RODRIGO DA SILVA DIAS
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Increased illness burden in women with co-morbid bipolar and premenstrual dysphoric disorder: data from the large step-BD study(2017) SLYEPCHENKO, A.; FREY, B.; LAFER, B.; NIERENBERG, A. A.; SACHS, G. S.; DIAS, R. S.- 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.
- Response to Harvey and Kornstein Letter(2011) DIAS, Rodrigo S.; LAFER, Beny; JOFFE, Hadine
- Internet use by older adults with bipolar disorder: international survey results(2018) BAUER, Rita; GLENN, Tasha; STREJILEVICH, Sergio; CONELL, Joern; ALDA, Martin; ARDAU, Raffaella; BAUNE, Bernhard T.; BERK, Michael; BERSUDSKY, Yuly; BILDERBECK, Amy; BOCCHETTA, Alberto; CASTRO, Angela M. Paredes; CHEUNG, Eric Y. W.; CHILLOTTI, Caterina; CHOPPIN, Sabine; CUOMO, Alessandro; ZOMPO, Maria Del; DIAS, Rodrigo; DODD, Seetal; DUFFY, Anne; ETAIN, Bruno; FAGIOLINI, Andrea; HERNANDEZ, Miryam Fernandez; GARNHAM, Julie; GEDDES, John; GILDEBRO, Jonas; GITLIN, Michael J.; GONZALEZ-PINTO, Ana; GOODWIN, Guy M.; GROF, Paul; HARIMA, Hirohiko; HASSEL, Stefanie; HENRY, Chantal; HIDALGO-MAZZEI, Diego; LUND, Anne Hvenegaard; KAPUR, Vaisnvy; KUNIGIRI, Girish; LAFER, Beny; LARSEN, Erik R.; LEWITZKA, Ute; LICHT, Rasmus W.; MISIAK, Blazej; PIOTROWSKI, Patryk; MIRANDA-SCIPPA, Angela; 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; SLANEY, Claire; SULAIMAN, Ahmad H.; SUOMINEN, Kirsi; SUWALSKA, Aleksandra; TAM, Peter; TATEBAYASHI, Yoshitaka; TONDO, Leonardo; VEEH, Julia; VIETA, Eduard; VINBERG, Maj; VISWANATH, Biju; ZETIN, Mark; WHYBROW, Peter C.; BAUER, MichaelBackground: The world population is aging and the number of older adults with bipolar disorder is increasing. Digital technologies are viewed as a framework to improve care of older adults with bipolar disorder. This analysis quantifies Internet use by older adults with bipolar disorder as part of a larger survey project about information seeking. Methods: A paper-based survey about information seeking by patients with bipolar disorder was developed and translated into 12 languages. The survey was anonymous and completed between March 2014 and January 2016 by 1222 patients in 17 countries. All patients were diagnosed by a psychiatrist. General estimating equations were used to account for correlated data. Results: Overall, 47% of older adults (age 60 years or older) used the Internet versus 87% of younger adults (less than 60 years). More education and having symptoms that interfered with regular activities increased the odds of using the Internet, while being age 60 years or older decreased the odds. Data from 187 older adults and 1021 younger adults were included in the analysis excluding missing values. Conclusions: Older adults with bipolar disorder use the Internet much less frequently than younger adults. Many older adults do not use the Internet, and technology tools are suitable for some but not all older adults. As more health services are only available online, and more digital tools are developed, there is concern about growing health disparities based on age. Mental health experts should participate in determining the appropriate role for digital tools for older adults with bipolar disorder.
- Online information seeking by patients with bipolar disorder: results from an international multisite survey(2016) CONELL, Jorn; BAUER, Rita; GLENN, Tasha; ALDA, Martin; ARDAU, Raffaella; BAUNE, Bernhard T.; BERK, Michael; BERSUDSKY, Yuly; BILDERBECK, Amy; BOCCHETTA, Alberto; BOSSINI, Letizia; CASTRO, Angela Marianne Paredes; CHEUNG, Eric Yat Wo; CHILLOTTI, Caterina; CHOPPIN, Sabine; ZOMPO, Maria Del; DIAS, Rodrigo; DODD, Seetal; DUFFY, Anne; ETAIN, Bruno; FAGIOLINI, Andrea; 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; LAM, Chun; LARSEN, Erik Roj; LEWITZKA, Ute; LICHT, Rasmus; 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 Miranda; SLANEY, Claire; SULAIMAN, Ahmad Hatim; SUOMINEN, Kirsi; SUWALSKA, Aleksandra; TAM, Peter; TATEBAYASHI, Yoshitaka; TONDO, Leonardo; VIETA, Eduard; VINBERG, Maj; VISWANATH, Biju; VOLKERT, Julia; ZETIN, Mark; ZORRILLA, Inaki; WHYBROW, Peter C.; BAUER, MichaelBackground: Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information. Methods: A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data. Results: 976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor. Conclusion: Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.
conferenceObject Predominant polarity determination from a machine learning approach(2018) BELIZARIO, G.; BORGES JUNIOR, R.; SALVINI, R.; LAFER, B.; DIAS, R.- Psychological therapies and psychoeducational recommendations for bipolar disorder treatment during COVID-19 pandemic(2020) ROTENBERG, Luisa de Siqueira; NASCIMENTO, Camila; KHAFIF, Tatiana Cohab; DIAS, Rodrigo Silva; LAFER, Beny
- 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.