Are There Differences Among Evidence-Based Psychotherapies for Treating Different DSM-5 PTSD Symptom Clusters? A Systematic Review and Meta-analysis of Controlled Clinical Trials.

ABSTRACT: Posttraumatic stress disorder (PTSD) is a heterogeneous disease defined by four Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) symptom clusters: reexperiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal. There are effective evidence-based psychotherapies (EBPs) for PTSD. However, given the variety of PTSD clinical presentations, we conducted the first meta-analysis investigating whether DSM-5 PTSD symptom clusters show different responses to EBPs. We systematically reviewed the literature for controlled clinical trials in five databases, performed a meta-analysis, and evaluated the methodological quality of the studies. We screened 633 studies and included seven. Three showed high risk, two showed some concerns, and one showed a low risk of bias. The symptom clusters do not seem to respond differently to EBPs (SMD cluster B: -0.40; 95% confidence interval [CI], -0.87 to 0.08; cluster C: -0.49; 95% CI, -0.90 to -0.08; cluster D: -0.44; 95% CI, -0.94 to 0.05; cluster E: -0.54; 95% CI, -1.07 to -0.0), even when analyzed by the therapeutic focuses. The findings dovetail nicely with the network theory of PTSD symptom, as although it is a heterogeneous disorder, the EBPs seem to promote a kind of cascade of symptom improvement.

The role of childhood cumulative trauma in the risk of lifetime PTSD: An epidemiological study.

Cumulative trauma is usually devastating and can lead to severe psychological consequences, including posttraumatic stress disorder (PTSD). Exposure to various types of traumas, particularly during childhood, can be even more deleterious than the sheer number of events experienced. This epidemiological study is the first to investigate the impact of discrete childhood traumatic exposure on the risk of developing lifetime PTSD in a representative sample of the general population of the two biggest Brazilian cities. Participants were aged between 15 and 75 years old, living in São Paulo and Rio de Janeiro, Brazil, who had experienced traumatic events (N = 3,231). The PTSD diagnosis was assessed using the DSM-IV criteria through the version 2.1 of Composite International Diagnostic Interview. To operationalize childhood cumulative trauma, we considered the sum of 15 different childhood trauma categories that occurred before PTSD onset. The final multivariate logistic regression model indicated a strong relationship between the number of discrete types of childhood traumas and the likelihood of the lifetime PTSD development. The lifetime PTSD risk increased 28 % with each different type of childhood trauma when adjusted by confounds. Our study strengthens the evidence associating childhood cumulative trauma to increased lifetime PTSD risk.

Transcription readthrough is prevalent in healthy human tissues and associated with inherent genomic features.

Transcription termination is a crucial step in the production of conforming mRNAs and functional proteins. Under cellular stress conditions, the transcription machinery fails to identify the termination site and continues transcribing beyond gene boundaries, a phenomenon designated as transcription readthrough. However, the prevalence and impact of this phenomenon in healthy human tissues remain unexplored. Here, we assessed transcription readthrough in almost 3000 transcriptome profiles representing 23 human tissues and found that 34% of the expressed protein-coding genes produced readthrough transcripts. The production of readthrough transcripts was restricted in genomic regions with high transcriptional activity and was associated with inefficient splicing and increased chromatin accessibility in terminal regions. In addition, we showed that these transcripts contained several binding sites for the same miRNA, unravelling a potential role as miRNA sponges. Overall, this work provides evidence that transcription readthrough is pervasive and non-stochastic, not only in abnormal conditions but also in healthy tissues. This suggests a potential role for such transcripts in modulating normal cellular functions.

Machine learning applied to fMRI patterns of brain activation in response to mutilation pictures predicts PTSD symptoms.

BACKGROUND: The present study aimed to apply multivariate pattern recognition methods to predict posttraumatic stress symptoms from whole-brain activation patterns during two contexts where the aversiveness of unpleasant pictures was manipulated by the presence or absence of safety cues. METHODS: Trauma-exposed participants were presented with neutral and mutilation pictures during functional magnetic resonance imaging (fMRI) collection. Before the presentation of pictures, a text informed the subjects that the pictures were fictitious ("safe context") or real-life scenes ("real context"). We trained machine learning regression models (Gaussian process regression (GPR)) to predict PTSD symptoms in real and safe contexts. RESULTS: The GPR model could predict PTSD symptoms from brain responses to mutilation pictures in the real context but not in the safe context. The brain regions with the highest contribution to the model were the occipito-parietal regions, including the superior parietal gyrus, inferior parietal gyrus, and supramarginal gyrus. Additional analysis showed that GPR regression models accurately predicted clusters of PTSD symptoms, nominal intrusion, avoidance, and alterations in cognition. As expected, we obtained very similar results as those obtained in a model predicting PTSD total symptoms. CONCLUSION: This study is the first to show that machine learning applied to fMRI data collected in an aversive context can predict not only PTSD total symptoms but also clusters of PTSD symptoms in a more aversive context. Furthermore, this approach was able to identify potential biomarkers for PTSD, especially in occipitoparietal regions.

