ANDRE RUSSOWSKY BRUNONI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Adverse Cardiovascular Effects of the Mood and Anxiety Disorders and Their Treatments on Heart Rate Variability. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): A Cross-Sectional Analysis of Baseline Characteristics(2013) KEMP, Andrew H.; BRUNONI, Andre R.; NUNES, Maria-Angelica; MILL, Iose-Geraldo; RIBEIRO, Antonio L.; PEREIRA, Alexandre C.; BENSENOR, Isabela M.; LOTUFO, Paulo A.- Transcranial direct current stimulation for major depression: an updated systematic review and meta-analysis (vol 17, pg 1443, 2014)(2014) SHIOZAWA, Pedro; FREGNI, Felipe; BENSENOR, Isabela M.; LOTUFO, Paulo A.; BERLIM, Marcelo T.; DASKALAKIS, Jeff Z.; CORDEIRO, Quirino; BRUNONI, Andre R.
conferenceObject Anxiety and Depressive Symptoms are Associated with Coronary Artery Calcium. A Cross-sectional Analysis of Elsa-Brasil Baseline Data(2016) SANTOS, Itamar S.; BITTENCOURT, Marcio S.; ROCCO, Priscila T.; PEREIRA, Alexandre C.; BARRETO, Sandhi M.; BRUNONI, Andre R.; GOULART, Alessandra C.; BLAHA, Michael J.; LOTUFO, Paulo A.; BENSENOR, Isabela M.- Suicide rates and trends in Sao Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis(2012) BANDO, Daniel H.; BRUNONI, Andre R.; FERNANDES, Tiotrefis G.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Objective: To evaluate suicide rates and trends in Sao Paulo by sex, age-strata, and methods. Methods: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide. Results: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (> 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners. Conclusions: Specific epidemiological trends for suicide in the city of Sao Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention.
- Glaucoma, but not cataracts, predicts lower verbal fluency performance: 3.8-year follow-up from the ELSA-Brasil study(2021) VIDAL, Kallene S. M.; BERTOLA, Laiss; SUEMOTO, Claudia K.; MORENO, Arlinda B.; DUNCAN, Bruce; SCHMIDT, Maria Ines; MAESTRI, Marcelo; BARRETO, Sandhi M.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BRUNONI, Andre R.Glaucoma, cataracts, and cognitive decline are most common in older ages. Although cross-sectional studies showed that these disorders are associated, follow-up studies are lacking. To investigate this issue, baseline and follow-up data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were employed. We evaluated participants >= 55 years-old at follow-up without diagnosis of dementia, stroke, and other eye conditions except for glaucoma and cataracts. Cognition was evaluated using delayed word recall, verbal fluency, and trail making (version B) tests. Regression models were employed to investigate associations between glaucoma and cognition, adjusted by several confounders. Out of 3,867 participants, 379 and 118 presented cataracts and glaucoma, respectively. Only glaucoma was apredictor of lower verbal fluency (B = -0.23, 95% CI -035 to -012, p< 0.001). Other associations were not significant (ps>0.57). Our results suggest that glaucoma may be related to declining cognition.
- Negative life events and migraine: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data(2014) SANTOS, Itamar S.; BRUNONI, Andre R.; GOULART, Alessandra C.; GRIEP, Rosane H.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Background: Stress is a typical migraine trigger. However, the impact of negative life events on migraine activity is poorly studied. The aim of this study is to investigate the association between negative life events and migraine using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: ELSA-Brasil is a multicenter cohort study conducted in six Brazilian cities. Baseline assessment included validated questionnaires for headache classification and the occurrence of five pre-specified negative life events (financial hardship, hospitalization other than for childbirth, death of a close relative, robbery and end of a love relationship), focusing on a 12-month period before evaluation. We built crude and adjusted logistic regression models to study the association between the occurrences of negative life events and migraine diagnosis and activity. Results: We included 4,409 individuals with migraine and 4,457 participants without headache (reference). After adjustment for age, sex, race, income and educational level, we found that the occurrence of a negative life event (Odds ratio = 1.31; 95% confidence interval = 1.19 - 1.45) was associated with migraine. However, after stratifying with subgroup analyses, only financial hardship (Odds ratio = 1.65; 95% confidence interval = 1.47 - 1.87) and hospitalization (Odds ratio = 1.47; 95% confidence interval = 1.25 - 1.72) were independently associated with migraine. Further adjustment for a current major depression episode and report of religious activity did not significantly change the results. Considering migraine frequency as (a) less than once per month, (b) once per month to once per week, or (c) more than once per week, financial hardship and hospitalization remained significantly associated with migraine in all episode frequency strata, with higher odds ratios for higher frequencies in adjusted models. We also observed a significant association between the death of a close relative and the highest migraine frequency stratum (Odds ratio = 1.38; 95% confidence interval = 1.09 - 1.75) in full-adjusted model. Conclusions: The occurrence of financial hardship and hospitalization had a direct and independent association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency stratum.
