Understanding the journey of patients with depression in Brazil: A systematic review

Abstract Despite having an organized mental health law and policy, a majority of patients with depression remain underreported and undertreated in Brazil. The study aimed to quantitatively map and identify the deficiencies in patient journey touchpoints in terms of awareness, screening, diagnosis, treatment, adherence, and control for depression in Brazil using a semi-systematic approach highlighting the knowledge gaps in the existing literature. A structured search of Embase, MEDLINE, and BIOSIS databases was conducted to identify the relevant studies published in English, Portuguese, and Spanish from 2006 to 2021. An unstructured search was also conducted on Google or government websites with no restrictions. To address the data gaps, anecdotal data were also considered. Weighted or simple means were calculated for the pooled data. Of 3175 articles retrieved, 10 articles met the inclusion criteria. Synthesized evidence indicates that the pooled prevalence of depression in Brazil ranged from 4.1% to 21.8%; 42.4% of patients had awareness of depression, 37.5% underwent screening, 18.7% had a diagnosis, and 54.4% received treatment. No data on adherence and control were available. The study findings highlight the need for more research to accurately estimate the common patient journey touchpoints for depression to achieve better clinical outcomes in Brazil.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

Tratamento da depressäo leve a moderada: avaliaçäo da eficácia e segurança do extrato LI 160 S de Hypericum perforatum / Treament of mild and moderate depression: evaluation of the effectiveness and tolerability of LI 160 Hypericum perforatum extract

A eficácia e a tolerabilidade

Revisäo: depressäo e insuficiência renal crônica: uma revisäo / Revision: depression and chronic renal insufficiency: a review

Apesar de provavelmente ser a complicacäo psiquiátrica mais comum nos pacientes com insuficiencia renal crônica (IRC), o transtorno depressivo maior permanece largamente subdiagnosticado. Há evidência de que a depressäo diminu a aderência ao tratamento da IRC, influencie negativamente a qualidade de vida, seja um fator importante de risco para a mortalidade cardiovascular, aumente em até 15 vezes a taxa de suicidio e, consequentemente, seja um preditor independente e potente de menor sobrevida. Os autores discutem os principais aspectos sobre o impacto, etiologia, diagnóstico e tratamento da depressäo nos portadores de IRC(au)

Dinâmica familiar na deficiência mental / Family dynamic in mental deficiency

Estudos longitudinais de famílias com elementos portadores de doenças crônicas mostram que elas auxiliam na recuperaçao do indivíduo doente, na integraçao social e aderência ao tratamento. Os autores, neste trabalho, abordam algumas questoes das relaçoes familiares quando nasce uma criança deficiente mental, que causa alteraçoes substanciais no papel dos demais elementos do grupo familiar, evidenciando-se a necessidade de um ajustamento que favorecerá o sistema a cumprir adequadamente o desenvolvimento e a maturaçao das potencialidades da família.

Cumplicidade como proposta de tratamento do distúrbio factício: relato de caso / Complicity as a therapeutic proposal for factitious disorder: case report

Os autores apresentam a descrição de um caso clínico com hipótese diagnóstica de Distúrbio Factício em paciente com pseudocrise epiléptica. Com base no caso apresentado, são discutidos diagnóstico diferencial e abordagem terapêutica, enfatizando a importância do vínculo entre equipe assistencial e paciente

Transtornos sexuais no DSMðIIIðR / Sexual disorders in DSMðIIIðR

A sexualidade humana é um fenômeno integrante da totalidade da vida psíquica, envolvendo fatores múltiplos. Os autores interrogam qual a população que deve receber tratamento e cuidado e, sugerem o uso do DSMðIIIðR em caráter provisório, enfatizando a necessidade de uma psicopedagogia sexual

A concepçäo da histeria ao longo do tempo: psiquiatria e psicanálise / The conception of hysteria over time: psychiatry and psychoanalysis

Os autores revêem o conceito de histeria em diferentes épocas. Mostram que a concepçäo de histeria variou num movimento pendular de etiologia orgânica-näo orgânica. Com o advento da Psicanálise, a Psiquiatria pôde aprofundar seu estudo sobre histeria. No entanto, apesar do avanço psicodinâmico, o pêndulo ainda volta a pesquisas biológicas

Particularidades das depressöes em hospital geral / Particular features of depression in the general hospital

Baseado na análise retrospectiva de 1.000 prontuários de pacientes internados no Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo autor discute o diagnóstico sindrômico de depressäo; encontrado em 20% dessa populaçäo. Levado em conta fatores como: sexo, idade, presença ou näo de fatores orgânicos, doença psiquiátrica e personalidade, procura classificar os vários quadros depressivos dessa populaçäo