Disengagement from the Ribeirão Preto early intervention program for psychosis: A retrospective cohort study.

BACKGROUND: Treatment discontinuation within Early Intervention Services (EIS) for psychosis poses a significant challenge to achieving better outcomes in the early stages of psychotic disorders. Prevalence and predictors of early disengagement from EIS located in low- and middle-income countries (LMICs) remain poorly investigated. We aimed to examine the rates and predictors of disengagement from the Ribeirão Preto Early Intervention Program for Psychosis (Ribeirão Preto-EIP) in Brazil. METHODS: We conducted a retrospective cohort study using data from patients referred to the Ribeirão Preto-EIP between January 01, 2015, and December 31, 2018. Exclusion criteria were individuals with a single consultation, a diagnosis other than a psychotic disorder, and documented cases of death. RESULTS: Our sample comprised 234 patients, with an overall median follow-up time of 14.2 months. Early treatment disengagement was observed in 26.5 % (n=62), with a median time to disengagement of 5.25 months. Univariable analysis identified non-white skin color (HR=2.10, 95 %CI 1.26-3.49), positive THC screening (HR=2.22, 95 %CI 1.23-4.01), and substance-induced psychosis (HR=2.15, 95 %CI 1.10-4.21) as significant predictors. In multivariable analysis, only non-white skin color remained a significant predictor of early disengagement (HR=1.87, 95 %CI 1.08-3.27). CONCLUSIONS: The observed rates of early disengagement in our sample are similar to those reported in wealthy countries, but higher than previously reported for LMICs. Non-white skin color predicted early disengagement in our sample, probably due to social disadvantages. Our data highlights the need for enhanced research elucidating the specific features of EIS in LMICs.

Factors associated with happiness among community-dwelling older adults: a systematic review.

OBJECTIVES: To identify factors associated with self-reported happiness among community-dwelling older adults. METHODS: A systematic review of the literature was conducted. Searches were conducted in the PsycInfo, Web of Science, Scopus and Pubmed databases for relevant articles published in English, Spanish or Portuguese using the following search strategy and Boolean operators: (happiness*) AND (elder* OR (old adult*)). No restriction was imposed with regards to year of publication. This review was registered in PROSPERO (CRD42018107302). RESULTS: Forty-six articles met the eligibility criteria and were included in the review. Economic, social and health-related factors were associated with happiness among community-dwelling older adults. The sociodemographic characteristics of older adults, such as the female sex, being married, an older age, a higher level of schooling and having a religion, were also associated with happiness. CONCLUSIONS: The articles included in the present systematic review demonstrate that social, economic and health-related aspects have an association with happiness in community-dwelling older adults.

Early intervention in psychosis in emerging countries: Findings from a first-episode psychosis programme in the Ribeirão Preto catchment area, southeastern Brazil.

AIM: People presenting with first-episode psychosis (FEP) can benefit from early intervention programmes. However, such programmes are scarce in low- and middle-income countries (LMICs). In Brazil, there are a few programmes, but they are unequally distributed across the country. We aimed to describe the implementation and performance of the Ribeirão Preto Early Intervention in Psychosis Programme (Ribeirão Preto-EIP), an outpatient service for patients presenting with FEP residing in the Ribeirão Preto catchment area in Southeastern Brazil. METHODS: A detailed description of the service, staff and theoretical framework was compiled. Furthermore, a retrospective cohort study of patients attending the programme throughout 4 years (2015-2018) was conducted. Data were obtained by analysing the medical records of all patients, and sociodemographic and diagnostic stability information for this period was recorded. RESULTS: The Ribeirão Preto-EIP had 358 new referrals during the study period. Among them, 237 patients were assessed for an average (median) duration of 14 months. Most patients were male (64.1%) and single (84.8%). The median age was 23.5 years (range, 9-86 years). Schizophrenia was the main diagnosis (43.4%), followed by substance-induced (25.7%) and affective (18.6%) psychosis. Referrals occurred from emergency, inpatient, community-based mental health and primary care services. CONCLUSIONS: Programmes such as the Ribeirão Preto-EIP demonstrate that early intervention in psychosis is feasible in LMICs despite significant challenges for their access and integration in the health system. Strategic scale-up policies could be undertaken to offer better short- and long-term outcomes for individuals presenting with FEP and their families.

Cognitive performance of older adults with a low level of education with and without depression.

Major depression can develop in individuals aged 60 years or older and is commonly associated with cognitive decline in this population, especially the domains of working memory, attention, executive functions, and processing speed. Schooling is a protective factor with regard to cognitive decline. OBJECTIVE: To compare the cognitive performance of community-dwelling older adults with a low level of schooling with and without major depression. METHODS: A descriptive, analytical, cross-sectional study was conducted with 22 community-dwelling older adults with depression and 187 without depression. The following assessment tools were employed: Mini Mental Health Examination, Brief Cognitive Screening Battery, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Digit Span Test (forward and backward), and an object similarity test. RESULTS: No statistically significant differences were found between the groups with and without depression on any of the tests. CONCLUSIONS: This study demonstrated that there are no differences in the cognitive performance of older people with and without depression on neurocognitive tests commonly used in clinical practice. Future studies with different designs and methods as well as specific tests for older people with a low level of schooling could assist in the understanding of these relations and the mechanisms involved.

