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3. Ketamine study: Protocol for naturalistic prospective multicenter study on subcutaneous ketamine infusion in depressed patients with active suicidal ideation

Author

Anzolin, Ana Paula, primary, Goularte, Jeferson Ferraz, additional, Pinto, Jairo Vinícius, additional, Belmonte-de-Abreu, Paulo, additional, Cruz, Luciane Nascimento, additional, Cordova, Victor Hugo Schaly, additional, Magalhaes, Lucas Sueti, additional, Rosa, Adriane R., additional, Cereser, Keila Maria, additional, and Kauer-Sant’Anna, Márcia, additional

Published
2023
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10. Clozapine prescription trends in Brazil in the last decade

Author

Massuda, Raffael, Gama, Clarissa S., Belmonte-de-Abreu, Paulo, Elkis, Helio, de Lucena, David Freitas, Bressan, Rodrigo, Noto, Cristiano, and Gadelha, Ary

Subjects
schizophrenia, treatment-resistant, antipsychotics, Clozapine
Abstract

Objective: Clozapine is a second-generation antipsychotic indicated for treatment-resistant schizophrenia. Studies in several countries have shown a low rate of clozapine use despite the fact that approximately 30% of schizophrenia cases are treatment-resistant. In Brazil, few studies have addressed the frequency and variety of antipsychotic use in individuals diagnosed with schizophrenia (ICD F20). The objective of this study was to measure the rates of clozapine use in this population in the last decade using Brazilian Ministry of Health data. Methods: Prescriptions made between 2010 and 2020 in all 26 states and the Federal District registered at the Outpatient Information System Database from the Brazilian Health System (SIASUS) were evaluated. Results: A total of 25,143,524 prescriptions were recorded in this period, with clozapine representing 8.86% of all antipsychotics. The most frequently prescribed antipsychotic for patients with schizophrenia was olanzapine (35.8%), followed by quetiapine (27.5%). From 2010 to 2020, the rate of clozapine prescriptions in Brazil increased from 7.2% to 10.9%. Conclusions: Despite a slight increase in prescriptions in the last decade, clozapine is still underutilized in Brazil.

Published
2022

11. Cognitive Deficits in Adults with ADHD Go beyond Comorbidity Effects

Author

Silva, Katiane L., Guimaraes-da-Silva, Paula O., Grevet, Eugenio H., Victor, Marcelo M., Salgado, Carlos A. I., Vitola, Eduardo S., Mota, Nina R., Fischer, Aline G., Contini, Veronica, Picon, Felipe A., Karam, Rafael G., Belmonte-de-Abreu, Paulo, Rohde, Luis A., and Bau, Claiton H. D.

Abstract

Objective: This study addresses if deficits in cognitive, attention, and inhibitory control performance in adults with ADHD are better explained by the disorder itself or by comorbid conditions. Method Adult patients with ADHD ("n" = 352) and controls ("n" = 94) were evaluated in the ADHD program of a tertiary hospital. The diagnostic process for ADHD and comorbidities was based on "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV") criteria. Stepwise regression analyses evaluated the effect of ADHD, demographics, and comorbidities on the scores from Wechsler Adult Intelligence Scale-Revised, Continuous Performance Test, and Stroop Color and Word Test. Results: Patients with ADHD of both genders had worse performance on neuropsychological domains, even after adjustment for comorbidities. The presence of comorbid bipolar disorder and specific phobia are associated with more Stroop errors, whereas patients with generalized anxiety disorder present a longer execution time in Stroop. Conclusion: Neuropsychological deficits in adults with ADHD go beyond comorbidity. Specific comorbid disorders may influence the neuropsychological functioning in adults with ADHD. (Contains 2 tables.)

Published
2013
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16. The Association of Child Abuse and Neglect with Adult Disability in Schizophrenia and the Prominent Role of Physical Neglect

Author

Gil, Alexei, Gama, Clarissa S., de Jesus, Danilo Rocha, Lobato, Maria Ines, Zimmer, Marilene, and Belmonte-de-Abreu, Paulo

Abstract

Objective: To assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia. Method: Ninety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT). Results: Childhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior (p = 0.023) and Global Evaluation (p = 0.032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior (p less than 0.000), Social Role Performance (p = 0.037) and Global Evaluation (p = 0.014). Higher emotional abuse was associated with impaired Overall Behavior (p = 0.026), and higher emotional neglect with poor Global Evaluation (p = 0.047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior (p = 0.042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality. Conclusions: Childhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability. Practice implications: Further investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia. (Contains 4 tables.)

