BERNARDO CARRAMAO GOMES
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Quality of life in youth with bipolar disorder and unaffected offspring of parents with bipolar disorder(2016) GOMES, Bernardo C.; KLEINMAN, Ana; CARVALHO, Andrea Ferrari; PEREIRA, Tatiana Couto F.; GURGEL, Ana Paola; LAFER, Beny; BUSATTO, Geraldo F.; CAETANO, Sheila C.; ROCCA, Cristiana Castanho de AlmeidaBackground: There have been few studies investigating quality of life (QoL) in pediatric bipolar disorder (BD) patients and none comparing it with that observed in unaffected offspring of parents with BD and healthy controls. Methods: The self-report Youth Quality of Life Instrument-Research version (YQoL-R) was administered in 26 pediatric BD patients, 17 unaffected offspring of parents with BD, and 24 individuals with no history of DSM-IV Axis I psychiatric disorders. All diagnoses were determined through interviews based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Results: There were statistical differences among the groups for all YQoL-R domains. Pairwise comparisons showed that perceived QoL was significantly worse in the BD group than in the unaffected offspring and healthy subjects, a difference that persisted even when only euthymic subjects were analyzed. There were no significant differences between the unaffected offspring and healthy subjects for any YQoL-R domain. Limitations: Our sample was small. There was no QoL report from subjects parents nor data about family environment or BD parents' mood state. Conclusions: There is a need for studies to investigate in greater detail the relationship between QoL and psychological resilience, particularly in the unaffected offspring of parents with BD.
- Quality of life and clinical outcomes in bipolar disorder: An 8-year longitudinal study(2021) KHAFIF, Tatiana Cohab; BELIZARIO, Gabriel Okawa; SILVA, Michelle; GOMES, Bernardo Carramao; LAFER, BenyObjectives: This longitudinal study examined the relationship of Quality of Life (QOL) throughout an 8-year follow-up period with baseline and longitudinal clinical variables indicative of outcome in patients with Bipolar Disorder (BD). Methods: 36 participants, ages 18-70, were recruited from the Bipolar Disorder Research Program (PROMAN) outpatient clinic. Participants completed the WHOQOL-BREF questionnaire in 2009 (baseline), 2015 (6-years) and 2017 (8-years), with high scores being associated with better quality of life. Baseline clinical variables were collected through the Structured Clinical Interview for DSM-IV (SCID-IV) and a structured baseline interview for demographic and clinical assessment. Longitudinal clinical variables were collected through medical records, including mood charts and mood symptoms scales. Results: The results suggest that the QoL, as measured by the WHOQOL-BREF scale, is negatively affected by depressive episodes and is rather stable throughout the course of patients diagnosed with BD. In our study, all three scores were negatively correlated to depressive episodes, and one WHOQOL-BREF score was positively correlated to manic episodes, suggesting that higher scores, both at baseline and throughout the course of the disorder, may be associated to a higher occurrence of manic episodes, while lower QoL scores may be predictive of a higher occurrence of depressive episodes. Also, all three scores revealed significant positive correlations between themselves, suggesting QoL, as measured by the WHOQOL-BREF, remained constant throughout the 8 year observed period. Finally, patients presenting Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD) and substance abuse comorbidities revealed consistent lower WHOQOL-BREF scores, suggesting that these comorbidities may be an important predictor of QoL in BD patients.
- Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial(2017) GOMES, Bernardo Carramao; ROCCA, Cristiana Castanho; BELIZARIO, Gabriel Okawa; LAFER, BenyBackground: Bipolar disorder (BD) is commonly associated with cognitive and functional impairments even during remission periods, and although a growing number of studies have demonstrated the benefits of psychotherapy as an add-on to pharmacological treatment, its effectiveness appears to be less compelling in severe presentations of the disorder. New interventions have attempted to improve cognitive functioning in BD patients, but results have been mixed. Methods: The study consists of a clinical trial comparing a new structured group intervention, called ""CognitiveBehavioral Rehabilitation,""with treatment as usual (TAU) for bipolar patients. The new approach is a combination of cognitive behavioral strategies and cognitive remediation exercises, consisting of 12 weekly group sessions of 90 min each. To be included in the study, patients must be diagnosed with BD type I or II, aged 18-55 years, in full or partial remission, and have an IQ of at least 80. A comprehensive neuropsychological battery, followed by mood, social functioning, and quality of life assessments will occur in three moments: pre and post intervention and 12 months later. The primary outcome of the study is to compare the time, in weeks, that the first full mood episode appears in patients who participated in either group of the study. Secondary outcome will include improvement in cognitive functions. Discussion: This is the first controlled trial assessing the validity and effectiveness of the new ""Cognitive-Behavioral Rehabilitation""intervention in preventing new mood episodes and improving cognitive and functional impairments.
