European Union Marie Curie Research Training Network (MRTN-CT-2006-035987).

As a result of a decade of partnership between the Stavros Niarchos Foundation (SNF) and the Child Mind Institute (CMI), the Children and Adolescent Mental Health Initiative (CAMHI) has been established to help enhance child and adolescent mental health care capacity and strengthen the infrastructure for prevention, assessment, and treatment of mental health struggles faced by children and adolescents in Greece. Under the SNF’s Health Initiative and the associated public-private partnership in place between SNF and the Greek State, the Child Mental Health Initiative (CAMHI) envisions to expand access to mental health care and offer ground-up resources in ways that can reinforce the critical work done by mental health and child protection providers across the country. Aimed (a) to raise mental health literacy and awareness; b) to increase access to evidence-based mental health care; (c) to build out technological capacity, and (d) to establish a country-wide Referral Network for children and adolescent mental health care, the CAMHI builds on a solid open science-based framework aspiring to leverage scientific knowledge production about children and adolescent mental health and mental health care in Greece. To approach that, the initiative has been following three research approaches (checkout the Home wiki for more).

Supplemental material, sj-docx-1-asm-10.1177_10731911231163136 for An Evaluation of Item Harmonization Strategies Between Assessment Tools of Psychopathology in Children and Adolescents by Maurício Scopel Hoffmann, Tyler Maxwell Moore, Luiza Kvitko Axelrud, Nim Tottenham, Pedro Mario Pan, Eurípedes Constantino Miguel, Luis Augusto Rohde, Michael Peter Milham, Theodore Daniel Satterthwaite and Giovanni Abrahão Salum in Assessment

in press, weitere Verfasser:innen aus Einrichtungen außerhalb der Universität Duisburg-Essen sind nicht aufgeführt. The canonical paradigm for converting genetic association to mechanism involves iteratively mapping individual associations to the proximal genes through which they act. In contrast, in the present study we demonstrate the feasibility of extracting biological insights from a very large region of the genome and leverage this strategy to study the genetic influences on autism. Using a new statistical approach, we identified the 33-Mb p-arm of chromosome 16 (16p) as harboring the greatest excess of autism’s common polygenic influences. The region also includes the mechanistically cryptic and autism-associated 16p11.2 copy number variant. Analysis of RNA-sequencing data revealed that both the common polygenic influences within 16p and the 16p11.2 deletion were associated with decreased average gene expression across 16p. The transcriptional effects of the rare deletion and diffuse common variation were correlated at the level of individual genes and analysis of Hi-C data revealed patterns of chromatin contact that may explain this transcriptional convergence. These results reflect a new approach for extracting biological insight from genetic association data and suggest convergence of common and rare genetic influences on autism at 16p.

This study aim to evaluate the item-wise harmonization performance of two mental health questionnaires, the Child Behavior Checklist (CBCL) and GOASSESS, a questionnaire derived from the Kiddie Schedule for Affective Disorders and Schizophrenia, while using bifactor models. We tested model fit, questionnaire invariance and how authentic the harmonized models are in relation to full item sem models.

The Reproducible Brain Charts initiative aims to aggregate and harmonize phenotypic and neuroimage data to delineate novel mechanisms regarding the developmental basis of psychopathology in youth and yield reproducible growth charts of brain development. To reach this objective, the first step to phenotypic harmonization is to characterize psychopathology in a way that general and specific aspects are dissociated, so more specific relationships with the brain could be established. Bifactor models of mental health problems suits this purpose. The understanding of what the bifactor model of psychopathology represents must go through the identification of the different published models, the estimation of their global fit, model-based reliability and criterion validity, whether the models are influenced by other sample characteristics and whether the derived factors from different models inform a similar construct. This would ultimately help to elucidate whether different models represent similar or distinct constructs while reliably representing psychopathology. To answer these questions, the present study aimed to compile published bifactor models of psychopathology originating from different methodologies and compare them in their global model fit, model-based reliability, invariance and correlations among the constructs of these models. Doing so allowed us to understand the extent to which the model specifications and item selection impacted model quality, and if the models are distinguishable, to select the best model to represent the bifactor model of psychopathology.