A bright side of adversity? A systematic review on posttraumatic growth among refugees.

Until the third trimester of 2022, 103 million people worldwide had been forced to leave their homes and become refugees. The traumatic experiences of refugees can lead not only to mental disorders but also to Posttraumatic Growth (PTG). (1) To find the variables positively and negatively associated with PTG in refugees. (2) To investigate the relationship between PTG and Posttraumatic Stress Disorder (PTSD) among refugees. We systematically searched Medline, Web of Knowledge, PsycInfo, Scopus, and PTSD Pubs for studies about PTG in refugees. Epidemiological studies using the Posttraumatic Growth Inventory. Grey literature, reviews, and meta-analysis. Risk of bias was assessed by the 'The Joanna Briggs Institute Prevalence Critical Appraisal Tool'. We included 24 studies investigating PTG and associated factors. The factors positively associated with PTG were social support, regular migration status, religiosity, satisfaction with life, time, and problem-focussed and emotion-focussed coping. The factors negatively associated with PTG were: irregular migration status, emotional suppression, and avoidance coping. Studies on PTG in refugees are essential to finding new ways to address mental health in this field. Few studies offered risk of bias, particularly regarding the sample selection. We conclude that PTG may be influenced by many factors and it would be of importance that the centres for support, as well as public policies, took that into account to foster the outcome and not only to focus on disease. This study was partially supported by CAPES and registered on PROSPERO (CRD42020215607).

Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study.

BACKGROUND: The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS: Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS: The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.

The top-100 cited articles on post-traumatic stress disorder: a historical bibliometric analysis.

This is a bibliometric analysis of the most-cited articles on post-traumatic stress disorder (PTSD) with the objective of identifying citation patterns for researchers, journals, centers, periods, topics, and nations. A search was conducted in Thomson Reuters' WoS Core Collection employing the expression TI = (posttraumatic stress disorder OR post-traumatic stress disorder OR PTSD). The 100 most-cited articles were downloaded, and the relevant data were extracted and analyzed. These studies had a total of 69,649 citations, ranging from a minimum of 360 to a maximum of 6029 citations, with an average of 696.49, a standard deviation of 720.92, mode of 369, and a median of 512. Eighty-eight percent of the most-cited articles on PTSD originated from the USA, with just six cities accounting for 52% of the publications and the Boston area alone responsible for almost one-fifth of the total output. The universities of Yale and Harvard headed the ranking of institutions with larger numbers of highly-cited articles. Female researchers represented 42.3% of all authors, 51% of the first authors, and 48% of the corresponding authors. The proportion of M.D. authors decreased significantly between the 1980-1999 (42%) and the 2000-2019 (27.2%) periods while that of Ph.D. authors increased from 44% to 57.4%. The most studied population was military veterans (28%). Female victims of sexual or physical violence, traumatized children, and adult survivors of childhood abuse were assessed in only 6-7% of the most-cited publications. Ten clinical trials evaluated psychological interventions but only three investigated pharmacotherapy. We concluded that influential research on PTSD remains centralized in the USA. A balanced gender representation in publications was found. There was a heavy reliance on combat veterans as the study population. Few highly-cited studies on the pharmacotherapy for PTSD were identified. Focused efforts are needed to address these challenges.

Stuck in a Moment: Tonic Immobility Predicts Poor Quality of Life in Treated PTSD Patients.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent and disabling multisystem disorder, with significant physical and psychiatric morbidity and poor quality of life (QOL). Although peritraumatic reactions - tonic immobility and dissociation - are established predictors of PTSD severity and development, there is a dearth of investigation assessing the impact of peritraumatic reactions on QOL of PTSD patients. Quality of life has become increasingly important in health care and research as a reliable outcome measure. It comprises psychological, physical, social and environmental domains, providing important information about the impact of diseases on patient's life. This study aims to investigate the impact of peritraumatic tonic immobility and peritraumatic dissociation on QOL of PTSD civilian outpatients. SUBJECTS AND METHODS: It is a cross-sectional study of 50 victims of urban violence with current PTSD, recruited in a specialized outpatient clinic. Instruments used were: Structured Clinical Interview IV, Peritraumatic Dissociative Experiences Questionnaire, Tonic Immobility Scale and WHOQOL-BREF (psychological, physical, social and environmental domains). Linear regression models were fitted to evaluate the impact of peritraumatic reactions - tonic immobility and dissociation - on WHOQOL-BREF scores. We controlled for sex as potential confounding. RESULTS: The severity of peritraumatic tonic immobility negatively impacted on psychological and environment domains of quality of life. For each additional point on the Tonic Immobility Scale, there was a decreased of 0.8 points on the scores of these domains of WHOQOL-BREF. Neither the peritraumatic reactions showed effects on physical nor social domains. Possible limitations of this study include cross-sectional design, relatively small sample size of tertiary center outpatients and recall bias. CONCLUSIONS: Peritraumatic tonic immobility is related to poor quality of life, adding new insights about the relationship between this immobility reaction and PTSD.