- A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder(2011) GOMES, B. C.; ABREU, L. N.; BRIETZKE, E.; CAETANO, S. C.; KLEINMAN, A.; NERY, F. G.; LAFER, B.Background: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. Methods: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. Results: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (chi(2) = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = -2.554; p = 0.011). Conclusions:Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.
- Negative expressed emotion best discriminates families with bipolar disorder children(2013) NADER, Edmir G.; KLEINMAN, Ana; GOMES, Bernardo Carramao; BRUSCAGIN, Claudia; SANTOS, Bernardo dos; NICOLETTI, Mark; SOARES, Jair C.; LAFER, Beny; CAETANO, Sheila C.Background: Children and adolescents with bipolar disorder (BD) live in family environments with high levels of expressed emotion (EE), conflict, and tension; as well as low maternal warmth and cohesion. These family characteristics have been evaluated in research settings using different scales. Nonetheless, empirically supported assessment instruments are not always feasible to be used in clinical settings. Our aim was to identify the best characteristics that discriminate BD families from control by building a classifier with the main characteristics found from different scales. We also built a classifier based on the adjective check-list scale (ACL) because this scale would be the most feasible one to be used in clinical setting. Methods: We evaluated 33 families of pediatric BD patients and 29 control families. Two self-report scales, ACL and the Family Environment Scale (FES), and a direct interview scale, the Psychosocial Schedule for School Age Children-Revised (PSS-R), were administered. Results: BD families presented lower positive EE and higher negative EE, less cohesion, organization, greater conflict and control; lower rate of intact family, higher maternal and paternal tension compared to control families. Both classifiers demonstrated high accuracy. The offspring's EE toward the mother was the family characteristic that best discriminated BD from control families. Limitations: Small sample size and cross-sectional design. Conclusions: Families of BD children presented altered communication and functioning. The high accuracy of the ACL-based classifier highlights a feasible scale to be used in clinical settings. Further studies assessing prognosis associated with the patterns of communication in such families are needed.
conferenceObject Dysfunctional Family Environment in Children at High Risk for Bipolar Disorder(2012) MOREIRA, Carolina R. L.; FERREIRA, Guilherme S.; KLEINMAN, Ana; NADER, Edmir; GOMES, Bernardo C.; TEIXEIRA, Ana Maria; BUSATTO, Geraldo F.; LAFER, Beny; CAETANO, Sheila C.Background: Children of parents with bipolar disorder (BD) are at heightened risk for developing psychiatric disorders. Environmental influences including family traits have been established as risk factors for psychopathology in children of affectively disordered parents. Our study evaluated the environment of families with at least one parent with BD compared to the environment of families with no history of axis I major psychiatric disorders (FNH). In addition, we compared the environment of BD families with offspring with BD or other psychiatric diagnoses (OPD), BD families with unaffected offspring (UO), and FNH. Methods: We used the Family Environment Scale to evaluate 47 BD families with at least one parent with a DSM-IV BD type I diagnosis and 30 FNH. BD and healthy parents were assessed through the Structured Clinical Interview for DSM-IV (SCID). Offspring of BD and healthy parents were ascertained through the K-SADS-PL interview. Results: Families with BD parents presented lower levels of family cohesion (p=0.001), intellectual-cultural orientation (p=0.005), active-recreational orientation (p=0.002) and organization (p[[Unsupported Character - ˂]]0.001), and higher levels of conflict (p[[Unsupported Character - ˂]]0.001) and control (p=0.04) compared to FNH. Secondary analysesrevealed significant difference between OBD, UO and FNH in cohesion (p=0.003), intellectual-cultural orientation (p=0,01), active-recreational orientation (p=0,007), conflict (p=0,001), control (p=0,01) and organization (p=0,001). BD families with affected offspring showed higher levels of control (p=0.02) compared to BD families with unaffected offspring. Conclusions: Families with BD parent show dysfunctional interaction among members. Moreover, the presence of BD or other psychiatric diagnosis in BD offspring is associated to higher levels of control.