LEANDRO DA COSTA LANE VALIENGO
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
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
12 resultados
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- Efficacy, Safety, and Tolerability of Theta-Burst Stimulation in Mixed Depression: Design, Rationale, and Objectives of a Randomized, Double-Blinded, Sham-Controlled Trial(2020) TAVARES, Diego Freitas; SANTOS, Carla Garcia Rodrigues dos; VALIENGO, Leandro Da Costa Lane; KLEIN, Izio; BORRIONE, Lucas; FORTE, Pamela Marques; BRUNONI, Andre R.; MORENO, Ricardo AlbertoIntroduction Mixed-specifier mood disorders are probably a different subgroup in terms of response to treatment, socio-demographic parameters, course, and family history. Here we describe the rationale and design of a clinical trial aimed to test the efficacy, safety, and tolerability of a non-pharmacological treatment known as theta-burst stimulation (TBS) for treating the mixed depressive episodes of both bipolar (I or II), and unipolar depression. Methods The study is designed as a randomized, sham-controlled, double-blinded clinical trial evaluating TBS for the treatment of moderate or severe major depressive episodes with mixed features of patients receiving at least one first or second-line pharmacological treatment for depressive episodes without adequate response. Ninety adult (18 to 65 years old) patients will be enrolled and submitted to 6-week (comprising 5 consecutive days a week sessions for the first 3 weeks and then 2 days a week for a further 3 week) of inhibitory followed by excitatory TBS in dorsolateral prefrontal cortex. Participants will be assessed using clinical and neuropsychological tests before and after the intervention. The primary outcome is change in Montgomery-angstrom sberg Depression Scale (MADRS) score over time and across groups. Cognitive parameters will also be assessed with neuropsychological tests. Results The clinical results will provide evidence about TBS as an adjunctive treatment for mixed depression treatment and neuropsychological parameters will contribute toward an improved understanding the effects of TBS in cognition. Conclusion Our results could introduce a novel therapeutic technique for mixed depressive episodes of both bipolar and unipolar disorders.
- Interventional psychiatry: 13 reasons why(2022) BRUNONI, Andre R.; VALIENGO, Leandro; GALLUCCI-NETO, Jose
- The Effects of Transcranial Direct Current Stimulation in Obsessive-Compulsive Disorder Symptoms: A Meta-Analysis and Integrated Electric Fields Modeling Analysis(2023) PINTO, Bianca Silva; CAVENDISH, Beatriz Araujo; SILVA, Pedro Henrique Rodrigues da; SUEN, Paulo Jeng Chian; MARINHO, Kalian Almeida Pereira; VALIENGO, Leandro da Costa Lane; VANDERHASSELT, Marie-Anne; BRUNONI, Andre Russowsky; RAZZA, Lais BoralliTranscranial direct current stimulation (tDCS) has been showing promising effects for the treatment of obsessive-compulsive disorder (OCD), but there is still no conclusion on its efficacy for this disorder. We performed a systematic review and meta-analysis of trials using tDCS for OCD and a computer modeling analysis to evaluate the electric field (EF) strengths of different electrode assemblies in brain regions of interest (ROIs) (PROSPERO-42021262465). PubMed/MEDLINE, Embase, Cochrane Library and Web of Science databases were searched from inception to 25 September 2022. Randomized controlled trials (RCTs) and open-label studies were included. The primary aim was the effect size (Hedges' g) of continuous outcomes and potential moderators of response. For EF modeling, SimNIBS software was used. Four RCTs and four open-label trials were included (n = 241). Results revealed a large effect of tDCS in the endpoint, but no significant effect between active and sham protocols. No predictor of response was found. EF analysis revealed that montages using the main electrode over the (pre)supplementary motor area with an extracephalic reference electrode might lead to stronger EFs in the predefined ROIs. Our results revealed that tDCS might be a promising intervention to treat OCD; however, larger studies are warranted.
