PAULA VILLELA NUNES
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
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- Caregiver burden in older adults with bipolar disorder: relationship to functionality and neuropsychiatric symptoms(2017) SANTOS, Glenda D. dos; FORLENZA, Orestes V.; LADEIRA, Rodolfo B.; APRAHAMIAN, Ivan; ALMEIDA, Jouce G.; LAFER, Beny; NUNES, Paula V.Background: There are few studies addressing caregivers of bipolar disorder (BD) patients, especially patients who are older adults with an increased need for care, often given by a relative. The aim of this study was to describe which factors increase caregiver burden among caregivers of elderly BD outpatients. Methods: Patients were older than 60 years and met the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, criteria for BD. They were evaluated for current mood, cognitive and other neuropsychiatric symptoms, functionality, medical comorbidities, quality of life, years since BD diagnosis, and number of psychiatric admissions. The caregiver who spent the greatest time with each patient was evaluated with the Zarit Caregiver Burden Interview. The caregivers' global health, mood symptoms, quality of life, and tasks performed for the patient were also assessed. Results: Thirty-six BD patients and their caregivers were assessed. The Zarit Caregiver Burden Interview was positively correlated with patients' neuropsychiatric symptoms (r = 0.508, P = 0.002) and functional impairment (r = 0.466, P = 0.004). The Zarit Caregiver Burden Interview was also correlated with caregivers' own depression (r = 0.576, P < 0.001), anxiety (r = 0.360, P = 0.031), quality of life (r = -0.406, P = 0.014), medical comorbidities (r = 0.387, P = 0.020), and number of tasks that they completed for the patient (r = 0.480, P = 0.003). Conclusions: In this group of elderly BD patients, caregiver burden was more associated with symptoms frequently seen in others diseases as in dementia than with depressive, manic, or anxiety symptoms, which are often used as treatment outcomes measures goals in BD. Potential treatable and modifiable factors associated with caregiver burden could be caregivers' depression, anxiety, and medical comorbidities, as well as support for caregivers in terms of services and social relationships.
- Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project(2024) SAJATOVIC, Martha; REJ, Soham; ALMEIDA, Osvaldo P.; ALTINBAS, Kursat; BALANZA-MARTINEZ, Vicent; BARBOSA, Izabela G.; BEUNDERS, Alexandra J. M.; BLUMBERG, Hilary P.; BRIGGS, Farren B. S.; DOLS, Annemiek; FORESTER, Brent P.; FORLENZA, Orestes V.; GILDENGERS, Ariel G.; JIMENEZ, Esther; KLAUS, Federica; LAFER, Beny; MULSANT, Benoit; MWANGI, Benson; NUNES, Paula Villela; OLAGUNJU, Andrew T.; OLUWANIYI, Stephen; ORHAN, Melis; PATRICK, Regan E.; RADUA, Joaquim; RAJJI, Tarek; SARNA, Kaylee; SCHOUWS, Sigfried; SIMHANDL, Christian; SEKHON, Harmehr; SOARES, Jair C.; SUTHERLAND, Ashley N.; TEIXEIRA, Antonio L.; TSAI, Shangying; VIDAL-RUBIO, Sonia; VIETA, Eduard; YALA, Joy; EYLER, Lisa T.Objectives: The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean +/- standard deviation age 47.2 +/- 13.5, 65% women, 49% aged over 50) dataset. Design/Methods: Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). Results: Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p <= 0.001, depression p <= 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. Conclusions: In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.
- Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial(2018) CIASCA, Eliana C.; FERREIRA, Rita C.; SANTANA, Carmen L. A.; FORLENZA, Orestes V.; SANTOS, Glenda D. dos; BRUM, Paula S.; NUNES, Paula V.Objective: There are few quantitative studies on art therapy for the treatment of depression. The objective of this study was to evaluate if art therapy is beneficial as an adjuvant treatment for depression in the elderly. Methods: A randomized, controlled, single-blind study was carried out in a sample of elderly women with major depressive disorder (MDD) stable on pharmacotherapy. The experimental group (EG) was assigned to 20 weekly art therapy sessions (90 min/session). The control group (CG) was not subjected to any adjuvant intervention. Patients were evaluated at baseline and after 20 weeks, using the Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and cognitive measures. Results: Logistic regression analysis adjusted for age revealed that women in EG (n=31) had significant improvement in GDS (p = 0.007), BDI (p = 0.025), and BAI (p = 0.032) scores as compared with controls (n=25). No difference was found in the cognitive measures. Conclusion: Art therapy as an adjunctive treatment for MDD in the elderly can improve depressive and anxiety symptoms.
