BENY LAFER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Líder
34 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 34
- Low brain-derived neurotrophic factor levels in post-mortem brains of older adults with depression and dementia in a large clinicopathological sample(2018) NUNES, Paula Villela; NASCIMENTO, Camila Fernandes; KIM, Helena Kyunghee; ANDREAZZA, Ana Cristina; BRENTANI, Helena Paula; SUEMOTO, Claudia Kimie; LEITE, Renata Elaine Paraizo; FERRETTI-REBUSTINI, Renata Eloah de Lucena; PASQUALUCCI, Carlos Augusto; NITRINI, Ricardo; GRINBERG, Lea Tenenholz; YONG, Lionel Trevor; JACOB-FILHO, Wilson; LAFER, BenyBackground: Disturbances in peripheral brain-derived neurotrophic factor (BDNF) have been reported in major depressive disorder (MDD). However, there are no studies measuring BDNF levels directly in post-mortem brains of older subjects with MDD and dementia. We aimed to verify if brain BDNF levels were lower in older adults with lifetime history of MDD with and without dementia. Methods: BDNF levels of post-mortem brains from 80 community-dwelling older individuals with lifetime MDD with and without dementia were compared with levels from 80 controls without lifetime MDD. Participants with no reliable close informant, or with prolonged agonal state were excluded. Lifetime MDD was defined as at least one previous episode according to the Structured Clinical Interview for DSM (SCID). Results: BDNF levels were lower in the MDD group with dementia than in participants with dementia and without MDD as confirmed by multivariate analysis adjusted for clinical and cardiovascular risk factors (beta = - 0.106, 95%CI = - 0.204; - 0.009, p = 0.034). No difference was found in the group with MDD without dementia compared with their controls. Limitations: The retrospective assessment of a lifetime history of depression may be subject to information bias and this study only establishes a cross-sectional association between lifetime history of MDD and lower levels of BDNF in patients with dementia. Conclusions: In this community sample of older individuals, lower brain BDNF levels were found in cases with both lifetime MDD and dementia. Low BDNF levels could be a moderator to accelerated brain aging observed in MDD with dementia.
- Are comorbid anxiety disorders a risk factor for suicide attempts in patients with mood disorders? A two-year prospective study(2018) ABREU, L. N.; OQUENDO, M. A.; GALFAVY, H.; BURKE, A.; GRUNEBAUM, M. F.; SHER, L.; SULLIVAN, G. M.; SUBLETTE, M. E.; MANN, J.; LAFER, B.Background: Comorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime and current comorbid anxiety disorders at baseline were risk factors for suicide attempts during the two-year follow-up. Methods: We evaluated 667 patients with mood disorders (504 with major depression and 167 with bipolar disorder) divided in two groups: those with lifetime comorbid anxiety disorders (n = 229) and those without (n = 438). Assessments were performed at baseline and at 3, 12, and 24 months. KaplanMeier survival analysis and log-rank test were used to evaluate the relationship between anxiety disorders and suicide attempts. Cox proportional hazard regression was performed to investigate clinical and demographic variables that were associated with suicide attempts during follow-up. Results: Of the initial sample of 667 patients, 480 had all three follow-up interviews. During the follow-up, 63 patients (13.1%) attempted suicide at least once. There was no significant difference in survival curves for patients with and without comorbid anxiety disorders (log-rank test = 0.269; P = 0.604). Female gender (HR = 3.66, P = 0.001), previous suicide attempts (HR = 3.27, P = 0.001) and higher scores in the Buss-Durkee Hostility Inventory (HR = 1.05, P = 0.001) were associated with future suicide attempts. Conclusions: Our results suggest that comorbid anxiety disorders were not risk factors for suicide attempts. Further studies were needed to determine the role of anxiety disorders as risk factors for suicide attempts.
