RODRIGO DA SILVA DIAS
Projetos de Pesquisa
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LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
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- Association between history of suicide attempts and family functioning in bipolar disorder(2016) BERUTTI, Mariangeles; DIAS, Rodrigo Silva; PEREIRA, Vivian Alves; LAFER, Beny; NERY, Fabiano G.Objectives: To investigate the association between history of suicide attempts (SA) and family functioning in bipolar disorder (BD) patients. Methods: Thirty-one BD type I patients with lifetime history of SA, 31 BD type I with no lifetime history of SA, participating in the Outpatient Clinic of the Bipolar Disorder Program at the Institute of Psychiatry of the University of Sao Paulo Medical School were recruited for this study. We used the Family Assessment Device (FAD) to evaluate family functioning. We compared these two groups on demographic and clinical variables to identify which variables were associated with family functioning impairment. Fifty-one relatives of the same patients were also asked to complete a FAD. Results: BD patients with SA presented more psychiatric hospitalizations, higher frequency of psychotic symptoms, and higher scores on depressive, manic, and suicidal ideation than BD patients without SA. BD patients with SA presented significantly higher scores in several subscales of the FAD, including Problem Solving (p=0.042), Communication (p=0.009), Roles (p=0.006), and General Functioning (p=0.025), when compared with BD patients without SA. Relatives of BD patients with SA presented significantly higher scores in Communication, Roles, Affective Responsiveness, and General Functioning than relatives of BD patients without SA. Limitations: Cross-sectional study and long time elapsed since last SA. Conclusion: History of SA in BD is associated with worse family functioning in several domains of FAD, including Problem Solving, Communication, Roles, and General Functioning. As suicide attempts are routinely assessed in clinical practice, these findings may help to identify patients with poorer family functioning and may suggest a role for environmental risk factors in suicidal behavior among BD patients.
- Predominant polarity classification and associated clinical variables in bipolar disorder: A machine learning approach(2019) BELIZARIO, Gabriel Okawa; BORGES JUNIOR, Renato Gomes; SALVINI, Rogerio; LAFER, Beny; DIAS, Rodrigo da SilvaBackground: Bipolar disorder (BD) is a severe psychiatric disorder characterized by periodic episodes of manic and depressive symptomatology. Predominant polarity (PP) appears to be an important specifier of BD. The present study employed machine learning (ML) algorithms to accurately determine a patient ' s PP without the inclusion of number and polarity of past episodes, while exploring associations between PP and demographic and clinical variables. Methods: From a cohort of 148 BD patients, demographic and clinical variables were collected using a customized questionnaire and the SCID-CV. The algorithm employed was the Random-Forest method. The algorithm was programed to classify patients into either depressive or manic predominant polarities and to reveal which variables were associated to the specifier. Results: The algorithm attained an AUC ROC of 74.72% (95% CI = 72.29-77.15%) in classifying patients into either manic or depressive PP. The variables selected by the algorithm were: (1) age at first depressive episode; (2) number of hospitalizations; (3) BD Type II; (4) manic onset; (5) delusions; (6) psychotic features at onset; (7) tobacco addiction; (8) family history of BD; (9) hallucinations; and (10) comorbid anxiety disorders, (11) alcohol dependence, (12) eating disorders and (13) substance dependence. Limitations: The study is limited due to the small sample size, the inclusion of only self-reported and clinician-observed clinical variables and its cross-sectional design. Discussion: The results suggest that the ML approach could be effective in determining a patient ' s PP. Furthermore, although not previously reported, some variables, such as tobacco use and comorbid eating disorders, appear to be closely associated with PP.
- Internet use by patients with bipolar disorder: Results from an international multisite survey(2016) BAUER, Rita; CONELL, Joern; GLENN, Tasha; ALDA, Martin; ARDAU, Raffaella; BAUNE, Bernhard T.; BERK, Michael; BERSUDSKY, Yuly; BILDERBECK, Amy; BOCCHETTA, Alberto; BOSSINI, Letizia; CASTRO, Angela M. Paredes; CHEUNG, Eric Y. W.; CHILLOTTI, Caterina; CHOPPIN, Sabine; ZOMPO, Maria Del; DIAS, Rodrigo; DODD, Seetal; DUFFY, Anne; ETAIN, Bruno; FAGIOLINI, Andrea; HERNANDEZ, Miryam Fernandez; GARNHAM, Julie; GEDDES, John; GILDEBRO, Jonas; GONZALEZ-PINTO, Ana; GOODWIN, Guy M.; GROF, Paul; HARIMA, Hirohiko; HASSEL, Stefanie; HENRY, Chantal; HIDALGO-MAZZEI, Diego; KAPUR, Vaisnvy; KUNIGIRI, Girish; LAFER, Beny; LARSEN, Erik R.; LEWITZKA, Ute; LICHT, Rasmus W.; LUND, Anne Hvenegaard; MISIAK, Blazej; MONTEITH, Scott; MUNOZ, Rodrigo; NAKANOTANI, Takako; NIELSEN, Rene E.; O'DONOVAN, Claire; OKAMURA, Yasushi; OSHER, Yamima; PIOTROWSKI, Patryk; REIF, Andreas; RITTER, Philipp; RYBAKOWSKI, Janusz K.; SAGDUYU, Kemal; SAWCHUK, Brett; SCHWARTZ, Elon; SCIPPA, Angela M.; SLANEY, Claire; SULAIMAN, Ahmad H.; SUOMINEN, Kirsi; SUWALSKA, Aleksandra; TAM, Peter; TATEBAYASHI, Yoshitaka; TONDO, Leonardo; VIETA, Eduard; VINBERG, Maj; VISWANATH, Biju; VOLKERT, Julia; ZETIN, Mark; WHYBROW, Peter C.; BAUER, MichaelThere is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important.
