LAURA HELENA SILVEIRA GUERRA DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Investigating the Dimensional Diagnosis of ICD-11 Nicotine Dependence(2018) CASTALDELLI-MAIA, Joao Mauricio; MARTINS, Silvia S.; STORR, Carla L.; VIANA, Maria C.; ANDRADE, Laura H.; ANDRADE, Arthur G.We investigated the dimensionality and possible measurement bias of ICD-11 Nicotine Dependence (ND) criteria in a sample of smokers from a middle-income country. Data are from the Sao Paulo Megacity Project (part of World Mental Health Surveys) collected between 2005 and 2007 (n = 5,037). The current analyses were restricted to the 1,388 participants who smoked at least once a week for 2 months in their lifetime. Item response theory (IRT) was used to investigate the severity and discrimination properties of 8 selected criteria. Additionally, differential criteria functioning (DCF) with sociodemographic characteristics (income, gender, age, employment status, marital status, and education) was investigated. All analyses were performed in Mplus software taking into account complex survey design features. IRT results indicated that the criterion Given Up had the lowest probability of endorsement (highest severity). The criterion Larger/Longer had the highest probability of endorsement (lowest severity), but the highest value of discrimination. Physical Withdrawal had the lowest discrimination property. No DCF was found both at criterion-and disorder-level, which would tear measurement bias. The absence of measurement bias in all sociodemographic, psychiatric, and medical subgroups gives psychometrical support to this set of criteria for ICD-11 ND diagnosis.
- Major Cardiac-Psychiatric Drug-Drug Interactions: a Systematic Review of the Consistency of Drug Databases(2021) CASTALDELLI-MAIA, Joao Mauricio; HOFMANN, Caio; CHAGAS, Antonio Carlos Palandri; LIPRANDI, Alvaro Sosa; ALCOCER, Alejandro; ANDRADE, Laura H.; WIELGOSZ, AndreasPurpose Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging. Methods The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey). Results Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis. Conclusion Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists.
- Gender differences in tobacco use disorder phenotypes among smokers in the largest metropolitan area of South America(2018) CASTALDELLI-MAIA, J. M.; MARTINS, S.; ANDRADE, L.
- Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users(2016) CASTALDELLI-MAIA, Joao Mauricio; ANDRADE, Laura H.; KEYES, Katherine M.; CERDA, Magdalena; PILOWSKY, Daniel J.; MARTINS, Silvia S.Background: There is a need to explore the dimensional and categorical phenotypes of criteria of opioid use disorder among frequent nonmedical users of prescription opioids (NMUPO) users. Methods: We used pooled data of 2011-2012 National Survey on Drug Use and Health to examine reliability and phenotypic variability in the diagnosis of OUD secondary to NMUPO in a nationally representative sample of 18+ years-old frequent past-year NMUPO users (120+ days, n = 806). Through exploratory factor analysis (EFA) and latent class analysis (LCA), we examined 10 past-year OUD criteria. We examined associations between the latent classes and sociodemographic/psychiatric/NMUPO correlates. Results: OUD criteria were unidimensional, and a three-class model was the overall best fitting solution for characterizing individuals into phenotypes along this unidimensional continuum: a ""non-symptomatic class"" (40.7%), ""Tolerance-Time spent class"" (29.0%) with high probability of endorsing Tolerance/Time Spent criteria, and a ""High-moderate symptomatic class"" (30.1%). The last class was significantly associated with being male, having insurance and obtaining prescription opioids (PO) nonmedically via ""doctor shopping"" as compared to the non-symptomatic class. ""Tolerance Time spent class"" was significantly associated with being younger (18-25 years) and obtaining PO nonmedically from family/friends as compared to the non-symptomatic class. Conclusion: This study revealed the different characteristics and routes of access to PO of different classes of frequent NMUPO users. It is possible that these groups may respond to different interventions, however such conclusions would require a clinical study.
- DSM-V NICOTINE USE DISORDER SYMPTOM PROFILES IN A REPRESENTATIVE SAMPLE OF THE LARGEST METROPOLITAN AREA IN SOUTH AMERICA(2013) CASTALDELLI-MAIA, Joao Mauricio; ANDRADE, Laura Helena Guerra de; VIANA, Maria Carmen; ANDRADE, Arthur Guerra de; MARTINS, Silvia SaboiaAims: Given the development of a new diagnostic classification(DSM-V) for nicotine use disorders(NUD), we aimed to identify continuous and cathegorical fenotipes among indivuduals who had at least 1 cigarette per week during life-time. Most of the conceptual framework for NUD come only from alcohol use disorder(AUD) studies. Data came from São Paulo Megacity Project (SPM) collected between 2005-2007, which is part of World Mental Health Surveys. Methods: Exploratory factorial analysis(EFA) and latent class analysis(LCA) of the DSM-V NUD symptoms - SPM did not include the 3 DSM-IV nicotine abuse questions - were performed using Mplus software taking into account complex survey design features. Then, via weighted logistic regression models, we examined socio-demographic correlates of the DSM-V NUD latent classes. Results: As in DSM-VAUD studies, an one-factor model reached the best fitin EFA, including very high loadings(>60%) of all eight symptoms tested. The best LCA model was a four-class model: 1) a “non-symptomatic class”(31.1%), 2) a “lost control class” (27.3%) - defined by high probabilities of “use in larger amounts” and unable to cut down criteria-, 3) a “craving-tolerance class” (7.9%) and 4) a “high-symptomatic class” (33.6%). Those in the “lost-control class” and “craving tolerance class” were more than 2 times more likely to be 18-34 years-old than those in the non-symptomatic class. Being in the three symptomatic classes was associated with unemployment/other as compared being in the non-symptomatic class. Conclusion: Prevention and specific treatment protocol can be designed based on this data. Varenicline or bupropion, as anti-craving medications, seem to be an interesting treatment option for those in the “craving-tolerance class”. Cognitive-behavioral therapy(plus pharmacological treatment) are adequate for those in “loss-control class”. Unemployed and young adults could be the target of prevention interventions for NUD in Brazil.