conferenceObject Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders targeting cognition task force(2018) MISKOWIAK, K.; BURDICK, K. E.; MARTINEZ-ARAN, A.; BONNIN, C. M.; BOWIE, C. R.; CARVALHO, A. F.; GALLAGHER, P.; LAFER, B.; LOPEZ-JARAMILLO, C.; SUMIYOSHI, T.; MCINTYRE, R. S.; SCHAFFER, A.; PORTER, R. J.; TORRES, I. J.; YATHAM, L. N.; YOUNG, A. H.; KESSING, L. V.; VIETA, E.- Lithium-associated anterior cingulate neurometabolic profile in euthymic Bipolar I disorder: A H-1-MRS study(2018) SOEIRO-DE-SOUZA, Marcio Gerhardt; OTADUY, Maria Concepcion Garcia; MACHADO-VIEIRA, Rodrigo; MORENO, Ricardo Alberto; NERY, Fabiano G.; LEITE, Claudia; LAFER, BenyObjective: In the treatment of Bipolar disorder (BD), achieving euthymia is highly complex and usually requires a combination of mood stabilizers. The mechanism of action in stabilizing mood has not been fully elucidated, but alterations in N-Acetylaspartate (NAA), Myo-Inositol (mI) and Choline (Cho) have been implicated. Proton magnetic resonance spectroscopy (H-1-MRS) is the gold standard technique for measuring brain NAA, Cho and mI in vivo. The objective of this study was to investigate the association of lithium use in BD type I and brain levels of NAA, mI and Cho in the (anterior cingulate cortex) ACC. Methods: 129 BD type I subjects and 79 healthy controls (HC) were submitted to a 3-Tesla brain magnetic resonance imaging scan (H-1-MRS) using a PRESS ACC single voxel (8cm(3)) sequence. Results: BD patients exhibited higher NAA and Cho levels compared to HC. Lithium prescription was associated with lower mI (combination + monotherapy) and higher NAA levels (monotherapy). Conclusion: The results observed add to the knowledge about the mechanisms of action of mood stabilizers on brain metabolites during euthymia. Additionally, the observed decrease in mI levels associated with lithium monotherapy is an in vivo finding that supports the inositol-depletion hypothesis of lithium pharmacodynamics.
- Caregiver burden regarding elderly with bipolar disorder: An underrecognized problem(2018) SANTOS, Glenda D.; LADEIRA, Rodolfo B.; ALMEIDA, Jouce G.; APRAHAMIAN, Ivan; FORLENZA, Orestes V.; LAFER, Beny; NUNES, Paula V.
- Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians(2018) MISKOWIAK, K. W.; BURDICK, K. E.; MARTINEZ-ARAN, A.; BONNIN, C. M.; BOWIE, C. R.; CARVALHO, A. F.; GALLAGHER, P.; LAFER, B.; LOPEZ-JARAMILLO, C.; SUMIYOSHI, T.; MCINTYRE, R. S.; SCHAFFER, A.; PORTER, R. J.; PURDON, S.; TORRES, I. J.; YATHAM, L. N.; YOUNG, A. H.; KESSING, L. V.; VIETA, E.ObjectivesCognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force aimed to develop consensus-based clinical recommendations on whether, when and how to assess and address cognitive impairment. MethodsThe task force, consisting of 19 international experts from nine countries, discussed the challenges and recommendations in a face-to-face meeting, telephone conference call and email exchanges. Consensus-based recommendations were achieved through these exchanges with no need for formal consensus methods. ResultsThe identified questions were: (I) Should cognitive screening assessments be routinely conducted in clinical settings? (II) What are the most feasible screening tools? (III) What are the implications if cognitive impairment is detected? (IV) What are the treatment perspectives? Key recommendations are that clinicians: (I) formally screen cognition in partially or fully remitted patients whenever possible, (II) use brief, easy-to-administer tools such as the Screen for Cognitive Impairment in Psychiatry and Cognitive Complaints in Bipolar Disorder Rating Assessment, and (III) evaluate the impact of medication and comorbidity, refer patients for comprehensive neuropsychological evaluation when clinically indicated, and encourage patients to build cognitive reserve. Regarding question (IV), there is limited evidence for current evidence-based treatments but intense research efforts are underway to identify new pharmacological and/or psychological cognition treatments. ConclusionsThis task force paper provides the first consensus-based recommendations for clinicians on whether, when, and how to assess and address cognition, which may aid patients' functional recovery and improve their quality of life.
