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RESUMO Objetivo: Na prática clínica, é importante diferenciar problema e conflito, porque os passos sugeridos na técnica de resolução de problemas costumam não ser suficientes para auxiliar o cliente a lidar com conflitos. Esta revisão sistemática teve como objetivos: investigar como a terapia cognitivo-comportamental (TCC) pode auxiliar na resolução de problemas e na mediação de conflito; sugerir uma estratégia que favoreça a melhor capacidade de mediar conflitos (QPD). Métodos: Foi realizada uma busca nas bases de dados: PubMed, PsycINFO, Web of Science (ISI) e Scopus. O método prisma foi utilizado, e foram selecionados para leitura na íntegra artigos experimentais. Resultados: Trezentos e sessenta e quatro ensaios clínicos aplicaram a resolução de problemas, apontando a eficácia dessa técnica juntamente com outras estratégias/intervenções da TCC. Livros-guias de TCC: não diferenciam problema e conflito; descrevem detalhadamente passos para resolução de problemas, focando na perspectiva do cliente, no momento presente e no uso da razão lógica; não abordam a mediação de conflitos pela TCC. Sugerimos uma estratégia que pode ajudar na mediação de conflitos: auxiliando na coleta/organização de informações; melhorando a comunicação – empática e assertiva; favorecendo escolhas com o intuito de causar o menor dano possível a todas as partes envolvidas no conflito. Conclusões: Para treinar terapeutas para aplicarem a resolução de problemas, há descrição detalhada dos passos a serem seguidos. Entretanto, para capacitar os terapeutas para mediarem conflitos, práticas clínicas que têm sido frequentemente descritas/utilizadas nas terapias cognitivas contextuais podem ser necessárias: aceitação psicológica, mindfulness , entender valores individuais, vivenciar/considerar a emoção em tomadas de decisão, ativar a compaixão/autocompaixão.

Alterations in the immune system have been associated with a variety of mental illnesses. An increase in circulating inflammatory cytokines is observed not only in people with mental disorders but also in their first-degree relatives. A considerable amount of data support the link between immune system activation and panic disorder (PD) pathogenesis, while it is still unclear whether differential immunological reactivity represents a propensity, a measure of disease activity, or both. To better understand the role of cytokines in PD pathophysiology, we compared the levels of serum inflammatory biomarkers interleukin (IL)-1B and IL-2R among PD patients, offspring of PD patients and healthy controls. The offspring of PD patients were evaluated by a psychiatrist and were considered unaffected by any mental disorder at the time of the evaluation. Concentrations of the cytokines IL-1B and IL-2R were assessed using the Immulite System (Diagnostic Products Corporation). The levels of proinflammatory markers IL-1B and IL-2R were increased in PD patients compared to those of controls, but offspring of PD patients and healthy controls demonstrated no differences regarding peripheral interleukin levels. Our findings suggest that interleukins might represent a disease-dependent marker in PD.

Introduction: Coronavirus (COVID-19) pandemic has caused social and economic damages. People have adapted to a new reality of physical distance. Objective: The study aimed to assess the use of digital devices and social media, focusing on psychosocial and demographic factors of people´s sexual behavior during the pandemic. Methods: A total of 1,357 Brazilian adults participated in a cross-sectional online survey. They were recruited through social media to obtain information regarding sexual behavior and the use of digital devices and social media. Results: Digital devices and social media were used by 38.8% of the participants. Among the group that used technological devices, most claimed to have changed their sexual behavior, with 76.9% consuming more sexual content through movies or series. Conclusion: In a smaller group, technological resources appeared as an alternative for safer sex, reducing the risks of COVID-19 transmission.

BackgroundDementia is a clinical syndrome which is more common in elderly people. Dementia with Lewy bodies (LBD) is not so rare in elderly people, with cognitive impairment in about 30% over age 65. The clinical picture is characterized by fluctuation in cognitive functions, recurrent, well-formed, detailed visual hallucinations, and Parkinsonism, with rigidity, tremor, bradykinesia, and slurred speech.Case presentationWe present a case report of LBD in a 73-year-old retired teacher, which a initial wrong diagnosis of refractory depression for at least 3 years. We also conduct a review of recent works on theme.ConclusionLBD diagnosis can be neglected for years, with a legal and clinical issues to patients and their families. Detailed medical research, including differential diagnosis, are very necessary on those cases, specially when they are called refractory. We encourage new research and adequate clinical training to prevent damage.

