HELIO ELKIS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Cognitive outcomes after tDCS in schizophrenia patients with prominent negative symptoms: Results from the placebo-controlled STARTS trial(2021) BULUBAS, Lucia; GOERIGK, Stephan; GOMES, July S.; BREM, Anna-Katharine; CARVALHO, Juliana B.; PINTO, Bianca S.; ELKIS, Helio; GATTAZ, Wagner F.; PADBERG, Frank; BRUNONI, Andre R.; VALIENGO, LeandroCognitive deficits and negative symptoms in schizophrenia are associated with poor functional outcomes and limited in terms of treatment. The Schizophrenia Treatment With Electric Transcranial Stimulation (STARTS) trial has shown efficacy of transcranial direct current stimulation (tDCS) for improving negative symptoms. In this secondary analysis, we investigate its effects on cognitive performance. In STARTS, a double-blinded, sham controlled, randomized clinical trial, patients were treated with twice-daily, 20-min, 2-mA fronto-temporal tDCS over 5 days or sham-tDCS. In 90 patients, we evaluated the cognitive performance up to 12 weeks post-treatment. We found that active-tDCS showed no beneficial effects over sham-tDCS in any of the tests. Based on a 5-factor cognitive model, improvements of executive functions and delayed memory were observed in favor of shamtDCS. Overall, the applied active-tDCS protocol, primarily designed to improve negative symptoms, did not promote cognitive improvement. We discuss possible protocol modification potentially required to increase tDCS effects on cognition. ClinicalTrials.gov identifier: NCT02535676
- Understanding the impact of persistent symptoms in schizophrenia: Cross-sectional findings from the Pattern study(2015) HARO, Josep Maria; ALTAMURA, Carlo; CORRAL, Ricardo; ELKIS, Helio; EVANS, Jonathan; MALLA, Ashok; KREBS, Marie-Odile; ZINK, Mathias; BERNASCONI, Corrado; LALONDE, Justine; NORDSTROEM, Anna-LenaBackground: The high societal burden of schizophrenia is largely caused by the persistence of symptoms and accompanying functional impairment. To date, no studies have specifically assessed the course of persistent symptoms or the individual contributions of positive and negative symptoms to patient functioning. The cross-sectional analysis of the Pattern study provides an international perspective of the burden of schizophrenia. Methods: Clinically stable outpatients from 140 study centers across eight countries (Argentina, Brazil, Canada, France, Germany, Italy, Spain and the United Kingdom) were assessed using clinical rating scales: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia (CGI-SCH) Scale and the Personal and Social Performance (PSP) Scale. Additional measures included patient-reported outcomes, patient sociodemographic variables, living situation, employment and resource use. Results: Overall, 1379 patients were assessed and analyzed and had similar sociodemographic characteristics across countries, with 61.6% having persistent positive and/or negative symptoms. Positive and negative symptoms had been persistent for a mean of 9.6 and 8.9 years (SD: 8.8 and 9.6), respectively. Approximately 86% of patients had a functional disability classified as greater than mild. Patients with a higher PANSS Negative Symptom Factor Score were more likely to have a poorer level of functioning. Conclusions: This analysis examines individual contributions of persistent positive and negative symptoms on patient functioning in different countries. A high prevalence of patients with persistent symptoms and functional impairment was a consistent finding across countries. Longitudinal observations are necessary to assess how to improve persistent symptoms of schizophrenia and overall patient functioning.
