GUILHERME VANONI POLANCZYK

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Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • conferenceObject
    CATEGORICAL AND DIMENSIONAL ASSESSMENT OF NUCLEUS ACCUMBENS AND AMYGDALA CONNECTIVITY IN DISRUPTIVE BEHAVIOR DISORDERS AND ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
    (2017) DIAS, Taciana G. Costa; SATO, Joao R.; FAIR, Damien A.; SALUM, Giovanni A.; ROHDE, Luis A.; BRESSAN, Rodrigo A.; PAN, Pedro M.; JACKOWSKI, Andrea P.; POLANCZYK, Guilherme V.
  • article 0 Citação(ões) na Scopus
    Smartphone-assisted online brief cognitive behavioral therapy to treat maternal depression: findings of a randomized controlled trial
    (2023) FATORI, Daniel; ZUCCOLO, Pedro; XAVIER, Mariana O.; MATIJASEVICH, Alicia; POLANCZYK, Guilherme V.
    Objective: To test the efficacy of smartphone-assisted online brief cognitive behavioral therapy (b-CBT) to treat maternal depression compared to online brief CBT plus an active control app.Methods: A randomized controlled trial was conducted. Assessments were performed at baseline (T0), midpoint (T1, week 4-5), post-treatment (T2, week 8), and follow-up (T3, 2-month postnatal follow-up) by blinded interviewers. The primary outcome was depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at T2. We also assessed anxiety, stress, sleep quality, well-being, physical activity, treatment response, and offspring child behavior problems. Results: Eighty-one participants were randomized to the intervention (n=37) or active control (n=44) groups. Seventy-one participants completed the post-treatment assessment or reported primary outcome data. No differences were found between the intervention and active control groups regarding maternal depression or other mental health outcomes. Overall, we found large within-group effect sizes, with 80% of the total sample responding to treatment. Conclusions: Our data showed no difference between the groups, suggesting that adding apps to psychotherapy treatment may not enhance treatment effects on prenatal depression. A within-groups analysis showed that most participants with depression responded to treatment; however, future studies are needed to confirm whether this effect is related to factors other than the intervention.
  • article 5 Citação(ões) na Scopus
    Attention-deficit/hyperactivity disorder from preschool to school age: change and stability of parent and teacher reports
    (2023) OVERGAARD, Kristin Romvig; OERBECK, Beate; FRIIS, Svein; PRIPP, Are Hugo; AASE, Heidi; BIELE, Guido; INGEBORGRUD, Christine Baalsrud; V, Guilherme Polanczyk; ZEINER, Pal
    Identifying attention-deficit/hyperactivity disorder (ADHD) in pre-schoolers may improve their development if treated, but it is unclear whether ADHD symptoms from this age are stable enough to merit treatment. We aimed to investigate the stability of parent- and teacher-reported ADHD symptoms and ADHD classified above the diagnostic symptom thresholds, including for hyperactivity-impulsivity (HI), inattention and combined presentations from age 3 to 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. At child age 3 years, parents were interviewed and teachers rated ADHD symptoms. At age 8 years, parents (n = 783) and teachers (n = 335) reported ADHD symptoms by the Child Symptom Inventory-4. We found a significant reduction in the mean number of parent-reported ADHD and HI symptoms from age 3 to 8 years, but otherwise similar mean numbers. Parent-reported ADHD symptoms were moderately correlated between ages, while correlations were low for teachers. A total of 77/108 (71%) of the children classified with parent-reported HI presentation at age 3 years were no longer classified within any ADHD presentation at age 8 years, the only clear trend across time for either informant. There was a low to moderate parent-teacher-agreement in the number of reported symptoms, and very low informant agreement for the classified ADHD presentations. Overall, clinicians should exercise caution in communicating concern about HI symptoms in preschool children. Age 3 years may be too early to apply the ADHD diagnostic symptom criteria, especially if parents and teachers are required to agree.
