Processos cognitivos em indivíduos com esquizofrenia da América Latina : investigação de fatores demográficos, sociais e clínicos

Contexto: A população da América Latina é uma das mais diversas do mundo pela mistura de diferentes grupos étnicos. No entanto, enfrenta desafios únicos provenientes da violência e da desigualdade. Não existem estudos em larga escala descrevendo as características dessa população e os possíveis impactos do meio nos desfechos da esquizofrenia. Portanto, nosso objetivo é descrever o desempenho cognitivo de uma amostra representativa de indivíduos latino-americanos com esquizofrenia e sua relação com fatores funcionais e clínicos. Além disso, nosso objetivo é analisar como os fatores socioeconômicos se relacionam com o desempenho cognitivo em pacientes e controles. Métodos: Foram incluídos 1125 participantes de 5 países da América Latina (Argentina, Brasil, Chile, Colômbia e México): 814 indivíduos com esquizofrenia e 311 controles saudáveis. Todos os participantes fizeram parte de projetos de pesquisa que incluíam avaliação cognitiva pela MCCB e avaliações clínicas. Resultados: Os pacientes apresentaram pior desempenho cognitivo comparados aos controles, que foram generalizados entre os domínios. A idade e o diagnóstico foram preditores independentes, indicando trajetórias semelhantes de envelhecimento cognitivo para pacientes e controles. A educação teve um papel significativo na melhor cognição dos pacientes, que também foi influenciada pela sintomatologia dos indivíduos. Os fatores sociais de renda e escolaridade dos pais foram mais relacionados a maiores comprometimentos cognitivos em pacientes do que em controles. Conclusões: Os pacientes não mostraram evidências de envelhecimento cognitivo acelerado; no entanto, eles foram mais afetados por um ambiente desfavorecido do que os controles. Esse achado pode indicar uma vulnerabilidade de indivíduos com psicose que poderia levar os pacientes a serem mais impactados pela exposição crônica a fatores sociais.Background: Latin America’s population is one of the most diverse in the world because of its mix of ancestries and ethnic groups. However, it faces unique challenges derived from violence and inequality. There are no large-scale studies describing the characteristics of this population and possible impacts of the environment to disease outcomes. Therefore, our aim is to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to functional and clinical factors. Additionally, we aim to analyze how socioeconomic factors relate to cognitive performance in patients and controls. Methods: We included 1125 participants from 5 Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 814 individuals with schizophrenia and 311 unaffected subjects. All participants were part of research projects that included cognitive evaluation with MCCB and clinical assessments. Results: Patients had worse cognitive performance than controls, which was generalized across domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. Education played a significant role in better cognition in patients, which was also influenced by individuals' symptomatology. The social factors of income and parental education were more related to cognitive impairments in patients than in controls. Conclusions: Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a deprived environment than controls. This finding might indicate a vulnerability of individuals with psychosis that could prompt patients to be more impacted by chronic exposure to social factors

Country-level gender inequality is associated with structural differences in the brains of women and men

Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women’s worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequal-ity acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7,876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women’s brains and provide initial evidence for neuroscience-informed policies for gender equality

Informações de saúde mental on-line : o que aprendemos com as métricas de mídias sociais na Semana de Saúde Mental do BuzzFeed

Introduction: The Internet has seen rapid growth in the number of websites focusing on mental health content. Considering the increased need for access to accurate information about mental health treatment, it is important to understand the promotion of this information online. Objective: To analyze BuzzFeed’s Mental Health Week (BFMHW) interactions on its own website and in related social media platforms (Facebook, Twitter and YouTube) using metrics of information delivery in mental health topics. Methods: We extracted social media metrics from the 20 posts with the highest number of BuzzFeed interactions on the BFMHW website and from 41 videos available on the BFMHW playlist created by the BuzzFeed Video profile on YouTube. We analyzed the format and content used in BuzzFeed’s publishing methods as well as the following social media metrics: exposure (presence online, views and time online), influence (likes) and engagement (comments, shares, replies and BuzzFeed interactions). Results: Analysis of the variables revealed that audience engagement is associated with the number of medias in which the content is published: views on YouTube and shares on Facebook (0.71, p<0.001), total interactions on Facebook (0.66, p<0.001) and BuzzFeed number of total interactions (0.56, p<0.001). Conclusions: Our results suggest that videos on YouTube may be an important information channel, including activity and engagement on other medias such as Facebook. Information may be more effective in reaching the audience if it is delivered in more than one media and includes personal experiences, some humor in content and detailed information about treatment.Introdução: O número de sites com foco em conteúdo de saúde mental vem crescendo rapidamente. Considerando a necessidade crescente de acesso a informações precisas sobre tratamento em saúde mental, é importante entender a promoção dessas informações on-line. Objetivo: Analisar as interações da Semana de Saúde Mental do BuzzFeed (BuzzFeed’s Mental Health Week – BFMHW) em seu próprio site e em plataformas de mídia social relacionadas (Facebook, Twitter e YouTube) usando métricas de entrega de informações em tópicos de saúde mental. Métodos: Extraímos métricas de mídias sociais das 20 postagens com o maior número de interações no site da BFMHW e de 41 vídeos disponíveis na playlist da BFMHW criada pelo perfil BuzzFeed Video no YouTube. Analisamos o formato e o conteúdo usados nos métodos de publicação do BuzzFeed, bem como as seguintes métricas de mídias sociais: exposição (presença on-line, visualizações e tempo on-line), influência (curtidas) e engajamento (comentários, compartilhamentos, respostas e interações do BuzzFeed). Resultados: A análise das variáveis revelou que o envolvimento do público está associado ao número de mídias em que o conteúdo é publicado: visualizações no YouTube e compartilhamentos no Facebook (0,71, p <0,001), interações totais no Facebook (0,66, p <0,001) e número de interações totais no BuzzFeed (0,56, p <0,001). Conclusões: Nossos resultados sugerem que o YouTube pode ser um importante canal de informações, incluindo atividades e envolvimento em outras mídias, como o Facebook. As informações podem alcançar o público de forma mais eficaz se forem exibidas em mais de uma mídia e incluírem experiências pessoais, algum humor no conteúdo e informações detalhadas sobre o tratamento

Clozapine use decreases the number of hospitalizations per year in patients with treatment-resistant schizophrenia

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS

Clozapine use decreases the number of hospitalizations per year in patients with treatment-resistant schizophrenia.

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS

Long-term treatment with clozapine and verbal memory performance in schizophrenia

Clozapine is more efficacious than first-generation antipsychotics for positive and negative symptoms, although it is related with serious adverse effects. Because of this profile, it could also have an impact on cognition. Therefore, we evaluated learning ability of 31 treatment-resistant individuals with SZ using clozapine uninterruptedly for 18.23 ± 4.71 years and 26 non-treatment-resistant using other antipsychotics that never used clozapine. Long-term treatment with clozapine did not improve verbal learning ability better than other antipsychotics. Although clozapine has a unique profile for reducing clinical symptoms, it may not have an additional benefit for cognition when started later on the course of schizophrenia