- Cortical surface abnormalities are different depending on the stage of schizophrenia: A cross-sectional vertexwise mega-analysis of thickness, area and gyrification(2021) ROSA, Pedro Gomes Penteado; ZUGMAN, Andre; CERQUEIRA, Carlos Toledo; SERPA, Mauricio Henriques; DURAN, Fabio Luis de Souza; ZANETTI, Marcus Vinicius; BASSITT, Debora Pastore; ELKIS, Helio; CRIPPA, Jose Alexandre S.; SALLET, Paulo Clemente; GATTAZ, Wagner Farid; HALLAK, Jaime Eduardo Cecilio; LOUZA, Mario Rodrigues; GADELHA, Ary; JACKOWSKI, Andrea Parolin; BRESSAN, Rodrigo Affonseca; BUSATTO FILHO, GeraldoBackground: Brain magnetic resonance imaging studies have not investigated the cortical surface comprehensively in schizophrenia subjects by assessing thickness, surface area and gyrification separately during the first episode of psychosis (FEP) or chronic schizophrenia (ChSch). Methods: We investigated cortical surface abnormalities in 137 FEP patients and 240 ChSch subjects compared to 297 Healthy Controls (HC) contributed by five cohorts. Maps showing results of vertexwise between-group comparisons of cortical thickness, area, and gyrification were produced using T1-weighted datasets processed using FreeSurfer 5.3, followed by validated quality control protocols. Results: FEP subjects showed large clusters of increased area and gyrification relative to HC in prefrontal and insuli cortices (Cohen's d: 0.049 to 0.28). These between-group differences occurred partially beyond the effect of sample. ChSch subjects displayed reduced cortical thickness relative to HC in smaller fronto-temporal foci (d:-0.73 to-0.35), but not beyond the effect of sample. Differences between FEP and HC subjects were associated with male gender, younger age, and earlier illness onset, while differences between ChSch and HC were associated with treatment-resistance and first-generation antipsychotic (FGA) intake independently of sample effect. Conclusions: Separate assessments of FEP and ChSch revealed abnormalities that differed in regional distribution, phenotypes affected and effect size. In FEP, associations of greater cortical area and gyrification abnormalities with earlier age of onset suggest an origin on anomalous neurodevelopment, while thickness reductions in ChSch are at least partially explained by treatment-resistance and FGA intake. Associations of between-group differences with clinical variables retained statistical significance beyond the effect of sample.
- Identifying strategies to improve PANSS based dimensional models in schizophrenia: Accounting for multilevel structure, Bayesian model and clinical staging(2022) HIGUCHI, Cinthia H.; COGO-MOREIRA, Hugo; FONSECA, Lais; ORTIZ, Bruno B.; CORRELL, Christoph U.; NOTO, Cristiano; CORDEIRO, Quirino; FREITAS, Rosana de; ELKIS, Helio; I, Sintia Belangero; BRESSAN, Rodrigo A.; GADELHA, AryBackground: Dimensional approaches can decompose a construct in a set of continuous variables, improving the characterization of complex phenotypes, such as schizophrenia. However, the five-factor model of the Positive and Negative Syndrome Scale (PANSS), the most used instrument in schizophrenia research, yielded poor fits in most confirmatory factor analysis (CFA) studies, raising concerns about its applications. Thus, we aimed to identify dimensional PANSS CFA models with good psychometric properties by comparing the traditional CFA with three methodological approaches: Bayesian CFA, multilevel modeling, and Multiple Indicators Multiple Causes (MIMIC) modeling.Methods: Clinical data of 700 schizophrenia patients from four centers were analyzed. We first performed a traditional CFA. Next, we tested the three techniques: 1) a Bayesian CFA; 2) a multilevel analysis using the centers as level; and 3) a MIMIC modeling to evaluate the impact of clinical staging on PANSS factors and items. Results: CFA and Bayesian CFA produced poor fit models. However, when adding a multilevel structure to the CFA model, a good fit model emerged. MIMIC modeling yielded significant differences in the factor structure between the clinical stages of schizophrenia. Sex, age, age of onset, and duration of illness did not significantly affect the model fit.Conclusion: Our comparison of different CFA methods highlights the need for multilevel structure to achieve a good fit model and the potential utility of staging models (rather than the duration of illness) to deal with clinical heterogeneity in schizophrenia. Large prospective samples with biological data should help to understand the interplay between psychometrics concerns and neurobiology research.