- Mental health in medical students during COVID-19 quarantine: a comprehensive analysis across year-classes(2021) PERISSOTTO, Thais; SILVA, Thamires Clair Rodrigues Pereira da; MISKULIN, Fabricio Petermann Choueiri; PEREIRA, Mariana Berwerth; NEVES, Beatriz Astolfi; ALMEIDA, Beatriz Cantieri; CASAGRANDE, Amanda Victoria; RIBEIZ, Salma Rose Imanari; NUNES, Paula VillelaOBJECTIVES: The COVID-19 pandemic brought abrupt changes when quarantine measures were implemented. Most medical students had distance learning as their main content delivery mode, but in clerkship (fifth and sixth years), in-person activities were maintained under new protocols. These different modes may have affected student mental health. This study examines mental burden and empathy in medical students during the beginning of the COVID-19 pandemic according to the year of attendance. METHODS: All students attending first to the sixth year in the same medical school were invited to participate. The Hospital Anxiety and Depression Scale (HADS), the Self-Reporting Questionnaire (SRQ-20), the Interpersonal Reactivity Index (IRI), and the Mindful Attention Awareness Scale (MAAS) were provided. RESULTS: HADS scores for Anxiety and Depression (n=347) were 9.8 +/- 4.3 and 7.1 +/- 3.6, respectively; the SRQ-20 (n=373) score was 8.1 +/- 4.5; all scores were negatively correlated with the year of attendance. IRI (n=373) scores were: 2.6 +/- 0.5 (Empathic Concern), 2.7 +/- 0.7 (Perspective Taking), 2.5 +/- 0.9 (Fantasy), and 1.7 +/- 0.7 (Personal Distress). Fantasy was negatively correlated with the year of attendance. MAAS scores were positively correlated with the year of attendance. Worse mental health scores were found for first-year students across all scales. CONCLUSIONS: We found high levels of mental burden in medical students in the early period of the COVID-19 pandemic, especially in first-year students, who may have fewer resources to deal with stress. Moreover, as they entered college a short time before the pandemic, they were unable to experience academic life fully or create important new social support networks to deal with adversities.
- Mental Health of Medical Students Before and During COVID-19 Pandemic: a 3-Year Prospective Study(2022) PEREIRA, Mariana Berwerth; CASAGRANDE, Amanda Victoria; ALMEIDA, Beatriz Cantieri; NEVES, Beatriz Astolfi; SILVA, Thamires Clair Rodrigues Pereira da; MISKULIN, Fabricio Petermann Choueiri; PERISSOTTO, Thais; RIBEIZ, Salma Rose Imanari; NUNES, Paula VillelaBackground Very few studies prospectively analyzed medical students' mental health before and during the COVID-19 pandemic. This study aimed to prospectively evaluate mental health in medical students in 2018, 2019, and 2020 during the COVID-19 pandemic lockdown. Methods All students from first to fourth year were invited to participate in 2018. These students were also invited to participate in the same period in 2019 and 2020 (during the peak of the COVID-19 lockdown). The Self-Reporting Questionnaire (SRQ-20), created by the WHO to investigate 20 nonpsychotic psychiatric symptoms, was used to evaluate common mental disorders. The cut-off for relevant symptom severity for mental distress is seven (SRQ-20 >= 7). Results In the years 2018, 2019, and 2020, a total of 860 SRQ-20 questionnaires were completed. Overall, mean SRQ-20 scores were 8.2 +/- 4.6, and SRQ-20 >= 7 frequency was 60.5%. When comparing the years 2018, 2019, and 2020, no differences were found for either SRQ-20 scores (8.4 +/- 4.7, 8.2 +/- 4.6, and 7.8 +/- 4.4, respectively; p = 0.351) or SRQ-20 >= 7 frequency (62.2%, 60.9%, and 59.2%, respectively; p = 0.762). Conclusion In contrast to our initial hypothesis, stable results on mental health measures were found even during the 2020 COVID-19 lockdown. Maintenance of daily routines through distance learning and the continuation of adapted clerkship activities with strict safety measures could have contributed to these results. However, this study points to high overall levels of common mental disorders, especially among women. Further studies should be conducted to understand all the factors responsible for such stability, such as social and economic support, resilience, or even previous high levels of common mental disorders.