- Chronic mood instability: Bipolar, borderline, or both?(2018) BERALDI, Gabriel H.; ALMEIDA, Karla M.; LAFER, Beny
- Cognitive outcomes of TMS treatment in bipolar depression: Safety data from a randomized controlled trial(2018) MYCZKOWSKI, Martin L.; FERNANDES, Adriano; MORENO, Marina; VALIENGO, Leandro; LAFER, Beny; MORENO, Ricardo A.; PADBERG, Frank; GATTAZ, Wagner; BRUNONI, Andre R.Background: Bipolar depression (BD) is a highly prevalent condition associated with marked cognitive deficits that persist even in the euthymic phase of the illness. Pharmacological treatments for BD might further aggravate cognitive impairment, highlighting the need of developing interventions that present cognitive safety. In this study, we evaluated the cognitive effects of H1-coil (deep) transcranial magnetic stimulation (TMS) in patients with treatment-resistant bipolar depression. Methods: Fourty-three patients were randomized to receive 20 sessions of active (55 trains, 18 Hz, 120% resting motor threshold intensity) or sham rTMS within a double-blind, sham-controlled trial. A battery of 20 neuropsychological assessments, grouped in 6 domains (attention and processing speed, working memory and executive function, inhibitory control, language, immediate verbal memory, and long-term verbal memory) was performed at baseline and after 4 and 8 weeks of trial onset. Depressive symptoms were assessed with the 17 item Hamilton Rating Scale for Depression. Results: Cognitive improvement was shown for all cognitive domains. It occurred regardless of intervention group and depression improvement. For the language domain, greater improvement was observed in the sham group over time. No correlations between depression (at baseline or during treatment) and cognitive improvement were found. Limitations: Absence of healthy control group. Conclusion: The results of this exploratory study provide evidence on the cognitive safety of H1-coil TMS for BD patients. Putative pro-cognitive effects of rTMS in BD were not observed and thus should be further investigated.
- Internet use by older adults with bipolar disorder: international survey results(2018) BAUER, Rita; GLENN, Tasha; STREJILEVICH, Sergio; CONELL, Joern; ALDA, Martin; ARDAU, Raffaella; BAUNE, Bernhard T.; BERK, Michael; BERSUDSKY, Yuly; BILDERBECK, Amy; BOCCHETTA, Alberto; CASTRO, Angela M. Paredes; CHEUNG, Eric Y. W.; CHILLOTTI, Caterina; CHOPPIN, Sabine; CUOMO, Alessandro; ZOMPO, Maria Del; DIAS, Rodrigo; DODD, Seetal; DUFFY, Anne; ETAIN, Bruno; FAGIOLINI, Andrea; HERNANDEZ, Miryam Fernandez; GARNHAM, Julie; GEDDES, John; GILDEBRO, Jonas; GITLIN, Michael J.; GONZALEZ-PINTO, Ana; GOODWIN, Guy M.; GROF, Paul; HARIMA, Hirohiko; HASSEL, Stefanie; HENRY, Chantal; HIDALGO-MAZZEI, Diego; LUND, Anne Hvenegaard; KAPUR, Vaisnvy; KUNIGIRI, Girish; LAFER, Beny; LARSEN, Erik R.; LEWITZKA, Ute; LICHT, Rasmus W.; MISIAK, Blazej; PIOTROWSKI, Patryk; MIRANDA-SCIPPA, Angela; MONTEITH, Scott; MUNOZ, Rodrigo; NAKANOTANI, Takako; NIELSEN, Rene E.; O'DONOVAN, Claire; OKAMURA, Yasushi; OSHER, Yamima; REIF, Andreas; RITTER, Philipp; RYBAKOWSKI, Janusz K.; SAGDUYU, Kemal; SAWCHUK, Brett; SCHWARTZ, Elon; SLANEY, Claire; SULAIMAN, Ahmad H.; SUOMINEN, Kirsi; SUWALSKA, Aleksandra; TAM, Peter; TATEBAYASHI, Yoshitaka; TONDO, Leonardo; VEEH, Julia; VIETA, Eduard; VINBERG, Maj; VISWANATH, Biju; ZETIN, Mark; WHYBROW, Peter C.; BAUER, MichaelBackground: The world population is aging and the number of older adults with bipolar disorder is increasing. Digital technologies are viewed as a