Sistemas inteligentes no diagnóstico da esquizofrenia

UNIFESP-EPM Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Culture-bound syndromes in Spanish speaking Latin America: the case of Nervios, Susto and Ataques de Nervios

Background Cultural issues are important for diagnostic validity between different countries; little has been addressed from Latin America and Caribbean countries (LAC). Objective To identify LAC studies on culture-bound syndromes (CBS) and extract potential empirical evidence about Susto,Nervios and Ataques de Nervios. Methods Search strategies were carried out in Medline, Embase, Lilacs, ISI and PsycINFO, covering 1992 to 2015. Inclusion criteria studies on CBS conducted on populations residing in LAC, LAC articles on diagnostic classification and culture, where LAC has been included. Exclusion criteria studies on Latin American migrants outside LAC. Content analysis used the system proposed by Guarnaccia and Rogler (1999): epidemiological, ethnographic and socio-demographic data and identification of comorbidities with other psychiatric disorders. Results Thirty one articles were selected out of 1.090. These CBS were selected out of 1aphic data and identification of comorbidities with other ps proposed by Guarnaccia diagnostic classification and cun panic disorders and post-traumatic stress disorder and presented more psychosocial vulnerability. Discussion Analysis showed that Nervios, Susto andAtaques de Nervios are important idioms of distress, associated with socio-economically vulnerable populations and comorbidities with other psychiatric conditions, particularly post-traumatic stress disorder. More studies are needed on their relation with stress and in more LAC countries

Saúde mental dos imigrantes coreanos em São Paulo, Brasil

This study investigated the frequency of lifetime mental disorders among Korean immigrants in the city of São Paulo, Brazil. Snowball sampling with multiple focuses was used to recruit Korean immigrants older than 18 years and living in São Paulo. A total of 324 Korean immigrants were selected and their mental status was evaluated using a structured interview, namely the Portuguese or the Korean version of the Composite International Diagnostic Interview 2.1. The diagnoses of mental disorders were made according to the ICD-10. The frequency of any lifetime psychiatric disorder was 41.9%. The frequencies of main disorders were: anxiety disorder, 13% (post-traumatic stress disorder, 9.6%); mood disorder, 8.6%; somatoform disorders, 7.4%; dissociative disorder, 4.9%; psychotic disorder, 4.3%; eating disorder, 0.6%; any substance (tobacco, alcohol, drugs) use disorder, 23.1%. The frequency of any psychiatric disorder except alcohol and tobacco use disorders was 26.2%. Korean immigrants have more psychiatric disorders than the Korean population in Korea, particularly post-traumatic stress disorder, and almost the same rate as the Brazilian population. Mental health authorities should promote a healthier integration and the development of culturally sensitive mental health programs for Korean immigrants.Este estudo verificou a freqüência de transtornos psiquiátricos em uma comunidade de imigrantes coreanos na cidade de São Paulo, Brasil. A amostragem snowball com vários focos foi utilizada para contatar os imigrantes coreanos, acima de 18 anos e residentes em São Paulo. Foram selecionados 324 sujeitos, cuja saúde mental foi avaliada por meio de uma entrevista estruturada, Composite International Diagnostic Interview 2.1, nas versões em português e coreano. Foi utilizado o critério de diagnóstico CID-10. A freqüência de algum diagnóstico psiquiátrico na vida foi de 41,9%. As freqüências de principais diagnósticos na vida foram: transtornos de ansiedade, 13% (transtorno de estresse pós-traumático, 9,6%); transtornos do humor, 8,6%; transtornos somatoformes, 7,4%; transtornos dissociativos, 4,9%; transtornos psicóticos, 4,3%; transtornos alimentares, 0,6%; transtornos decorrentes de substâncias (álcool, tabaco ou drogas), 23,1%. A freqüência de diagnósticos psiquiátricos na vida, excluindo-se os decorrentes de álcool e tabaco, foi de 26,2%. Os imigrantes coreanos apresentam mais transtornos psiquiátricos do que a população coreana na Coréia, especialmente transtorno de estresse pós-traumático, e uma taxa semelhante à encontrada na população brasileira. As autoridades de saúde mental devem promover uma integração mais saudável por meio de programas culturalmente sensíveis aos imigrantes coreanos.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Departamento de PsquiatriaUNIFESP, Depto. de PsquiatriaSciEL

Decision support system for the diagnosis of schizophrenia disorders

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Informática MédicaUNIFESP, EPM, Depto. de PsiquiatriaUNIFESP, EPM, Depto. de Informática MédicaSciEL

Pesquisa em psiquiatria e saúde mental no Brasil: produção científica de 1999 a 2003

