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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.

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.

AIMS: To verify the profile of the elderly and their main diagnoses in the geriatrics psychiatric outpatient clinic and the psychiatric hospitalization unit of a tertiary hospital. METHODS: A cross-sectional study of population-based was performed in a tertiary referral hospital, with individuals aged ≥55 years attending the geriatric psychiatric outpatient clinic and psychiatric hospitalization, from 2014 to 2018. Data were collected through interviews. The studied variables were sociodemographic and clinical aspects. RESULTS: A total of 497 individuals were evaluated, 269 from the psychiatric outpatient clinic and 228 from the psychiatric hospital. The mean age was 69.34±8.87 years. Most of the patients were female (75.8%), had no partner (56.3%), had primary education (50.3%), lived in Porto Alegre (75.6%) and were retired (66.5%). According to the clinical variables studied, 89.6% of the individuals had some morbidity, 36.9% had already been admitted to the psychiatric ward, the most common diagnosis was depression (40.8%), followed by bipolar disorder (19%) and anxiety (14.1%). CONCLUSIONS: With the population aging, it is expected to increase morbidity and mental disorders, requiring more specific diagnostic tools and better treatment approaches. There are still no consistent data on the management of mood disorders in the elderly, so our study can guide a better care for elderly and aging individuals, improving the planning of health services and policies. OBJETIVOS: Verificar el perfil de ancianos y sus principales diagnósticos en el ambulatorio de psiquiatría geriátrica y unidad de internación psiquiátricade un hospital terciario. MÉTODOS: Estudio transversal de base poblacional realizado en un hospital terciario de referencia, con individuos con edad ≥55 años atendidos en el ambulatorio de psiquiatría geriátrica y en la internación psiquiátrica, en el período de 2014 a 2018. Los datos fueron recolectados por medio de entrevista. Las variables estudiadas fueron sociodemográficas y aspectos clínicos. RESULTADOS: Se evaluaron 497 individuos, de estos 269 procedentes del ambulatorio de psiquiatría y 228 de la internación psiquiátrica. El promedio de edad fue de 69,34±8,87 años. La mayoría de los pacientes eran del sexo femenino (75,8%), no tenían compañero (56,3%), tenían la enseñanza fundamental (50,3%), residían en Porto Alegre (75,6%) y eran jubilados 66,5%). De acuerdo con las variables clínicas estudiadas, el 89,6% de los individuos poseía alguna morbilidad, el 36,9% ya habían sido internados en ala psiquiátrica, el diagnóstico más encontrado fue de depresión (40,8%), seguido de trastorno del humor bipolar (19%) y ansiedad (14,1%). CONCLUSIONES: Con el envejecimiento poblacional se espera el aumento de las morbilidades y de los trastornos mentales, exigiendo herramientas diagnósticas más específicas y mejores abordajes de tratamiento. No hay datos consistentes sobre el manejo de los trastornos del humor en los ancianos, por lo que nuestro estudio puede guiar una mejor atención a los ancianos e individuos que están envejeciendo, mejorando la planificación de los servicios y políticas de salud. OBJETIVOS: Verificar o perfil de idosos e seus principais diagnósticos no ambulatório de psiquiatria geriátrica e unidade de internação psiquiátrica de um hospital terciário. MÉTODOS: Estudo transversal de base populacional realizado em um hospital terciário de referência, com indivíduos com idade ≥55 anos atendidos no ambulatório de psiquiatria geriátrica e na internação psiquiátrica, no período de 2014 a 2018. Os dados foram coletados por meio de entrevista. As variáveis estudadas foram sociodemográficas e aspectos clínicos. RESULTADOS: Foram avaliados 497 indivíduos, destes 269 procedentes do ambulatório de psiquiatria e 228 da internação psiquiátrica. A média de idade foi de 69,34±8,87 anos. A maioria dos pacientes eram do sexo feminino (75,8%), não possuíam companheiro (56,3%), tinham o ensino fundamental (50,3%), residiam em Porto Alegre (75,6%) e eram aposentados (66,5%). De acordo com as variáveis clínicas estudadas, 89,6% dos indivíduos possuíam alguma morbidade, 36,9% já haviam sido internados em ala psiquiátrica, o diagnóstico mais encontrado foi de depressão (40,8%), seguido de transtorno do humor bipolar (19%) e ansiedade (14,1%). CONCLUSÕES: Com o envelhecimento populacional é esperado o aumento das morbidades e dos transtornos mentais, exigindo ferramentas diagnósticas mais específicas e melhores abordagens de tratamento. Ainda não existem dados consistentes sobre o manejo dos transtornos do humor nos idosos, sendo assim, nosso estudo pode nortear um melhor atendimento aos idosos e indivíduos que estão envelhecendo, aprimorando o planejamento dos serviços e políticas de saúde.