- The Influence of Skin Redness on Blinding in Transcranial Direct Current Stimulation Studies: A Crossover Trial(2017) EZQUERRO, Fernando; MOFFA, Adriano H.; BIKSON, Marom; KHADKA, Niranjan; APARICIO, Luana V. M.; SAMPAIO-JUNIOR, Bernardo de; FREGNI, Felipe; BENSENOR, Isabela M.; LOTUFO, Paulo A.; PEREIRA, Alexandre Costa; BRUNONI, Andre R.ObjectiveTo evaluate whether and to which extent skin redness (erythema) affects investigator blinding in transcranial direct current stimulation (tDCS) trials. Material and MethodsTwenty-six volunteers received sham and active tDCS, which was applied with saline-soaked sponges of different thicknesses. High-resolution skin images, taken before and 5, 15, and 30 min after stimulation, were randomized and presented to experienced raters who evaluated erythema intensity and judged on the likelihood of stimulation condition (sham vs. active). In addition, semi-automated image processing generated probability heatmaps and surface area coverage of erythema. Adverse events were also collected. ResultsErythema was present, but less intense in sham compared to active groups. Erythema intensity was inversely and directly associated to correct sham and active stimulation group allocation, respectively. Our image analyses found that erythema also occurs after sham and its distribution is homogenous below electrodes. Tingling frequency was higher using thin compared to thick sponges, whereas erythema was more intense under thick sponges. ConclusionsOptimal investigator blinding is achieved when erythema after tDCS is mild. Erythema distribution under the electrode is patchy, occurs after sham tDCS and varies according to sponge thickness. We discuss methods to address skin erythema-related tDCS unblinding.
- The association between mood and anxiety disorders, and coronary heart disease in Brazil: a cross-sectional analysis on the Brazilian longitudinal study of adult health (ELSA-Brasil)(2015) KEMP, Andrew H.; BRUNONI, Andre R.; NUNES, Maria A.; SANTOS, Itamar S.; GOULART, Alessandra C.; RIBEIRO, Antonio L.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Background: Associations between major depressive disorder (MDD) and coronary heart disease (CHD) have been established, and these associations increase risk of future morbidity and mortality. Prior research has been carried out in high-income countries. Here we examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations. Methods: Participants included 15,105 civil servants aged 35 to 74 at baseline (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (N = 721) included self-reported angina pectoris (n = 305), myocardial infarction (n = 259) and coronary revascularization (n = 239). Hierarchical logistic regression analyses were conducted to estimate odds ratios and confidence intervals. Results: Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) symptoms present, but diagnostic threshold not reached are associated with a 1.5-fold increase in CHD, after full adjustment for covariates. Conclusion: The association with CHD is greatest in those with psychiatric comorbidity, while associations were also observed in MDD and generalized anxiety disorder without comorbidity. While findings are limited by the cross-sectional design of the study, given the known risks associated with comorbidity of the mood and anxiety disorders with CHD, findings reinforce the importance of comprehensive health assessment in Brazil.
- Omega 3 Consumption and Anxiety Disorders: A Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2018) NATACCI, Lara; MARCHIONI, Dirce M.; GOULART, Alessandra C.; NUNES, Maria Angelica; MORENO, Arlinda B.; CARDOSO, Leticia O.; GIATTI, Luana; MOLINA, Maria del Carmen B.; SANTOS, Itamar S.; BRUNONI, Andre R.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Few studies have evaluated the association between diet and mental disorders, and it has been established that omega-3 (n-3) fatty acids may have a beneficial effect for sufferers of anxiety disorders. This study is part of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a population-based cohort study on diet and mental health-and searched for associations between anxiety disorders and consumption of n-3 polyunsaturated fatty acids (PUFA). The study had a cross-sectional design, with a total sample of 12,268 adults. Dietary exposure was measured by a quantitative food-frequency questionnaire, and mental diagnoses were assessed by the Clinical Interview Schedule-Revised Version and diagnosed according to the International Classification of Diseases (ICD-10). Logistic regression models were built using quintiles of n-3, omega 6 (n-6), n-6/n-3 ratio, and PUFA, using the 1st quintile as reference. Anxiety disorders were identified in 15.4% of the sample. After adjusting for sociodemographic variables, cardiovascular risk factors, diet variables, and depression, intakes in the 5th quintile were inversely associated with anxiety disorders for EPA (OR = 0.82, 95% CI = 0.69-0.98), DHA (OR = 0.83, 95% CI = 0.69-0.98), and DPA (OR = 0.82, 95% CI = 0.69-0.98). Participants in the fifth quintile of n-6/n-3 ratio had a positive association with anxiety disorders. Although results suggest a possible protective effect of n-3 fatty acids against anxiety, all associations lost significance after adjustment for multiple comparisons.
- Emotional reactivity to valence-loaded stimuli are related to treatment response of neurocognitive therapy(2016) VANDERHASSELT, Marie-Anne; RAEDT, Rudi De; NAMUR, Victoria; VALIENGO, Leandro C. L.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BAEKEN, Chris; BOGGIO, Paulo S.; BRUNONI, Andre R.Emotional Context Insensitivity (ECI) is a psychological feature observed in depressed patients characterized by a decreased emotional reactivity when presented to positive- and negative valence-loaded stimuli. Given that fronto-cingulate-limbic circuits are implicated in abnormal reactivity to valence-loaded stimuli, neurocognitive treatments engaging the prefrontal cortex may be able to modulate this emotional blunting observed in MDD. Therefore, our goal was to evaluate emotional reactivity in depressed patients before and after a combination of neurocognitive interventions that engage the prefrontal cortex (cognitive control training and/or transcranial direct current stimulation). In line with the premises of the ECI framework, before the start of the antidepressant intervention, patients showed blunted emotional reactivity after exposure to negative valence-loaded stimuli. This emotional reactivity pattern changed after 9 sessions of the intervention: positive affect decreased and negative affect increased after watching a series of negative valence-loaded stimuli (i.e. images). Interestingly, higher emotional reactivity (as indexed by a larger increase in negative affect after watching the valence-loaded stimuli) at baseline predicted reductions in depression symptoms after the intervention. On the other hand, higher emotional reactivity (as indexed by a decrease in positive affect) after the intervention was marginally associated with reductions in depression symptoms. To conclude, emotional reactivity increased after the neurocognitive antidepressant intervention and it was directly associated to the degree of depression improvement.