conferenceObject IQ MEASURE: RELATION WITH REFRACTORY SCHIZOPHRENIA(2012) OLIVEIRA, Graca Maria R.; KAYO, Monica; ISO, Sandra M. K.; ELKIS, HelioconferenceObject THE EFFICACY OF OCCUPATIONAL THERAPY IN THE REHABILITATION OF EXECUTIVE FUNCTIONS IN PATIENTSWITH TREATMENT-RESISTANT SCHIZOPHRENIA: A PILOT RANDOMIZED CONTROLLED TRIAL(2014) VIZZOTTO, Adriana Dias Barbosa.; CELESTINO, Diego Luis; BUCHAIN, Patricia Cardoso; OLIVEIRA, Alexandra Martini de; OLIVEIRA, Graca Maria Ramos de; SARNO, Elaine Scapaticio Di; NAPOLITANO, Isabel Cristina; ELKIS, Helio- Pimavanserin, a selective serotonin (5-HT)2A-inverse agonist, enhances the efficacy and safety of risperidone, 2 mg/day, but does not enhance efficacy of haloperidol, 2 mg/day: Comparison with reference dose risperidone, 6 mg/day(2012) MELTZER, Herbert Y.; ELKIS, Helio; VANOVER, Kimberly; WEINER, David M.; KAMMEN, Daniel P. van; PETERS, Perry; HACKSELL, UliMost atypical antipsychotic drugs (APDs), e. g. risperidone (RIS), produce more extensive blockade of brain serotonin (5-HT)(2A) than dopamine (DA) D-2 receptors. This distinguishes them from typical APDs, e.g. haloperidol (HAL). Our objective was to test the hypothesis that augmentation of low doses of RIS or HAL (2 mg/day) with pimavanserin (PIM), a selective 5-HT2A inverse agonist, to enhance 5-HT2A receptor blockade, can achieve efficacy comparable to RIS, 6 mg/day, but with lesser side effects. In a multi-center, randomized, double-blind, 6 week trial, 423 patients with chronic schizophrenia experiencing a recent exacerbation of psychotic symptoms were randomized to RIS2mg + placebo (RIS2PBO), RIS2mg + PIM20mg (RIS2PIM), RIS6mg + PBO (RIS6PBO), HAL2mg + PBO (HAL2PBO), or HAL2mg + PIM20mg (HAL2PIM). Improvement in psychopathology was measured by the PANSS and CGI-S. The reduction in PANSS Total Score with RIS2PIM at endpoint was significantly greater than RIS2PBO: -23.0 vs. -16.3 (p = 0.007), and not significantly different from the RIS6PBO group: -23.2 points. The percentage of patients with >= 20% improvement at day 15 in the RIS2PIM group was 62.3%, significantly greater than the RIS6PBO (42.1%; p = 0.01) and the RIS2PBO groups (37.7%; p = 0.002). Weight gain and hyperprolactinemia were greater in the RIS6PBO group than the RIS2PIM group but there was no difference in extrapyramidal side effects (EPS). HAL2PBO and HAL2PIM were not significantly different from each other in efficacy but HAL2PIM had less EPS at end point. Both HAL groups and RIS6PBO showed equal improvement in psychopathology at endpoint, indicating HAL 2 mg/day is effective to treat an acute exacerbation in chronic schizophrenia patients. In conclusion, a sub-effective RIS dose combined with PIM to enhance 5-HT2A receptor blockade provided faster onset of action, and at endpoint, equal efficacy and better safety, compared to standard dose RIS. These results support the conclusion that 5-HT2A receptor blockade is a key component of the action of some atypical APDs and can reduce EPS due to a typical APD.
conferenceObject ATTENTION AND MEMORY TRAINING IN STABLE SCHIZOPHRENIC PATIENTS: A DOUBLE-BLIND, RANDOMIZED, CONTROLLED TRIAL USING SIMPLE RESOURCES(2012) PONTES, Livia M.; MARTINS, Camila B.; NAPOLITANO, Isabel C.; FONSECA, Juliana R.; OLIVEIRA, Graca M.; ISO, SandraM.; MENEZES, Anny K.; VIZZOTTO, Adriana D.; SARNO, Elaine S. di; NOGUEIRA, Marcelo; ELKIS, HelioconferenceObject THE USE OF SOCIAL SKILLS INVENTORY IN PATIENTS WITH REFRACTORY AND NON-REFRACTORY SCHIZOPHRENIA(2012) SCEMES, Silvia; KAYO, Monica; SAVOIA, Mariangela Gentil; SANTOS, Bernardo; MESTRINER, Paulo; ELKIS, HelioconferenceObject THOUGHT AND LANGUAGE DISORDERS IN YOUNG PATIENTS WITH SCHIZOPHRENIA, SCHIZOAFFECTIVE DISORDER AND BIPOLAR DISORDER(2012) PANTANO, Telma; LEE, Fu I.; CURATOLO, Eliana; MARTINS, Camila B.; HELIO, Elki