The Reproducible Brain Charts initiative aims to aggregate and harmonize phenotypic and neuroimage data to delineate novel mechanisms regarding the developmental basis of psychopathology in youth and yield reproducible growth charts of brain development. To reach this objective, the second step of our project is to test item-wise matching strategies of phenotypic harmonization between studies using bifactor models of psychopathology. We focused on this model because general and specific aspects of mental health problems can dissociated, so more specific relationships with the brain could be established. In the current study, we benchmarked six item matching strategies for harmonizing the Child Behavioral Checklist (CBCL) and the Sstrenghts and Difficulties Qquestionnaire (SDQ) within a bifactor model framework in two samples that were assessed with both instruments. It proceded in the following steps: 1) harmonization of items according to the six strategies, 2) estimated bifactor models with harmonized items for each sample separately, 3) estimated factor score correlation between assessment tools in each sample, 4) estimated factor reliability, 5) tested the assessment’s invariance according to each strategy and 6) calculated the root expected mean square difference (REMSD) to estimate the factor score difference of using a proxy measure instead of a target measure while integrating the two samples. We expect that the results of this study can encourage the use of the best streategy to date to increase reproducibility in the field while aggregating data from different contexts and instruments in the context of the bifactor model of psychopathology.

Comparing cortical and subcortical brain structure between patients with generalized anxiety disorder and healthy comparison subjects – findings from the ENIGMA Generalized Anxiety Disorder Working Group

A recent neurodevelopmental hypothesis posits that cortical maturation progresses along the sensorimotor-association (S-A) axis, which spans from unimodal sensorimotor to transmodal association cortices (Sydnor et al., 2021). Prior work suggests that patterns of functional network development vary across this cortical hierarchy (Pines et al., 2022). In this pre-registered analysis, we will use multiple large-scale datasets to replicate and extend this prior work on functional network development. We will use resting-state and task functional MRI in youth ages 5-22 from four large datasets. The Philadelphia Neurodevelopmental Cohort (N=1621) was used for discovery and feature selection (Satterthwaite et al., 2016); these findings will be replicated prospectively in other large-scale developmental datasets including the Human Connectome Project: Development (N= 652), Healthy Brain Network (N=5,290), and Nathan Kline Institute-Rockland (N=505) (Alexander et al., 2017; Nooner et al., 2012; Somerville et al., 2018). Results from this study will robustly establish how patterns of functional brain development align with a major axis of brain organization.

Objective: To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses. Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder. Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.

Crime is a major public problem in low- and middle-income countries (LMICs) and its preventive measures could have great social impact. The extent to which multiple modifiable risk factors among children and families influence juvenile criminal conviction in an LMIC remains unexplored; however, it is necessary to identify prevention targets. This study examined the association between 22 modifiable individual and family exposures assessed in childhood (5–14 years, n = 2511) and criminal conviction at a 7-year follow-up (13–21 years, n = 1905, 76% retention rate) in a cohort of young people in Brazil. Population attributable risk fraction (PARF) was computed for significant risk factors. Criminal convictions were reported for 81 (4.3%) youths. Although most children living in poverty did not present criminal conviction (89%), poverty at baseline was the only modifiable risk factor significantly associated with crime (OR 4.14, 99.8% CI 1.38–12.46) with a PARF of 22.5% (95% CI 5.9–36.1%). It suggests that preventing children’s exposure to poverty would reduce nearly a quarter of subsequent criminal convictions. These findings highlight the importance of poverty in criminal conviction, as it includes several deprivations and suggest that poverty eradication interventions during childhood may be crucial for reducing crime among Brazilian youth.

Over the past 25 years, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, there are no reference standards against which to anchor measures of individual differences in brain morphology, in contrast to growth charts for traits such as height and weight. Here, we built an interactive online resource (www.brainchart.io) to quantify individual differences in brain structure from any current or future magnetic resonance imaging (MRI) study, against models of expected age-related trends. With the goal of basing these on the largest and most inclusive dataset, we aggregated MRI data spanning 115 days post-conception through 100 postnatal years, totaling 122,123 scans from 100,071 individuals in over 100 studies across 6 continents. When quantified as centile scores relative to the reference models, individual differences show high validity with non-MRI brain growth estimates and high stability across longitudinal assessment. Centile scores helped identify previously unreported brain developmental milestones and demonstrated increased genetic heritability compared to non-centiled MRI phenotypes. Crucially for the study of brain disorders, centile scores provide a standardised and interpretable measure of deviation that reveals new patterns of neuroanatomical differences across neurological and psychiatric disorders emerging during development and ageing. In sum, brain charts for the human lifespan are an essential first step towards robust, standardised quantification of individual variation and for characterizing deviation from age-related trends. Our global collaborative study …