  • article 1 Citação(ões) na Scopus
    Brazilian Portuguese Childhood Autism Spectrum Test an investigation of the factor structure of autistic traits in school-aged children
    (2022) RIBEIRO, Tatiane Cristina; FARHAT, Luis C.; CASELLA, Erasmo B.; GRAEFF-MARTINS, Ana Soledade; BARON-COHEN, Simon; ALLISON, Carrie; POLANCZYK, Guilherme V.
    Objective: There is limited evidence about the cross-cultural validity of autistic symptoms in schoolaged children in Brazil. We used data from a large school survey to evaluate the factor structure of autism symptoms in community-dwelling children and adolescents. Methods: We translated the Childhood Autism Spectrum Test to Brazilian Portuguese and performed factor analyses to investigate the factor structure of parent-reported autistic symptoms in a large sample (n=8,571) of children/adolescents from a school survey in the metropolitan area of Sa similar to o Paulo. Results: Autistic symptoms were best conceptualized under a correlated-factors model with two factors: one predominantly characterized by social-communication symptoms and the other by symptoms of inflexible/restricted language, behaviors, and interests. Conclusions: These findings provide evidence that the structure of autistic symptoms in Brazil is similar to that described in other countries, indicating the cross-cultural validity of autism in Brazil.
  • article 5 Citação(ões) na Scopus
    Maternal distress, DNA methylation, and fetal programing of stress physiology in Brazilian mother-infant pairs
    (2023) WILEY, Kyle S.; CAMILO, Caroline; GOUVEIA, Gisele; EUCLYDES, Veronica; PANTER-BRICK, Catherine; MATIJASEVICH, Alicia; FERRARO, Alexandre Archanjo; FRACOLLI, Lislaine Aparecida; CHIESA, Anna Maria; MIGUEL, Euripedes Constantino; POLANCZYK, Guilherme V.; BRENTANI, Helena
    Maternal prenatal psychosocial stress is associated with adverse hypothalamic-pituitary-adrenal axis (HPAA) function among infants. Although the biological mechanisms influencing this process remain unknown, altered DNA methylation is considered to be one potential mechanism. We investigated associations between maternal prenatal psychological distress, infant salivary DNA methylation, and stress physiology at 12 months. Mother's distress was measured via depression and anxiety in early and late pregnancy in a cohort of 80 pregnant adolescents. Maternal hair cortisol was collected during pregnancy. Saliva samples were collected from infants at 12 months to quantify DNA methylation of three stress-related genes (FKBP5, NR3C1, OXTR) (n = 62) and diurnal cortisol (n = 29). Multivariable linear regression was used to test for associations between prenatal psychological distress, and infant DNA methylation and cortisol. Hair cortisol concentrations in late pregnancy were negatively associated with two sites of FKBP5 (site 1: B = -22.33, p = .003; site 2: B = -15.60, p = .012). Infants of mothers with elevated anxiety symptoms in late pregnancy had lower levels of OXTR2 CpG2 methylation (B = -2.17, p = .03) and higher evening salivary cortisol (B = 0.41, p = .03). Furthermore, OXTR2 methylation was inversely associated with evening cortisol (B = -0.14, p-value <= .001). Our results are, to our knowledge, the first evidence that the methylation of the oxytocin receptor may contribute to the regulation of HPAA during infancy.