- Mental Health Status of Psychogeriatric Patients During the 2019 New Coronavirus Disease (COVID-19) Pandemic and Effects on Caregiver Burden(2020) PENTEADO, Camila T.; LOUREIRO, Julia C.; PAIS, Marcos V.; CARVALHO, Claudia L.; SANT'ANA, Livea F. G.; VALIENGO, Leandro C. L.; STELLA, Florindo; FORLENZA, Orestes V.Introduction: There is a growing awareness about the noxious effects of the 2019 Coronavirus Disease (COVID-19) pandemic on the mental health of the elderly. However, there is limited information from clinically driven research. The objectives of the present study were to examine the magnitude of psychiatric symptoms and to determine their association with caregiver distress, in a cross-section of community-dwelling older adults and a subsample of aging adults with Down syndrome (DS) attending a psychogeriatric service in Sao Paulo, Brazil. Method: Telephone-based interviews and electronically filled self-assessment questionnaires were used to collect information from patients and caregivers, addressing their impressions and concerns about the pandemic and related effects on the patient's emotional state and behavior. Clinical information was obtained from hospital charts, medical records, and psychometric tests administered through telephone interviews [Hospital Anxiety and Depression Scale (HADS) and Neuropsychiatric Inventory Questionnaire (NPI-Q)]. Results: We included 100 consecutive participants, comprising 71 older adults with psychogeriatric/neurocognitive disorders and 29 aging adults with DS. Higher HADS and NPI-Q scores were significantly associated with caregiver distress (p < 0.05) in both groups. Correlation analyses indicated strong, positive associations between caregiver burden and scores in HADS anxiety (HADS-A) and HADS depression (HADS-D) scales in the subsamples of euploid and DS subjects. Higher NPI-Q scores in the former group were also correlated with caregiver distress, with stronger associations for neuropsychiatric symptoms. Similar findings were observed among DS subjects. ANOVA tests indicated significant associations between NPI-Q scores and caregiver distress among dementia patients, as well as with HADS scores. Similar results were found after multiple linear regressions; as such, among the elderly subsample, higher scores in HADS-A (p = 0.002) and HADS-D (p = 0.001) predict a significant impact on caregiver burden (p < 0.00001, R-2 0.46); taking into consideration caregiver burden as a dependent variable and NPI-Q total score as an independent variable, we obtained significant strong prediction values for either DS (p < 0.00001, R-2 0.95) or elderly adults (p < 0.00001, R-2 0.88). Conclusion: During the COVID-19 pandemic, patients with neurocognitive disorders present with clinically relevant neuropsychiatric symptoms, with significant impact on caregiver distress. Apathy, aberrant motor behavior, sleep disorders, and psychoses were the main psychopathological domains, which had determined caregiver burden worsening.
- Home-Based Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial(2016) HUNGERBUEHLER, Ines; VALIENGO, Leandro; LOCH, Alexandre A.; ROSSLER, Wulf; GATTAZ, Wagner F.Background: There is a tremendous opportunity for innovative mental health care solutions such as psychiatric care through videoconferencing to increase the number of people who have access to quality care. However, studies are needed to generate empirical evidence on the use of psychiatric outpatient care via videoconferencing, particularly in low-and middle-income countries and clinically unsupervised settings. Objective: The objective of this study was to evaluate the effectiveness and feasibility of home-based treatment for mild depression through psychiatric consultations via videoconferencing. Methods: A randomized controlled trial with a 6-and 12-month follow-up including adults with mild depression treated in an ambulatory setting was conducted. In total, 107 participants were randomly allocated to the videoconferencing intervention group (n=53) or the face-to-face group (F2F; n=54). The groups did not differ with respect to demographic characteristics at baseline. The F2F group completed monthly follow-up consultations in person. The videoconferencing group received monthly follow-up consultations with a psychiatrist through videoconferencing at home. At baseline and after 6 and 12 months, in-person assessments were conducted with all participants. Clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence were assessed. Results: The severity of depression decreased significantly over the 12-month follow-up in both the groups. There was a significant difference between groups regarding treatment outcomes throughout the follow-up period, with better results in the videoconferencing group. There were 4 relapses in the F2F group and only 1 in the videoconferencing group. No significant differences between groups regarding mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence, or medication compliance were found. However, after 6 months, the rate of dropouts was significantly higher in the F2F group (18.5% vs 5.7% in the videoconferencing group, P<. 05). Conclusions: Psychiatric treatment through videoconferencing in clinically unsupervised settings can be considered feasible and as effective as standard care (in-person treatment) for depressed outpatients with respect to clinical outcomes, patient satisfaction, therapeutic relationship, treatment adherence, and medication compliance. These results indicate the potential of telepsychiatry to extend access to psychiatric care to remote and underserved populations.
- Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders (Review)(2015) SOEIRO-DE-SOUZA, Marcio G.; DIAS, Vasco Videira; MISSIO, Giovanni; BALANZA-MARTINEZ, Vicent; VALIENGO, Leandro; CARVALHO, Andre F.; MORENO, Ricardo AlbertoThe aim of the present review was to discuss the following aspects of treatment with quetiapine in psychiatric disorders: i) Neurocognition and functional recovery in bipolar disorder (BD); ii) neuroprotective profile in different models; and iii) potential off-label indications. A PubMed search was conducted of articles published in English between 2000 and 2012 on quetiapine, cross-referenced with the terms 'anxiety', 'attention deficit disorder', 'borderline personality disorder', 'dementia', 'insomnia', 'major depressive disorder' (MDD), 'obsessive-compulsive disorder', 'post-traumatic stress disorder', 'remission', 'cognition', 'neurobiology', 'neuroprotection', 'efficacy' and 'effectiveness'. Articles were selected from meta-analyses, randomized clinical trials and open trials, and the results were summarized. Quetiapine, when studied in off-label conditions, has shown efficacy as a monotherapy in MDD and general anxiety disorder. Quetiapine also appears to exhibit a small beneficial effect in dementia. The review of other conditions was affected by methodological limitations that precluded any definitive conclusions on the efficacy or safety of quetiapine. Overall, the present review shows evidence supporting a potential role for quetiapine in improving cognition, functional recovery and negative symptoms in a cost-effective manner in BD. These benefits of quetiapine are potentially associated with its well-described neuroprotective effects; however, further studies are clearly warranted.
- Mood disorders in the elderly: prevalence, functional impact, and management challenges(2016) VALIENGO, Leandro da Costa Lane; STELLA, Florindo; FORLENZA, Orestes VicenteDespite the lower prevalence of severe mood disorders in the elderly as compared to younger adults, late-life depression and bipolar disorder (BD) are more strongly associated with negative outcomes related to the presence of medical comorbidities, cognitive deficits, and increased suicide risk and overall mortality. The mechanisms that contribute to these associations are probably multifactorial, involving pathological factors related directly and indirectly to the disease itself, ranging from biological to psychosocial factors. Most of the accumulated knowledge on the nature of these associations derives from naturalistic and observational studies, and controlled data are still scarce. Nonetheless, there has clearly been a recent growth of the scientific interest on late-life BD and geriatric depression. In the present study, we review the most relevant studies on prevalence, clinical presentation, and cognitive/functional impact of mood disorders in elderly. Several clinical-epidemiological studies were dedicated to the study of the prevalence of mood disorders in old age in distinct settings; however, fewer studies investigated the underlying neurobiological findings and treatment specificities in late-life depression and BD. In the present study, we further discuss the implications of these findings on the management of mood disorders in older adults.
- Treatment of depression in the elderly with repetitive transcranial magnetic stimulation using theta-burst stimulation: Study protocol for a randomized, double-blind, controlled trial(2022) VALIENGO, Leandro; PINTO, Bianca S.; MARINHO, Kalian A. P.; SANTOS, Leonardo A.; TORT, Luara C.; BENATTI, Rafael G.; TEIXEIRA, Bruna B.; MIRANDA, Cristiane S.; CARDEAL, Henriette B.; SUEN, Paulo J. C.; LOUREIRO, Julia C.; VAUGHAN, Renata A. R.; MATTAR, Roberta A. M. P. F. Dini; LESSA, Maira; OLIVEIRA, Pedro S.; SILVA, Valquiria A.; GATTAZ, Wagner Farid; BRUNONI, Andre R.; FORLENZA, Orestes VicenteIntroduction: Transcranial magnetic stimulation (TMS) is a consolidated procedure for the treatment of depression, with several meta-analyses demonstrating its efficacy. Theta-burst stimulation (TBS) is a modification of TMS with similar efficacy and shorter session duration. The geriatric population has many comorbidities and a high prevalence of depression, but few clinical trials are conducted specifically for this age group. TBS could be an option in this population, offering the advantages of few side effects and no pharmacological interactions. Therefore, our aim is to investigate the efficacy of TBS in geriatric depression.