Background: Alterations of sexual functions are frequent in major depressive disorder (MDD), however there are little data on sexual functions in patients with treatment-resistant depression (TRD).Aim: To assess sexual desire impairment in patients with TRD.Methods: Baseline data were analyzed from an ongoing cohort study from an outpatient clinic specialized in TRD treatment in Brazil. The cohort comprised consecutive patients with the diagnosis of TRD that sought treatment in this center.Main outcome measures: The Hamilton Depression Rating Scale (HAMD) Genital Symptoms Item (item 14) was used as a proxy to assess sexual desire impairmentResults: Sixty-five participants with TRD were included. There was sexual desire impairment in 67.7% of patients. Men (87.5%) were more affected than women (61.2%) and depression severity was associated with greater complaints of this aspect of sexual function.Clinical Implications: Our findings suggest that health care professionals should systematically assess sexual desire in patients with TRD in daily clinical practice.Strengths & Limitations: To our knowledge, this is the first study to assess impairment in sexual desire in TRD. A major limitation that need to be addressed in future studies is the reliance on item 14 of the HAMD, which was not designed specifically for assessing sexual dysfunction.Conclusion: Participants with TRD had a high prevalence of sexual desire impairment, this being associated with greater depressive symptoms severity and male gender. Further longitudinal studies are needed, in larger samples, using specific instruments for assessing sexual dysfunction comparing TRD and non-TRD populations.

Background Despite controversial evidence, intra-aortic balloon pump (IABP) is still the most used temporary mechanical support in cardiogenic shock (CS), as a bridge to recovery or to more advanced mechanical support and/or heart transplantation [1]. Indeed, the available evidence, which is mainly restricted to the context of acute coronary syndromes (ACS) and is limited by the variability of CS definitions, shows no benefit in terms of mortality [2]. Randomized controlled trials on IABP in the setting of non-ACS CS are still missing. As a result, European guidelines do not recommend the routine use of IABP, which may be considered in refractory CS [3]. Purpose The aim of our study was to analyse the use of IABP in the context of CS, providing insights into its indications, outcomes, and complications in relation to the aetiology (ACS vs non-ACS) of CS. Methods We retrospectively enrolled all consecutive adult patients receiving IABP for refractory CS at our tertiary referral Hospital between 2009 and 2018, and analysed data focusing on in-hospital outcomes, including death, recovery, heart transplantation, and escalation to more advanced mechanical support such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or left ventricular assist device (LVAD), and on IABP-related complications. Results 403 patients received IABP, 75.2% (n=303) for ACS CS and 24.8% (n=100) for non-ACS CS. With respect to ACS patients, non-ACS patients were younger (age 59±18.3 vs 73.1±12.6 years old, p0.05]. The incidence of IABP-related overall and major complications (including ischemic stroke, major bleeding, and peripheral or visceral ischemia) was not different with respect to the non-ACS vs ACS aetiology [major complications: 8.0% (n=8) vs 5.0% (n=15), p>0.05]. Conclusions In our experience, in the clinical setting of CS treated with IABP, non-ACS patients show a worse clinical profile and prognosis than ACS patients, and more often require escalation to more advanced mechanical support and/or heart transplantation, while the incidence of IABP-related complications appears similar independently of the aetiology. Funding Acknowledgement Type of funding sources: None.

