TENG CHEI TUNG
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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Agora exibindo 1 - 8 de 8
- Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment(2021) BALDACARA, Leonardo; ROCHA, Gislene A.; LEITE, Veronica da S.; PORTO, Deisy M.; GRUDTNER, Roberta R.; DIAZ, Alexandre P.; MELEIRO, Alexandrina; CORREA, Humberto; TUNG, Teng C.; QUEVEDO, Joao; SILVA, Antonio G. daSuicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissao de Emergencias Psiquiatricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan.
- Suicide and meteorological factors in Sao Paulo, Brazil, 1996-2011: a time series analysis(2017) BANDO, Daniel H.; TENG, Chei T.; VOLPE, Fernando M.; MASI, Eduardo de; PEREIRA, Luiz A.; BRAGA, Alfesio L.Objective: Considering the scarcity of reports from intertropical latitudes and the Southern Hemisphere, we aimed to examine the association between meteorological factors and suicide in Sao Paulo. Method: Weekly suicide records stratified by sex were gathered. Weekly averages for minimum, mean, and maximum temperature (degrees C), insolation (hours), irradiation (MJ/m(2)), relative humidity (%), atmospheric pressure (mmHg), and rainfall (mm) were computed. The time structures of explanatory variables were modeled by polynomial distributed lag applied to the generalized additive model. The model controlled for long-term trends and selected meteorological factors. Results: The total number of suicides was 6,600 (5,073 for men), an average of 6.7 suicides per week (8.7 for men and 2.0 for women). For overall suicides and among men, effects were predominantly acute and statistically significant only at lag 0. Weekly average minimum temperature had the greatest effect on suicide; there was a 2.28% increase (95% CI 0.90-3.69) in total suicides and a 2.37% increase (95% CI 0.82-3.96) among male suicides with each 1 degrees C increase. Conclusion: This study suggests that an increase in weekly average minimum temperature has a short-term effect on suicide in Sao Paulo.
- Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach(2019) BALDACARA, Leonardo; DIAZ, Alexandre P.; LEITE, Veronica; PEREIRA, Lucas A.; SANTOS, Roberto M. dos; GOMES JUNIOR, Vicente de P.; CALFAT, Elie L. B.; ISMAEL, Flavia; PERICO, Cintia A. M.; PORTO, Deisy M.; ZACHARIAS, Carlos E. K.; CORDEIRO, Quirino; SILVA, Antonio Geraldo da; TUNG, Teng C.Objective: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. Methods: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. Conclusion: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation.
- Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention(2021) BALDACARA, Leonardo; GRUDTNER, Roberta R.; LEITE, Veronica da S.; PORTO, Deisy M.; ROBIS, Kelly P.; FIDALGO, Thiago M.; ROCHA, Gislene A.; DIAZ, Alexandre P.; MELEIRO, Alexandrina; CORREA, Humberto; TUNG, Teng C.; MALLOY-DINIZ, Leandro; QUEVEDO, Joao; SILVA, Antonio G. daThis article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention.
- Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach(2019) BALDACARA, Leonardo; ISMAEL, Flavia; LEITE, Veronica; PEREIRA, Lucas A.; SANTOS, Roberto M. dos; GOMES JUNIOR, Vicentede P.; CALFAT, Elie L. B.; DIAZ, Alexandre P.; PERICO, Cintia A. M.; PORTO, Deisy M.; ZACHARIAS, Carlos E.; CORDEIRO, Quirino; SILVA, Antonio Geraldo da; TUNG, Teng C.Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient's appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint.
- Depression and suicidal ideation in treatment-resistent depression patients in latam: cross-sectional analysis from the multicentre, prospective, observational TRAL study(2019) FUENTE-SANDOVAL, C. De la; BONETTO, G. Garcia; LACERDA, A. L. T.; LOPEZ-JARAMILLO, C.; SAUCEDO, E.; TUNG, C. T.; CABRERA, P.; KANEVSKY, G.; SOARES, B.