- Digitalized transcranial electrical stimulation: A consensus statement(2022) BRUNONI, Andre R.; EKHTIARI, Hamed; ANTAL, Andrea; AUVICHAYAPAT, Paradee; BAEKEN, Chris; BENSENOR, Isabela M.; BIKSON, Marom; BOGGIO, Paulo; BORRONI, Barbara; BRIGHINA, Filippo; BRUNELIN, Jerome; CARVALHO, Sandra; CAUMO, Wolnei; CIECHANSKI, Patrick; CHARVET, Leigh; CLARK, Vincent P.; KADOSH, Roi Cohen; COTELLI, Maria; DATTA, Abhishek; DENG, Zhi-De; RAEDT, Rudi De; RIDDER, Dirk De; FITZGERALD, Paul B.; FLOEL, Agnes; FROHLICH, Flavio; GEORGE, Mark S.; GHOBADI-AZBARI, Peyman; GOERIGK, Stephan; HAMILTON, Roy H.; JABERZADEH, Shapour J.; HOY, Kate; KIDGELL, Dawson J.; ZONOOZI, Arash Khojasteh; KIRTON, Adam; LAUREYS, Steven; LAVIDOR, Michal; LEE, Kiwon; LEITE, Jorge; LISANBY, Sarah H.; LOO, Colleen; MARTIN, Donel M.; MINIUSSI, Carlo; MONDINO, Marine; MONTE-SILVA, Katia; MORALES-QUEZADA, Leon; NITSCHE, Michael A.; OKANO, Alexandre H.; OLIVEIRA, Claudia S.; ONARHEIM, Balder; PACHECO-BARRIOS, Kevin; PADBERG, Frank; NAKAMURA-PALACIOS, Ester M.; PALM, Ulrich; PAULUS, Walter; PLEWNIA, Christian; PRIORI, Alberto; RAJJI, Tarek K.; RAZZA, Lais B.; REHN, Erik M.; RUFFINI, Giulio; SCHELLHORN, Klaus; ZARE-BIDOKY, Mehran; SIMIS, Marcel; SKORUPINSKI, Pawel; SUEN, Paulo; THIBAUT, Aurore; VALIENGO, Leandro C. L.; VANDERHASSELT, Marie-Anne; VANNESTE, Sven; VENKATASUBRAMANIAN, Ganesan; VIOLANTE, Ines R.; WEXLER, Anna; WOODS, Adam J.; FREGNI, FelipeObjective: Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome methodological barriers and increase equity of access. The study aims are to discuss the implementation of tES digital trials by performing a systematic scoping review and strategic process mapping, evaluate methodological aspects of tES digital trial designs, and provide Delphi-based recommendations for implementing digital trials using tES. Methods: We convened 61 highly-productive specialists and contacted 8 tES companies to assess 71 issues related to tES digitalization readiness, and processes, barriers, advantages, and opportunities for implementing tES digital trials. Delphi-based recommendations (>60% agreement) were provided. Results: The main strengths/opportunities of tES were: (i) non-pharmacological nature (92% of agreement), safety of these techniques (80%), affordability (88%), and potential scalability (78%). As for weaknesses/threats, we listed insufficient supervision (76%) and unclear regulatory status (69%). Many issues related to methodological biases did not reach consensus. Device appraisal showed moderate digitalization readiness, with high safety and potential for trial implementation, but low connectivity. Conclusions: Panelists recognized the potential of tES for scalability, generalizability, and leverage of digital trials processes; with no consensus about aspects regarding methodological biases. Significance: We further propose and discuss a conceptual framework for exploiting shared aspects between mobile-Health tES technologies with digital trials methodology to drive future efforts for digitizing tES trials.
- Transcranial direct current stimulation in psychiatric disorders(2015) TORTELLA, Gabriel; CASATI, Roberta; APARICIO, Luana V. M.; MANTOVANI, Antonio; SENCO, Natasha; D'URSO, Giordano; BRUNELIN, Jerome; GUARIENTI, Fabiana; SELINGARDI, Priscila Mara Lorencini; MUSZKAT, Debora; PEREIRA JUNIOR, Bernardo de Sampaio; VALIENGO, Leandro; MOFFA, Adriano H.; SIMIS, Marcel; BORRIONE, Lucas; BRUNONI, Andre R.The interest in non-invasive brain stimulation techniques is increasing in recent years. Among these techniques, transcranial direct current stimulation (tDCS) has been the subject of great interest among researchers because of its easiness to use, low cost, benign profile of side effects and encouraging results of research in the field. This interest has generated several studies and randomized clinical trials, particularly in psychiatry. In this review, we provide a summary of the development of the technique and its mechanism of action as well as a review of the methodological aspects of randomized clinical trials in psychiatry, including studies in affective disorders, schizophrenia, obsessive compulsive disorder, child psychiatry and substance use disorder. Finally, we provide an overview of tDCS use in cognitive enhancement as well as a discussion regarding its clinical use and regulatory and ethical issues. Although many promising results regarding tDCS efficacy were described, the total number of studies is still low, highlighting the need of further studies aiming to replicate these findings in larger samples as to provide a definite picture regarding tDCS efficacy in psychiatry.