73 year old male. He has a brother with an unspecified heart disease, three children, all in good health. Former smoker, arterial hypertension, bilateral carpal tunnel syndrome for several years. Therapy used: zofenopril 7.5 mg 1 cp/day. In August 2019 hospitalization for acute heart failure. Echocardiogram showed severe concentric left ventricular hypertrophy with a granular sparkling myocardial appearance, moderately reduced EF, moderate mitral regurgitation, restrictive transmitral pattern, and pulmonary hypertension (PAPS 60 mmHg). ICV with increased dimensions and not collapsible. Moderate circum–cardiac pericardial effusion. During this hospitalization, therapy with an ACE inhibitor, beta blocker and MRI was started with clear clinical benefit. He also started anticoagulant therapy for evidence of atrial fibrillation. At discharge, NYHA class II. Myocardial scintigraphy with bone tracer was positive for the presence of grade 2 myocardial uptake according to the Perugini score. Blood chemistry tests were performed to exclude the AL form and finally the genetic test showed the presence of a mutation on the transthyretin Val122Ile gene (mutation associated with a variant of amyloidosis with a predominantly cardiological phenotype). Then, heart failure therapy was optimized and disease modifying therapy was started with Tafamidis 61 mg/day. Over time there was a reduction in left ventricular function, so sacubitril/valsartan was started; this drug was not tolerated due to hypotensive episodes. The NYHA class has however always remained stable (class II). During the follow–up in September 2022 he had a new hospitalization for heart failure during which the therapy was optimized with the insertion of the SGLT–2 inhibitor, which was well tolerated. During this hospitalization, symptoms related to the neurological involvement of the pathology emerged: severe weight loss and paresthesias in the four limbs for which it was decided to associate therapy with patisiran IV. To date, the approved therapy for amyloid cardiomyopathy is tafamidis but, in consideration of the neurological symptoms and the results obtained from patisiran in patients with the variant form, it was decided to associate the two therapies, taking care to also optimize therapy for heart failure.

Aim: The present study investigated the differences between the Panic Disorder (PD) patients groups’ and healthy controls for the EEG alpha dynamics under the frontal cortex and reaction time during the oddball task. Material and Methods: The reaction time during the oddball paradigm concomitant to EEG alpha power was tested in nine PD patients and ten healthy controls before and after a computer simulation presentation. Results: The findings revealed a decrease in EEG alpha power in PD patients concerning the control group (p ≤ 0.0125). However, both groups demonstrated an increased cortical oscillation after the computer simulation, except for the Fp1 electrode during M3 moment in the experimental group. The experimental group has a fast reaction time compared to healthy individuals during the oddball task (p = 0.002). Conclusions: We propose that the decrease in EEG alpha power in the PD patients may indicate an increase in processing related to an anxiogenic stimulus and interference of the anxiety state that compromises the inhibitory control. The reaction time task reveals cognitive symptoms in the experimental group, which may be related to the faster reactivity and high impulsivity to stimuli.

From a neurobiological perspective, diverse studies have associated emotional regulation with cognitive deficits. Structural and/or metabolic changes in the frontal cortex are often inferred from dysfunction in cognitive-emotional processing. In addition, electroencephalographic findings support the idea that alpha band oscillations are responses to these same processes. Thus, the objective of this meta-analytical literature review is to verify whether the possible hemispheric lateralization attributed to frontal alpha asymmetry (FAA) correlates with emotional regulation and the cognitive deficits underlying depression. The data included in our meta-analysis are from articles published from 2009 to July 2020, which utilized DSM or ICD criteria to diagnose depression or anxiety disorders and included a control group. For statistical analysis, the measurements obtained through the 10–20 electroencephalography system were used. The frontal alpha asymmetry index was calculated from the difference between the logarithm of the absolute spectral values in the alpha rhythm observed from the F4 and F3 electrodes that were fixed to the scalp of the frontal region of the right and left hemispheres (ln µV² RH−ln µV² LH) = (F4−F3). Eighteen articles were included in the systematic review. Of these, 9 were homogeneous enough for statistical analyses (total N: 1061; NDep: 326; Ncont: 735). Nine others could not be statistically analyzed due to the absence of FAA measurements from the F4 and F3 electrodes. A random effects meta-analysis revealed low heterogeneity (Qt = 11,00, df = 8, p = 0.20, I2 = 27%) and an average effect size of the studies equal to −0.03 (CI = [−0.07 to 0.01]). The results, although not significant, suggested a slight tendency toward left lateralization in the depression group. Although the effects shown in these data did not confirm hemispherical lateralization in depressed patients, it was found that emotional regulation and cognitive processes share similar neural circuits. Therefore, future research on this complex relationship is encouraged, especially studies that are focused on the search for quantitative biological markers in depression.

