ALEXANDRE ANDRADE LOCH

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Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina

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Assunto: schizophrenia ×

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Agora exibindo 1 - 10 de 21
  • 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.
  • article 21 Citação(ões) na Scopus
    Hearing spirits? Religiosity in individuals at risk for psychosis-Results from the Brazilian SSAPP cohort
    (2019) LOCH, Alexandre Andrade; FREITAS, Elder Lanzani; HORTENCIO, Lucas; CHIANCA, Camille; ALVES, Tania Maria; SERPA, Mauricio Henriques; ANDRADE, Julio Cesar; BILT, Martinus Theodorus van de; GATTAZ, Wagner Farid; ROESSLER, Wulf
    In the last decades, biological and environmental factors related to psychosis were investigated in individuals at ultra-risk for psychosis (UHR) to predict conversion. Although religion relates to psychosis in a variety of ways, it is understudied in subclinical samples. Therefore, we assessed the interplay between religion and prodromal symptoms in 79 UHR and 110 control individuals. They were interviewed with the Duke University Religion Index and the Structured Interview for Prodromal Syndromes (SIPS). Organizational religious activity, a measure of how often someone attends churches/temples, was positively related to perceptual abnormalities/hallucinations (Spearman's rho = 0.262, p = 0.02). This relationship was replicated in a path analysis model (beta = 0342, SE = 0.108, p = 0.002), as well as a link between organizational religious activity and lower ideational richness (beta = 0.401. SE = 0.105, p = 0.000) with no influence of sex, age, religious denomination, or socioeconomic class. Intrinsic religious activity was negatively correlated with suspiciousness (SIPS P2) (beta = -0.028, SE = 0.009, p = 0.002), and non-organizational religious activity was correlated with higher ideational richness (N5) (beta = -0220,SE = 0.097, p = 0.023). We hypothesize that subjects with subclinical psychosis may possibly use churches and other religious organizations to cope with hallucinations. Indeed, Brazil is characterized by a religious syncretism and a strong influence of Spiritism in the popular culture. The mediumistic idea that some might be able to hear and/or see spirits is probably employed to explain subclinical hallucinations in the lay knowledge. Our results emphasize the importance of assessing religion and other region-specific aspects of various cultures when studying UHR individuals. This sort of assessment would enhance understanding of differences in conversion rates, and would help to transpose prevention programs from high-income countries to other settings.
  • article 28 Citação(ões) na Scopus
    The psychosis continuum in the general population: findings from the Sao Paulo Epidemiologic Catchment Area Study
    (2011) LOCH, Alexandre Andrade; WANG, Yuan-Pang; ROESSLER, Wulf; TOFOLI, Luis Fernando; SILVEIRA, Camila Magalhaes; ANDRADE, Laura Helena
    The aim of the study was to examine the psychosis continuum in a Latin-American community setting. Data were from the Brazilian Sao Paulo Epidemiologic Catchment Area Study, a cross-sectional survey conducted in two boroughs of the city of Sao Paulo. The Composite International Diagnosis Interview (version 1.1) was applied to a probabilistic sample of 1,464 adults, who were interviewed in their household, in order to identify the presence of psychotic symptoms. A subsample was assessed with Schedules for Clinical Assessment in Neuropsychiatry interview. We described the occurrence of psychotic symptoms, categorized into subgroups according to their clinical impact, disability, and help-seeking behavior. The correlation of socio-demographic variables, depressive symptoms, and alcohol and substance use disorders with those psychotic subgroups was analyzed. Polychotomic logistic regression tested the associations between subgroups of psychosis (clinical and subclinical) and the correlates. Of the total sample, 38.0% presented at least one lifetime psychotic symptom, 1.9% met the criteria for an ICD-10 diagnosis of non-affective psychosis, 5.4% presented clinically relevant psychotic symptoms, and 30.7% endorsed clinically non-relevant symptoms. The most common psychotic symptom was delusion with a plausible explanation (in 18.6%). The presence of any psychiatric diagnosis was associated with the presence of psychotic symptoms (OR range, 1.9-8.9). Subclinical psychosis subgroups were found to be associated with the 18-24 year age bracket, chronic depressive mood, and alcohol use disorder. Our results support the concept of a psychosis continuum in Latin-American populations, suggesting that different risk factors influence their manifestation across the continuum.
  • article 27 Citação(ões) na Scopus
    Public stigmatization of different mental disorders: a comprehensive attitude survey
    (2013) HENGARTNER, M. P.; LOCH, A. A.; LAWSON, F. L.; GUARNIERO, F. B.; WANG, Y. -P.; ROESSLER, W.; GATTAZ, W. F.