  • article 1 Citação(ões) na Scopus
    Treatment Outcomes With Licensed and Unlicensed Stimulant Doses for Adults With Attention-Deficit/Hyperactivity Disorder A Systematic Review and Meta-Analysis
    (2024) FARHAT, Luis C.; FLORES, Jose M.; AVILA-QUINTERO, Victor J.; POLANCZYK, Guilherme V.; CIPRIANI, Andrea; FURUKAWA, Toshi A.; BLOCH, Michael H.; CORTESE, Samuele
    Importance: Stimulants (methylphenidate and amphetamines) are often prescribed at unlicensed doses for adults with attention-deficit/hyperactivity disorder (ADHD). Whether dose escalation beyond US Food and Drug Administration recommendations is associated with positive risk benefits is unclear.Objective: To investigate the impact, based on averages, of stimulant doses on treatment outcomes in adults with ADHD and to determine, based on averages, whether unlicensed doses are associated with positive risk benefits compared with licensed doses.Data sources: Twelve databases, including published (PubMed, Cochrane Library, Embase, Web of Sciences) and unpublished (ClinicalTrials.gov) literature, up to February 22, 2023, without language restrictions.Study selection: Two researchers independently screened records to identify double-blinded randomized clinical trials of stimulants against placebo in adults (18 years and older) with ADHD.Data extraction and synthesis: Aggregate data were extracted and synthesized in random-effects dose-response meta-analyses and network meta-analyses.Main outcome measures: Change in ADHD symptoms and discontinuations due to adverse events.Results: A total of 47 randomized clinical trials (7714 participants; mean age, 35 (SD, 11) years; 4204 male [56%]) were included. For methylphenidate, dose-response curves indicated additional reductions of symptoms with increments in doses, but the gains were progressively smaller and accompanied by continued additional risk of adverse events dropouts. Network meta-analyses showed that unlicensed doses were associated with greater reductions of symptoms compared with licensed doses (standardized mean difference [SMD], -0.23; 95% CI, -0.44 to -0.02; very low certainty of evidence), but the additional gain was small and accompanied by increased risk of adverse event dropouts (odds ratio, 2.02; 95% CI, 1.19-3.43; moderate certainty of evidence). For amphetamines, the dose-response curve approached a plateau and increments in doses did not indicate additional reductions of symptoms, but there were continued increments in the risk of adverse event dropouts. Network meta-analysis did not identify differences between unlicensed and licensed doses for reductions of symptoms (SMD, -0.08; 95% CI, -0.24 to 0.08; very low certainty of evidence).Conclusions and relevance: Based on group averages, unlicensed doses of stimulants may not have positive risk benefits compared with licensed doses for adults with ADHD. In general, practitioners should consider unlicensed doses cautiously. Practitioners may trial unlicensed doses if needed and tolerated but should be aware that there may not be large gains in the response to the medication with those further increments in dose. However, the findings are averages and will not generalize to every patient.
  • article 0 Citação(ões) na Scopus
    Impact of COVID-19 on physical and mental functioning in adolescents with disabilities in a sports nongovernmental organization
    (2023) LAURENTINO, Moises de Freitas; LINDOSO, Livia; ASTLEY, Camilla; LAVORATO, Sofia Simao Martins; IHARA, Bianca Pires; LIMA, Dandara Carvalho Casado de; GUALANO, Bruno; QUEIROZ, Ligia Bruni; PEREIRA, Rosa Maria Rodrigues; POLANCZYK, Guilherme Vanoni; CAMARGO, Olavo Pires de; SILVA, Clovis Artur; GRANGEIRO, Patricia Moreno
    Objective:This study aimed to assess physical and mental health, and health-related quality of life (HRQL) parameters in adolescents with physical disabilities enrolled in a sports nongovernmental organization (NGO) versus adolescents without disabilities during coronavirus disease 2019 (COVID-19) pandemic. Methods: This cross-sectional study included 30 adolescents with disabilities and 86 adolescents without disabilities who responded to an online questionnaire with sociodemographic data and self-rated healthcare routine information during the COVID-19 quarantine. Validated self-report versions of the Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), Pittsburgh Sleep Quality Index (PSQI), and Pediatric Outcome Data Collection Instrument (PODCI) were also applied. Results: The median of emotional [4 (0-10) vs. 5 (0-10), p=0.018] and prosocial [7 (0-10) vs. 9 (3-10), p=0.006] problems was lower in adolescents with disabilities versus adolescents without disabilities. Adolescents with disabilities had significantly lower global function [68 (21-99) vs. 94 (67-100), p<0.001] and higher happiness scores in the PODCI scale [90 (65-100) vs. 80 (0-100), p=0.016] compared to controls. Logistic regression analysis demonstrated that physical activity/week (OR=1.03; 95%CI 1.01-1.05, p=0.002) was higher in adolescents with disabilities compared to adolescents without disabilities. However, housework activities (OR=0.14; 95%CI 0.04-0.43, p=0.001) and screen time >= 3 h/day (OR=0.09; 95%CI 0.02-0.38, p=0.001) were lower in adolescents with disabilities compared to adolescents without disabilities. Conclusion: Adolescents with disabilities attending a sports NGO were not at higher risk of adverse health-related indicators; despite showing reduced physical function, they reported more physical activity, higher happiness, and less screen time compared to adolescents without disabilities during the COVID-19 pandemic.
