(Fonte: Lattes)
Índice h a partir de 2011
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina

Resultados de Busca

Agora exibindo 1 - 10 de 72
  • bookPart
    Pródromos da esquizofrenia
    (2021) LOCH, Alexandre Andrade
  • article 24 Citação(ões) na Scopus
    Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
    (2019) LOCH, Alexandre Andrade
    Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings-in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign-probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations.
  • article 55 Citação(ões) na Scopus
    Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization
    (2014) LOCH, Alexandre Andrade
    Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue.
  • article 2 Citação(ões) na Scopus
    Ninety Years of Multiple Psychotic-Like and Spiritual Experiences in a Doctor Honoris Causa A Case Report and Literature Review
    (2021) DAMIANO, Rodolfo Furlan; MACHADO, Liliane; LOCH, Alexandre Andrade; MOREIRA-ALMEIDA, Alexander; MACHADO, Leonardo
    Psychotic experiences are common experiences shared by a considerable part of the world's population. Moreover, most of the individuals who report these experiences also report those called spiritual and dissociative phenomena. In specific culture and religious backgrounds, these experiences are frequently seen as a part of normal human experiences, usually called mediumship. We report a case of a famous Brazilian medium with 90 years of experiencing psychotic-like, dissociative and/or spiritual experiences, but coped well with the experiences and never sought psychiatric or psychological assistance. The medium received several honorific prizes, such as doctor honoris causa from different institutions, published more than 200 books, and ran a nonprofit organization that takes care of 5000 people daily. Finally, we review the literature on this topic and stress the urge for more research aiming to distinguish pathological and nonpathological psychotic experiences to avoid overmedicalization and iatrogenic treatments.
  • conferenceObject
    Association between Childhood Adversity and Ultra-High Risk for Psychosis Status in a Populational Sample of Sao Paulo, Brazil
    (2017) LOCH, Alexandre; ALVES, Tania Maria; FREITAS, Elder Lanzani; HORTENCIO, Lucas; ANDRADE, Julio Cesar; BILT, Martinus Theodorus van de; FONTONI, Marcos Roberto; SERPA, Mauricio; CHIANCA, Camille; GATTAZ, Wagner Farid; ROESSLER, Wulf
  • article 11 Citação(ões) na Scopus
    Epistasis between COMT Val(158)Met and DRD3 Ser(9)Gly polymorphisms and cognitive function in schizophrenia: genetic influence on dopamine transmission
    (2015) LOCH, Alexandre A.; BILT, Martinus T. van de; BIO, Danielle S.; PRADO, Carolina M. do; SOUSA, Rafael T. de; VALIENGO, Leandro L.; MORENO, Ricardo A.; ZANETTI, Marcus V.; GATTAZ, Wagner F.
    Objective: To assess the relationship between cognitive function, a proposed schizophrenia endophenotype, and two genetic polymorphisms related to dopamine function, catechol-O-methyl transferase (COMT) Val(158)Met and dopamine receptor 3 (DRD3) Ser(9)Gly. Methods: Fifty-eight outpatients with schizophrenia/schizoaffective disorder and 88 healthy controls underwent neurocognitive testing and genotyping. Analyses of covariance (ANCOVAs) using age, sex, and years of education as covariates compared cognitive performance for the proposed genotypes in patients and controls. ANCOVAs also tested for the epistatic effect of COMT and DRD3 genotype combinations on cognitive performance. Results: For executive functioning, COMT Val/Val patients performed in a similar range as controls (30.70-33.26 vs. 35.53-35.67), but as COMT Met allele frequency increased, executive functioning worsened. COMT Met/Met patients carrying the DRD3 Ser/Ser genotype performed poorest (16.184 vs. 27.388-31.824). Scores of carriers of this COMT/DRD3 combination significantly differed from all DRD3 Gly/Gly combinations (p < 0.05), from COMT Val/Met DRD3 Ser/Gly (p = 0.02), and from COMT Val/Val DRD3 Ser/Ser (p = 0.01) in patients. It also differed significantly from all control scores (p < 0.001). Conclusion: Combined genetic polymorphisms related to dopamine neurotransmission might influence executive function in schizophrenia. Looking at the effects of multiple genes on a single disease trait (epistasis) provides a comprehensive and more reliable way to determine genetic effects on endophenotypes.
  • article 1 Citação(ões) na Scopus
    Detecting at-risk mental states for psychosis (ARMS) using machine learning ensembles and facial features
    (2023) LOCH, Alexandre Andrade; GONDIM, Joao Medrado; ARGOLO, Felipe Coelho; LOPES-ROCHA, Ana Caroline; ANDRADE, Julio Cesar; BILT, Martinus Theodorus van de; JESUS, Leonardo Peroni de; HADDAD, Natalia Mansur; CECCHI, Guillermo A.; MOTA, Natalia Bezerra; GATTAZ, Wagner Farid; CORCORAN, Cheryl Mary; ARA, Anderson
    Aims: Our study aimed to develop a machine learning ensemble to distinguish ""at-risk mental states for psychosis"" (ARMS) subjects from control individuals from the general population based on facial data extracted from video-recordings.Methods: 58 non-help-seeking medication-naive ARMS and 70 healthy subjects were screened from a general population sample. At-risk status was assessed with the Structured Interview for Prodromal Syndromes (SIPS), and ""Subject's Overview"" section was filmed (5-10 min). Several features were extracted, e.g., eye and mouth aspect ratio, Euler angles, coordinates from 51 facial landmarks. This elicited 649 facial features, which were further selected using Gradient Boosting Machines (AdaBoost combined with Random Forests). Data was split in 70/30 for training, and Monte Carlo cross validation was used.Results: Final model reached 83 % of mean F1-score, and balanced accuracy of 85 %. Mean area under the curve for the receiver operator curve classifier was 93 %. Convergent validity testing showed that two features included in the model were significantly correlated with Avolition (SIPS N2 item) and expression of emotion (SIPS N3 item).Conclusion: Our model capitalized on short video-recordings from individuals recruited from the general population, effectively distinguishing between ARMS and controls. Results are encouraging for large-screening purposes in low-resource settings.
