GABRIEL OKAWA BELIZARIO
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- Predominant polarity classification and associated clinical variables in bipolar disorder: A machine learning approach(2019) BELIZARIO, Gabriel Okawa; BORGES JUNIOR, Renato Gomes; SALVINI, Rogerio; LAFER, Beny; DIAS, Rodrigo da SilvaBackground: Bipolar disorder (BD) is a severe psychiatric disorder characterized by periodic episodes of manic and depressive symptomatology. Predominant polarity (PP) appears to be an important specifier of BD. The present study employed machine learning (ML) algorithms to accurately determine a patient ' s PP without the inclusion of number and polarity of past episodes, while exploring associations between PP and demographic and clinical variables. Methods: From a cohort of 148 BD patients, demographic and clinical variables were collected using a customized questionnaire and the SCID-CV. The algorithm employed was the Random-Forest method. The algorithm was programed to classify patients into either depressive or manic predominant polarities and to reveal which variables were associated to the specifier. Results: The algorithm attained an AUC ROC of 74.72% (95% CI = 72.29-77.15%) in classifying patients into either manic or depressive PP. The variables selected by the algorithm were: (1) age at first depressive episode; (2) number of hospitalizations; (3) BD Type II; (4) manic onset; (5) delusions; (6) psychotic features at onset; (7) tobacco addiction; (8) family history of BD; (9) hallucinations; and (10) comorbid anxiety disorders, (11) alcohol dependence, (12) eating disorders and (13) substance dependence. Limitations: The study is limited due to the small sample size, the inclusion of only self-reported and clinician-observed clinical variables and its cross-sectional design. Discussion: The results suggest that the ML approach could be effective in determining a patient ' s PP. Furthermore, although not previously reported, some variables, such as tobacco use and comorbid eating disorders, appear to be closely associated with PP.
- Quality of life and clinical outcomes in bipolar disorder: An 8-year longitudinal study(2021) KHAFIF, Tatiana Cohab; BELIZARIO, Gabriel Okawa; SILVA, Michelle; GOMES, Bernardo Carramao; LAFER, BenyObjectives: This longitudinal study examined the relationship of Quality of Life (QOL) throughout an 8-year follow-up period with baseline and longitudinal clinical variables indicative of outcome in patients with Bipolar Disorder (BD). Methods: 36 participants, ages 18-70, were recruited from the Bipolar Disorder Research Program (PROMAN) outpatient clinic. Participants completed the WHOQOL-BREF questionnaire in 2009 (baseline), 2015 (6-years) and 2017 (8-years), with high scores being associated with better quality of life. Baseline clinical variables were collected through the Structured Clinical Interview for DSM-IV (SCID-IV) and a structured baseline interview for demographic and clinical assessment. Longitudinal clinical variables were collected through medical records, including mood charts and mood symptoms scales. Results: The results suggest that the QoL, as measured by the WHOQOL-BREF scale, is negatively affected by depressive episodes and is rather stable throughout the course of patients diagnosed with BD. In our study, all three scores were negatively correlated to depressive episodes, and one WHOQOL-BREF score was positively correlated to manic episodes, suggesting that higher scores, both at baseline and throughout the course of the disorder, may be associated to a higher occurrence of manic episodes, while lower QoL scores may be predictive of a higher occurrence of depressive episodes. Also, all three scores revealed significant positive correlations between themselves, suggesting QoL, as measured by the WHOQOL-BREF, remained constant throughout the 8 year observed period. Finally, patients presenting Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD) and substance abuse comorbidities revealed consistent lower WHOQOL-BREF scores, suggesting that these comorbidities may be an important predictor of QoL in BD patients.
- Impact of predominant polarity on long-term outcome in bipolar disorder: A 7-year longitudinal cohort study(2018) BELIZARIO, Gabriel Okawa; SILVA, Michelle; LAFER, BenyIntroduction: Recent studies suggest that Predominant Polarity (PP) may be an important specifier of Bipolar Disorder (BD), establishing distinct groups of patients and providing a potential tool for tailored treatment. PP has been associated to various clinical variables present in the course of the disorder, including deficits in cognitive functioning, suicide attempts, hospitalizations and response to pharmacological treatment. However, most published studies are retrospective and cross-sectional, frequently relying on patients' ability to recall past information, which may often be inaccurate. Methods: Participants were recruited from the outpatient clinic of the Bipolar Disorder Research Program at the Institute of Psychiatry of the University of Sao Paulo. Baseline clinical and demographic variables were collected using a semi-structured questionnaire and the SCID-CV. Longitudinal data were collected through medical records, mood charts, and mood symptom scales conducted throughout a 7-year follow-up period. Results: Manic Predominant Polarity (MPP) was associated with a significantly higher number of hospitalizations, suicide attempts, and episodes with psychotic symptoms throughout the 7-year observed period in comparison to Depressive Predominant Polarity (DPP) and Indefinite Predominant Polarity (IPP) patients. Moreover, baseline PP was significantly associated with 7-year PP, with 67% of patients maintaining their PP both at baseline and after the 7-year follow-up period. Limitations: The present study is limited due to the statistically small sample size, although, to our knowledge, it is the largest longitudinal study conducted in this topic, and the unequally distributed frequency of patients' visitations, which may have created intervals of unobserved periods within the follow-up period. Discussion: The results revealed PP to be an important specifier for predicting the course of the disorder. Overall, MPP was significantly associated with variables indicative of a worse outcome, suggesting that greater attention to preventive treatment should be addressed to this subgroup. Lastly, baseline PP was significantly associated with 7-year observed PP, suggesting that patients tend to remain within the same PP throughout the course of the disorder.