  • article 14 Citação(ões) na Scopus
    Children and adolescents' emotional problems during the COVID-19 pandemic in Brazil
    (2023) ZUCCOLO, Pedro Fonseca; CASELLA, Caio Borba; FATORI, Daniel; SHEPHARD, Elizabeth; SUGAYA, Luisa; GURGEL, Wagner; FARHAT, Luis Carlos; ARGEU, Adriana; TEIXEIRA, Monike; OTOCH, Luara; V, Guilherme Polanczyk
    Brazil has been severely affected by the COVID-19 pandemic with one of the largest numbers of youth impacted by school closure globally. This longitudinal online survey assessed emotional problems in children and adolescents aged 5-17 years living in Brazil during the COVID-19 pandemic. Recruitment occurred between June to November 2020 and participants were invited for follow-up assessments every 15 days until June 2021. Participants were 5795 children and adolescents living across the country with mean age of 10.7 (SD 3.63) years at recruitment; 50.5% were boys and 69% of white ethnicity. Weighted prevalence rates of anxiety, depressive and total emotional symptoms at baseline were 29.7%, 36.1% and 36%, respectively. Longitudinal analysis included 3221 (55.6%) participants and revealed fluctuations in anxiety and depressive symptoms during one year follow-up, associated with periods of social mobility and mortality. Emotional problems significantly increased in July and September 2020 and decreased from December 2020 to February 2021 and then significantly increased in May 2021 relative to June 2020. Older age, feeling lonely, previous diagnosis of mental or neurodevelopmental disorder, previous exposure to traumatic events or psychological aggression, parental psychopathology, and sleeping less than 8/h a day were associated with increased rates of anxiety and depressive symptoms at baseline and over time. Food insecurity and less social contact with family and peers were associated with baseline anxiety and depressive symptoms, and lowest socio-economic strata, chronic disease requiring treatment and family members physically ill due to COVID-19 were associated with increasing rates over time. The pandemic severely affected youth, particularly those from vulnerable populations and in moments of increased mortality and decreased social mobility. Results underscore the need for allocation of resources to services and the continuous monitoring of mental health problems among children and adolescents.