- Problematic Social Media Use and Its Relationship with Depression or Anxiety: A Systematic Review(2022) LOPES, Lucas Silva; VALENTINI, Joao Pedro; MONTEIRO, Thomas Hagemann; COSTACURTA, Marcelo Cunha de Freitas; SOARES, Luiza Oliveira Nicastro; TELFAR-BARNARD, Lucy; NUNES, Paula VillelaThere has been a notable increase in social media and Internet use over recent decades, not only for social interaction or entertainment, but also for working and meeting tools, as seen during the COVID-19 pandemic. A relationship between this usage and the development of mental illness is frequently hypothesized, but a few studies have empirical findings. This study is a systematic review of the relationship between social media use and depression or anxiety. Our Medline search yielded 1,747 papers. Our study found a strong and often bidirectional relationship between social media use and depression or anxiety. This relationship was frequently related to problematic social media use. No definite linear relationship was found between time spent using social media and depressive or anxious symptoms, but usually, the longer the time spent in that activity, the worse the outcomes. Factors related to problematic social media use were often different for men and women. Other variables may also play a role, such as nighttime-specific use, emotional involvement, and whether the individual behaves as an active or passive user. Evidence from this review provides a solid base for recommending cautious use of social media. Intense use and unhealthy habits, evidenced by addiction symptoms, may be problematic in less resilient individuals.
conferenceObject Late life depression in cases without dementia is associated to vascular lesions and Lewy Body pathology but not Alzheimer pathology in a large community sample neuropathological study(2019) NUNES, P. V.; SUEMOTO, C. K.; RODRIGUEZ, R. D.; FERRETTI-REBUSTINI, E. de Lucena; LEITE, R. E. P.; NASCIMENTO, F.; SALDANHA, N. M.; PASQUALUCCI, C. A.; NITRINI, R.; GRINBERG, L. T.; JACOB-FILHO, W.; LAFER, B.- Higher proportion of inactive Gsk3 beta in platelets of elderly patients with bipolar disorder: an effect of treatment?(2013) LADEIRA, Rodolfo Braga; JOAQUIM, Helena Passarelli Giroud; TALIB, Leda Leme; NUNES, Paula Villela; FORLENZA, Orestes VicenteObjective: It has been postulated that mood stabilizers inhibit glycogen synthase kinase 3-beta (Gsk3 beta) activity, mainly through its phosphorylation on serine-9 (Ser9). However, in vivo studies addressing Gsk3 beta activity in patients with bipolar disorder are scarce. Here, we compare Gsk3 beta inactivation (as indicated by Ser9-phosphorylation) in platelets of elderly patients with bipolar disorder undergoing clinical treatment and healthy elderly adults not taking medication. Methods: Platelet samples were obtained from 37 elderly adults (bipolar disorder = 19, controls = 18). Relative changes in Gsk3 beta inactivation was estimated by comparing the ratios of phosphorylated Gsk3 beta to total Gsk3 beta (p-Gsk3 beta Ser9/Gsk3 beta) between the disease and control groups. Results: Phosphorylated-Gsk3 beta (p < 0.001) and the p-Gsk3 beta Ser9/Gsk3 beta ratio (p = 0.006) were elevated in bipolar patients. In the bipolar disorder group, p-Gsk3 beta Ser9/Gsk3 beta was positively correlated with serum lithium levels (r = 0.478, p = 0.039). Conclusions: Gsk3 beta inactivation is higher in this group of elderly adults undergoing treatment for bipolar disorder. However, whether the treatment or the disease causes Gsk3 beta inactivation was confounded by the lack of an unmedicated, bipolar control group and the non-uniform treatment regimens of the bipolar disorder group. Thus, further studies should help distinguish whether Gsk3 beta inactivation is an effect of drug treatment or an intrinsic characteristic of bipolar disorder.