OBJECTIVE: To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. METHODS: Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. RESULTS: In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database). The main topics were: depression (29.1%), substance misuse (14.6%), psychoses (10%), childhood disorders (7%) and dementia (6.7%). Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. CONCLUSIONS: There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.OBJETIVO: Mapear a produção científica brasileira em saúde mental no período 1999-2003 e identificar a natureza das publicações geradas, suas fontes de financiamento e as formas de divulgação pública dos resultados. MÉTODOS: As buscas dos artigos foram realizadas nas bases de dados do PsychInfo e Medline no período 1999-2003. Um questionário semi-estruturado, desenvolvido por uma equipe internacional, foi aplicado a 626 pesquisadores de saúde mental, abordando-se as seguintes áreas: formação pessoal, experiência em pesquisa, acesso a fontes de financiamento, impacto público e prioridades de pesquisa de cada entrevistado. A amostra foi composta por 626 profissionais de Saúde Mental identificados a partir de 792 publicações indexadas no Medline e PsychInfo, (1999-2003) e também, de uma lista de pareceristas da Revista Brasileira de Psiquiatria. RESULTADOS: Foram recuperadas 792 publicações, produzidas por 525 autores brasileiros no período 1999-2003 (441 indexadas no Medline e 398 na base ISI). Essas publicações abordavam os tópicos: depressão (29,1%), abuso de substâncias (14,6%), psicoses (10%), transtornos da infância (7%) e demência (6,7%). Dos 626 investigadores envolvidos com pesquisa em saúde mental, 329 responderam ao questionário. CONCLUSÕES: Houve um crescimento contínuo da publicação de artigos brasileiros em saúde mental em periódicos internacionais entre 1999 e 2003: o número de artigos na base Medline triplicou e duplicou nas bases ISI. O conteúdo dos artigos corresponde às prioridades da saúde mental, mas é necessário um maior entrosamento entre pesquisadores e tomadores de decisão na política de saúde mental.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Centro de Avaliação e Integração de DadosUNIFESP, EPM, Depto. de PsiquiatriaUNIFESP, EPM, Centro de Avaliação e Integração de DadosSciEL

Agenda de prioridades de pesquisa para saúde mental no Brasil

BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) matrix support, c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment.INTRODUÇÃO: O principal objetivo desse estudo foi revisar a agenda de prioridades em pesquisa em saúde mental no Brasil. MÉTODO: Foram selecionados 28 especialistas (22 pesquisadores, cinco legisladores e o coordenador) de diferentes regiões. Responderam ao que consideravam mais relevante em pesquisa para a saúde mental para os próximos 10 anos. Dezessete responderam e configuraram 110 questões, que foram reavaliadas por eles, com atribuição de escore, a partir de 15 itens distribuídos segundo grau de responsividade, eficácia, aplicabilidade, equidade e impacto na redução da carga da doença mental. 35 questões, e dentre elas as 10 mais bem pontuadas, foram destacadas. RESULTADOS: Prevaleceram indicações para estudos de efetividade das intervenções, matriciamento, comparação entre modelos de intervenção e detecção e tratamento de transtornos mais prevalentes na Estratégia da Saúde da Família. Avaliação de serviços quanto às barreiras ao tratamento; custo-efetividade dos antipsicóticos, intervenções contra efeitos do álcool e outras drogas, e aplicação de tecnologias (telemedicina) para educação e supervisão dos generalistas foram outros. CONCLUSÃO: Apontou-se para necessidade de investimentos na saúde mental na atenção primária à saúde; avaliação do sistema de serviços de cuidados de saúde mental, e pesquisas para romper barreiras ao acesso e à equidade no tratamento dos transtornos mentais.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Department of PsychiatryStellenbosch University Department of PsychologyUniversity of Cape Town Department of Psychiatry and Mental HealthUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre Department of PsychiatryUniversity of London Institute of Psychiatry, King's College Health Services and Population Research DepartmentUNIFESP, Department of PsychiatrySciEL

The Impact of Antipsychotic Polytherapy Costs in the Public Health Care in São Paulo, Brazil

IntroductionGuidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.ObjectiveTo estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of São Paulo, Brazil.MethodA cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of São Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. the impact of polytherapy on total direct costs was evaluated.Results147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. the costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.ConclusionAntipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Ministry of Health of BrazilConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Psychiat, CESM, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Psychiat, CESM, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, SP, BrazilFAPESP: 2009/53286-3Web of Scienc

Investigación en Salud Mental en América Latina y el Caribe: Enfoque en las Ciencias Básicas.

Objetivo: Evaluar el estado de la investigación en ciencias básicas (CB) dentro del ámbito de la salud mental (SM),en países de América Latina y el Caribe (pALC). Material y métodos: Se recopiló información de bases de datos depublicaciones (PubMed/PsycINFO), mediante buscadores de internet y muestreo bola de nieve, para identificarinvestigadores y otros actores involucrados en la gestión de la salud mental. Los 2 555 actores identificados recibieronun cuestionario dirigido a evaluar su capacidad personal/institucional para realizar investigación en SM. Tanto labase de datos de publicaciones como las respuestas al cuestionario fueron utilizadas para el análisis. Resultados: Seidentificó 2 397 publicaciones en SM, de las cuales 222 estuvieron vinculadas a las CB. Sólo 9 de los 30 pALC teníanpublicaciones en esta área. Uno de cada cuatro investigadores en SM de la región –la mayoría psiquiatras y neurólogosdeclarótener entrenamiento formal en CB. El 41% de los investigadores declaró contar con apoyo técnico para lainvestigación en CB en sus instituciones. Sólo 10% de los proyectos de investigación realizados en los últimos 5años estuvieron relacionados a las CB. De éstos, un 62% se realizó con colaboración local, y 30% con colaboradoresde países desarrollados. La financiación provino principalmente de fundaciones, ONGs y universidades. Las principalesmotivaciones de los investigadores de SM en el área de las CB fueron el interés personal (77%), y la carga deenfermedad (63%). La investigación en CB no fue considerada una prioridad por la mayor parte de los investigadores(55%) y tomadores de decisión (56%). Los investigadores con entrenamiento formal en CB tuvieron más publicacionesy accedieron a mayores fondos de investigación que el resto de investigadores. Conclusiones: La investigación enCB en el área de SM permanece relegada en la región. Es necesario que el papel de las CB como parte integral de l