Objectives: To translate and validate the Reported and Intended Behaviour Scale (RIBS) into Brazilian Portuguese. Methods: A native Brazilian speaker fluent in English translated the RIBS into Brazilian Portuguese. Comprehensibility and face validity were assessed through discussions with mental health professionals and volunteers recruited from the community. Brazilian Portuguese version of the questionnaire was back translated into English by another Brazilian researcher fluent in English and the researcher who developed the original RIBS was consulted to check the adequacy of the questionnaire translation, and approved the final translated version. RIBS-BP was administered to 1357 caregivers from a community-based cohort. Internal consistency and factor loading were assessed through Confirmatory Factor Analysis (CFA). Differential item functioning was examined using Multiple Indicator Multiple Causes for subgroups of gender, socioeconomic status and caregiver education. To assess external validity, we examined whether responses in RIBS-BP varied among these subgroups, considering respondents’ previous contact with people with mental illness. Results: CFA fit indices were good to excellent (RMSEA = 0.07 [0.04 – 0.10 90% CI]; CFI = 1.00; TLI = 1.00). All loadings were above 0.4 (0.73 to 0.89), indicating that intended behaviour items are related to the same unidimensional latent factor. In the latent model, higher socioeconomic status was associated with less intended stigma-related behaviour (ß=0.20, pConclusion: RIBS-BP has good internal consistency, demonstrate measurement invariance among subgroups, and appears to be a valid measure of stigma, representing a suitable tool to assess reported and intended stigma-related behaviours in Brazil.

Objectives: To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. Methods: All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. Results: There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. Conclusions: Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses. This report summarizes the background information and rationale for the various methodological decisions made by the ENIGMA-GAD group. The aim of this work is to help guide other research groups working with large brain imaging data sets

Additional file 1. Contains tables of complementary analyses.

DESAFIOS ATUAIS EM PSIQUIATRIA INFANTIL Diagnóstico e Tratamento da Ansiedade na Infância e Adolescência

Additional file 1: Table S1. Description of CBCL total, internalizing and externalizing scores. Figure S1. Multi-dimensional scaling (MDS) plots colored by BeadChip number, BeadChip position and waves. Figure S2. PC1 x PC2 plot from principal components analysis generated from SNParray data. Figure S3. Line plot of chronological age between Wave 0 and Wave 1 for the 24 HRC individuals, grouped by gender. Figure S4. Scatter plot of the variation of cg08517799 DNA methylation values and the variation of RB1CC1 mRNA levels (rp = − 0.580; p = 0.005). Figure S5. Scatter plot of the variation of total score of CBCL and the variation of KMT2E mRNA levels (rp = 0.436; p = 0.042). Figure S6. Scatter plot of the variation of total score of CBCL and the variation of FAM217B mRNA levels (rp = 0.475; p = 0.025). Figure S7. Overview of the most significant differentially methylated region (DMR) and of its genomic context. Figure S8. Scatter plot of the variation of total score of CBCL and the variation of RPS6KB1 mRNA levels (rp = 0.442; p = 0.040). Figure S9. Plot of bisulfite conversion median value for each sample from High-Risk Cohort (HRC). Figure S10. Plot of bisulfite conversion median value for each sample from Philadelphia Neurodevelopmental Cohort (PNC). Figure S11. Error bar plot comparing blood cell type estimations (CD19+ B cells, CD4+ T cells, CD8+ T cells, granulocytes, CD14+ monocytes and CD56+ natural killer cells) between Wave 0 and Wave 1. Figure S12. Principal components analysis plot of the 24 HRC participants and of the population from 1000 genomes.

Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes. Resumo Objetivo: Este estudo objetivou avaliar crianças e adolescentes com transtornos de ansiedade leve e moderada nas funções neuropsicológicas de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global, comparando o seu desempenho ao de crianças com desenvolvimento típico. Métodos: Participaram do estudo 68 crianças e adolescentes com idade de 10 a 17 anos (41 com diagnósticos clínicos atuais de transtornos de ansiedade e 27 controles), selecionados de uma amostra transversal mais ampla de adolescentes da comunidade. Os adolescentes com diagnóstico foram divididos ainda em dois grupos com base na gravidade dos transtornos (leve ou moderado). Todos os participantes realizaram uma avaliação neuropsicológica individual das funções de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global. Resultados: Nenhum dos testes neuropsicológicas demonstrou diferenças significativas, sendo a única exceção a tarefa de span de dígitos ordem inversa, na qual o grupo com ansiedade leve apresentou desempenho superior ao do grupo com ansiedade moderada e também ao dos controles (p = 0.041; η2 = 0.11). Conclusão: Os resultados sugerem que não só os transtornos de ansiedade podem preservar as principais funções cognitivas durante a adolescência, mas que podem até melhorar certos processos de memória de trabalho.

This study examines the extent to which children's positive attributes are distinct from psychopathology. We also investigate whether positive attributes change or "buffer" the impact of low intelligence and high psychopathology on negative educational outcomes.METHOD:In a community sample of 2,240 children (6-14 years of age), we investigated associations among positive attributes, psychopathology, intelligence, and negative educational outcomes. Negative educational outcomes were operationalized as learning problems and poor academic performance. We tested the discriminant validity of psychopathology versus positive attributes using confirmatory factor analysis (CFA) and propensity score matching analysis (PSM), and used generalized estimating equations (GEE) models to test main effects and interactions among predictors of educational outcomes.RESULTS:According to both CFA and PSM, positive attributes and psychiatric symptoms were distinct constructs. Positive attributes were associated with lower levels of negative educational outcomes, independent of intelligence and psychopathology. Positive attributes buffer the negative effects of lower intelligence on learning problems, and higher psychopathology on poor academic performance.CONCLUSION:Children's positive attributes are associated with lower levels of negative school outcomes. Positive attributes act both independently and by modifying the negative effects of low intelligence and high psychiatric symptoms on educational outcomes. Subsequent research should test interventions designed to foster the development of positive attributes in children at high risk for educational problems.

National Institute of Developmental Psychiatry for Children and Adolescents, a science and technology institute Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) AimChildhood maltreatment (CM) has been related to a persistent reprograming of stress-response. Copeptin is a marker of hypothalamic-pituitary-adrenal axis activation however, few studies have examined copeptin levels in children exposed to CM. The aim of this study was to compare serum copeptin levels in children reporting child abuse and/or neglect and children with no history of CM. MethodsThis study included 65 children with a positive history of moderate to severe CM, as reported by themselves and their parent(s) during a clinical interview, and 71 children with no history of CM as a comparison group. CM was considered moderate to severe based on the child-reported frequency of being exposed to events related to sexual abuse, physical abuse, emotional abuse, emotional neglect, and/or physical neglect. Child psychopathology symptoms were assessed using the Child Behavior Checklist (CBCL). We measured serum copeptin concentration using enzyme-linked immunosorbent assay. ResultsChildren exposed to CM exhibited higher levels of serum copeptin compared to children without CM when controlling for sex, age, and psychiatric morbidity. The CBCL total score, including internalizing and externalizing symptoms, was higher in children with CM. We found no correlation between copeptin and CBCL scores for internalizing symptoms and externalizing symptoms. Conclusion CM is associated with copeptin serum levels independently of age, sex, and symptom severity. Copeptin is a promising new biomarker for children with a history of abuse and/or neglect. Pontifical Catholic Univ Rio Grande Sul PUCRS, DCNL, Ave Ipiranga 6681,Predio 11,Sala 928 Partenon, BR-90619900 Porto Alegre, RS, Brazil Univ Fed Rio Grande do Sul, Dept Psychiat, Porto Alegre, RS, Brazil CNPq, Natl Inst Dev Psychiat Children & Adolescents, Sao Paulo, Brazil Fed Univ Sao Paulo UNIFESP, Dept Psychiat, Sao Paulo, Brazil Univ Fed Sao Paulo, Interdisciplinary Lab Clin Neurosci LINC, Sao Paulo, Brazil Univ Sao Paulo, Inst Psychiat IPq, Sao Paulo, Brazil Univ Toronto, Univ Hlth Network, MDPU, Toronto, ON, Canada Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil CNPq: 573974/2008-0 CNPq: 305141/2011-2 CNPq: 476468/ 2012-4 FAPESP: 2008/57896-8 Web of Science