Using Qualitative Synthesis to Explore Heterogeneity of Randomized Trials on ICU Diaries.

OBJECTIVE: We aimed to identify which set of components differentiates the ICU diaries that were effective in reducing psychologic symptoms after critical illness. DATA SOURCES: We searched the online databases MEDLINE, OVID, Embase, and EBSCOhost from inception to December 2021. STUDY SELECTION: Randomized controlled trials (RCTs) of the ICU diary were included, irrespective of the language, with samples of adult patients (≥ 18 yr old) and/or their relatives hospitalized in an ICU for more than 24 hours. Two qualitative syntheses on patients' and healthcare providers' perceptions on the ICU diary were included. DATA EXTRACTION: Four findings were extracted from the qualitative synthesis of patients' perspectives on the ICU diary. From the RCTs, we extracted the components of the ICU diary and whether the patients were ventilated for at least 3 days. We reported the outcome as effective or not, regardless of the psychiatric symptoms and diagnostic tools used for evaluation. We built a matrix in which each column represented a recommendation for an intervention component derived from the qualitative review, and each row represented whether the components of an individual trial's intervention matched any of the recommendations. DATA SYNTHESIS: Eight RCTs were included in the final analysis. The sample of five studies consisted of patients under mechanical ventilation (MV) for at least 3 days. Two were positive trials. Three RCTs included family members, and two of those were positive trials. CONCLUSIONS: For patients under MV for at least 3 days, the ICU diaries that were effective in preventing psychiatric symptoms after critical illness were written by the ICU staff, delivered after hospital discharge, and read with a healthcare professional in order to better understand the diary and the ICU stay. For family members, the presence of photographs was the only characteristic identified a successful ICU diary.

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources / Dificuldades na gestão do espectro da placenta acreta em hospitais com recursos limitados

Abstract Objective Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources. Methods A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis. Results In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative. Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist. Conclusion The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.

Resumo Objetivo O espectro da placenta accreta é uma patologia grave, cujo tratamento é recomendado emcentros de excelência. Esses hospitais não são fáceis de encontrar em países de baixa e média renda. Procuramos descrever o processo de diagnóstico prénatal, tratamento cirúrgico, e análise histológica pós-natal em um hospital de referência de baixa renda com recursos limitados. Métodos Foi realizado um estudo descritivo, retrospectivo, incluindo pacientes com diagnóstico pré ou intraoperatório de espectro da placenta accreta. Foram estudados os resultados clínicos das pacientes, bem como os resultados da ultrassonografia prénatal e a correlação com o diagnóstico patológico pós-natal. Resultados No total, 129 pacientes foram incluídas. Quarenta e oito delas tiveramum diagnóstico de ultrassom do espectro da placenta accreta pré-natal (37,2%). Nos 81 (62,8%) restantes, o diagnóstico foi intraoperatório. Embora a histerectomia tenha sido realizada em todos os casos, um terço deles (31%) não tinha estudo histológico do útero. Em 40% dos pacientes que tiveram estudo histológico, o espectro da placenta accreta não foi relatado pelo patologista. Conclusão A frequência do diagnóstico pré-natal e a disponibilidade de estudos histológicos pós-natais foram muito baixas na população estudada. A habilidade cirúrgica, favorecida por um alto fluxo de pacientes, é um fator importante para evitar complicações em ambientes com recursos limitados.

Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources.

OBJECTIVE: Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources. METHODS: A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis. RESULTS: In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative.Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist. CONCLUSION: The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.