- Microcephaly measurement in adults and its association with clinical variables(2022) COSTA, Nicole Rezende da; MANCINE, Livia; SALVINI, Rogerio; TEIXEIRA, Juliana de Melo; RODRIGUEZ, Roberta Diehl; LEITE, Renata Elaine Paraizo; NASCIMENTO, Camila; PASQUALUCCI, Carlos Augusto; NITRINI, Ricardo; JACOB-FILHO, Wilson; LAFER, Beny; GRINBERG, Lea Tenenholz; SUEMOTO, Claudia Kimie; NUNES, Paula VillelaOBJECTIVE: To establish a microcephaly cut-off size in adults using head circumference as an indirect measure of brain size, as well as to explore factors associated with microcephaly via data mining. METHODS: In autopsy studies, head circumference was measured with an inelastic tape placed around the skull. Total brain volume was also directly measured. A linear regression was used to determine the association of head circumference with brain volume and clinical variables. Microcephaly was defined as head circumference that were two standard deviations below the mean of significant clinical variables. We further applied an association rule mining to find rules associating microcephaly with several sociodemographic and clinical variables. RESULTS: In our sample of 2,508 adults, the mean head circumference was 55.3 +/- 2.7cm. Head circumference was related to height, cerebral volume, and sex (p < 0.001 for all). Microcephaly was present in 4.7% of the sample (n = 119). Out of 34,355 association rules, we found significant relationships between microcephaly and a clinical dementia rating (CDR) > 0.5 with an informant questionnaire on cognitive decline in the elderly (IQCODE) = 3.4 (confidence: 100% and lift: 5.6), between microcephaly and a CDR > 0.5 with age over 70 years (confidence: 42% and lift: 2.4), and microcephaly and males (confidence: 68.1% and lift: 1.3). CONCLUSION: Head circumference was related to cerebral volume. Due to its low cost and easy use, head circumference can be used as a screening test for microcephaly, adjusting it for gender and height. Microcephaly was associated with dementia at old age.
- Cognitive-linguistic deficits in euthymic elderly patients with bipolar disorder(2013) RADANOVIC, Marcia; NUNES, Paula Villela; FORLENZA, Orestes Vicente; LADEIRA, Rodolfo Braga; GATTAZ, Wagner FaridBackground: There is increasing evidence that bipolar disorder is also associated with neuropsychological impairments persisting during euthymia, thus representing a trait-like feature of the disease. Language and speech abnormalities are also present in bipolar disorder, especially in verbal fluency and verbal memory. However, there is a lack of studies in the literature investigating different levels of linguistic processing (phonological, syntactical, and semantic) in a single cohort of euthymic bipolar patients. Based on previous Findings of pervasive language impairment in euthymic elderly bipolar patients, the aim of this study was to comprise a more thorough investigation on the subject. Methods: We studied 19 euthymic bipolar patients aged 60 and above, and 20 cognitively healthy subjects using the Arizona Battery for Communication Disorders of Dementia (ABCD) and the Test for Reception of Grammar Version 2 (TROG-2) in order to assess the phonological, syntactic, and semantic domains of language. Results: Bipolar patients performed poorer than controls in Linguistic Expression (p=0.011), in Linguistic Comprehension (Following Commands; p=0.025 and Reading Comprehension of Sentences; p=0.007), and in the TROG-2 (p=0.006). Limitations: The small sample comprising only elderly patients; the lack of statistical power to analyze the potential effect of individual medications on the cognitive performance. Conclusions: Our data demonstrate that linguistic impairment is present in euthymic bipolar patients, affecting mostly syntactic and lexical semantic abilities, both in comprehension and production of language. These deficits are interrelated with other cognitive skills also known to be affected in bipolar disorder, such as executive functions and episodic memory.