  • conferenceObject
    DNA METHYLATION OF STRESS-RESPONSE HPA RELATED GENES COULD BE PROGRAMMED BY PRENATAL STRESS EXPOSURES
    (2022) GOUVEIA, Gisele; EUCLYDES, Veronica; BRAGA, Caio; WILEY, Kyle; CAMILO, Caroline; POLANCZYK, Guilherme; BRENTANI, Helena
  • article 7 Citação(ões) na Scopus
    Efficacy and safety of methylphenidate and behavioural parent training for children aged 3-5 years with attentiondeficit hyperactivity disorder: a randomised, double-blind, placebo-controlled, and sham behavioural parent training-controlled trial
    (2022) SUGAYA, Luisa Shiguemi; SALUM, Giovanni Abrahao; GURGEL, Wagner de Sousa; MORAIS, Erika Mendonca de; PRETTE, Giovana Del; PILATTI, Caroline Drehmer; DALMASO, Bianca Batista; LEIBENLUFT, Ellen; ROHDE, Luis Augusto; POLANCZYK, Guilherme Vanoni
    Background There is insufficient evidence to support treatment recommendations for preschool children aged 3-5 years with attention-deficit hyperactivity disorder (ADHD). We aimed to investigate the efficacy and safety of methylphenidate and behavioural parent training in reducing the frequency and severity of symptoms and improving global functioning in preschool children with ADHD. Methods We did an 8-week, randomised, double-blind, placebo-controlled and sham behavioural parent trainingcontrolled clinical trial (the MAPPA Study) in children aged 3-5 years with moderate-to-severe ADHD. The trial was conducted at the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. Participants were randomly assigned (1:1:1) to receive immediate-release methylphenidate plus educational intervention (sham behavioural parent training), placebo medication plus behavioural parent training, or placebo medication plus educational intervention. Randomisation was done by an independent research manager by use of a permuted block randomisation procedure. Parents, teachers, study staff, and evaluators remained masked to group allocation. Methylphenidate and placebo were titrated to a maximum dose of 1 center dot 25 mg/kg per day administered orally twice daily, and behavioural parent training and the educational intervention were delivered weekly through 90 min sessions with both the child and parent, conducted by two psychologists or learning therapists. The primary outcomes were parents' and teachers' composite scores of the Swanson, Nolan, and Pelham-IV scale (SNAP-IV-P/T), the Clinical Global Impressions Severity (CGI-S) scale, and the Children's Global Assessment Scale (CGAS). This trial is registered with ClinicalTrials.gov, NCT02807870, and is now complete. All participants were invited to participate in an open observational follow-up, which is ongoing. Findings Between Aug 21, 2016, and Oct 21, 2019, 153 children were randomly assigned to receive methylphenidate plus the educational intervention (n=51), placebo plus behavioural parent training (n=51), or placebo plus the educational intervention (n=51). Nine (6%) children discontinued treatment. All participants were included in the intention-to-treat analysis. Children in the methylphenidate plus educational intervention group showed greater reductions in the SNAP-IV-P/T (endpoint mean difference -3 center dot 93 [95% CI -7 center dot 14 to -0 center dot 73], p=0 center dot 049; effect size -0 center dot 55 [95% CI -0 center dot 99 to -0 center dot 10]) and CGI-S scores (endpoint mean difference -0 center dot 49 [-0 center dot 82 to -0 center dot 17], p=0 center dot 0088; effect size -0 center dot 70 [- 1 center dot 16 to -0 center dot 24]) and a greater increase in CGAS scores ( endpoint mean difference 5 center dot 25 [95% CI 2 center dot 09 to 8 center dot 40], p=0 center dot 0036; effect size 0 center dot 80 [95% CI 0 center dot 32 to 1 center dot 28]) than children in the placebo plus educational intervention group. Children in the placebo plus behavioural parent training group did not have significantly different SNAP-IV-P/T scores (endpoint mean difference -3 center dot 18 [95% CI -6 center dot 38 to 0 center dot 02], p=0 center dot 077; effect size -0 center dot 44 [95% CI -0 center dot 89 to 0 center dot 003]) or CGI-S scores (endpoint mean difference -0 center dot 35 [-0 center dot 68 to -0 center dot 03], p=0 center dot 052; effect size -0 center dot 50 [-0 center dot 96 to -0 center dot 04]) compared to children in the placebo plus educational intervention group, but they had a greater increase in CGAS scores compared to the placebo plus educational inter-vention group (endpoint mean difference 3 center dot 69 [0 center dot 53 to 6 center dot 85], p=0 center dot 033; effect size 0 center dot 56 [0 center dot 08 to 1 center dot 04]). Children in the methylphenidate plus educational intervention versus placebo plus behavioural parent training group did not have statistically or clinically significant differences in primary outcomes. Children in the methylphenidate plus educational intervention group had more mild adverse events than the other two groups, and there were no between-group differences for moderate or severe adverse events. Interpretation Methylphenidate was effective in reducing ADHD symptoms and improving functionality, and behavioural parent training was effective in improving functionality for preschool children with ADHD after 8 weeks of treatment.