framework to improve care of older adults with bipolar disorder. This analysis quantifies Internet use by older adults with bipolar disorder as part of a larger survey project about information seeking. Methods: A paper-based survey about information seeking by patients with bipolar disorder was developed and translated into 12 languages. The survey was anonymous and completed between March 2014 and January 2016 by 1222 patients in 17 countries. All patients were diagnosed by a psychiatrist. General estimating equations were used to account for correlated data. Results: Overall, 47% of older adults (age 60 years or older) used the Internet versus 87% of younger adults (less than 60 years). More education and having symptoms that interfered with regular activities increased the odds of using the Internet, while being age 60 years or older decreased the odds. Data from 187 older adults and 1021 younger adults were included in the analysis excluding missing values. Conclusions: Older adults with bipolar disorder use the Internet much less frequently than younger adults. Many older adults do not use the Internet, and technology tools are suitable for some but not all older adults. As more health services are only available online, and more digital tools are developed, there is concern about growing health disparities based on age. Mental health experts should participate in determining the appropriate role for digital tools for older adults with bipolar disorder.
- Factors associated with brain volume in major depression in older adults without dementia: results from a large autopsy study(2018) NUNES, Paula Villela; SUEMOTO, Claudia Kimie; LEITE, Renata Elaine Paraizo; FERRETTI-REBUSTINI, Renata Eloah de Lucena; PASQUALUCCI, Carlos Augusto; NITRINI, Ricardo; FARFEL, Jose Marcelo; OLIVEIRA, Katia Cristina de; GRINBERG, Lea Tenenholz; COSTA, Nicole Rezende da; NASCIMENTO, Camila Fernandes; SALMASI, Faraz; KIM, Helena Kyunghee; YOUNG, Lionel Trevor; JACOB-FILHO, Wilson; LAFER, BenyObjectiveWe examined brain volume and atrophy in individuals with major depressive disorder (MDD) without dementia that were referred to a large autopsy service. We also examined potential risk factors for brain atrophy, including demographics and clinical variables. MethodsIn this study, 1373 participants (787 male) aged 50years or older who died from natural causes were included. Participants with no reliable informant, with cognitive impairment or dementia, with a medical history of severe chronic disease, or with prolonged agonal state were excluded. Presence of MDD at least once in their lifetime was defined according to the Structured Clinical Interview for DSM. Brain volume was measured immediately after removal from the skull. ResultsMean age at death was 68.611.6, and MDD was present in 185 (14%) individuals. Smaller brain volume was associated with older age (p<0.001), lower education (years; p<0.001), hypertension (p=0.001), diabetes (p=0.006), and female gender (p<0.001). In the multivariate analysis adjusted for sociodemographics and cardiovascular risk factors, smaller brain volume was not associated with major depression (=-0.86, 95% CI=-26.50 to 24.77, p=0.95). ConclusionsIn this large autopsy study of older adults, MDD was not associated with smaller brain volumes. Regardless of the presence of MDD, in this sample of older adults without dementia, we found that smaller brain volumes were associated with risk factors for brain neurodegeneration such as older age, diabetes, hypertension, and lower education.