Introduction: Studies suggest that anxiety is an independent predictor of adverse cardiovascular events. However, few studies have investigated the association between cardiovascular risk factors (RF) and severity of anxiety disorders (AD) in childhood and adolescents. Objectives: To assess the prevalence of cardiovascular RF in children and adolescents with anxiety disorders and their association with disease severity. Method: Cross-sectional study assessing nutritional and anthropometric RF, as well as % body fat (BF), blood pressure (BP), physical activity level, anxiety symptoms and severity of the anxiety disorder of children and adolescents. Results: A total of 65 children and adolescents (8.6) 1.7 years) took part in the study. Excess saturated fatty acid intake (52.3%), high body mass index (50.8%), high BP (50.8%) and physical inactivity (50.0%) were the most prevalent cardiovascular RF. There was a significant association between the severity of the anxiety and the presence of > 6 RF per patient (p=0.026), excess abdominal body fat as assessed by waist circumference (p=0.019) and conicity index (p=0,053), and excess % BF (p=0.035). Generalized anxiety disorder was significantly associated with high BP (p=0.044). Conclusion: A high prevalence of cardiovascular RF was found in the present sample, and individuals with more severe anxiety had greater cardiovascular risk. The characterization of the cardiovascular risk in young populations, especially in individuals with AD who are therefore more susceptible to CVD, is crucial for the development of lifestyle interventions in these patients. Introducción: Evidencias sugieren que la ansiedad es una prediciente independiente de los eventos cardiovasculares adversos. Entretanto, pocos estudios evaluaron la presencia de factores de riesgo (FR) para estas enfermedades en niños y adolescentes. Objetivos: Identificar la prevalencia de FR cardiovasculares en niños y adolescentes diagnosticados con disturbio de ansiedad y su asociación con la gravedad de la enfermedad. Metodología: Estudio transversal que evaluó FR nutricional, antropométricos, % de gordura corporal (CG), presión arterial (PA), nivel de actividad física y escalas de síntomas y gravedad de la ansiedad. Resultados: 65 niños y adolescentes (8.6 �± 1.7 años) fueron incluidos en el estudio. Cuanto a los FR, el consumo excesivo de ácidos grasos saturados (52.3%), índice de masa corporal alto (50.8%), PA alterada (50.8%) y la falta de ejercicio físico (50.0%) fueron los mas prevalecientes. Hubo asociación significativa entre la mayor gravedad del disturbio y el acumulo de > 6FR (p=0,026), exceso de gordura abdominal medida por la circunferencia de cintura (p=0.019) y por el indice de conicidad (p=0.053) y exceso en el % GC (p=0.044). Conclusión: Los resultados encontrados indican que hay una alta prevalencia de FR cardiovascular en la muestra estudiada y los pacientes mas graves presentaron mayor riesgo. La caracterización del perfil de riesgo en las poblaciones con predisposición a las enfermedades cardiovasculares es crucial para la elaboración de estrategias de intervención que oportunicen la reducción en la prevalencia de estas enfermedades.

Introduction: Studies suggest that anxiety is an independent predictor of adverse cardiovascular events. However, few studies have investigated the association between cardiovascular risk factors (RF) and severity of anxiety disorders (AD) in childhood and adolescents. Objectives: To assess the prevalence of cardiovascular RF in children and adolescents with anxiety disorders and their association with disease severity. Method: Cross-sectional study assessing nutritional and anthropometric RF, as well as % body fat (BF), blood pressure (BP), physical activity level, anxiety symptoms and severity of the anxiety disorder of children and adolescents. Results: A total of 65 children and adolescents (8.6) 1.7 years) took part in the study. Excess saturated fatty acid intake (52.3%), high body mass index (50.8%), high BP (50.8%) and physical inactivity (50.0%) were the most prevalent cardiovascular RF. There was a significant association between the severity of the anxiety and the presence of > 6 RF per patient (p=0.026), excess abdominal body fat as assessed by waist circumference (p=0.019) and conicity index (p=0,053), and excess % BF (p=0.035). Generalized anxiety disorder was significantly associated with high BP (p=0.044). Conclusion: A high prevalence of cardiovascular RF was found in the present sample, and individuals with more severe anxiety had greater cardiovascular risk. The characterization of the cardiovascular risk in young populations, especially in individuals with AD who are therefore more susceptible to CVD, is crucial for the development of lifestyle interventions in these patients.

