Non-Invasive Neuromodulation Methods to Alleviate Symptoms of Huntington\u27s Disease: A Systematic Review of the Literature

Huntington\u27s disease (HD) is a progressive and debilitating neurodegenerative disease. There is growing evidence for non-invasive neuromodulation tools as therapeutic strategies in neurodegenerative diseases. This systematic review aims to investigate the effectiveness of noninvasive neuromodulation in HD-associated motor, cognitive, and behavioral symptoms. A comprehensive literature search was conducted in Ovid MEDLINE, Cochrane Central Register of Clinical Trials, Embase, and PsycINFO from inception to 13 July 2021. Case reports, case series, and clinical trials were included while screening/diagnostic tests involving non-invasive neuromodulation, review papers, experimental studies on animal models, other systematic reviews, and meta-analyses were excluded. We have identified 19 studies in the literature investigating the use of ECT, TMS, and tDCS in the treatment of HD. Quality assessments were performed using Joanna Briggs Institute\u27s (JBI\u27s) critical appraisal tools. Eighteen studies showed improvement of HD symptoms, but the results were very heterogeneous considering different intervention techniques and protocols, and domains of symptoms. The most noticeable improvement involved depression and psychosis after ECT protocols. The impact on cognitive and motor symptoms is more controversial. Further investigations are required to determine the therapeutic role of distinct neuromodulation techniques for HD-related symptoms

Adult Outcomes Of Childhood Disruptive Disorders In Offspring Of Depressed And Healthy Parents

Background: Longitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders. Method: Offspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested. Results: Eighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group. Limitations: Associations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began. Conclusion: If there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity

Association Between the Epigenetic Lifespan Predictor GrimAge and History of Suicide Attempt in Bipolar Disorder

Bipolar disorder (BD) has been previously associated with premature mortality and aging, including acceleration of epigenetic aging. Suicide attempts (SA) are greatly elevated in BD and are associated with decreased lifespan, biological aging, and poorer clinical outcomes. We investigated the relationship between GrimAge, an epigenetic clock trained on time-to-death and associated with mortality and lifespan, and SA in two independent cohorts of BD individuals (discovery cohort - controls (n = 50), BD individuals with (n = 77, BD/SA) and without (n = 67, BD/non-SA) lifetime history of SA; replication cohort - BD/SA (n = 48) and BD/non-SA (n = 47)). An acceleration index for the GrimAge clock (GrimAgeAccel) was computed from blood DNA methylation (DNAm) and compared between groups with multiple general linear models. Differences in epigenetic aging from the discovery cohort were validated in the independent replication cohort. In the discovery cohort, controls, BD/non-SA, and BD/SA significantly differed on GrimAgeAccel (F = 5.424, p = 0.005), with the highest GrimAgeAccel in BD/SA (p = 0.004, BD/SA vs. controls). Within the BD individuals, BD/non-SA and BD/SA differed on GrimAgeAccel in both cohorts (p = 0.008) after covariate adjustment. Finally, DNAm-based surrogates revealed possible involvement of plasminogen activator inhibitor 1, leptin, and smoking pack-years in driving accelerated epigenetic aging. These findings pair with existing evidence that not only BD, but also SA, may be associated with an accelerated biological aging and provide putative biological mechanisms for morbidity and premature mortality in this population

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil

Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels

Diretrizes da Associação Brasileira de Psiquiatria para o manejo do comportamento suicida: fatores de risco e de proteção

Neste artigo serão avaliados os fatores de risco e proteção para futuras tentativas e suicídio completo. Atualmente, não há meios precisos que garantam a predição do desfecho de uma fatalidade relacionada ao comportamento suicida. Sendo assim, a anamnese, o exame psíquico e a avaliação dos fatores mencionados são as ferramentas atuais que auxiliam na tomada de decisão de pacientes em risco. Tais fatores de risco e proteção são identificados através de estudos epidemiológicos, caso-controle e coortes. O objetivo deste artigo será apresentar tais fatores que foram encontrados na revisão bibliográfica e que apresentam algum nível de evidência para serem utilizados na prática clínica

Diretrizes da Associação Brasileira de Psiquiatria para o manejo do comportamento suicida: triagem e avaliação

Este artigo detalha as diretrizes para a triagem e avaliação do comportamento suicida. A triagem envolve o uso de instrumentos ou protocolos para identificar indivíduos com comportamentos suicidas, podendo ser aplicada de forma independente ou como parte de uma avaliação de saúde mais ampla. Esta pode ser realizada de maneira manual ou eletrônica e aplicada seletivamente ou de forma universal a toda a população alvo. A avaliação do risco de suicídio deve ser conduzida por um médico e incluir questionários estruturados e conversas abertas com o paciente, familiares e amigos para obter uma visão completa do comportamento, fatores de risco e proteção, e histórico de cuidados de saúde mental. A eficácia da triagem e avaliação é aumentada quando combinada com estratégias de intervenção, como o Plano de Segurança, que integra a avaliação de riscos e a criação de um plano terapêutico individualizado

Diretrizes da Associação Brasileira de Psiquiatria para o manejo do comportamento suicida: introdução

O suicídio representa um grave desafio de saúde pública em escala mundial, resultando na perda anual de mais de 700 mil vidas, com uma incidência significativa entre a população jovem. No contexto brasileiro, a taxa de mortalidade por suicídio tem uma média de 5,23 por 100 mil habitantes. A despeito da existência de diversas diretrizes destinadas ao manejo do comportamento suicida, percebe-se a ausência de protocolos desenvolvidos sob os rigores da medicina baseada em evidências específicos para o panorama brasileiro do suicídio. Este estudo visa estabelecer diretrizes fundamentais para a intervenção junto a pacientes demonstrando comportamento suicida no Brasil. O desenvolvimento destas diretrizes contou com a participação de onze psiquiatras renomados, escolhidos pela Comissão de Emergências Psiquiátricas da Associação Brasileira de Psiquiatria (ABP) com base em sua vasta experiência e conhecimento especializado tanto na psiquiatria geral quanto no tratamento de emergências psiquiátricas. A elaboração destas diretrizes foi embasada na análise criteriosa de diversos artigos científicos, selecionados após o exame preliminar de 5362 registros. Neste suplemento procurou-se traduzir os 3 artigos das diretrizes e atualizar, sem alterar sua essência, para a língua portuguesa as informações de maior relevância clínica