  • article 4 Citação(ões) na Scopus
    Motion energy analysis during speech tasks in medication-naive individuals with at-risk mental states for psychosis
    (2022) LOPES-ROCHA, Ana Caroline; CORCORAN, Cheryl Mary; ANDRADE, Julio Cesar; PERONI, Leonardo; HADDAD, Natalia Mansur; HORTENCIO, Lucas; SERPA, Mauricio Henriques; BILT, Martinus Theodorus van de; GATTAZ, Wagner Farid; LOCH, Alexandre Andrade
    Movement abnormalities are commonly observed in schizophrenia and at-risk mental states (ARMS) for psychosis. They are usually detected with clinical interviews, such that automated analysis would enhance assessment. Our aim was to use motion energy analysis (MEA) to assess movement during free-speech videos in ARMS and control individuals, and to investigate associations between movement metrics and negative and positive symptoms. Thirty-two medication-naive ARMS and forty-six healthy control individuals were filmed during speech tasks. Footages were analyzed using MEA software, which assesses movement by differences in pixels frame-by-frame. Two regions of interest were defined-head and torso-and mean amplitude, frequency, and coefficient of variability of movements for them were obtained. These metrics were correlated with the Structured Interview for Prodromal Syndromes (SIPS) symptoms, and with the risk of conversion to psychosis-inferred with the SIPS risk calculator. ARMS individuals had significantly lower mean amplitude of head movement and higher coefficients of movement variability for both head and torso, compared to controls. Higher coefficient of variability was related to higher risk of conversion. Negative correlations were seen between frequency of movement and most SIPS negative symptoms. All positive symptoms were correlated with at least one movement variable. Movement abnormalities could be automatically detected in medication-naive ARMS subjects by means of a motion energy analysis software. Significant associations of movement metrics with symptoms were found, supporting the importance of movement analysis in ARMS. This could be a potentially important tool for early diagnosis, intervention, and outcome prediction.
  • article 1 Citação(ões) na Scopus
    Cognitive Patterns and Conversion in a Representative Sample of Individuals at Risk for Psychosis
    (2022) HADDAD, Natalia Mansur; HORTENCIO, Lucas; ANDRADE, Julio Cesar; SERPA, Mauricio Henriques; ALVES, Tania Maria; BILT, Martinus Theodorus van de; ROSSLER, Wulf; GATTAZ, Wagner Farid; LOCH, Alexandre Andrade
    Clinical high-risk (CHR) individuals belong to a heterogeneous group, of which only a few will cross the threshold for a clinical diagnosis. Cognitive disturbances are present in CHR subjects and may be indicative of transition. Our study aims to identify such deficits in a representative CHR for psychosis sample. Our sample comprised 92 CHR individuals and 54 controls from a representative cohort of the general population. They were followed up for a mean of 2.5 years, with 15 individuals converting to schizophrenia or other Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnoses. Neurocognitive assessment was performed with the University of Pennsylvania Computerized Neuropsychological Testing, and CHR status was assessed with the Structured Interview for Prodromal Syndromes (SIPS). Baseline scores were entered in a latent profile analysis model. Our study brought forward a four-class model on cognitive performance. One class displayed better performance, whereas the other three performed worse, all compared with controls. The class with lower executive function also had the highest score on disorganized communication (SIPS P5 = 1.36, p < 0.05), although unrelated to conversion. Among the low performers, the class significantly related to conversion (p = 0.023) had the highest score in decreased expression of emotion (SIPS N3 = 0.85, p < 0.05). Our study brings new and relevant data on non-help-seeking CHR individuals and the relationship between cognitive patterns and conversion. We have highlighted a specific cognitive signature, associated with negative symptoms, which represents a stable trait with presumed lower conversion to a psychiatric illness.
  • article 0 Citação(ões) na Scopus
    A dopamine receptor D2 genetic polymorphism associated with transition to mental disorders in a cohort of individuals with at-risk mental state for psychosis
    (2023) MARQUES, Julia Hatagami; TALIB, Leda Leme; HORTENCIO, Lucas; ANDRADE, Julio Cesar; ALVES, Tania Maria; SERPA, Mauricio Henriques; YAMAMOTO, Guilherme Lopes; BILT, Martinus Theodorus van de; ROSSLER, Wulf; GATTAZ, Wagner Farid; LOCH, Alexandre Andrade
    Objectives: To test the association of 45 single nucleotide polymorphisms (SNPs) with transition to psychiatric disorders in a cohort of individuals at ultrahigh risk (UHR) mental state for psychosis.Methods: Through general population screening, 88 non-help-seeking UHR subjects and 130 healthy control individuals were genotyped for 45 SNPs related to psychosis. They were followed for a mean of 2.5 years, and conversion to psychotic and to general psychiatric disorders was assessed. Genotype frequencies between controls, converters, and non-converters were analyzed.Results: There were no differences in sociodemographics between controls and UHR. Also, UHR converters and non-converters had no differences in their baseline symptoms scores. The dopamine receptor D2 gene (DRD2) SNP rs6277 was significantly more common among UHR who transitioned to psychosis (p o 0.001) and to UHR who transitioned to any psychiatric disorders (p = 0.001) when compared to UHR who did not transition. The rs6277 T allele was related to psychiatric morbidity in a dose-response fashion, being significantly more frequent in UHR converters than UHR non-converters and control subjects (p = 0.003).Conclusion: Our findings suggest that rs6277 could potentially constitute a genetic marker of transition to psychiatric disorders in subjects with at-risk mental states, warranting further investigation in larger samples.