OBJETIVO: O espectro da placenta accreta é uma patologia grave, cujo tratamento é recomendado em centros de excelência. Esses hospitais não são fáceis de encontrar em países de baixa e média renda. Procuramos descrever o processo de diagnóstico pré-natal, tratamento cirúrgico, e análise histológica pós-natal em um hospital de referência de baixa renda com recursos limitados. MéTODOS: Foi realizado um estudo descritivo, retrospectivo, incluindo pacientes com diagnóstico pré ou intraoperatório de espectro da placenta accreta. Foram estudados os resultados clínicos das pacientes, bem como os resultados da ultrassonografia pré-natal e a correlação com o diagnóstico patológico pós-natal. RESULTADOS: No total, 129 pacientes foram incluídas. Quarenta e oito delas tiveram um diagnóstico de ultrassom do espectro da placenta accreta pré-natal (37,2%). Nos 81 (62,8%) restantes, o diagnóstico foi intraoperatório.Embora a histerectomia tenha sido realizada em todos os casos, um terço deles (31%) não tinha estudo histológico do útero. Em 40% dos pacientes que tiveram estudo histológico, o espectro da placenta accreta não foi relatado pelo patologista. CONCLUSãO: A frequência do diagnóstico pré-natal e a disponibilidade de estudos histológicos pós-natais foram muito baixas na população estudada. A habilidade cirúrgica, favorecida por um alto fluxo de pacientes, é um fator importante para evitar complicações em ambientes com recursos limitados.

To BDZ or not to BDZ? That is the question! Is there reliable scientific evidence for or against using benzodiazepines in the aftermath of potentially traumatic events for the prevention of PTSD? A systematic review and meta-analysis.

BACKGROUND: Most international guidelines suggest that benzodiazepines (BDZs) may be inefficient or iatrogenic in the aftermath of a potentially traumatic event (PTE). The goal of this study was to assess the strength of the evidence on whether the use of BDZs in the aftermath of a PTE negatively affects the incidence and severity of post-traumatic stress disorder (PTSD). METHODS: We systematically scrutinized the ISI Web of Knowledge, MEDLINE, SCOPUS, and PTSDpubs electronic databases in addition to citation searching. We included original studies providing data about the development of PTSD in adults after BDZ administration in the aftermath of a PTE. We screened 387 abstracts and selected eight studies for the qualitative synthesis and seven for the meta-analysis. We performed two separate meta-analyses, one for randomized clinical trials (RCTs) and the other for cohort studies. Heterogeneity between studies was evaluated with Higgins I² statistic and tested using the χ². This study was registered at PROSPERO (number 127170). RESULTS: The meta-analysis of the cohort studies showed an increased risk of PTSD in patients who received BDZs compared to those who did not (risk ratio (RR) = 1.53; 95% confidence interval (CI): 1.05-2.23) with a modest heterogeneity among studies (I2 = 41.8, p = 0.143). Regarding the RCTs, the combined measure revealed a tendency toward an increased severity of the PTSD symptoms (standardized mean difference (SMD): 0.24; 95% CI: 0.32-0.79). CONCLUSION: The studies reviewed showed a possible harmful effect of BDZs when used immediately after a PTE. However, these conclusions were based on a small number of studies of poor to moderate methodological quality.

Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU): an international survey before and during the COVID-19 pandemic.

BACKGROUND: Since the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them. METHODS: This study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic. RESULTS: We analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p < 0.001) and sedation goals were discussed more frequently in daily rounds. Morphine was the main drug used for analgesia (77.2%), and some sedative drugs, such as midazolam, propofol, ketamine and quetiapine, were used more frequently. CONCLUSIONS: Most sedation, analgesia and delirium practices were comparable before and during the COVID-19 pandemic. During the pandemic, the intensive care specialty was a variable that was independently associated with the best practices. Although many findings are in accordance with evidence-based recommendations, some practices still need improvement.

The growth and development of research on personality disorders: A bibliometric study.

This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.

Prevalência de positividade do anticorpo ANCA em pacientes hemodialisados / Prevalence of Positive ANCA Antibody in Patients in Hemodialysis

Objetivo: Estimar a prevalência do anticorpo anticitoplasma de neutrófilos (ANCA) positivo em pacientes submetidos à hemodiálise, assim como também associar essa prevalência às características sociodemográficas e clínicas destes pacientes. Métodos: Estudo transversal realizado em 78 pacientes de uma Clínica de Hemodiálise no Sul de Santa Catarina nos meses de agosto a novembro de 2013. Foi realizada entrevista, coleta de dados em prontuário eletrônico e pesquisa do anticorpo anticitoplasma de neutrófilos por imunofluorescência indireta WAMA em plasma heparinizado. Resultados: A prevalência de anticorpo anticitoplasma de neutrófilos reagente em amostra titulada 1:10 foi de 24,4%, sendo que 10,3% apresentaram padrão c-ANCA e 14,1% apresentaram padrão p-ANCA, do total. Não foram observadas associações com características clínicas e sociodemográficas. Conclusão: Com base na alta prevalência de anticorpo anticitoplasma de neutrófilos positivo encontrada neste estudo, salienta-se a necessidade de mais estudos nesse grupo de pacientes para definição da contribuição deste exame no diagnóstico e prognóstico da doença renal e suas complicações