- DSM-5 latent classes of alcohol users in a population-based sample: Results from the Sao Paulo Megacity Mental Health Survey, Brazil(2014) CASTALDELLI-MAIA, Joao Mauricio; SILVEIRA, Camila M.; SIU, Erica R.; WANG, Yuan-Pang; MILHORANCA, Igor A.; ALEXANDRINO-SILVA, Clovis; BORGES, Guilherme; VIANA, Maria C.; ANDRADE, Arthur G.; ANDRADE, Laura H.; MARTINS, Silvia S.Background: We aimed to identify different categorical phenotypes based upon the DSM-V criteria of alcohol use disorders (AUD) among alcohol users who had at least one drink per week in the past year (n = 948). Methods: Data are from the Sao Paulo Megacity Mental Health Survey collected in 2005-2007, as part of the World Mental Health Survey Initiative. A latent class analysis of the 11 DSM-5-AUD criteria was performed using Mplus, taking into account complex survey design features. Weighted logistic regression models were used to examine demographic correlates of the DSM-5-AUD latent classes. Results: The best latent-class model was a three-class model. We found a ""non-symptomatic class"" (69.7%), a ""use in larger amounts class"" (23.2%), defined by high probability (>70%) of the ""use in larger amounts"" criterion only, and a ""high-moderate symptomatic class"" (7.1%), defined by high-moderate probability of all the 11 AUD criteria. Compared to those in the non-symptomatic class, individuals in the ""high-moderate symptomatic class"" were more likely to have been married, have lower educational attainment and to be unemployed or in non-regular/informal employment. Those on the ""use in larger amounts class"" were more likely to have been married or never married. Conclusion: The two symptomatic classes clearly represented the dimensionality of the new proposed AUD criteria, and could be more specifically targeted by different prevention or treatment strategies. DSM-5-AUD has the advantage of shedding light on risky drinkers included in the ""use in larger amounts class"", allowing for preventive interventions, which will reach a large number of individuals.
- Investigating dimensionality and measurement bias of DSM-5 alcohol use disorder in a representative sample of the largest metropolitan area in South America(2015) CASTALDELLI-MAIA, Joao Mauricio; WANG, Yuan-Pang; BORGES, Guilherme; SILVEIRA, Camila M.; SIU, Erica R.; VIANA, Maria C.; ANDRADE, Arthur G.; MARTINS, Silvia S.; ANDRADE, Laura H.Background: Given the recent launch of a new diagnostic classification (DSM-5) for alcohol use disorders (AUD), we aimed to investigate its dimensionality and possible measurement bias in a non-U.S. sample. Methods: The current analyses were restricted to 948 subjects who endorsed drinking at least one drink per week in the past year from a sample of 5037 individuals. Data came from Sao Paulo Megacity Project (which is part of World Mental Health Surveys) collected between 2005 and 2007. First, exploratory factor analysis (EFA) was carried out to test for the best dimensional structure for DSM-5-AUD criteria. Then, item response theory (IRT) was used to investigate the severity and discrimination properties of each criterion of DSM-5-AUD. Finally, differential criterion functioning (DCF) were investigated by socio-demographics (income, gender, age, employment status, marital status and education). All analyses were performed in Mplus software taking into account complex survey design features. Results: The best EFA model was a one-dimensional model. IRT results showed that the criteria ""Time Spent' and ""Given Up"" have the highest discrimination and severity properties, while the criterion ""Larger/Longer"" had the lowest value of severity, but an average value of discrimination. Only female gender had DCF both at criterion- and factor-level, rendering measurement bias. Conclusion: This study reinforces the existence of a DSM-5-AUD continuum in the largest metropolitan area of South America, including subgroups that had previously higher rates of alcohol use (lower educational/income levels). Lower DSM-5-AUD scores were found in women.
- The latent trait of ICD-11 nicotine dependence criteria: Dimensional and categorical phenotypes(2018) CASTALDELLI-MAIA, Joao Mauricio; ANDRADE, Laura H.; STORR, Carla L.; VIANA, Maria C.; ANDRADE, Arthur G.; MARTINS, Silvia S.We aimed to identify phenotypes of DSM-ICD nicotine dependence among a representative sample of lifetime weekly smokers in the largest metropolitan area in South America. Data came from 1,387 lifetime weekly smokers in the Sao Paulo Megacity Mental Health Survey. We used exploratory factor analysis (EFA) and latent class analysis (LCA) on ICD-11 nicotine dependence proposed criteria to explore dimensionality and phenotypes profiles, followed by logistic regression models to examine the association between latent classes and sociodemographic, psychiatric and chronic medical conditions. Analyses were performed using Mplus taking into account the complex survey design features. An unidimensional model had the best EFA fit with high loadings on all criteria. Response patterns detected by LCA indicated class differences based on severity continuum: a ""non symptomatic class"" (32.0%), a ""low-moderate symptomatic class"" (34.9%) with high probability of the criterion ""use in larger amounts"", and a ""high-moderate symptomatic class"" (33.1%). We found an association between high-income and the intermediate class that differs from findings in high-income countries, and high likelihood of psychiatric comorbidity among the most symptomatic smokers. The best dimensional model that pulled together nicotine dependence criteria supported a single factor, in concordance with the changes proposed for ICD-11.