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
13 resultados
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bookPart Diagnóstico em psiquiatria: desde os primórdios até as classificações contemporâneas(2021) WANG, Yuan-Pang; SANTANA, Geilson Lima; CôELHO, Bruno Mendonça; ANDRADE, Laura Helena Silveira Guerra de- A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines(2021) KOGAN, Cary S.; MAJ, Mario; REBELLO, Tahilia J.; KEELEY, Jared W.; KULYGINA, Maya; MATSUMOTO, Chihiro; ROBLES, Rebeca; HUANG, Jingjing; ZHONG, Na; CHAKRABARTI, Subho; FIGUEIRA, Maria Luisa; STEIN, Dan J.; STRAKOWSKI, Stephen M.; GARCIA-PACHECO, Jose A.; BURNS, Samantha; MONTOYA, Madeline; ANDRADE, Laura; AYUSO-MATEOS, Jose L.; ARANGO, Ivan; BALHARA, Yatan Pal Singh; BRYANT, Richard; COURNOS, Francine; PORTO, Jose Alberto Del; MEYER, Thomas D.; MEDINA-MORA, Maria-Elena; GUREJE, Oye; FIRST, Michael B.; GAEBEL, Wolfgang; KHOURY, Brigitte; KRASNOV, Valery N.; MARI, Jair de Jesus; MARUTA, Toshimasa; PIKE, Kathleen M.; ROBERTS, Michael C.; SHARAN, Pratap; ZHAO, Min; REED, Geoffrey M.Background: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. Methods: 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD11 or ICD-10 guidelines to one of eleven pairs of case vignettes. Results: Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. Limitations: Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. Conclusions: Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
- A randomized clinical trial to assess the efficacy of trial-based cognitive therapy compared to prolonged exposure for post-traumatic stress disorder: preliminary findings(2021) DURAN, Erica Panzani; CORCHS, Felipe; VIANNA, Andrea; ARAUJO, Alvaro Cabral; REAL, Natalia Del; SILVA, Claudio; FERREIRA, Ana Paula; FRANCEZ, Paula De Vitto; GODOI, Claudio; SILVEIRA, Helena; MATSUMOTO, Lina; GEBARA, Cristiane Maluhy; BARROS NETO, Tito Paes de; CHILVARQUER, Raquel; SIQUEIRA, Luciana Lima de; BERNIK, Marcio; LOTUFO NETO, FranciscoBackground Post-traumatic stress disorder (PTSD) is a prevalent mental health condition that is often associated with psychiatric comorbidities and changes in quality of life. Prolonged exposure therapy (PE) is considered the gold standard psychological treatment for PTSD, but treatment resistance and relapse rates are high. Trial-based cognitive therapy (TBCT) is an effective treatment for depression and social anxiety disorder, and its structure seems particularly promising for PTSD. Therefore, we evaluated the efficacy of TBCT compared to PE in patients with PTSD. Methods Ninety-five patients (77.6% females) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for PTSD were randomly assigned to receive either TBCT (n = 44) or PE (n = 51). Patients were evaluated before and after treatment, and at follow-up 3 months after treatment. The primary outcome was improvement in PTSD symptoms as assessed by the Davidson Trauma Scale (DTS). Secondary outcomes were depression, anxiety, and dysfunctional attitudes assessed by the Beck Depression/Anxiety Inventories and Dysfunctional Attitudes Scale, as well as the dropout rate. Results A significant reduction in DTS scores was observed in both arms, but no significant difference between treatments. Regarding the secondary outcomes, we found significant differences in depressive symptoms in favor of TBCT, and the dropout rate was lower in the TBCT group than the PE group. Conclusion Our preliminary results suggest that TBCT may be an effective alternative for treating PTSD. Further research is needed to better understand its role and the mechanisms of change in the treatment of this disorder.
- 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.
- Cardiovascular risk factors and major depressive disorder: a cross-sectional study in Sao Paulo, Brazil(2021) BIVANCO-LIMA, Danielle; SANTOS, Itamar de Souza; WANG, Yuan-Pang; VIANA, Maria Carmen; ANDRADE, Laura Helena; LOTUFO, Paulo Andrade; BENSENOR, Isabela Judith MartinsBACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of Sao Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in Sao Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.
- Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys(2021) VRIES, Ymkje Anna de; HARRIS, Meredith G.; VIGO, Daniel; CHIU, Wai Tat; SAMPSON, Nancy A.; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura H.; BENJET, Corina; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HU, Chiyi; KARAM, Elie G.; KAWAKAMI, Norito; KOVESS-MASFETY, Viviane; LEE, Sing; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; OJAGBEMI, Akin; VILLA, Jose Pusada; SCOTT, Kate; TORRES, Yola; ZARKOV, Zahari; NIERENBERG, Andrew; KESSLER, Ronald C.; JONGE, Peter deBackground: Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. Methods: Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. Results: 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. Limitations: Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. Conclusions: Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
- Perceived helpfulness of treatment for alcohol use disorders: Findings from the World Mental Health Surveys(2021) DEGENHARDT, Louisa; BHARAT, Chrianna; CHIU, Wai Tat; HARRIS, Meredith G.; KAZDIN, Alan E.; VIGO, Daniel V.; SAMPSON, Nancy A.; ALONSO, Jordi; ANDRADE, Laura Helena; BRUFFAERTS, Ronny; BUNTING, Brendan; CARDOSO, Graca; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HU, Chiyi; KARAM, Aimee N.; KARAM, Elie G.; KOVESS-MASFETY, Viviane; LEE, Sing; MAKANJUOLA, Victor; MCGRATH, John J.; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; POSADA-VILLA, Jose; RAPSEY, Charlene; STAGNARO, Juan Carlos; TACHIMORI, Hisateru; HAVE, Margreet ten; TORRES, Yolanda; WILLIAMS, David R.; ZARKOV, Zahari; KESSLER, Ronald C.Aim: We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment. Methods: Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843). Participants with a lifetime history of treated AUD were asked if they ever received helpful AUD treatment, and how many professionals they had talked to up to and including the first time they received helpful treatment (or how many ever, if they had not received helpful treatment). Results: 11.8% of respondents with lifetime AUD reported ever obtaining treatment (n = 9378); of these, 44% reported that treatment was helpful. The probability of obtaining helpful treatment from the first professional seen was 21.8%; the conditional probability of subsequent professionals being helpful after earlier unhelpful treatment tended to decrease as more professionals were seen. The cumulative probability of receiving helpful treatment at least once increased from 21.8% after the first professional to 79.7% after the seventh professional seen, following earlier unhelpful treatment. However, the cumulative probability of persisting with up to seven professionals in the face of prior treatments being unhelpful was only 13.2%. Conclusion: Fewer than half of people with AUDs who sought treatment found treatment helpful; the most important factor was persistence in seeking further treatment if a previous professional had not helped. Future research should examine how to increase the likelihood that AUD treatment is found to be helpful on any given contact.
- Association between childhood adversities and psychopathology onset throughout the lifespan: Findings from a large metropolitan population(2021) COELHO, Bruno Mendonca; ANDRADE, Laura Helena; SANTANA, Geilson Lima; VIANA, Maria Carmen; WANG, Yuan-PangBackground: Childhood adversities (ECA) are deleterious experiences that can occur during individuals' development, which has been associated with several negative health outcomes. Aim: Analyze the effect of ECA on the onset of DSM-IV disorders throughout life. Method: The Composite International Diagnostic Interview (CIDI) was used in a stratified, multistage area probability sample of 5037 individuals aged 18 or more to assess the presence of childhood adversities, 20 psychiatric disorders and their ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset. Data are from the Sao Paulo Megacity Mental Health Survey, the Brazilian branch of the World Mental Health Survey Initiative. Findings: 53.6% of the sample experienced at least one ECA, and parental death (16.1%) and physical abuse (16%) were the most reported occurrences. Parental mental illness (OR = 1.99 to 2.27) and family violence (OR = 1.55 to 1.99) were the adversities most consistently associated with psychopathology across all age groups, while economic adversities (OR = 2.71 to 3.30) and parent criminality (OR = 1.72 to 1.77) were associated with psychopathology in individuals whose onset of disorder occurred from age 13 years on. Parental mental disorders and economic adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined in multivariate models controlled for the clustering of adversities. Physical abuse was associated with externalizing disorders, while sexual abuse with internalizing disorders. Interpretation: Childhood adversities were consistently associated with mental disorders. Economic adversities and parent mental disorders were predictive of psychopathology even if controlled for type (additive) and type and number of adversities (interactive models). Parental mental disorder and family violence were the main predictors of psychopathology onset across all age groups. Parental mental disorder was the only adversity that predicted all classes of disorders investigated.
bookPart Epidemiologia dos transtornos mentais na populaçãp geral adulta(2021) WANG, Yuan-Pang; VIANA, Maria Carmen; ANDRADE, Laura Helena Silveira Guerra de- I don't need any treatment'' - barriers to mental health treatment in the general population of a megacity(2021) COELHO, Bruno M.; SANTANA, Geilson L.; VIANA, Maria C.; WANG, Yuan-Pang; ANDRADE, Laura H.Objective: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. Methods: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. Results: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). Conclusion: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.