Objective: Investigating dimensions of oppositional symptoms may help to explain heterogeneity of etiology and outcomes for mental disorders across development and provide further empirical justification for the DSM-5-proposed modifications of oppositional defiant disorder (ODD). However, dimensions of oppositionality have not previously been tested in samples outside Europe or the United States. In this study, we used a large Brazilian community sample to compare the fit of different models for dimensions of oppositional symptoms; to examine the association of psychiatric diagnoses and symptoms with dimensions of oppositionality; and to examine the associations between dimensions of oppositionality and parental history of mental disorders. Method: A Brazilian community sample of 2,512 children 6 through 12 years old were investigated in this study. Confirmatory factorial analyses were performed to compare the fit of alternative models, followed by linear and logistic regression analyses of associations with psychiatric diagnosis and parental history of psychopathology. Results: A three-factor model with irritable, headstrong, and hurtful dimensions fitted best. The irritable dimension showed a strong association with emotional disorders in the child (p

Objetivo: Testar algumas propriedades psicométricas da versão brasileira do Youth Quality of Life Instrument-Research (YQOL-R) em uma amostra comunitária de adolescentes brasileiros. Métodos: Este é um estudo transversal comunitário realizado em seis escolas localizadas na área de abrangência de uma unidade de saúde da família. De uma população original de 2.754 estudantes com idade entre 10 e 17 anos, selecionamos aleatoriamente 419 para responder à versão brasileira do YQOL-R. Testamos a confiabilidade, as diferenças já conhecidas entre os grupos (utilizando sintomas de ansiedade e envolvimento em episódios de bullying) e a estrutura fatorial. Resultados: O YQOL-R apresentou boa consistência interna, e as diferenças já conhecidas entre os grupos mostraram-se adequadas e estiveram dentro do esperado tanto com relação ao bullying quanto à ansiedade. A estrutura fatorial do modelo conceitual foi em parte fundamentada por nossa análise. Conclusões: A versão brasileira do YQOL-R apresentou propriedades psicométricas suficientemente boas. São necessários mais estudos a fim de melhor investigar configurações alternativas da estrutura fatorial. Objective: To test some psychometric properties of the Brazilian- Portuguese version of the Youth Quality of Life Instrument-Research (YQOL-R) in a community sample of Brazilian adolescents. Methods: This is a cross-sectional community study conducted in six schools of the catchment area of a family health unit. From an original population of 2,754 students from 10 to 17 years old, we randomly selected 419 to answer the Brazilian-Portuguese version of the YQOL-R. We tested reliability, known group differences (using anxiety symptoms and bullying involvement), and factor structure. Results: The YQOL-R showed a good internal consistency and had an adequate and expected known group differences with both bullying and anxiety. The factor structure of the conceptual model was partially supported by our analysis. Conclusions: The Brazilian-Portuguese version of the YQOL-R showed sufficiently good psychometric properties. Further studies are needed in order to better investigate alternative configurations of the factor structure.