- A randomized, double-blind, placebo-controlled, proof-of-concept trial of creatine monohydrate as adjunctive treatment for bipolar depression(2018) TONIOLO, Ricardo Alexandre; SILVA, Michelle; FERNANDES, Francy de Brito Ferreira; AMARAL, Jose Antonio de Mello Siqueira; DIAS, Rodrigo da Silva; LAFER, BenyDepressive episodes are a major cause of morbidity and dysfunction in individuals suffering from bipolar disorder. Currently available treatments for this condition have limited efficacy and new therapeutic options are needed. Extensive research in the pathophysiology of bipolar disorder points to the existence of mitochondrial and bioenergetic dysfunction. We hypothesized that creatine monohydrate, a nutraceutical that works as a mitochondrial modulator, would be effective as an adjunctive therapy for bipolar depression. We conducted a double-blind trial in which 35 patients with bipolar disorder type I or II in a depressive episode by DSM-IV criteria and in use of regular medication for the treatment of this phase of the disease were randomly allocated into two adjunctive treatment groups for 6 weeks: creatine monohydrate 6 g daily (N = 17) or placebo (N = 18). Primary efficacy was assessed by the change in the Montgomery-sberg Depression Rating Scale (MADRS). We did not find a statistically significant difference in the comparison between groups for the change in score on the MADRS after 6 weeks in an intention-to-treat (ITT) analysis (p = 0.560; Cohen's d = 0.231). However, we found significant superiority of creatine add-on vs. placebo when we considered the remission criterion of a MADRS score ae 12 at week 6 analyzing the outcome of the 35 randomized patients on ITT (52.9% remission in the creatine group vs. 11.1% remission in the placebo group) and of the 23 completers (66.7% remission in the creatine group vs. 18.2% remission in the placebo group) (p = 0.012; OR = 9.0 and p = 0.036; OR = 9.0, respectively). Two patients who received creatine switched to hypomania/mania early in the trial. No clinically relevant physical side-effects were reported or observed. This proof-of-concept study, aiming to restore brain bioenergetics using an adjunctive mitochondrial modulator, is not conclusive on the efficacy of creatine add-on for bipolar depression, but suggests that this compound may have a role in the adjunctive treatment of this phase of the illness. Further investigation through randomized controlled trials with larger samples should be conducted to verify the efficacy of creatine supplementation for bipolar depression and also for subsyndromal depressive symptoms.
- Exploring machine learning to predict depressive relapses of bipolar disorder patients(2021) ROTENBERG, Luisa de Siqueira; BORGES-JUNIOR, Renato Gomes; LAFER, Beny; SALVINI, Rogerio; DIAS, Rodrigo da SilvaBackground: Bipolar disorder (BD) is a chronic mood disorder characterized by recurrent episodes of mania or hypomania and depression, expressed by changes in energy levels and behavior. However, most of relapse studies use evidence-based approaches with statistical methods. With the advance of the precision medicine this study aims to use machine learning (ML) approaches as a possible predictor in depressive relapses in BD. Method: Four accepted and well used ML algorithms (Support Vector Machines, Random Forests, Naive Bayes, and Multilayer Perceptron) were applied to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) dataset in a cohort of 800 patients (507 patients presented depressive relapse and 293 did not), who became euthymic during the study and were followed for one year. Results: The ML algorithms presented reasonable performance in the prediction task, ranging from 61 to 80% in the F-measure. The Random Forest algorithm obtained a higher average of performance (Relapse Group 68%; No Relapse Group 74%). The three most important mood symptoms observed in the relapse visit (Random Forest) were: interest; depression mood and energy. Limitations: Social and psychological parameters such as marital status, social support system, personality traits, might be an important predictor in depressive relapses, although we did not compute this data in our study. Conclusions: Our findings indicate that applying precision medicine models by means of machine learning in BD studies could be feasible as a sensible approach to better support medical decision-making in the BD treatment and prevention of future relapses.
- Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial(2017) TONIOLO, Ricardo Alexandre; FERNANDES, Francy de Brito Ferreira; SILVA, Michelle; DIAS, Rodrigo da Silva; LAFER, BenyBackground: Depressive episodes and cognitive impairment are major causes of morbidity and dysfunction in individuals suffering from bipolar disorder (BD). Novel treatment approaches that target clinical and cognitive aspects of bipolar depression are needed, and research on pathophysiology suggests that mitochondrial modulators such as the nutraceutical creatine monohydrate might have a therapeutic role for this condition. Methods: Eighteen (N=18) patients with bipolar depression according to DSM-IV criteria who were enrollled in a 6-week, randomized, double-blind, placebo-controlled trial of creatine monohydrate 6 g daily as adjunctive therapy were submitted to neuropsychological assessments (Wisconsin Card Sorting Test, Digit Span subtest of the Wechsler Adult Intelligence Scale-Third Edition, Stroop Color-Word Test, Rey-Osterrieth complex figure test, FAS Verbal Fluency Test) at baseline and week 6. Results: There was a statistically significant difference between the treatment groups of the change on the total scores after 6 weeks in the verbal fluency test, with improvement in the group receiving adjunctive treatment with creatine. We did not find significant differences between the groups of the changes on other neuropsychological tests. Limitations: Small sample and lack of a control group of healthy subjects. Conclusions: Our trial, which was the first to investigate the cognitive effects of creatine monohydrate on bipolar depression, indicates that supplementation with this nutraceutical for 6 weeks is associated with improvement in verbal fluency tests in patients with this condition.
- Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study(2016) GIGANTE, Alexandre D.; BARENBOIM, Ivan Y.; DIAS, Rodrigo da S.; TONIOLO, Ricardo A.; MENDONCA, Tiago; MIRANDA-SCIPPA, Ngela; KAPCZINSKI, Flavio; LAFER, BenyObjective: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.
- International multi-site survey on the use of online support groups in bipolar disorder(2017) BAUER, Rita; CONELL, Joern; GLENN, Tasha; ALDA, Martin; ARDAU, Raffaella; BAUNE, Bernhard T.; BERK, Michael; BERSUDSKY, Yuly; BILDERBECK, Amy; BOCCHETTA, Alberto; BOSSINI, Letizia; CASTRO, Angela M. Paredes; CHEUNG, Eric Y. W.; CHILLOTTI, Caterina; CHOPPIN, Sabine; ZOMPO, Maria Del; DIAS, Rodrigo; DODD, Seetal; DUFFY, Anne; ETAIN, Bruno; FAGIOLINI, Andrea; HERNANDEZ, Miryam Fernandez; GARNHAM, Julie; GEDDES, John; GILDEBRO, Jonas; GONZALEZ-PINTO, Ana; GOODWIN, Guy M.; GROF, Paul; HARIMA, Hirohiko; HASSEL, Stefanie; HENRY, Chantal; HIDALGO-MAZZEI, Diego; KAPUR, Vaisnvy; KUNIGIRI, Girish; LAFER, Beny; LARSEN, Erik R.; LEWITZKA, Ute; LICHT, Rasmus W.; LUND, Anne Hvenegaard; MISIAK, Blazej; PIOTROWSKI, Patryk; 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; SCIPPA, Angela M.; SLANEY, Claire; SULAIMAN, Ahmad H.; SUOMINEN, Kirsi; SUWALSKA, Aleksandra; TAM, Peter; TATEBAYASHI, Yoshitaka; TONDO, Leonardo; VIETA, Eduard; VINBERG, Maj; VISWANATH, Biju; VOLKERT, Julia; ZETIN, Mark; WHYBROW, Peter C.; BAUER, MichaelBackground: Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient's convenience. Prior research in bipolar disorder has reported value from online support groups.Aims: To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking.Methods: The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages. The survey was completed between March 2014 and January 2016 and included questions on the use of online support groups. All patients were diagnosed by a psychiatrist. Analysis included descriptive statistics and general estimating equations to account for correlated data.Results and conclusions: The survey was completed by 1222 patients in 17 countries. The patients used the Internet at a percentage similar to the general public. Of the Internet users who looked online for information about bipolar disorder, only 21.0% read or participated in support groups, chats, or forums for bipolar disorder (12.8% of the total sample). Given the benefits reported in prior research, clarification of the role of online support groups in bipolar disorder is needed. With only a minority of patients using online support groups, there are analytical challenges for future studies.