Objective: To estimate the Antibodies, Antineutrophil Cytoplasmic (ANCA) prevalence in patients submitted to hemodialysis, as well as associate this prevalence to sociodemographic and clinical characteristics of these patients. Methods: Cross-sectional study performed with 78 users from a Hemodialysis Clinic in Southern Santa Catarina on the period from August to November 2013. Interviews, data collection of electronic records and antibodies, antineutrophil cytoplasmic research by WAMA indirect immunofluorescence on heparinized plasma were performed. Results: The prevalence of ANCA reagent 1:10 titrated sample was 24.4%, and 10.3% had c-ANCA pattern and 14.1% had p-ANCA pattern, from total sample. No associations were observed with clinical and sociodemographic characteristics. Conclusions: Based on the high antibodies, antineutrophil cytoplasmic prevalence in this study, and no statistically significant association with clinical and sociodemographic characteristics, we emphasize the need for more studies on this group of patients to determine the contribution of this exam in the diagnosis and prognosis of kidney disease and its complications.

The Jornal Brasileiro de Psiquiatria: a bibliometric survey of the one hundred most cited articles in the last 15 years / Jornal Brasileiro de Psiquiatria: uma pesquisa bibliométrica sobre os 100 artigos mais citados nos últimos 15 anos

OBJECTIVE: Bibliometrics is a group of statistical and mathematical methods employed to measure and analyze the quantity and the quality of scientific articles, books, and other forms of publications. The objective of the present study was to conduct a bibliometric analysis of the Jornal Brasileiro de Psiquiatria (JBP) by listing its 100 most highly cited articles in the scientific literature and identifying their main characteristics in terms of authorship and research topics and design. METHODS: The 100 topcited references in the JBP were identified through a search with Google Scholar. The main author, last author, corresponding author, the total number of authors, gender of the authors, year of publication, research institution, geographic origin, language, and the research design and subject of each reference were recorded and analyzed. RESULTS: A marked increase in the number of citations in the last 15 years, a relatively balanced distribution of publications among the Brazilian states and research centers, absence of gender bias among authors, and a varied range of published topics suggest a good current editorial performance by the JBP. Relative lack of systematic reviews and longitudinal studies, dearth of articles published in the English language, and modest participation of foreign authors were points requiring improvement. CONCLUSION: The present study suggests that a survey of the 100 most cited articles in the JBP can provide a historical overview of the progress of this journal, as well as highlight the main obstacles, constraints, and challenges faced by its editors and authors.

OBJETIVO: Bibliometria é um grupo de métodos estatísticos e matemáticos empregados para medir e analisar a quantidade e a qualidade de artigos científicos, livros e outras formas de publicações. O objetivo do presente estudo foi realizar uma análise bibliométrica do Jornal Brasileiro de Psiquiatria (JBP), relacionando seus 100 artigos mais citados na literatura científica e identificando suas principais características em termos de autoria e questões de pesquisa e delineamento experimental. MÉTODOS: As 100 referências mais citadas no JBP foram identificadas por meio de uma busca no Google Scholar. Foram registradas e analisadas as seguintes informações: autor principal, último autor, autor correspondente, número total de autores, gênero dos autores, ano de publicação, instituição de pesquisa, origem geográfica e idioma de cada referência e seu tema de investigação e delineamento metodológico. RESULTADOS: O aumento acentuado no número de citações nos últimos 15 anos, a boa distribuição das publicações entre os estados e centros de pesquisa brasileiros, a ausência de viés de gênero entre os autores e a variada gama de tópicos publicados sugerem um bom desempenho editorial atual do JBP. A relativa falta de revisões sistemáticas e estudos longitudinais, os poucos artigos publicados em inglês e a pequena participação de autores estrangeiros são pontos que requerem melhorias. CONCLUSÃO: O presente estudo sugere que o levantamento dos 100 artigos mais citados no JBP pode fornecer um panorama histórico da evolução dessa revista, bem como destacar os principais obstáculos, restrições e desafios enfrentados por seus editores e autores.

Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents.

PURPOSE: Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. METHODS: The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). RESULTS: We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. CONCLUSION: These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.