  • article 18 Citação(ões) na Scopus
    O estigma atribuído pelos psiquiatras aos indivíduos com esquizofrenia
    (2011) LOCH, Alexandre Andrade; HENGARTNER, Michael Pascal; GUARNIERO, Francisco Bevilacqua; LAWSON, Fabio Lorea; WANG, Yuan-Pang; GATTAZ, Wagner Farid; ROESSLER, Wulf
    Background: Literature on how the general population stigmatizes individuals with mental disorders has increased considerably over the last decades. But the question remains if psychiatrists also stigmatize their patients. Objective: The present study aimed to assess Brazilian psychiatrists' attitude towards individuals with schizophrenia. Methods: Out of the approximately 6,000 participants of the 2009 National Psychiatry Congress in Brazil, 1,414 psychiatrists agreed to undergo the survey. Face-to-face interviews were conducted using a questionnaire that assessed stigma in three dimensions: stereotypes, social distance and prejudice towards a person with schizophrenia. Their opinion on psychotropic drugs and tolerance of side-effects were also assessed. Socio-demographic and professional data were collected. Results: Brazilian psychiatrists tend to negatively stereotype individuals with schizophrenia. More negative stereotypes correlated with a positive opinion on psychotropic drugs and with a higher tolerance of side-effects. Higher age was correlated with positive stereotyping and with less prejudice. Discussion: Psychiatrists stigmatize individuals with schizophrenia and possibly find it difficulty admit this fact. Anti-stigma campaigns among mental health professionals should be promoted.
  • article 1 Citação(ões) na Scopus
    Use of a Bayesian Network Model to predict psychiatric illness in individuals with 'at risk mental states' from a general population cohort
    (2022) LOCH, Alexandre Andrade; ARA, Anderson; HORTENCIO, Lucas; MARQUES, Julia Hatagami; TALIB, Leda Leme; ANDRADE, Julio Cesar; SERPA, Mauricio Henriques; SANCHEZ, Luciano; ALVES, Tania Maria; BILT, Martinus Theodorus van de; ROESSLER, Wulf; GATTAZ, Wagner Farid
    The 'at risk mental state' (ARMS) paradigm has been introduced in psychiatry to study prodromal phases of schizophrenia. With time it was seen that the ARMS state can also precede mental disorders other than schizophrenia, such as depression and anxiety. However, several problems hamper the paradigm's use in preventative medicine, such as varying transition rates across studies, the use of non-naturalistic samples, and the multifactorial nature of psychiatric disorders. To strengthen ARMS predictive power, there is a need for a holistic model incorporating-in an unbiased fashion-the small-effect factors that cause mental disorders. Bayesian networks, a probabilistic graphical model, was used in a populational cohort of 83 ARMS individuals to predict conversion to psychiatric illness. Nine predictors-including state, trait, biological and environmental factors-were inputted. Dopamine receptor 2 polymorphism, high private religiosity, and childhood trauma remained in the final model, which reached an 85.51% (SD = 0.1190) accuracy level in predicting conversion. This is the first time a robust model was produced with Bayesian networks to predict psychiatric illness among at risk individuals from the general population. This could be an important tool to strengthen predictive measures in psychiatry which should be replicated in larger samples to provide the model further learning.
  • article 5 Citação(ões) na Scopus
    Plasmatic endocannabinoids are decreased in subjects with ultra-high risk of psychosis
    (2022) JOAQUIM, Helena P. G.; COSTA, Alana C.; PEREIRA, Cicero A. C.; TALIB, Leda L.; V, Martinus M. Bilt; LOCH, Alexandre A.; GATTAZ, Wagner F.
    The onset of frank psychosis is usually preceded by a prodromal phase characterized by attenuated psychotic symptoms. Currently, research on schizophrenia prodromal phase (ultra-high risk for psychosis [UHR]) has focused on the risk of developing psychosis, on the transition to full blown psychosis and on its prediction. Neurobiological differences between UHR individuals who fully recover (remitters) versus those who show persistent/progressive prodromal symptoms (nonremitters) have been little explored. The endocannabinoid system constitutes a neuromodulatory system that plays a major role in brain development, synaptic plasticity, emotional behaviours and cognition. It comprises two cannabinoid receptors (CB1/CB2), two endocannabinoid ligands, arachidonylethanolamide (AEA) and 2-arachidonoylglycerol (2AG) along with their inactivation enzymes. Despite much evidence that the endocannabinoid system is imbalanced during psychosis, very little is known about it in UHR. Therefore, we aimed to quantify the plasma endocannabinoid levels in UHR and healthy controls (HC) and verify if these metabolites could differentiate between remitters and nonremitters. Circulating concentrations of AEA (p = .003) and 2AG (p < .001) were lower in UHR when compared with HC, with no difference between remitters and nonremitters. Regarding clinical evolution, it was observed that out of 91 UHRs initially considered, 16 had psychiatric complaints (3 years of follow-up). Considering those subjects, there were weak correlations between clinical parameters and plasma concentrations of endocannabinoids. Our results suggest that the endocannabinoids are imbalanced before frank psychosis and that changes can be seen in plasma of UHR individuals. These molecules proved to be potential biomarkers to identify individuals in the prodromal phase of psychosis.