OBJETIVOS: Revisar o transtorno do pânico (TP), considerando seus aspectos clínicos, epidemiológicos, diagnósticos e etiológicos, bem como os avanços no tratamento, uma vez que o TP é uma entidade nosológica acompanhada de importante prejuízo psíquico e funcional. MÉTODO: Foi realizada uma revisão narrativa da literatura nas principais bases de dados existentes (MEDLINE, PsychINFO e SciELO) e em livros-textos atualizados. RESULTADOS: Devido à sintomatologia predominantemente física desse transtorno, os pacientes geralmente procuram vários atendimentos clínicos até que o diagnóstico seja feito. Em função desses aspectos e da sua cronicidade, o TP está associado a elevados custos econômicos. O tratamento do TP pode ser feito com psicoterapia e/ou psicofármacos. As diversas abordagens terapêuticas são apresentadas com o nível de evidência de cada recomendação. Em virtude da cronicidade e morbidade do TP, pesquisas têm se voltado para o estudo de estratégias de prevenção já na infância. CONCLUSÕES: O TP é um transtorno crônico e com baixas taxas de remissão dos sintomas em longo prazo. Sendo assim, sugere-se que sejam delineados novos estudos para tratamento precoce dos transtornos de ansiedade ou mesmo para prevenção em crianças de risco. OBJECTIVE: To review panic disorder (PD) considering its clinical, epidemiological, diagnostic, and etiologic aspects, as well as the advances in its treatment, since PD is a nosologic entity characterized by important psychiatric and functional impairment. METHODS: A review of the literature was carried out using the main databases available (MEDLINE, PsychINFO and SciELO) and up-to-date textbooks. RESULTS: Due to the prevalence of physical symptoms in this disorder, patients usually have to seek clinical care for several times before the diagnosis is established. As a result of these aspects and because of its chronicity, PD is associated with high economic costs. PD treatment may include psychotherapy and/or use of psychotropic drugs. In this review, we present several different therapeutic approaches, as well as the levels of evidence of each recommendation. Due to PD chronicity and morbidity, researches have been focused on the study of strategies to prevent PD since childhood. CONCLUSIONS: PD is a chronic disorder with low long-term remission rates. Therefore, we suggest that new studies should be designed concerning the early treatment of anxiety disorders or even the prevention of this disorder in children at risk.

Objective: To evaluate the techniques learned by patients with panic disorder (PD) and residual symptoms after cognitive-behavioral group therapy (CBGT) up to a 2-year follow-up. Methods: Sixty-four PD patients were treated with a 12-session CBGT and 62 (97%) were followed for 2 years after the end of the treatment. Outcomes were evaluated by Clinical Global Impression (CGI), Panic Inventory, and Hamilton Anxiety Scale. The tools used by patients were assessed through a semi-structured interview and classified as follows: (a) diaphragmatic breathing, (b) muscle relaxation; (c) cognitive technique; and (d) exposure. Results: Of the 62 patients assessed at the follow-up, 39 (63%) met the remission criteria (CGI ? 2 and no panic attacks) in the first year and 35 (57%) in the second year of follow-up. Despite meeting the remission criteria, 87% of patients kept using the tools learned in CBGT up to 2 years after the treatment. Diaphragmatic breathing was the most used technique in both periods. Conclusion: The results of the present study suggest that CBGT is efficacious for patients with residual symptoms of PD. The techniques learned during the 12 therapy sessions are used by the patients up to 2 years after the treatment, suggesting long-term benefits of the skills learned at CBGT protocols. Objetivo: Avaliar a utilização das técnicas aprendidas durante a terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) que apresentam sintomas residuais em até 2 anos após o término do tratamento. Méto-dos: Um total de 64 pacientes completou o protocolo de 12 sessões de TCCG, e 62 (97%) foram encontrados para avaliação 2 anos após o término da terapia. As medidas de desfecho foram avaliadas pelos seguintes instrumentos: Impressão Global Clínica (CGI), Inventário de Pânico e Escala Hamilton para Ansiedade. O uso das técnicas foi avaliado através de entrevista semi-estruturada nas avaliações de seguimento, sendo classificadas em: (a) respiração diafragmática; (b) relaxamento muscular; (c) técnica cognitiva; e (d) exposição. Resultados: Considerando os 62 pacientes avaliados no seguimento, 39 (63%) preencheram o critério de remissão (CGI ? 2 e ausência de ataques de pânico) no primeiro ano e 35 (57%) no segundo ano de seguimento. A despeito dos critérios de remissão, um número grande de pacientes (87%) continuava a utilizar as técnicas aprendidas durante a terapia 1 a 2 anos após o término do protocolo. A técnica mais utilizada em ambos os períodos de seguimento foi a respiração diafragmática. Conclusões: Os resultados sugerem que a TCCG é eficaz para pacientes com sintomas residuais de TP. O uso das técnicas aprendidas durante as 12 sessões foi evidenciado em até 2 anos após o término do tratamento, sugerindo benefícios em longo prazo das habilidades desenvolvidas na TCCG.