A depressão maior pode se manifestar em indivíduos com 60 anos ou mais e, comumente, está associada ao declínio cognitivo, especialmente nos domínios memória de trabalho, atenção, função executiva e velocidade de processamento. Nesse contexto, a escolaridade é um fator de proteção em relação ao declínio cognitivo. OBJETIVO: Comparar o desempenho cognitivo entre idosos de baixa escolaridade da comunidade com e sem depressão maior. MÉTODOS: Trata-se de um estudo transversal, descritivo e analítico. Foram selecionados 22 idosos da comunidade com depressão e 187 idosos sem depressão, que foram avaliados por meio dos seguintes instrumentos: Mini-Exame do Estado Mental (MEEM), Bateria Breve de Rastreio Cognitivo (BBRC), Consortium to Establish a Registry for Alzheimer's Disease (CERAD), teste de extensão de dígitos de ordem direta e inversa, e um teste de semelhança de objetos. RESULTADOS: Não foram encontradas diferenças estatisticamente significativas entre os grupos com depressão e sem depressão em nenhum dos testes aplicados. CONCLUSÕES: O presente estudo demonstrou que não existem diferenças no desempenho cognitivo de idosos com e sem depressão em testes neurocognitivos comumente utilizados na prática clínica. Estudos futuros com métodos e delineamentos diferentes, com testes específicos para idosos com baixa escolaridade, podem auxiliar na compreensão dessas relações e dos mecanismos envolvidos.

Cognitive performance of older adults with a low level of education with and without depression / Desempenho cognitivo de idosos com baixa escolaridade com e sem depressão

ABSTRACT. Major depression can develop in individuals aged 60 years or older and is commonly associated with cognitive decline in this population, especially the domains of working memory, attention, executive functions, and processing speed. Schooling is a protective factor with regard to cognitive decline. Objective: To compare the cognitive performance of community-dwelling older adults with a low level of schooling with and without major depression. Methods: A descriptive, analytical, cross-sectional study was conducted with 22 community-dwelling older adults with depression and 187 without depression. The following assessment tools were employed: Mini Mental Health Examination, Brief Cognitive Screening Battery, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Digit Span Test (forward and backward), and an object similarity test. Results: No statistically significant differences were found between the groups with and without depression on any of the tests. Conclusions: This study demonstrated that there are no differences in the cognitive performance of older people with and without depression on neurocognitive tests commonly used in clinical practice. Future studies with different designs and methods as well as specific tests for older people with a low level of schooling could assist in the understanding of these relations and the mechanisms involved.

RESUMO. A depressão maior pode se manifestar em indivíduos com 60 anos ou mais e, comumente, está associada ao declínio cognitivo, especialmente nos domínios memória de trabalho, atenção, função executiva e velocidade de processamento. Nesse contexto, a escolaridade é um fator de proteção em relação ao declínio cognitivo. Objetivo: Comparar o desempenho cognitivo entre idosos de baixa escolaridade da comunidade com e sem depressão maior. Métodos: Trata-se de um estudo transversal, descritivo e analítico. Foram selecionados 22 idosos da comunidade com depressão e 187 idosos sem depressão, que foram avaliados por meio dos seguintes instrumentos: Mini-Exame do Estado Mental (MEEM), Bateria Breve de Rastreio Cognitivo (BBRC), Consortium to Establish a Registry for Alzheimer's Disease (CERAD), teste de extensão de dígitos de ordem direta e inversa, e um teste de semelhança de objetos. Resultados: Não foram encontradas diferenças estatisticamente significativas entre os grupos com depressão e sem depressão em nenhum dos testes aplicados. Conclusões: O presente estudo demonstrou que não existem diferenças no desempenho cognitivo de idosos com e sem depressão em testes neurocognitivos comumente utilizados na prática clínica. Estudos futuros com métodos e delineamentos diferentes, com testes específicos para idosos com baixa escolaridade, podem auxiliar na compreensão dessas relações e dos mecanismos envolvidos.

Epidermoid carcinoma of the skin mimicking breast cancer.

Nonmelanoma skin cancer is the most frequent cancer in the world. Squamous cell cancer often occurs in sun-exposed areas, such as the head and neck. When it involves the breast and ulce-rates, invading the glandular parenchyma, it may mimic breast cancer. Confirmation by means of histopathological examination, combined with clinical examination, is a critical instrument for the accuracy of the diagnosis. We report a case of an epidermoid carcinoma located on the breast skin, initially diagnosed as breast cancer.

Epidermoid carcinoma of the skin mimicking breast cancer / Carcinoma epidermoide na pele da mama simulando câncer de mama

Nonmelanoma skin cancer is the most frequent cancer in the world. Squamous cell cancer often occurs in sun-exposed areas, such as the head and neck. When it involves the breast and ulce-rates, invading the glandular parenchyma, it may mimic breast cancer. Confirmation by means of histopathological examination, combined with clinical examination, is a critical instrument for the accuracy of the diagnosis. We report a case of an epidermoid carcinoma located on the breast skin, initially diagnosed as breast cancer.

O câncer de pele não-melanoma é o câncer mais frequente no mundo. O carcinoma espinocelular ocorre mais frequentemente em áreas expostas ao sol como cabeça e pescoço. Quando o carcinoma espinocelular se desenvolve na região da mama, ulcerando e invadindo o tecido glandular, pode simular um câncer de mama. A confirmação histopatológica, aliada à história clínica, é ferramenta importante para o diagnóstico correto. Apresentamos um caso de carcinoma epidermóide da pele da mama diagnosticado inicialmente como câncer de mama.