- Prevalence and Impact of Treatment-Resistant Depression in Latin America: a Prospective, Observational Study(2021) SOARES, Bernardo; KANEVSKY, Gabriela; TENG, Chei Tung; PEREZ-ESPARZA, Rodrigo; BONETTO, Gerardo Garcia; LACERDA, Acioly L. T.; URIBE, Erasmo Saucedo; CORDOBA, Rodrigo; LUPO, Christian; SAMORA, Aline Medeiros; CABRERA, PatriciaApproximately one-third of patients with major depressive disorder (MDD) have treatment-resistant depression (TRD). The TRAL study will evaluate the prevalence and impact of TRD among patients with MDD in four Latin American countries. In this multicenter, prospective, observational study, patients with MDD were recruited from 33 reference sites in Mexico, Colombia, Brazil, and Argentina. Patients were assessed for TRD, defined as failure to respond to >= 2 antidepressant medications of adequate dose and duration. Demographics, previous/current treatments, depressive symptoms, functioning, healthcare resource utilization, and work impairment were also collected and evaluated using descriptive statistics, chi-square test, Fisher exact test, t-test for independent samples, or the Mann-Whitney nonparametric test, as appropriate. 1475 patients with MDD were included in the analysis (mean age, 45.6 years; 78% women); 89% were receiving relevant psychiatric treatment. 429 patients met criteria for TRD, and a numerically higher proportion of patients with TRD was present in public versus private sites of care (31% vs 27%). The mean Montgomery-Asberg Depression Rating Scale score was 25.0 among all MDD patients and was significantly higher for patients with TRD versus non-TRD (29.4 vs 23.3; P < 0.0001). Patients with TRD, versus those with non-TRD, were significantly more likely to be older, have a longer disease duration, have more comorbidities, be symptomatic, have a higher median number of psychiatric consultations, and report greater work impairment. Patients with TRD have a disproportionate burden of disease compared to those with non-TRD. Appropriate treatment for TRD is a substantial unmet need in Latin America. identifier NCT03207282, 07/02/2017.
- Depression and suicidality severity among TRD patients after 1-year under standard of care: Findings from the TRAL study, a multicenter, multinational, observational study in Latin America(2023) CALDIERARO, Marco Antonio; TUNG, Teng Chei; BAENA, Lina Maria Agudelo; DUPRAT, Manuel Vilaprino; CORRAL, Ricardo Marcelo; SERNA, Luis Daniel Alviso de la; SAUCEDO, Erasmo; KANEVSKY, Gabriela; CABRERA, PatriciaIntroduction: Treatment resistant depression (TRD) is one of the most pressing issues in mental healthcare in LatAm. However, clinical data and outcomes of standard of care (SOC) are scarce. The present study reported on the Treatment-Resistant Depression in America Latina (TRAL) project 1-year follow-up of patients under SOC assessing clinical presentation and outcomes. Materials and methods: 420 patients with clinical diagnoses of TRD from Argentina, Brazil, Colombia and Mexico were included in a 1-year follow-up to assess clinical outcomes of depression (MADRS) and suicidality (C-SSRS), as well as evolution of clinical symptoms of depression. Patients were assessed every 3 months and longitudinal comparison was performed based on change from baseline to each visit and end of study (12 months). Socio demographic characterization was also performed. Results: Most patients were female (80.9%), married (42.5%) or single (34.4%), with at least 10 years of formal education (71%). MDD diagnosis was set at 37.29 (SD = 14.00) years, and MDD duration was 11.11 years (SD = 10.34). After 1-year of SOC, 79.1% of the patients were still symptomatic, and 40% of the patients displayed moderate/severe depression. Only 44.1% of the patients achieved a response (>= 50% improvement in MADRS), and 60% of the sample failed to achieve remission. Suicidal ideation was reported by more than half of the patients at the end of study. Conclusions: Depression and suicidality symptoms after a 1-year of SOC is of great concern. Better thera-peutic options are needed to tackle this debilitating and burdensome disease.