Objetivo: Avaliar a utilização das técnicas aprendidas durante a terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) que apresentam sintomas residuais em até 2 anos após o término do tratamento. Méto-dos: Um total de 64 pacientes completou o protocolo de 12 sessões de TCCG, e 62 (97%) foram encontrados para avaliação 2 anos após o término da terapia. As medidas de desfecho foram avaliadas pelos seguintes instrumentos: Impressão Global Clínica (CGI), Inventário de Pânico e Escala Hamilton para Ansiedade. O uso das técnicas foi avaliado através de entrevista semi-estruturada nas avaliações de seguimento, sendo classificadas em: (a) respiração diafragmática; (b) relaxamento muscular; (c) técnica cognitiva; e (d) exposição. Resultados: Considerando os 62 pacientes avaliados no seguimento, 39 (63%) preencheram o critério de remissão (CGI ? 2 e ausência de ataques de pânico) no primeiro ano e 35 (57%) no segundo ano de seguimento. A despeito dos critérios de remissão, um número grande de pacientes (87%) continuava a utilizar as técnicas aprendidas durante a terapia 1 a 2 anos após o término do protocolo. A técnica mais utilizada em ambos os períodos de seguimento foi a respiração diafragmática. Conclusões: Os resultados sugerem que a TCCG é eficaz para pacientes com sintomas residuais de TP. O uso das técnicas aprendidas durante as 12 sessões foi evidenciado em até 2 anos após o término do tratamento, sugerindo benefícios em longo prazo das habilidades desenvolvidas na TCCG., Objective: To evaluate the techniques learned by patients with panic disorder (PD) and residual symptoms after cognitive-behavioral group therapy (CBGT) up to a 2-year follow-up. Methods: Sixty-four PD patients were treated with a 12-session CBGT and 62 (97%) were followed for 2 years after the end of the treatment. Outcomes were evaluated by Clinical Global Impression (CGI), Panic Inventory, and Hamilton Anxiety Scale. The tools used by patients were assessed through a semi-structured interview and classified as follows: (a) diaphragmatic breathing, (b) muscle relaxation; (c) cognitive technique; and (d) exposure. Results: Of the 62 patients assessed at the follow-up, 39 (63%) met the remission criteria (CGI ? 2 and no panic attacks) in the first year and 35 (57%) in the second year of follow-up. Despite meeting the remission criteria, 87% of patients kept using the tools learned in CBGT up to 2 years after the treatment. Diaphragmatic breathing was the most used technique in both periods. Conclusion: The results of the present study suggest that CBGT is efficacious for patients with residual symptoms of PD. The techniques learned during the 12 therapy sessions are used by the patients up to 2 years after the treatment, suggesting long-term benefits of the skills learned at CBGT protocols.

Human brain structure changes throughout our lives. Altered brain growth or rates of decline are implicated in a vast range of psychiatric, developmental, and neurodegenerative diseases. While heritable, specific loci in the genome that influence these rates are largely unknown. Here, we sought to find common genetic variants that affect rates of brain growth or atrophy, in the first genome-wide association analysis of longitudinal changes in brain morphology across the lifespan. Longitudinal magnetic resonance imaging data from 10,163 individuals aged 4 to 99 years, on average 3.5 years apart, were used to compute rates of morphological change for 15 brain structures. We discovered 5 genome-wide significant loci and 15 genes associated with brain structural changes. Most individual variants exerted age-dependent effects. All identified genes are expressed in fetal and adult brain tissue, and some exhibit developmentally regulated expression across the lifespan. We demonstrate genetic overlap with depression, schizophrenia, cognitive functioning, height, body mass index and smoking. Several of the discovered loci are implicated in early brain development and point to involvement of metabolic processes. Gene-set findings also implicate immune processes in the rates of brain changes. Taken together, in the world’s largest longitudinal imaging genetics dataset we identified genetic variants that alter age-dependent brain growth and atrophy throughout our lives. One-sentence summary We identified common genetic variants associated with the rate of brain development and aging, in longitudinal MRI scans worldwide.

The results leading to this publication have received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Any views expressed are those of the author(s) and not necessarily those of the funders.