Published
2009
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19. Ketamine study: Protocol for naturalistic prospective multicenter study on subcutaneous ketamine infusion in depressed patients with active suicidal ideation.

Author

Paula Anzolin, Ana, Ferraz Goularte, Jeferson, Vinícius Pinto, Jairo, Belmonte-de-Abreu, Paulo, Nascimento Cruz, Luciane, Schaly Cordova, Victor Hugo, Sueti Magalhaes, Lucas, Rosa, Adriane R., Maria Cereser, Keila, and Kauer-Sant'Anna, Márcia

Subjects
KETAMINE abuse, COLUMBIA-Suicide Severity Rating Scale, SUICIDAL ideation, SUBCUTANEOUS infusions, KETAMINE, SUICIDE risk factors
Abstract

Background: Psychiatric disorders are associated with more than 90% of reported suicide attempts worldwide, but few treatments have demonstrated a direct effect in reducing suicide risk. Ketamine, originally an anesthetic, has been shown anti-suicide effects in clinical trials designed to treat depression. However, changes at the biochemical level were assessed only in protocols of ketamine with very limited sample sizes, particularly when the subcutaneous route was considered. In addition, the inflammatory changes associated with ketamine effects and their correlation with response to treatment, dose-effect, and suicide risk warrant further investigation. Therefore, we aimed to assess whether ketamine results in better control of suicidal ideation and/or behavior in patients with depressive episodes and whether ketamine affects psychopathology and inflammatory biomarkers. Materials and methods: We report here the design of a naturalistic prospective multicenter study protocol of ketamine in depressive episodes carried out at Hospital de Clínicas de Porto Alegre (HCPA) and Hospital Moinhos de Vento (HMV). The study was planned to recruit adult patients with Major depressive disorder (MDD) or Bipolar disorder (BD) types 1 or 2, who are currently in a depressive episode and show symptoms of suicidal ideation and/or behavior according to the Columbia-Suicide Severity Rating Scale (C-SSRS) and have been prescribed ketamine by their assistant psychiatrist. Patients receive ketamine subcutaneously (SC) twice a week for 1 month, but the frequency can be changed or the dose decreased according to the assistant physician's decision. After the last ketamine session, patients are followed-up via telephone once a month for up to 6 months. The data will be analyzed using repeated measures statistics to evaluate the reduction in suicide risk as a primary outcome, as per C-SSRS. Discussion: We discuss the need for studies with longer follow-ups designed to measure a direct impact on suicide risk and that additional information about the safety and tolerability of ketamine in particular subset of patients such as those with depression and ideation suicide. In line, the mechanism behind the immunomodulatory effects of ketamine is still poorly understood. [ABSTRACT FROM AUTHOR]

Published
2023
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20. Similarities in serum oxidative stress markers and inflammatory cytokines in patients with overt schizophrenia at early and late stages of chronicity

Author

Pedrini, Mariana, Massuda, Raffael, Fries, Gabriel R., de Bittencourt Pasquali, Matheus A., Schnorr, Carlos Eduardo, Moreira, José Claudio F., Teixeira, Antonio L., Lobato, Maria Ines R., Walz, Julio C., Belmonte-de-Abreu, Paulo Silva, Kauer-Sant’Anna, Marcia, Kapczinski, Flavio, and Gama, Clarissa S.

Published
2012
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36. The role of a mineralocorticoid receptor gene functional polymorphism in the symptom dimensions of persistent ADHD

Author

Kortmann, Gustavo Lucena, Contini, Verônica, Bertuzzi, Guilherme Pinto, Mota, Nina Roth, Rovaris, Diego Luiz, Paixão-Côrtes, Vanessa Rodrigues, de Lima, Leandro Leal, Grevet, Eugenio Horacio, Salgado, Carlos Alberto Iglesias, Vitola, Eduardo Schneider, Rohde, Luis Augusto, Belmonte-de-Abreu, Paulo, and Bau, Claiton Henrique Dotto

Published
2013
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