Introduction: Sexual dysfunction is common in patients with psychotic illness. This article describes the translation and cross-cultural adaptation of the Sexual Function Questionnaire (SFQ) into Brazilian Portuguese. Methods: The translation and cross-cultural adaptation followed the guidelines for adapting self-report instruments proposed by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Briefly, ISPOR steps include: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, before proofreading and final version. The original authors authorized the translation and participated in the study. Results: There was good agreement between translations and between the back-translation and the original English version of the SFQ. The final version was prepared with certificated evaluators in the original language and in Portuguese. Few changes were necessary to the new version in Portuguese. Conclusion: The translated and adapted Brazilian Portuguese version of the SFQ is reliable and semantically equivalent to the original version. Studies on psychotropic-related sexual dysfunction may now test the validity of the instrument and can investigate sexual dysfunction in Portuguese-speaking patients.

De Clu00e9rambault syndrome refers to a deliriant conviction of love that generally involves a woman with an older man of higher social position. This syndrome is estimated to affect 15:100.000 patients.The objective of this poster is to describe a case of de Clu00e9rambault syndrome.

Introdução: O Temperament & Personality Questionnaire (T&P) é um instrumento de autorrelato criado para avaliar quais estilos de personalidade têm maior representação em pacientes com depressão. Este trabalho descreve brevemente o processo de tradução e adaptação do T&P para o português brasileiro. Métodos: A tradução e a adaptação cultural se desenvolveram em 10 passos e seguiram as diretrizes para adaptação de instrumentos de autorrelato definidas por força-tarefa do ISPOR (International Society For Pharmacoeconomics and Outcomes Research). Resultados: O autor do questionário T&P original autorizou e participou da tradução feita pelos autores e por falantes nativos independentes. A avaliação do questionário traduzido mostrou que apenas pequenos ajustes foram necessários na versão em português. Conclusões: A versão brasileira do questionário T&P, traduzido e adaptado seguindo um rígido processo padronizado, está disponível gratuitamente e pode ser de grande utilidade na pesquisa sobre as relações entre estilos de personalidade e quadros depressivos. Introduction: The Temperament & Personality Questionnaire (T&P) is a self-report instrument designed to evaluate personality styles overrepresented in patients with depression. This report briefly describes the translation and adaptation of the T&P into Brazilian Portuguese. Methods: The procedures, which included 10 steps, followed guidelines for the adaptation of self-report instruments defined by the International Society For Pharmacoeconomics and Outcomes Research (ISPOR) Task Force for Translation and Cultural Adaptation. Results: The author of the original T&P questionnaire authorized and participated in the translation conducted by the authors and independent native speakers. Evaluation of the translated questionnaire indicated that only minor adjustments were required in the Portuguese version. Conclusions: The Brazilian version of T&P, translated and adapted following a rigid standardized process, is available for use free of charge and may be especially useful in pursuing links between personality styles and depressive conditions.