  • article 34 Citação(ões) na Scopus
    Genetic Studies on the Tripartite Glutamate Synapse in the Pathophysiology and Therapeutics of Mood Disorders
    (2017) SOUSA, Rafael T. de; LOCH, Alexandre A.; CARVALHO, Andre F.; BRUNONI, Andre R.; HADDAD, Marie Reine; HENTER, Ioline D.; ZARATE JR., Carlos A.; MACHADO-VIEIRA, Rodrigo
    Both bipolar disorder (BD) and major depressive disorder (MDD) have high morbidity and share a genetic background. Treatment options for these mood disorders are currently suboptimal for many patients; however, specific genetic variables may be involved in both pathophysiology and response to treatment. Agents such as the glutamatergic modulator ketamine are effective in treatment-resistant mood disorders, underscoring the potential importance of the glutamatergic system as a target for improved therapeutics. Here we review genetic studies linking the glutamatergic system to the pathophysiology and therapeutics of mood disorders. We screened 763 original genetic studies of BD or MDD that investigated genes encoding targets of the pathway/mediators related to the so-called tripartite glutamate synapse, including pre- and post-synaptic neurons and glial cells; 60 papers were included in this review. The findings suggest the involvement of glutamate-related genes in risk for mood disorders, treatment response, and phenotypic characteristics, although there was no consistent evidence for a specific gene. Target genes of high interest included GRIA3 and GRIK2 (which likely play a role in emergent suicidal ideation after antidepressant treatment), GRIK4 (which may influence treatment response), and GRM7 (which potentially affects risk for mood disorders). There was stronger evidence that glutamate-related genes influence risk for BD compared with MDD. Taken together, the studies show a preliminary relationship between glutamate-related genes and risk for mood disorders, suicide, and treatment response, particularly with regard to targets on metabotropic and ionotropic receptors.
  • bookPart 4 Citação(ões) na Scopus
    Who is contributing?
    (2016) LOCH, A. A.
    In this chapter, we will address the question of who might potentially hold stigmatizing beliefs toward persons with mental illness. While examining these potential contributors, we want to show that, by harboring such beliefs, these groups and individuals perpetuate the stigmatization process now present in popular culture. This process, as we shall see, is inherent to every society and is generalized rather than focused. Therefore, anyone can, hypothetically, add to the stigma of mental illness, including even some healthcare and mental health professionals who might maintain such prejudices. As such, we start with a short introduction that shows how stigmatization does not apply exclusively to mental disorders but, rather, is a natural activity within every society. We then course through the stigmatization process, beginning at the macrolevel, which comprises society as a whole as well as the mass media. We then continue to the intermediate level, comprising healthcare professionals, and finally to the microlevel, which includes the individual with mental illness himself, who also contributes to this process via self-stigmatization. © Springer International Publishing Switzerland 2017.
  • article 4 Citação(ões) na Scopus
    Patterns of religiosity and spirituality of psychiatrists in Brazil and the implications for clinical practice: a latent profile analysis
    (2020) MENEGATTI-CHEQUINI, Maria Cecilia; LOCH, Alexandre A.; LEAO, Frederico C.; PERES, Mario F. P.; VALLADA, Homero
    BackgroundAlthough there is consensus, in psychiatry, over the inclusion of religious and spiritual aspects when evaluating and treating the patient, investigation of these dimensions is rare. There is evidence as to the relationship between psychiatrists' religious/spiritual beliefs and their willingness to discuss a patient's religion and spirituality (R/S). Due to the lack of information about how psychiatrists in Brazil deal with R/S in patient care, the aim of the present study is to analyze the religious/spiritual profile of these professionals and to ascertain its influence on attitudes and behavior in clinical practice.MethodsFive hundred and ninety-two psychiatrists from Brazil answered a questionnaire about R/S in clinical practice. The latent profile analysis was used to search for differences of religious/spiritual profiles. The ANOVA and Pearson's chi-square tests were employed to identify any correlation between clinical opinion and behaviors according to the different profiles.ResultsTwo religious/spiritual profiles were identified (entropy value >0,96): the so called ""less religious"" group (n=245), comprised predominantly by men, professionally more experienced, with a higher level of academic education (Master or PhD degrees) and were the ones who least enquired about their patients' R/S; and the ""more religious"" psychiatrists (n=347) those who had higher consideration for R/S on health, and who more often addressed R/S with their patients and therefore usually ascribed importance to include R/S in their professional training.ConclusionThe latent profile analysis produced two distinct classes between the Brazilian psychiatrists according to their R/S views: the more religious professionals, who investigate the patient's R/S in a more detailed manner, and the less religious, who tend to disregard this aspect.