The offspring of parents with Anxiety Disorders (AD) are at high risk for different types of psychopathology, including AD. However, little is known about how parental anxiety during pregnancy and/or the postnatal period might result in alterations in behavior or neurodevelopmental changes in offspring. To examine the effect of parental AD on offspring behavior and neurodevelopment, we conducted a systematic review.Following PRISMA guidelines, we searched the Web of Science, PubMed, and PsycINFO databases.Forty-seven articles met the inclusion criteria for the systematic review. Prenatal maternal anxiety is related to negative temperament, increased attention to fearful vocalizations, decreased alertness, and impaired psychomotor and cognitive development in early and middle childhood. AD during the postnatal period is associated with greater negative temperament, internalizing symptoms, and anxiety symptoms in early childhood, middle childhood, and adolescence.Our review is the first to demonstrate that prenatal and postnatal AD symptoms impact offspring. Future research should explore the mediating and moderating factors leading to the development of psychopathology in the offspring of parents with AD.

This paper provides an integrative review of psychometric instruments targeting sexual function and clinical measures of sexuality available to the Brazilian population. Our aim was to summarize the existing measures, indicating current development needs related to the quality of psychometric evidence, research design and untapped theoretical ground that could be relevant for clinical practice and research in sexuality. Electronic databases were searched. Additional records were found through a manual search. The general search terms and operators were (scale OR inventory OR questionnaire) AND (validation) AND (sexual beliefs OR sexuality OR sexual behavior OR sexual function OR sexual satisfaction) AND (Brazil or Brazilian). The results indicate a total of 18 developed or transculturally adapted and/or validated scales and questionnaires available in Brazilian Portuguese, covering sexual dysfunctions and clinical measures. Despite development, adaptation and validation efforts, there is a critical need for better psychometric and sampling strategies as well as norms for the clinical interpretation of test results. Ecological validity is also a challenge. At present, sexual assessments in Brazil offer some useful information, but reaching the applied clinical field remains a challenge.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2022.2035869 .

Although accumulating evidence suggests that inflammatory processes play a role in the pathophysiology of mental disorders, few studies have investigated this matter in panic disorder (PD). Furthermore, no studies to date have evaluated cytokine levels in drug-naïve patients with PD. Therefore, little is known about the presence of inflammation at the onset of this disorder. The aim of the present study was to determine the levels of the proinflammatory interleukins IL-1B and IL-2R and the anti-inflammatory cytokine IL-10 in drug-naïve PD patients. Analysis of serum chemokine levels revealed increased proinflammatory activity in the early phase of PD through increased IL-2R and IL-1B levels and a decrease in IL-10 levels in drug-naïve PD patients compared to matched healthy controls. Neurotransmitters and neurocircuits that are targets of inflammatory responses are discussed, followed by an examination of brain–immune interactions as risk factors for PD. This study is the first to identify a proinflammatory cytokine response in drug-naïve PD subjects. These findings indicate that treatments targeting proinflammatory markers may ameliorate anxiety symptoms in PD patients.

Background Withdrawal syndromes can occur after dose reduction or discontinuation of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Few measurement instruments are available to assess them: Diagnostic Clinical Interview for Drug Withdrawal 1-New Symptoms of SSRI and SNRI (DID-W1) and Discontinuation Emergent Signs and Symptoms (DESS) checklist. We assessed their interrater reliability, verified the percent agreement between the two, and tested DESS sensitivity and specificity on the basis of the diagnoses formulated via the DID-W1. Methods One-hundred thirty-four subjects who referred for withdrawal at 3 outpatient facilities were enrolled and assessed via the DESS and the DID-W1. Percent agreement and Cohen kappa were calculated to measure DID-W1 and DESS interrater reliability, as well as the agreement between DID-W1 and DESS items. Sensitivity and specificity of DESS were derived from the identification of true-positive, false-negative, true-negative, and false-positive on the DID-W1. Results Both tools showed excellent interrater reliability (DID-W1 Cohen kappa = 0.958; DESS Cohen kappa = 0.81-1). The degree of agreement between DID-W1 and DESS items was poor or fair (Cohen kappa < 0.40) for some items and moderate (Cohen kappa = 0.41-0.60) for others. Sensitivity and specificity of DESS were 0.937 (true-positive = 60, false-negative = 4) and 0.285 (true-negative = 20, false-positive = 50), respectively. Conclusions DID-W1 was a reliable method to identify and diagnose withdrawal syndromes. The DESS checklist showed to be a useful tool for detecting withdrawal SSRI/SNRI symptoms when the aim is to achieve high sensitivity to identify true positives.