A depressão é um transtorno psiquiátrico altamente prevalente e oneroso, sendo uma das principais causas mundiais de morbimortalidade. Contudo, seu status nosológico é tema de profundas controvérsias, uma vez que apresenta uma definição pouco precisa, gerando uma enorme heterogeneidade clínica. Esta tese é composta por quatro artigos, e visa estudar a heterogeneidade da depressão investigando suas interações com o construto de personalidade e com marcadores biológicos. Os dois primeiros artigos visam viabilizar o uso de um instrumento de avaliação de estilos de personalidade, o Temperament and Personality Questionnaire (T&P). O primeiro artigo descreve o processo de tradução e adaptação transcultural do T&P para o português brasileiro, utilizando uma metodologia estandardizada. O segundo artigo examina as propriedades psicométricas do T&P em uma amostra de pacientes deprimidos. Nesse artigo, análises fatoriais confirmatórias foram realizadas para testar os sete níveis do instrumento, sendo encontrados índices de ajuste adequados para modelos com dois até quatro fatores, com alta consistência interna para todos os níveis. Foram encontradas as associações esperadas entre os estilos de personalidade e dois validadores externos, com estilos de personalidade resilientes apresentando menor qualidade de vida e maiores níveis de depressão, enquanto estilos de personalidade desordenados apresentaram o inverso. Além disso, a performance dos itens foi explorada utilizando a Teoria de Resposta ao Item, com a maioria dos itens apresentando melhor padrão de respostas dicotômico. Por fim, correlações altas entre os estilos de personalidade de níveis de baixa ordem com seus correspondentes construtos molares, confirmaram a organização hierárquica do instrumento. O terceiro artigo estudou a heterogeneidade da depressão em relação a personalidade. Nele, foi avaliada a associação entre dimensões depressivas (definidas por análise fatorial exploratória) e quatro classes de personalidade (criadas a partir de uma análise de classes latentes) em uma amostra de pacientes deprimidos. As classes de personalidade foram denominadas resilientes e desordenadas de acordo com seu nível de funcionamento e qualidade de vida. A classes desordenadas apresentaram maiores escores de sintomatologia depressiva, principalmente na dimensão cognitiva, com maior comorbidade com transtornos ansiosos. As dimensões depressivas melancólicas foram pouco ou nada discriminativas em relação às classes de personalidade, reforçando sua maior relevância para as depressões não-melancólicas. O quarto artigo analisou subgrupos depressivos classificados por um instrumento de avaliação de alterações da psicomotricidade (o CORE). Os grupos melancólico e não-melancólico foram comparados em relação a três dimensões de marcadores biológicos (estresse oxidativo, neurotrofina e marcadores imunológicos). Os resultados replicaram e estenderam achados sobre diferenças biológicas de subtipos depressivos, mostrando a importância da avaliação dos sinais de melancolia. Assim, essa tese contribui no estudo da heterogeneidade da depressão viabilizando o uso de um instrumento de avaliação da personalidade e estendendo achados que podem possibilitar que subtipos depressivos possam ser avaliados em relação a estilos de personalidade e marcadores biológicos. Depression is a highly prevalent and burdensome psychiatric disorder, and one of the main causes of morbidity and mortality. However, its nosological status remains the subject of deep controversies, since it presents an imprecise definition, generating an enormous clinical heterogeneity. This thesis comprises four papers, and aims to study the heterogeneity of depression investigating its interactions with the construct of personality and with biologic markers. The first two papers aim to enable the use of an instrument for assessing personality styles, the Temperament and Personality Questionnaire (T&P). The first paper describes the process of translation and cross-cultural adaptation of the T&P into Brazilian Portuguese using standardized methodology. The second paper examines the psychometric properties of the T&P in a sample of depressed patients. In this paper, confirmatory factor analyzes were conducted in order to test the seven tiers of the instrument, with proper goodness fit for models from two to four factors, and high internal consistency for all levels. The expected associations between personality styles and two external validators (quality of life and depression) were found, with resilient personality styles presenting lower quality of life and higher levels of depression, while disordered personality styles showed the reverse. Moreover, the performance of the items was explored using the Item Response Theory, and most items showed a better dichotomous response pattern. Finally, high correlations between lower-order personality styles and their corresponding molar personality constructs were found, confirming the hierarchical organization of the instrument. The third paper studied the heterogeneity of depression in relation to personality. In it, the association between depressive dimensions (defined by exploratory factor analysis) and four personality classes (created by latent class analysis) was evaluated in a sample of depressed patients. Classes were named resilient and disordered according to their level of functioning and quality of life. The disordered classes had higher scores of depressive symptoms, especially in the cognitive dimension, and higher comorbidity with anxiety disorders. The melancholic depressive dimensions were little or no discriminative with respect to the personality classes, reinforcing its greater relevance to non-melancholic depression. The fourth paper examined depressive subgroups classified by an assessment instrument of psychomotor changes (the CORE). The melancholic and non-melancholic groups were compared with respect to three dimensions of biomarkers (oxidative stress, neurotrophin and immunological markers). Results replicated and have extended findings on biological differences in depressive subtypes, showing the importance of evaluating signs of melancholia. Thus, this thesis contributes to the study of depression heterogeneity enabling the use of an instrument for assessing personality and extending findings that may allow that depressive subtypes can be assessed in relation to personality styles and biological markers.