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive–Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). Method: A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. Result: This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. Conclusion: It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive–Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. Method: A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. Result: The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders. For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs. Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated. For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option. Conclusion: OCD and PTSD can be effectively treated with CBT and medications.

Background: The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life-threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment. Methods: A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: “quality of life” OR “health-related quality of life” OR “QoL” OR “HRQoL” OR “H-QoL” AND “chronic myeloid leukemia”. Interval was set from January 2000 to December 2020. Results: 40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment versus TKI therapy as usual. The results of all these trials were examined and discussed. Conclusion: All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects.

Humanity is sporadically subjected to leaders with deviant behavior, ego problems, or psychiatric disorders, potentially leading to social instability. Bipolar disorder is not common in all populations, but coincidentally, studies suggest that it affected two sovereigns that were contemporaries, King George III of England, who died 201 years ago, and Queen Maria I of Portugal, who died 205 years ago. They lived during a time of European turmoil with the French Revolution and Napoleonic Wars, coinciding with the rise of psychiatry. Both monarchs were forced to have prince regents to rule in their place, due to their emotional decline, and they shared the same medical consultant, Francis Willis.

Positron beams, both polarized and unpolarized, are identified as essential ingredients for the experimental programs at the next generation of lepton accelerators. In the context of the hadronic physics program at Jefferson Lab (JLab), positron beams are complementary, even essential, tools for a precise understanding of the electromagnetic structure of nucleons and nuclei, in both the elastic and deep-inelastic regimes. For instance, elastic scattering of polarized and unpolarized electrons and positrons from the nucleon enables a model independent determination of its electromagnetic form factors. Also, the deeply-virtual scattering of polarized and unpolarized electrons and positrons allows unambiguous separation of the different contributions to the cross section of the lepto-production of photons and of lepton-pairs, enabling an accurate determination of the nucleons and nuclei generalized parton distributions, and providing an access to the gravitational form factors. Furthermore, positron beams offer the possibility of alternative tests of the Standard Model of particle physics through the search of a dark photon, the precise measurement of electroweak couplings, and the investigation of charged lepton flavor violation. This document discusses the perspectives of an experimental program with high duty-cycle positron beams at JLab., Comment: 18 pages, 7 figures This version superseeds the previous version which scientific content was decomposed into several more elaborated articles. All of these articles will be collected in the EPJ A Topical Issue about "Positron beam and physics at Jefferson Lab (e+@Jlab)"

Financiado para publicación en acceso aberto: Universidade da Coruña/CISUG [Abstract] To promote a circular economy and sustainable development, the possibility of using a lignin-rich industrial byproduct as a partial substitute for asphalt emulsions in road pavements is analysed. A half-warm mix reclaimed asphalt (HWMRA)-type AC 16 surf S, manufactured with 100% reclaimed asphalt pavement, is selected. Substitution percentages of 0% (control mixture), 5%, 10%, 15%, and 20% are employed. The microstructure of the blend of the byproduct and asphalt emulsion is observed using scanning electron microscopy. The water resistance of the mixture is investigated using indirect tensile tests, as well as its volumetric properties. The stiffness, thermal susceptibility by indirect tensile tests, and resistance to permanent deformation by confined uniaxial compression tests and Hamburg wheel tracking tests are also studied. The optimum percentage of byproduct substitution is 5%, resulting in an enhanced HWMRA with a slightly better water resistance, higher resistance to permanent deformation at low and medium environmental temperatures, and higher indirect tensile strength and stiffness than those of the control mix. This work was supported by the Spanish Ministry of Science, Innovation and Universities through the project PID2019-110985RB-I00 (“Programa Estatal de Generación de Conocimiento y Fortalecimiento Científico y Tecnológico del Sistema de I + D + i y en el marco del Programa Estatal de I + D + i Orientada a los Retos de la Sociedad, del Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020”)